To ask the Secretary of State for Health if she will make a statement about the future size, number and role of regional health authorities.

I announced to the House last week my intention to abolish the 14 statutory regional health authorities. In advance of the necessary legislation, I propose to reduce the number of RHAs from 14 to eight by next April. These changes will help improve the management of the health service, reduce administration and overhead costs and support the continued drive towards a decentralised health service.

When I tabled the question, I hardly expected it to be the catalyst for the change announced by the Secretary of State last week. Will the right hon. Lady tell the House how many jobs will be lost and how many extra doctors are likely to work in the national health service as a consequence of the changes? She will recognise that the regional health authorities had as part of their responsibilities the encouragement of regional centres of excellence. Will she tell the House who or what will take over that responsibility?

I am pleased that the hon. Gentleman should be a catalyst for change. We welcome a sinner who repents—even at a late stage—to the changes which we are introducing in the NHS. The hon. Gentleman makes some good points about the importance of safeguarding specialist centres. The management executive outposts will be working to ensure that there is a strategic role to safeguard precisely the units to which the hon. Gentleman refers.

Will my right hon. Friend tell the House who will decide on the allocation of resources to the districts once the regional health authorities have been abolished?

The regional director of the management executive will of course be involved in the allocation of resources to the districts, but in line with policies that have been laid down and approved by Ministers.

In the Secretary of State's statement to the House last week, she avoided giving any details of the future arrangements for the development of community health councils. Will she now tell the House what those arrangements will be?

The hon. Gentleman makes two different points. With regard to his latter point about accident and emergency centres, he will know that the patients charter has set explicit targets for the time that it should take for people to be treated. Special issues concern the development of primary care in London so that all elderly people can have the services to which they are entitled.

To ask the Secretary of State for Health what further plans she has to spread the benefits of fund holding to other practices.

The GP fund-holding scheme has empowered family doctors to improve services for patients. We wish to see more fund holding and more fund holders and we are pursuing several arrangements, such as consortia, to fulfil our manifesto commitment to extending the benefits of fund holding to all GPs.

Does my right hon. Friend agree that GP fund holding is proving to be one of the great success stories of the health service? Does she agree that the best way to nail the lie that there is a two-tier service, so often put about by the Opposition, is to extend GP fund holding and the benefits thereof to all practices, including the smaller ones, as soon as possible? Will she confirm her support for consortium arrangements and the multi-fund applications that she is now receiving?

My hon. Friend is exactly right. We want to extend the benefits of fund holding to all GPs. We welcome the number of groups that are forming consortia. Of the 800 fund-holding practices that are coming forward for next April, about 350 are precisely for those smaller schemes. We are looking particularly to see further development in London, where the energising effect of GP fund holding on primary care in general could play an important part.

Can the Secretary of State tell the House how she intends to fund the initiative that she announced last week whereby non-GP fund holders' patients will receive urgent treatment within six weeks? I welcome the announcement. I believe that it means that the Secretary of State has accepted that she created a two-tier health service. How does she intend to fund it?

Fifty per cent. of cases are now seen within five weeks. We must make sure that those are the most urgent cases. All emergency cases are, of course, seen immediately. It is clear that GP fund holding is leading to improvements in primary care generally. GPs are funded on a comparable basis for their patients. Any new fund holders who join the scheme will have their budgets arranged on the basis of their referral patterns this year. There is no two-tier system. We are seeing a levelling up.

Will my right hon. Friend take steps to contact directly non-fund-holding GPs who may have some doubts and acquaint them with the facts about the advantages of fund holding? That would offset some of the misleading impressions given until recently by the British Medical Association and which continue to be given by those who seem more interested in making party political points than in pointing out the benefits to patients.

My hon. Friend has it exactly right. There is no more effective advocate for GP fund holding than the fund holders themselves. GP fund holding is all about empowering the general practitioners. The GP is the most effective advocate on behalf of the patient. A party such as ours, the priorities of which are dominated by the interests of patients, not providers, wishes to see that further advanced. I strongly urge the Labour party to speak to many of its supporters who are active, innovative and energetic GP fund holders. They are showing the way to others.

