Object.

To ask the Secretary of State for Health when he last met representatives of the British Medical Association to discuss the health service reforms.

To ask the Secretary of State for Health when he last met representatives of the British Medical Association to discuss the health service reforms; and if he will make a statement.

To ask the Secretary of State for Health when he next plans to meet leaders of the British Medical Association to discuss changes in the national health service.

I last met representatives of the British Medical Association on 9 July. We had useful talks on several topics related to the reform programme.

I am sure that the Secretary of State is aware that the BMA is concerned about the policy of opt-out for hospitals and I know that he is also aware of the consultations taking place between Withington and Wythenshawe hospitals about the rationalisation of services, especially the closure of the maternity unit. Now that Wythenshawe hospital has expressed an interest in opting out, the management of Withington hospital may now wish to retain all its services, including the maternity unit. Will the Secretary of State give the assurance today that the maternity unit at Withington can remain open until decisions have been taken about whether Wythenshawe can opt out?

As the hon. Gentleman knows, there is no question of opting out. There has been a first expression of interest in establishing a national health service trust for one of those hospitals. As the hon. Gentleman knows—I believe that he recently met the Under-Secretary of State, my hon. Friend the Member for Loughborough (Mr. Dorrell) to discuss the matter—we are considering that reorganisation, as we are statutorily required to do, on its merits and quite separate from the issue of approving any NHS trusts in due course.

Is not one of the most important aspects of the reforms the emphasis that is placed on health promotion, by encouraging people to eat and drink sensibly, warning them of the dangers of tobacco products and providing doctors with incentives to provide health checks, immunisation and screening? Is it not a fact that the British Medical Association and all doctors fully support those changes?

My hon. Friend is right. The British Medical Journal contained a generous leader by Mr. John Ashton, head of the department of public health at the university of Liverpool welcoming the steps that the Government have taken in publishing "The Health of the Nation". There has been widespread welcome for the publication of the report of the Committee on Medical Aspects of Food and for the tougher action that we are taking on cigarette labelling. Together with the general practitioners' contract and its emphasis on preventive medicine, those steps allow the Government to claim that we are the first Government to take forward those matters with such vigour.

Does my right hon. Friend agree that an increasing number of GP members of the BMA are seeking to pass on the undoubted benefits of his reforms to their patients by becoming fund-holders and will he now end the patient list limitation so that an increasing number of doctors can become fund-holders if that is their wish?

My hon. Friend is right. GP fund-holders are bringing forward many innovative new ideas for the better treatment of their patients, which are already being picked up by the district health authorities for the general benefit. Many GPs are pressing me to lower the list size qualification. We are running some experiments and pilot schemes on that, which I hope will be successful.

I welcome the innovative movements, but has the BMA suggested that it needs more GP trainers and trainees? In drawing up the junior doctors' contract, has any consideration been given to increasing the number of medical students?

Yesterday evening I met the regional deans, including the dean from Northern Ireland, to discuss these matters. Although in general they welcome the new structure, which protects their budget, we discussed real issues about the total number of doctors needed. That is why yesterday I announced the establishment of a new committee chaired by Professor Colin Campbell to examine and measure objectively the total need for doctors in the years ahead.

Does my right hon. Friend agree that some of the anxiety expressed by Opposition Members about national health service reforms is caused by their astonishment that the Government have listened so carefully and effectively to what GPs and many others have been saying for many years? For example, in Kent, where the number of practice nurses has trebled in the past three years, general practitioners are finding increasingly that the NHS reforms provide them with a tremendous opportunity to improve and innovate.

There is absolutely no question but that the improvements which have been made in general practice and community medicine in the past 10 years have in many cases transformed the services available to patients. Patients know that and welcome it warmly, as they have done in my hon. Friend's constituency.

If the Secretary of State is so anxious to listen to the views of GPs, which of the BMA's conference resolutions will he be most anxious to discuss when he next meets that body? Will it be the one that records the BMA's view that the reforms of the health service mean that the NHS is not safe in his hands? Or will it be the one that expressed concern at the rapid deterioration of the NHS? Or would the Secretary of State rather meet the 600 consultants who paid for a page in The Observer warning that as a result of the changes there are now serious restrictions on patients' choice? If the Secretary of State prefers the views of patients, will he meet the community health councils, whose conference a week ago resolved that contracting could not remedy underfunding? Is not the reality that the Government are not interested in anyone's opinion but their own and will not listen to anyone but themselves?

I shall address that part of the BMA motion that said that it sought

"constructive dialogue with the Government rather than confrontation."

Of course, that is what we shall seek.