Is the Secretary of State aware of the blatant abuse of the two-tier system in the Coventry and Warwickshire area, and of the consequences of it on the Walsgrave hospital trust? The hospital has refused to operate a two-tier service. The nearby George Eliot hospital offers to fund holders' patients half the waiting time that it offers to health authority patients. As a result, the George Eliot hospital is undermining the Walsgrave hospital trust and is in danger of causing redundancies in the trust. Surely the Secretary of State is aware of this. The blatant introduction of a two-tier service and abuse of the service are causing redundancies within the system that would otherwise be unnecessary.

All hospitals are maintaining their patients charter standards. We are seeing a steady downward pressure on waiting times for all patients. The average was previously nine months. It is now down to five months. There has been a 20 per cent. fall in the number waiting more than a year in the past year alone.

"GP fund holding shifts the balance of power away from hospitals towards GPs and primary care. It replaces a top-down model of the NHS resource allocation with a bottom-up model driven by GPs acting as purchasers on behalf of patients."

My right hon. Friend will recall that she was good enough to waive the requirement that there should be 7,000 patients for one practice in the southern end of my constituency, when it had already recruited every man, woman and child in its area. That practice is now going from strength to strength. It has extended its buildings and is an example to all others in the area. Will she help fund-holding practices to extend now to the north end of my constituency?

I thank my hon. Friend. Those general practitioners with practice sizes that did not reach the 7,000-patient limit are bringing to bear pressure that they should be able to join the scheme. That is why we so welcome the consortia that are developing, which make it possible to push through the preferences of general practitioners in the delivery of care for patients.

When will the Secretary of State accept the evidence that a two-tier system is being created by GP fund holders? The joint consultants committee has handed her a document which demonstrates that 70 per cent. of hospitals are fast-tracking GP fund holder patients. When will she act on that information? When will she make it impossible for GP fund holders to make profits for themselves instead of spending the money in the national health service where it is needed? When will she finally agree to prevent the payment of a £35,000 management fee to every GP fund holder to be spent on bureaucracy and instead give it to practice nurses, who are desperately needed in our community?

When a hospital has completed the contract that it has agreed with the district health authority to meet its patients' targets and to ensure that it improves the quality and quantity of care, if it has spare capacity it can give it to another health authority or to a GP fund holder. The hon. Lady should ask why the GP fund holders have been able to use comparable amounts of money so much more effectively. Let us learn from that. Let us level up and have good value for money, rather than look for the lowest common denominator.

To ask the Secretary of State for Health in how many hospital accident and emergency units medical staff are routinely made available to assess the seriousness of each case immediately on arrival.

I cannot give my hon. Friend the information that he seeks in numerical form, but I assure him that there has been excellent progress around the country, including in his local hospital, in achieving the targets set under the patients charter for accident and emergency units.

Does my hon. Friend agree that, in addition to immediate assessments by medically qualified staff as to the seriousness of an accident, a patient at an emergency unit also wishes to know how long he or she is likely to wait and where he or she stands in the queue? As the latter seems to be capable of being achieved at the delicatessen counters of supermarkets, will he please ensure that it is also achieved in our hospitals?

I very much welcome my hon. Friend's advice, but he should remember that the giving out of tickets in an accident and emergency unit would not necessarily be appropriate as patients are not necessarily seen in the order in which they arrive. In his hospital and many others, there is now a formal system of triage by which patients are prioritised and seen in order, depending on the seriousness of their condition.

Will the emergency units be able to cope with more, clearly very urgent, cases of babies with neo-natal hypothermia when, as expertly forecast, more vulnerable babies in low-income families feel the effects of VAT on domestic heating? Is the hon. Gentleman aware that leading midwives have warned that there will be a sharp increase in deaths from that cause? What advice have Health Ministers given Treasury Ministers about that preventable tragedy?

I note what the right hon. Gentleman said about neo-natal intensive care. May I point out that accident and emergency units are now better equipped and better staffed to deal with all eventualities.

May I press my hon. Friend to look again at the suggestion from the conference of royal medical colleges last week to the effect that all cancer and heart patients ought to be assessed expertly as to the urgency of their needs? After all, accident and emergency patients are seen on the same day while some other patients have to wait up to six months for an appointment with a consultant. Will my hon. Friend please try to do something about that?

I note what my hon. Friend says. Clearly, all urgent cases must be seen as a matter of priority. That must be sorted out between general practitioners and consultants.

To ask the Secretary of State for Health what is the Government's policy on charging for contact lenses prescribed and supplied by national health service hospital eye clinics.

Contact lenses may be prescribed through the hospital eye service if the patient has clinical need for them. A charge is made, although there are a number of categories of patient who are exempt.

Will the Minister give the House an assurance that my 70-year-old pensioner constituent, Dorothy Shanley, and 20 or 30 other people like her in my area will not have to pay £300 a year for the contact lenses that they need? Is it not a fact that the regulations are about as clear as mud and that hundreds of anomalies need to be ironed out if my pensioner constituents are not to face such disgraceful treatment?

I am aware that the hon. Gentleman's constituent had a problem with the Burnley trust. I know that my hon. Friend the Member for Battersea (Mr. Bowis), the Under-Secretary of State, wrote about that case to the hon. Gentleman on 29 July. I am happy to repeat what was said in the letter, which is that I regret the fact that there was a misinterpretation of the guidelines at Burnley which caused a degree of distress to the hon. Gentleman's constituent. The guidelines are not "clear as mud" but are perfectly clear and are operating in the rest of the country. There was a misinterpretation in Burnley which has been resolved. As my hon. Friend the Under-Secretary said in his letter, Mrs. Shanley's case can now be carried forward under the proper guidelines and in line with the advice of her consultant.

My hon. Friend is aware that the number of eye tests carried out is broadly similar to that before charges were imposed. Will my hon. Friend give the House an assurance that he will continue to ensure that we provide the most help in respect of charges where the need is greatest?

My hon. Friend makes a good point in both regards. As he said, the number of sight tests has come back to the original level. We are concerned to ensure that needs are met and, as my hon. Friend will know, a significant number of people are entitled to help as a consequence of those need and exemption arrangements.

In the light of the discussions between BUPA and GP fund holders about the sale of private insurance through GP practices and the words of the Chief Secretary—I use his words—that charges will be needed to offer comfort and choice to people in hospitals as part of cutting back on NHS spending, will the Minister give an assurance to the House that all existing free prescription charges will remain, including for categories such as pregnant women and nursing mothers, and that no new charges will be introduced in the NHS for all of us who pay our taxes for a free and equal service?

I would not want any element of discord to arise between the hon. Gentleman and myself, but his question went considerably wider than the one that we were discussing.

Answer the question.

If the hon. Gentleman will give his lungs a rest, I might have a chance to do so.

To ask the Secretary of State for Health what plans she has to ensure the continuance of satisfactory deputising/on-call services for general practice.

The Government remain committed to ensuring the continuance of a good quality out-of-hours service. To this end, we are currently discussing with the medical profession how best to take forward this commitment.

My hon. Friend is well aware of the high regard in which services such as Maidstone doctors on call —MAIDDOC—and Medway doctors on call—MEDDOC—in my constituency are held, and the anxiety with which MAIDDOC views the new formula because of the difficulties that patients have in rural areas. Can my hon. Friend offer words of comfort to the committed doctors, that they will be able to continue in those services after he has completed his negotiations?

My hon. Friend is right, I am aware of those issues, not least because of the eloquent advocacy with which my hon. Friend expresses the concern of his constituents. I am further aware that his constituents hold the services that they receive in high regard, and those services form part of the discussions that I am having with the general medical services committee. We need to look at a number of issues, not least the use of the cash-limited funds of the family health services authority. We want to do that against a background of ensuring that decisions are devolved as closely towards the patient as possible.

To ask the Secretary of State for Health if she will make a statement on progress towards the target of placing a paramedic on each frontline emergency ambulance.

There has been excellent progress in paramedic training in all ambulance services.

Will my hon. Friend join me in congratulating the Cleveland ambulance trust on achieving its target of having a paramedic on each of its 18 frontline ambulances three years ahead of target? It was the first ambulance service to do so. Does my hon. Friend agree that this is another example of how the new ambulance trusts are delivering improvements in health care and emergency cover to the communities that they serve?

Indeed. After my visit to the Cleveland ambulance service—I thank my hon. Friend for his invitation—I said to myself that if Cleveland can do it, why not the rest of the country? At that time, Cleveland was four years ahead of target, and I decided to bring forward to 1995 the target date by which there would be a fully trained paramedic on every frontline ambulance. The manner in which my hon. Friend's local ambulance service has achieved its target is a tribute to it, and I hope that he will pass on my congratulations.