I am surprised to see the hon. Member for Livingston (Mr. Cook) engage in such debate. He recently visited Walton. It was a rather unsuccessful visit during which he involved himself in the affairs of the Fazakerley hospital with the result that one of the consultants said:

"These electioneering politicians make me sick. They won't talk about the expansion at Fazakerley … The Fazakerley option was what the clinicians wanted. It is clearly the best way to deliver health care on one site."

That was followed up by the hospital doctor who said:

"It is ironic that Labour, which criticises the Government for not listening to the views of doctors on its health reforms, is now itself choosing to ignore medical opinion."

A little quiet from the hon. Gentleman would be in order.

I warmly congratulate my right hon. Friend on the new constructive dialogue which has been established between his Department and the BMA. Will the new committee that has been set up merely discuss the health service and the reforms, or could it be extremely constructive and seek to monitor and evaluate the effects of the reforms in the national health service? If the latter is the case, I should be grateful if my right hon. Friend could confirm it to the House this afternoon.

I think that my hon. Friend is referring to the joint work that we intend to do on GP fundholding, in particular with the general medical services committee. I assure my hon. Friend that that will be a continuing assessment and that we shall listen to recommendations which come out of that work.

To ask the Secretary of State for Health how many health authorities have now met the targets set for the time scale of results of cervical smears to be relayed to general practitioners and patients.

Health authority laboratories must aim to return the results of cervical smear tests within one month to the doctor who took them. Latest figures show that 173 district health authorities—that is 93 per cent.—were meeting the target.

The Minister will appreciate that that is an improvement on the previous statistics. Does she recall that on 21 February she said that one third of the laboratories were not meeting that target and that there was a waiting list of about 7·5 weeks for the processing of tests? What is the waiting time in areas where the target is not being met?

Thirteen districts are not meeting the target, the longest wait, at the latest date, being 13 weeks. The vast majority have waits of much less than that. The particular case is being closely investigated, but there has been a substantial improvement. Last July, about two thirds of districts were meeting the target. Now, 93 per cent. of them are. Perhaps even more important, nine out of 10 GPs are obtaining their target payments for making sure that they take cervical smears in the first place. This is real health promotion and disease prevention.

Health Ministers are rightly introducing initiatives to deal with the health care of women, but half the population, by and large, is made up of men. What health care initiatives does my hon. Friend intend to put forward to look after us?

I have every sympathy with my hon. Friend and I shall enter into urgent discussions with him to see what further steps we can take to improve the health care of men. Women not only make up the majority of the population; they make up the overwhelming majority of those who work in the NHS, and for the most part, they are the decision makers and communicators in their families about health. I agree, however, that we must give further concern to the health care of men, whose life expectancy is not, I regret, as great as that of women.

To ask the Secretary of State for Health what was the level of capital expenditure in the national health service in 1978–79; and what is the figure for 1991–92.

NHS capital expenditure is planned to be £1·9 billion in 1991–92 compared with £0·4 billion in 1978–79, an increase in real terms of 68 per cent.

I thank my hon. Friend for those excellent figures. He will have laid emphasis on the fact that in 1979 the last Labour Government —to balance their financial books, at the behest of the International Monetary Fund—cut and cut again capital expenditure in the NHS. Those cuts impeded the development of the service in the Birmingham area, which under the present Government is launching the "Building a Healthy Birmingham" campaign, along with hundreds of millions of pounds of investment. Does my hon. Friend agree that only under a Conservative Government is that possible?

The track record squares absolutely with my hon. Friend's version. Between 1974 and 1979 the Labour party cut the NHS capital programme by 16 per cent. in real terms, compared with the increase of 68 per cent. that I have just announced. My hon. Friend will be pleased to hear that in Birmingham we currently have in progress a programme costing £15·9 million at the Queen Elizabeth hospital, £23·4 million at the East Birmingham hospital, £5·6 million at the Good Hope hospital, and £2·5 million at the Dudley Road hospital. That represents a total of schemes in progress of £47·4 million, without taking account of the £310 million which we are committed to spend on the "Building a Healthy Birmingham" programme.

Before the Minister and other members of the Government try to score too many party political points in relation to figures such as those, may I ask him to find time to read the letter in The Independent today, which is an account by a patient in a leading London hospital casualty department which is filthy, hot and overcrowded? Is the Minister aware that that is the reality facing many patients in Britain today?

The question that that patient or anyone else wishing to compare the records of the parties on capital expenditure must ask is which of the rival management teams available offers the best prospect of solving the problem—a team which, when it last had the opportunity, cut capital expenditure by 16 per cent., or a team which, since 1979, has seen capital expenditure increase by 68 per cent.

To ask the Secretary of State for Health how many hospitals applied for and were granted trust status in the first wave; and how many have expressed interest in possible inclusion in the second and third waves.