Will not the Minister agree that, irrespective of the importance of paramedics, it is even more important to get an ambulance to the scene in the first place, within the limits laid down by the patients charter? Is the Minister aware that in London in the summer there was an average of 50 occasions a day when ambulances arrived more than 26 minutes after they were called? Does the Minister not realise, from the answers that were given last Friday, that all ambulance authorities in the country comply with the 90 per cent. standard of response times, other than the London ambulance service, which achieved 58 per cent? Will he persuade the Secretary of State for Health to see the Chief Secretary to the Treasury to assure him that it costs more to run an ambulance service in London and to tell him that more money should be made available to the London ambulance service to enable it to meet the standards of the patients charter?

I am aware of the sad fact that, almost uniquely in the country, the London ambulance service has not managed to come near the targets set down in the patients charter. I appreciate that there are special problems in London. There is a new management structure for the central area—where many of the problems occur—which will receive extra resources. With good will on all sides, there is no reason why the London ambulance service should not meet the targets achieved elsewhere in the country.

Is not one of the advantages of putting a paramedic on every frontline emergency ambulance that he can assess the case and take the patient to the most appropriate trauma centre, particularly to local casualty units such as the Gravesend and North Kent hospital?

My hon. Friend is right to point to the possibility of trauma units. We have funded centrally the trauma unit at Stoke so that ambulance paramedics can pre-assess the most serious cases, bypass certain district accident and emergency units and take patients to a hospital where a special trauma team can be assembled. We are fairly certain that that experiment will show that it is possible greatly to increase the chances of survival after the most serious accidents.

To ask the Secretary of State for Health what representations she has received on the future provision of health services by the Wakefield and Pontefract trust hospitals; and if she will make a statement.

We have received a number of letters, including one from the hon. Member.

The Minister is aware of the concerns and complaints that have been registered by the relatives and friends of elderly people who have been treated at the Pontefract and Pinderfields hospitals. When will he persuade his right hon. Friend the Secretary of State to commence the public inquiry, which the right hon. Lady promised the people in my area, to investigate the allegations of mistreatment of the elderly at Pinderfields hospital? When will she also agree to the request that I made many months ago for a meeting to discuss the future of the hospitals and the medical care provided in the Wakefield area? Will the Minister investigate future provision for the mentally ill and the mentally disabled in the Pontefract and Wakefield areas?

The hon. Gentleman is aware that I visited Pontefract twice in the past year. I am aware of three incidents involving elderly people in which care fell well below the standard we would expect. He is also aware, however, that the Nuffield Institute is investigating those cases and has contacted the families of patients of the past few years. An internal inquiry into those cases is also being led by two consultants from Manchester and Cornwall. If there are lessons to be learnt, we shall act on them, but if the hon. Gentleman visits the geriatric department now he will find little cause for concern.

Is the Minister aware that a great deal of concern is felt within the Wakefield and Pontefract areas, and throughout the country, about the impact of trust status and fund holding on community care? Has the Minister had the opportunity to read the reply published this morning by Values into Action, entitled "The Resettlement Game", which reveals conclusively that trust status is obstructing the process of providing community care for people with learning difficulties? Has the hon. Gentleman also had an opportunity to talk to Dr. David Tod, the president of the National Association of Fund Holding GPs, a prominent Tory who spoke at the Conservative conference in Blackpool about the value of fund holding? Has the Minister asked that doctor why he, along with certain other GPs has refused to take patients from mental handicap hospitals? Where does that leave the Government's community care policies?

I am aware that there are a great number of GP fund holders in the hon. Gentleman's area, but that is nothing to be scared of and I would thank him for not putting around scare stories. I have no reason to believe that GP fund holders would take decisions that are not in the interests of their patients overall.

To ask the Secretary of State for Health what measures are available for health authorities to set up dedicated hormone replacement therapy clinics.

Health authorities are required to assess local needs and place contracts for services accordingly. These services may include clinics specialising in the menopause and hormone replacement therapy.