A total of 66 hospitals and other units applied for trust status in the first wave, of which 57 were established as trusts on 1 April this year; 130 expressions of interest were received for inclusion in the second wave, and 107 applications have been submitted. We also expect five or six first-wave candidates which were not established to resubmit their applications. We have not yet asked for formal expressions of interest in the third wave.

Can my right hon. Friend confirm that, of the four district general hospitals that serve Twickenham, Kingston already has trust status, Ashford has applied for it in the second wave, and West Middlesex and Queen Mary's Roehampton, hospitals intend to apply for it in the third stage? Does he agree that that great enthusiasm for trust status is despite the efforts of Labour politicians to intimidate those national health service staff who might wish to be involved?

The fact that so many hospitals are applying for trust status shows that the staff involved have not been intimidated. We had to make the hon. Member for Livingston (Mr. Cook) back down from his threats before the House on one occasion. I am delighted to say that, as my hon. Friend already knows, Kingston hospital NHS trust has already reduced the number of long waiters from 2,000 to 400 and the new building will be open this year, and the other applications are coming forward. In the case of Ashford, trust status was strongly supported by more than 80 per cent. of the consultants.

Does the Secretary of State agree that it would be better to sort out what is happening with the first wave before considering another wave? Where trust status has been granted, as in the case of Leeds general infirmary, the impact has been the loss of 10 beds in Cookridge cancer hospital and eight night staff being told on 14 June, without any prior notification, that their jobs were to go. Is not that what is happening?

No. The trust hospitals are matching good management to problems which have often existed for many years, and we are seeing quicker and better solutions to those problems for the benefit of patients. I should have thought that the hon. Gentleman would welcome that.

Weston-super-Mare general hospital was fortunate enough to achieve trust status in the first round, the trust is working extremely well and I can reasonably claim that the people of that excellent town are receiving better health care than ever before, but will my right hon. Friend discourage the regional health authority from seeking to remove some of the peripheral hospitals such as Burnham-on-Sea and Axbridge simply in the interests of tidy bureaucracy?

As my hon. Friend would expect, being a relatively near neighbour I am well aware of the issue and I shall look at it closely. I am also aware that the trust is doing extremely well and bringing new benefits to patients every week.

The Secretary of State will be aware that one of the hospitals included in the figures that he has announced for the second wave is King's College hospital in Camberwell. Since the changes in April, that hospital has been on red alert and closed to routine cases. Before the Secretary of State considers that hospital for a trust, will he reconsider the three invitations to visit the hospital that he has refused? Would it not be better for the Secretary of State to visit that hospital in financial crisis rather than spend time tomorrow only half a mile away from it at the Dulwich picture gallery, where he is opening an exhibition of portraits of old Etonians?

That is a very heavyweight contribution. The hon. Gentleman is going to a meeting at King's College hospital tomorrow, and the leaflets advertising his presence contain untruths. I hope that he will take the opportunity to dissociate himself from those leaflets, which say:

"King's College hospital to opt out of the national health service."

The hon. Gentleman knows that that is a lie. He has backed down on the point before and I hope that he will do so again now.

The hon. Gentleman recently made another unsuccessful visit, to Oldham hospital, to campaign against the consultants who wished the hospital to be a trust. He said then that a Labour Government would pour money into the NHS—[Interruption.] Oh yes, he did—I have the quote with me. A local newspaper reported the hon. Gentleman as saying:

"A Labour Government would pour money into the NHS."

On a recent visit to the British Medical Association, the hon. Gentleman said that additional expenditure of £6 billion was not out of the ball park, but when he was asked on "Panorama" where the money would come from, he said:

"These are questions … that you will have to address to John Smith, who is my colleague"—

there may be some doubt about that—

"who handles the Exchequer questions."

May we have answers from the Member who is responsible for those matters?

To ask the Secretary of State for Health what progress has been made in reducing hospital waiting lists in Shropshire.

In the 12 months to March 1991, the number of patients waiting for in-patient and day case treatment in Shropshire fell by 17 per cent. More importantly, the number waiting for more than one year fell by 58 per cent.

I am most grateful for those encouraging figures. Does not my hon. Friend agree that they are by no means unique in the country today and that, under the Conservative Government, and as a result of the management changes introduced last year, waiting lists have been reduced throughout the country? Will my hon. Friend take this opportunity to remind the Labour party that there is scarcely a patient today who cannot see a doctor, scarcely a patient who, having seen a doctor, is denied the drugs and medicine required, and scarcely a patient who, having been admitted to hospital, has not been entirely delighted with the care and attention received in hospital?

My hon. Friend makes a good point, particularly in relation to waiting lists. One figure has been consistently collected before and through the period of the last Labour Government and through this Government's term of office—the number of people waiting for in-patient treatment in the health service. That figure rose by 48 per cent. between 1974 and 1979, and has fallen by 9 per cent. since 1979.

To ask the Secretary of State for Health when he last met representatives of the British Medical Association to discuss clinical guidelines; and if he will make a statement.

Ministers and officials have regular contact with representatives of the British Medical Association and discuss a broad range of issues of mutual interest.

Does the Minister accept that, if the resources of the national health service are to be used to the maximum advantage of patients, it is crucial that clinical guidelines are laid down, both for general practitioners and for consultant surgeons, so that patients can have full confidence that the operations undertaken on them do not do them more harm than good, as is plainly the case in a large number of current procedures, including hysterectomies and operations for glue ear, to give just two examples?

The hon. Gentleman is taking us into deep waters. I would not want the House to be the judge of which medical procedures are correct. We have effective royal colleges which monitor the standards and the Government have greatly strengthened the process of medical and clinical audit, which should further improve standards. If the hon. Gentleman wishes to raise a particular issue with me in relation to a procedure that he fears is being wrongly applied, I shall be happy to put him in touch with the chief medical officer to discuss the issue further.

The key clinical guideline that all patients want when they see the consultant is to be told the date on which they will be operated on. Will my right hon. Friend put pressure on the NHS executive so that that is the norm in all 14 regions of this country?

My hon. Friend makes a fair point. It is in some of those spheres of convenience to patients—quite apart from medical standards, which I do not question—that the NHS can do a great deal more. The Government are doing a great deal more both to bring down the waiting times which were left at a high level by the last Labour Government, and to make the service more convenient for patients.

What clinical guidelines are given to consultants who identify a patient with an urgent need for an operation, cannot cope with the patient within the NHS for months, yet find time to do the operation privately at their own profit? Is that not a matter which should be regulated by severe clinical guidelines?

I think the hon. Gentleman knows that urgent cases are admitted—50 per cent. of all cases are admitted at once off the waiting lists in the NHS, and of the remaining cases, the great majority are seen within about five weeks. Recently, the work that we did with the joint consultants committee laid down clear guidelines for the treatment of urgent cases, with the total support of all the professionals involved, including the British Medical Association.

To ask the Secretary of State for Health what new initiatives have been taken by the national health service ambulance trusts; and how this will affect patient care.

All three ambulance service trusts have taken positive steps to ensure quicker response times, staff are fully trained and each ambulance is manned with a paramedic. These improvements enhance the quality of care to patients.

Is my hon. Friend aware that the new, well-run Norfolk and Waveney national health service ambulance trust has recently speeded up its paramedic training and has initiated a 24-hour message handling service for general practitioners? Does not this show that trust status leads to good management and value for money, to the benefit of NHS patients throughout the area?

My hon. Friend is right. The fame of the NHS as an organisation that runs good ambulance services has spread beyond these shores. Yesterday, the Evening Standard reported that the Barcelona Olympics will benefit from NHS expertise in the operation of an ambulance service. Labour Members will benefit from hearing a quote from the director of NHS Overseas Enterprise Ltd., Mrs. Wark, who said:

"The NHS gets a lot of criticism within the UK, but it still has the highest reputation of any health service in the world."

Most NHS patients would agree with that.

Is the Minister aware that the only initiative taken by the Northumbria ambulance trust, apart from entering the car repair business, has been an increase in the salaries of the officers who first decided to apply for trust status? Does the Minister believe that these increases are in the interests of patients and if he does, will he say why the trust refuses to publish the figures?

When the hon. Gentleman asks a question, he should be better informed. Since the establishment of the NHS trust in Northumbria, four new accident and emergency vehicles have been introduced into the service, response times for the ambulance service have improved, standby services in Northumbria have been increased so that there is 24-hour manning on the A1 route to Scotland, there is now one paramedic per vehicle, and the Northumbria ambulance service has been approved by the British Standards Institution under the BS 5750 scheme.

Is not it monstrous for Labour Front-Bench spokesmen to go grubbing round our hospitals and ambulance stations with their trade union friends, cynically manipulating the fears of the elderly and the frail for a few cheap votes? Will my hon. Friend ask the hon. Member for Livingston (Mr. Cook) to come clean and admit that trusts are not opting out of the health service and that it is against the law for them to make a profit?

Order. That is a bit wide of ambulances.

I echo my hon. Friend's invitation to the hon. Member for Livingston (Mr. Cook). Perhaps I might also make a more modest suggestion, which is that he listens to the Devon branch of NUPE, which is anxious to ensure that the Devon ambulance service has the opportunity to become an NHS trust in the second wave.