I thank my hon. Friend for that reply. Is he aware that there are still relatively few specialist units around the country and that most are in the private sector? That means that women who rely on the national health service do not have access to such treatment unless they can afford to pay for it. Given the amazing benefit from that treatment, of which I am an amazing example—[HON. MEMBERS: "Hear, hear"] and the fact that this treatment could save the health service millions of pounds, because without it women are currently likely to suffer from osteoporosis, strokes and other terrible diseases, does my hon. Friend agree with me that the health service should be encouraged to dedicate funds to it so that lots more women can grow old gracefully?

I know, and the world knows, of my hon. Friend's interest in this matter. She knows, as I know, that such therapy is available from the national health service in all its forms. The number of prescriptions for such treatment has quadrupled in the past decade. My hon. Friend will also be aware, as I am, that although HRT is one of the answers to diseases such as osteoporosis, there are many other ways in which to ensure that women grow old gracefully, as my hon. Friend said, and that brittle bones and other problems are avoided. My hon. Friend will be aware that one such alternative is exercise. Having seen my hon. Friend work out with her pompoms, I can assure the House that she takes that side of the argument as seriously as that in favour of HRT.

The hon. Member for Billericay (Mrs. Gorman) is radiant proof of the efficacy of hormone replacement therapy. Will the Minister acknowledge that HRT is not help for women only, but many men could benefit from it—certainly an awful lot of men in this place?

To be fair, I am not sure that the hon. Gentleman would benefit from remedies for problems related to the menopause, but I rely on him to assure me about that. Men and women benefit from better women's health, and women's health can be helped by that therapy. That is why in the past year we spent £61 million supporting it.

To ask the Secretary of State for Health by how much long waits for hospital treatment have been reduced in Hampshire over the past two years.

Since 31 March 1991, the number of patients waiting for in-patient and day case treatment for more than a year in the four health districts in Hampshire has fallen from 3,489 to 1,033. At 31 March 1991, more than 950 patients were waiting more than two years for treatment. Now no one in Hampshire has to wait for more than two years.

That is exceptionally good news, especially for those people—[Interruption.] Hon. Members may jeer, but for those waiting many years for hip replacements that is especially good news. Does my hon. Friend agree that if further action is to be taken to reduce waiting lists one course would be to complete the reorganisation of London hospitals so that areas such as Hampshire get a fairer share of the budget? Given that Southampton general hospital has a greater success rate in general surgery than any London hospital, is it not right that the system by which London hospitals receive the lion's share of resources should be ended as soon as possible?

My hon. Friend makes important points about resources and the spreading of them across the country, about the reforms that we have put in place and about the review that is going on in London. I can assure him that the progress that has been made in his part of the world is being made in other parts of the country, including London. Overall, 50 per cent. of patients needing hospital treatment are immediately admitted—98 per cent. in under one year. My hon. Friend drew attention to the number of hip replacements. There have been 50,000 such operations in the past year, as well as 60,000 varicose vein operations, and 90,000 people have had cataract operations. It is a pity that those figures are not sometimes recognised by Opposition Members.

Do people in Hampshire have to wait two or three years for referral to a pain relief clinic, as they do in Preston? I am informed by the Preston health authority that people in Preston—[HON. MEMBERS: "Reading."] I am quoting—

Order. The hon. Lady is aware that quotations are not allowed during Question Time.

Do people in Hampshire have to wait until the end of 1996—three years—for reference to a pain relief clinic for chronic pain?

We shall certainly look at any particular problem in Preston. As the hon. Lady is aware, Preston is not in Hampshire, but in both Hampshire and Preston we have great progress. The decisons on planning for meeting the needs of the hon. Lady's area are down to the health authorities there, and I must not second guess their clinical health decisions. I am sure that the health authorities for the Preston area are doing their best to ensure that people get their treatment on time as set out in the patients charter.

To ask the Secretary of State for Health how many general practitioner practices are now participating in the fund-holding initiative; and what was the figure in April 1991.

The number of fund-holding practices is more than double what it was in 1991. It now includes 6,000 family doctors in 1,235 practices. The growing success of the scheme is shown by the fact that we expect a further 800 practices to join from next April.

Does my right hon. Friend agree that the rapid expansion that she has just announced, together with the fact that north Hertfordshire has more GP fund holders than any other district in the North West Thames region, shows the popularity of the scheme with ordinary family doctors? Does she agree that the next battle is to persuade the remaining doctors to join the scheme and to enable them to do so?