Is the Under-Secretary of State aware that the London ambulance service is applying for trust status, but at the same time has vehicles with inferior specifications, a reduction in the number of its officers by 50, a capping of the necessary overtime for emergency services and a move to divide patient transport services into 32 different organisations? Is he aware that the management is appointed entirely and directly by the Secretary of State, who, despite those deficiencies, has refused to see a deputation of London Members of Parliament? Is not this arrogant and undemocratic behaviour, which demands the condemnation of the House?

No. The hon. Gentleman has got it diametrically wrong. Mr. Wilby has offered on a number of occasions to meet hon. Members from both sides of the House—[HON. MEMBERS: "Who?"] Mr. Wilby is the man who has been charged with the management of the London ambulance service and he is accountable to my right hon. Friend the Secretary of State. Some of my hon. Friends have met Mr. Wilby. Labour Members have consistently refused to do so. If the hon. Member for Newham, South (Mr. Spearing) was seriously interested in representing the intrests of his constituents, rather than those of NALGO, he would agree to meet Mr. Wilby to learn something about the affairs of the London ambulance service from its management.

To ask the Secretary of State for Health if he has any plans to meet the British Medical Association to discuss working arrangements for junior hospital doctors.

To ask the Secretary of State for Health when he last met representatives of the British Medical Association to discuss junior doctors' hours.

To ask the Secretary of State for Health what plans he has further to improve the working arrangements of junior hospital doctors.

We launched a new deal for junior doctors on 12 June aimed at reducing their hours of work and improving their living and working conditions. This has the full backing of the ministerial group on junior doctors' hours which includes British Medical Association representatives. This group, and its supporting technical group, will continue to meet to monitor progress in implementing the new arrangements. I spoke at the BMA's hospital junior staff committee conference on 15 June.

Does my hon. Friend agree that that is a welcome new agreement, but that its success depends on the co-operation of the consultants, nurses and ancillary workers and that there will have to be some changes of attitude towards junior hospital doctors, particularly among some senior consultants?

Indeed, Sir. However, the agreement is a great breakthrough. For 15 months the consultants, junior doctors and the NHS management worked together to hammer out the agreement setting explicit limits on the amount of time that junior doctors should work. It is not good enough that they should be working night and day. It is not good for the junior doctors; it is not good for the patients. The consultants and the royal colleges have had to think carefully about the implementation of the agreement and I am confident that, through the ministerial group, we shall continue to see vital progress.

On junior doctors working long hours and the consequences for patients, has not it taken between five and six years to obtain the agreement and is not it true that it is not expected to be fully implemented until the end of 1996 and that even then junior doctors' hours will be reduced to only a 60-hour week? Will the Minister give us a guarantee that there will be no change of mind and that funding will be available?

Before taking lectures from the hon. Gentleman, I remind him that when the Labour party was in government junior doctors worked an average of 91 hours a week. That is now down to about 81 hours. There is, of course, a difference between contracted hours of duty on call and actual working hours. We make it clear that the maximum amount of time on shift working should be 60 hours immediately and 56 hours by the end of 1994.

If the hon. Gentleman wants more details, he should go to the regional conference in Manchester on 25 July, one of nine regional conferences, where the guidance will be spelt out and those who have only a partial understanding of the agreement will have the opportunity to understand the full significance of the breakthrough.

I warmly congratulate my hon. Friend on her expert handling of the successful negotiations on junior hospital doctors' conditions of service. This is a major step forward—a view endorsed by the BMA in its recent letter to me. However, bearing in mind the fact that some 50 per cent. of medical students are women, what special steps, if any, does she propose to take to help women junior hospital doctors in particular?

I pay tribute to all the junior doctors' leaders who worked so hard to secure the agreement. It is another example of practical working together, quite distinct from the rhetoric of adversity and conflict peddled by the Opposition, and building up solid achievements and making progress. My hon. Friend is right that half medical students are women and we are concerned about losing so many of them. There are growing numbers of women general practitioners and doctors. As a practical step forward we have quadrupled the number of part-time registrar posts and developed further initiatives to secure their future so that they can serve the health service on the basis of their training.

The Minister will be aware of the case on which I have corresponded with her and the Secretary of State and which I raised with the Prime Minister about three weeks ago of a young junior hospital doctor who worked almost 120 hours during his first week at a hospital and who, at the end of those seven days, collapsed and died. Given that the agreement of which the Minister has spoken this afternoon means that in five years' time, in 1997, it will still be possible for junior hospital doctors to work 72 hours a week, is not that still too little of an agreement to stop the stress and strain on the young doctors replicating that experience, thus risking another death in the next five years?

I agree that being a junior doctor is much more stressful than it used to be. Modern medicine is much more complex and detailed. Ensuring that juniors are better supported, a better pastoral system, and improved working conditions are all part and parcel of the agreement. It is important to ensure also that junior doctors are properly supervised and that their working arrangements are adequately considered. The 72-hour maximum applies to doctors on duty, but those working consistently on a shift system would work a maximum of 56 hours. To ensure that progress is achieved, we not only established regional working parties but provided 200 extra consultants this year and an additional 50 staff grades. We have backed the agreement with new resources.

To ask the Secretary of State for Health how many people had been waiting for an operation (a) for more than one year and (b) for more than two years on 30 April; and what were the comparable figures a year before.

Information on numbers waiting for operations is not available for April 1991, but provisional figures for all specialties show a fall of 20 per cent. in the number waiting more than one year since March 1990. The number waiting more than two years reduced by 39 per cent.

Is not that an outstandingly successful achievement in the course of one year? Does my right hon. Friend agree that it has less to do with the quantity of health service resources and more to do with the quality of management? How does that successful record compare with the achievement of the last Labour Government?

I agree with my hon. Friend that the health service is getting better at avoiding long waiting lists and that it is treating more people more quickly. The last Labour Government, like all previous Labour Governments, left waiting lists higher than they found them.

Is not the Minister aware that the number of patients currently awaiting treatment is at 906,406, higher than in 1979, when the figure was 752,400? Is he aware that the percentage waiting more than one year remains almost unchanged at 25 per cent.? Does the Secretary of State agree with Sir Terence English, president of the Royal College of Surgeons, who commented today on waiting lists:

"The overall provision of resources and manpower are currently insufficient … to provide patients with the benefits of modern surgery"?

Is not the real problem that identified by Sir Terence English—underfunding?

I am a little disappointed with the hon. Gentleman, who should know better. He knows that he arrived at his first figure by not comparing like with like. In-patient figures have fallen. The hon. Gentleman was badly briefed on his second point. We have 40,000 fewer long-wait patients than did Labour, which is a drop of about 25 per cent.

I am glad that the hon. Gentleman gives me an opportunity to refer to our co-operative work with the Royal College of Surgeons, announced today, in respect of waiting list management. We welcome the college's contribution, which fits very closely with the guidelines that we issued.

To ask the Secretary of State for Health what steps have been taken by the Government to improve the health of women; and how it will build on this work for attaining future targets.

The Government place a high priority on improving the health of women. We are one of the first countries in the world to introduce computerised call and recall breast cervical cancer screening programmes. We recently published a booklet to publicise the help and services available to women.

Is my hon. Friend aware of a recent survey of 5,000 women showing that cancer remains their single most worrying health concern? Does not that prove, if proof were needed, that the Government were right to guarantee a cervical smear to every woman between the ages of 20 and 64 and breast screening to every woman aged between 50 and 64? Were not the Government also right to hold out on targeting, despite all the opposition, to ensure that general practitioners encouraged women to come forward for cervical screening? I am pleased to report that all 70 GP practices in Wolverhampton have achieved one of the two targets set for them.

My hon. Friend makes the point extremely powerfully. Labour advocates a two-tier health service in which inner city areas would have a lower target. We held out for all general practitioners to achieve higher targets, of the same standard, across the country. To help inner city areas, we introduced deprivation payments. That is the way to extend health care. My hon. Friend is right that health promotion and disease prevention for women have been a real breakthrough.

To ask the Secretary of State for Health what conclusions the Government have drawn from the voluntary named HIV testing studies among pregnant women initiated by the Medical Research Council; and if he will make a statement.

The results of the voluntary named testing studies in ante-natal clinics initiated by the Medical Research Council are being analysed. They will be published in the autumn.

What is the Government's response to the vote at the annual general meeting of the British Medical Association in favour of routine provision of voluntary named testing for all women who attend ante-natal clinics? Does the Minister accept that if the Government are to implement such a desirable policy, they must first tackle the insurance companies, which ask people whether they have been tested and downgrade them for insurance purposes, regardless of whether the results were positive or negative?

Yes. The recent results of anonymised testing are worrying: in many inner-city areas, there is a risk of about one in 200 pregnant women being HIV positive, while in rural areas the proportion is about one in 16,000.

As a result, we have set up the AIDS action group, which will focus work on areas where the prevalence is high. We want to build on that and we shall give careful consideration to the BMA resolution, which states that it should be easier for women to present themselves voluntarily for testing.

I entirely endorse what the hon. Gentleman said about the importance of the insurance aspect. We have made it clear that we feel that someone whose test has produced a negative result should be treated in the same way as someone who has not taken a test. Research is under way and we shall be making an announcement shortly.

To ask the Prime Minister if he will list his official engagements for Tuesday 16 July.

I have been asked to reply.

My right hon. Friend the Prime Minister is hosting the economic summit.

Is my right hon. Friend aware that many members of the electricians' trade union on Tyneside play a great part in the economic success of our region? That union is not tied to out-of-date practices. Did my right hon. Friend know that Eric Hammond had recently warned his members of the dire consequences of socialist policy and does he agree that those consequences should be made known to all trade union members?

I think that all trade union members are becoming increasingly aware of them. Eric Hammond was talking about the minimum wage policy, which he said would

"cause industrial unrest, discourage training, harm the economy, put more people on the dole and create a cycle whereby inflation continues to rise."

No wonder Opposition Ministers do not want to hear what a trade union leader has said. That is only one in a long line of devastating indictments of Labour's minimum wage policy. It is beginning to look like Napoleon's retreat from Moscow: bad news and more bad news every day.

Will the right hon. Gentleman take this opportunity to confirm that the Bank of England and the Treasury have known since the publication of the March 1990 Price Waterhouse report that serious irregularities were operating in the Bank of Credit and Commerce International?

The right hon. Gentleman knows that the Bank took action as soon as it was satisfied that it would have evidence—[HON. MEMBERS: "Answer the question."] This is a very important point. It took action as soon as it was satisfied that it would have evidence to support the use of its statutory powers. It cannot act on mere suspicion.

Will the right hon. Gentleman now confirm that the 1990 Price Waterhouse report said that BCCI was then virtually bankrupt and that hundreds of millions of dollars were being given in unsecured loans? Does he not think that if businesses, individuals and council treasurers had been aware of those conditions, they would then have formed an appropriate opinion on whether to use BCCI? A great deal of hardship and misery might thus have been avoided.

The point is that the Bank must act according to the Banking Act 1987. Actions under that Act are subject to appeal and the Bank must therefore have evidence that would stand up in court before it does anything. It cannot act on rumours; it must have good evidence before acting. In this case, it acted as soon as it had such evidence.

We are not talking about the Bank or the Government acting on the basis of rumours. We are talking about both bodies acting on the basis of a serious report from the auditors. The bank has now closed, 200,000 people have lost all or part of their savings and councils of all political descriptions have lost scores of millions of pounds. Does not the right hon. Gentleman think that it is time that the Government accepted their share of the blame for these conditions instead of trying to shift the blame to the shoulders of people who simply could not have known what was going on in the same way as the Government could?

There is no question of shifting the blame. On the question of the individuals concerned, the right hon. Gentleman knows that under the deposit protection scheme compensation is paid to depositors up to certain levels of deposit. That gives considerable protection to small depositors. It is essential for the Bank to act on evidence that would stand up in court and it did so as soon as it had that evidence.

To ask the Prime Minister if he will list his official engagements for Tuesday 16 July.

I have been asked to reply.

I refer my hon. Friend to the reply that I gave some moments ago.

Will my right hon. Friend take an early opportunity to reconsider the laws governing prison visits and the number of visitors allowed at any one time so that all 28 Labour Members who agree with the hon. Member for Liverpool, Broadgreen (Mr. Fields) about nonpayment of the community charge may visit him together in gaol?

My hon. Friend asks an intriguing question, but it has a serious point. Since he raised the matter of the 28 Labour Members, it is worth mentioning that three years ago the Leader of the Opposition said that he would wipe out the Militants once and for all. He failed then, which is why we have called upon him to take action ever since. My hon. Friend has made the good point that the influence of Militant in the Labour party is still strong.

Will the Leader of the House bring to the Prime Minister's notice the serious allegations made in The Guardian today about a "World in Action" programme which reported the comments of a former member of the Joint Intelligence Committee and the fact that serious matters are not brought to the attention of Cabinet Ministers or Parliament? They are serious allegations which should be investigated. Will he ask the Prime Minister, when he has finished today, to institute an inquiry, because such allegations cast doubt on matters that should not be in question?

I have not seen that "World in Action" programme, but I shall arrange for it to be looked at and will draw the right hon. Gentleman's point to the notice of my right hon. Friend the Prime Minister.

To ask the Prime Minister if he will list his official engagements for Tuesday 16 July.

I have been asked to reply.

I refer my hon. Friend to the answer that I gave some moments ago.

Will my right hon. Friend find an opportunity to get a message to the Prime Minister at the economic summit to ask him to express regret at the assertion revealed today in The Sun that the election of Mr. Bush to the Presidency was based on a disgraceful campaign of slurs and attacks? Those assertions are apparently made in a letter from the general secretary of the Labour party.

I have seen the report and I hope that it is not true. If it is true, it is a disgraceful slur and I am sure that the Leader of the Opposition would wish to have it withdrawn.

With so many international leaders meeting in London this week, will the right hon. Gentleman take this opportunity to tell the House why his Government have no policy on British shipping? Now that the House has been denied the opportunity to debate and vote on this matter, will he tell us why he is not giving the support to British shipping that other countries enjoy?

There already is support for British shipping, but it was made clear in one of the debates last night that my right hon. Friend the Chancellor of the Exchequer was considering proposals put forward during that debate.

To ask the Prime Minister if he will list his official engagements for Tuesday 16 July.

I have been asked to reply.

I refer my hon. Friend to the reply that I gave some moments ago.

Will my right hon. Friend ensure that when he sees the Prime Minister—

Will he recognise him?

During the Group of Seven conference and discussions with President Gorbachev, will my right hon. Friend the Prime Minister make it clear that the Baltic states have not been forgotten, that none of the G7 countries has ever accepted the Soviet conquest of those three states and that that must be a starting point for any discussions about aid and investment?

I certainly take note of my hon. Friend's point.

Is the Leader of the House aware that at this morning's annual general meeting of British Airways, Lord King announced that, because of the appalling incompetence of the Secretary of State for Transport in his dealings with American airlines, British Airways is considering selling off all but its core operations, including an aero overhaul plant in my constituency which employs 1,000 men and women? What is he going to do to prevent such a calamity for south Wales?

I certainly reject the allegation about my right hon. and learned Friend the Secretary of State for Transport. The whole House knows of the way in which he has conducted these matters.

To ask the Prime Minister if he will list his official engagements for Tuesday 16 July.

I have been asked to reply.

I refer my hon. Friend to the reply that I gave some moments ago.

Will my right hon. Friend take time today to re-read the excellent speech made a few days ago by my right hon. Friend the Prime Minister about the future of our education system and will he pay special attention to the passage which deals with the future of city technology colleges? Can we expect early action by the Government to ensure a great increase in the number of CTCs?

I agree entirely with my hon. Friend. I thought that it was an admirable speech which showed the tremendous progress that has been made under our education policies. My hon. Friend makes it clear that one programme—only one among many—is that for city technology colleges. There are now 13 in operation or about to be in operation and two more in the pipeline. They are undoubtedly making a big impact in inner-city areas by extending technology and involving industry and commerce. My right hon. Friend mentioned two other ways in which the programme can be carried forward—allowing local education authorities to invest in CTCs and allowing grant-maintained CTCs. It is worth pursuing both ideas and I am sure that we shall do so as soon as legislative time permits.

To revert to the BCCI affair, is the Leader of the House satisfied that in all respects the Bank of England and the relevant Government Departments took the proper action at the proper time?

I have already said that I believe that the Bank of England acted on the evidence at the proper time.

To ask the Prime Minister if he will list his official engagements for Tuesday 16 July.

I have been asked to reply.

I refer my hon. Friend to the reply that I gave some moments ago.

Has my right hon. Friend had time today to read the report that has just been issued by the Department of Trade and Industry's Invest in Britain Bureau? Does he agree that it is encouraging to hear overseas business men say that we have better-qualified and better-trained engineers than the Japanese and that we now have almost no strikes in this country? Does not the report show that under this Government the British disease of the 1960s and 1970s has now been cured—[Interruption] Would not that be reversed under a Labour Government?

I am not at all surprised that some members of the Opposition did not want my hon. Friend to finish his question, because they do not like good news. I believe that the Invest in Britain Bureau survey is the authentic verdict on the country's economic progress and policies. It is worth telling the House that the majority of those involved in the survey found that British factories were more productive than those in the rest of the world. They found our industrial relations excellent and improving. They found that our workers had the skill and expertise that they wanted and they intend to make further investments in this country.

Opposition Members did not like the comment that my hon. Friend made about the so-called "British disease" of the 1960s and 1970s. It is worth referring to the statement made recently by Gavyn Davies in reference to current trends on pay and prices. He said—[Interruption.] I am not surprised that Opposition Members do not like it. He said—it is directly relevant to my hon. Friend's point—

"This means that Britain's perennial problem of excess labour cost is being solved."

Will the Leader of the House confirm that in addition to describing the incompetence of the Secretary of State for Transport in giving away large chunks of British Airways' business to American Airlines and United Airlines, Lord King also said that he was reviewing the practice by British Airways of making large donations to the Tory party? He said that he was considering opening negotiations with the Labour party, because, unlike the Government, we have a transport policy. As the leader of a large transport undertaking, Lord King wanted there to be a Government with whom he could work in helping British transport undertakings to create more jobs and more business for this country.

I hope that any industrialist considering opening negotiations with the Labour party will ask it about its policy of an extra £35 billion on public expenditure and about the consequences of that for higher taxation, higher borrowing and higher interest. I hope that such an industrialist will ask it about its policy for the minimum wage and about its industrial relations policies which will take us back to a situation such as we had, alas, in the late 1970s and which we hope never to see again.