I entirely agree with my hon. Friend. It looks as though, from next April, 99 per cent. of patients in his area will have a GP fund holder. It is a voluntary scheme for consenting adults. We believe that more GPs should see the advantages of fund holding. The best way in which they can do that is for them to talk to someone who has already taken forward the scheme, which now provides care for 12 million patients.

Is the right hon. Lady aware that she is correct to say that we do not have a two-tier health service? In fact, we have a three-tier health service, with private patients jumping the queue and getting their treatment within days, fund-holding GPs' patients getting their treatment within months and non-fund-holding GPs' patients getting their treatment only within years. Is she proud to have increased privilege in the health service?

Once again, the hon. Gentleman shows a bitter, blinkered and rather vindictive approach to the delivery of health care. I suggest that he talks to David Colin-Thome, who was previously a Labour candiate and who said that GP fund holding was the most energising thing to have happened to general practice in his 20 years as a doctor. We must not only set the national standards that the Labour party said we would never meet—we have not only met them, but beaten them—but find ways in which to encourage the rest to do as well as the best. The scheme is voluntary and we want more fund holders to come forward.

Does my right hon. Friend agree that GP fund holding is very popular with patients, because it improves patient services, and also with GPs, who are voting with their feet? Can my right hon. Friend offer any psychoanalysis to explain why the Labour party is intent on abolishing this popular reform?

I am afraid that the Labour party, which constantly looks backwards rather than forwards, cannot bear to devolve power: it all has to be command and control. The whole point about GP fund holding is that it empowers the GP. It is the GP who is the agent of the patient and when he has control over the budget, which would otherwise have been spent for him, he makes shrewd and wise decisions which are sensitive to patients' needs. That is the distinction between our party and the Labour party. The Labour party wants to tell people what to do; we want to empower them.

To ask the Secretary of State for Health what plans she has to meet the Spastics Society to discuss community care.

My right hon. Friend met the society when she opened its Ruth Garwood lodge in the summer. I have not been approached for a meeting, but I am always ready to consider any such request. I personally very much value the contribution of the Spastics Society to community care.

Does the Minister realise that such is the shortage of funds in local authorities that they cannot afford the level of occupational therapists needed? The Spastics Society is now having to divert its funds into that employment, and the local authority assessment services using occupational therapists now cannot get round to the people desperately in need of assistance and adaptations in their homes. What does he intend to do about that?

The whole question of assessment of need is central to our community care policy. We have in place a system which assesses each individual's needs, both in terms of residential needs where that is appropriate and in terms of any medical treatments and therapies. Those needs are assessed and they are then put out to be met by the providers. The Spastics Society makes excellent provision, although some of that provision has proved costly. The society needs to look at efficiency and savings within its own organisation. I assure the hon. Gentleman that the money that has been put into community care is more than sufficient, as has been recognised by the Association of Directors of Social Services, which has said that in the early months of community care the system is up and running and that it is optimistic about the future.

Will my hon. Friend ensure that as much as possible of the £565 million for community care goes to efficient voluntary groups and not to town hall bureaucracies, which do not deliver an efficient and fair service?

My hon. Friend is right. As he knows, we have encouraged local authorities to work closely in both the planning and execution of community care with the voluntary and the independent sector. Voluntary and private providers have an important part to play. We have made a requirement that 85 per cent. of the transitional grant be allocated to that sector. That requirement is being met in most parts of the country. There is a great willingness among social services departments to meet it. I am confident that we can go forward with community care in partnership with the public, private and voluntary sectors.

To ask the Prime Minister if he will list his official engagements for Tuesday 26 October.

This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

In relation to the Bilsthorpe colliery disaster, in the light of new photographic evidence which refutes the report of the health and safety inspectorate into that disaster, will the Prime Minister now agree to a full public inquiry, as soon as possible, that is open to the public so that we can get over the whole of this nonsense which shows the difficulties that are hitting the coalfield communities of Britain?

I have not seen the photographic evidence to which the hon. Gentleman refers. I will certainly look at that photographic evidence and examine it. I believe that there has been a substantial inquiry. None the less, I will examine it and be in touch with the hon. Gentleman.

Does my right hon. Friend agree that one of the major impediments to reducing unemployment across Europe is high wage costs—not to be confused with high wages? We must continually draw a distinction between the high cost of employment loaded on top of paying high wages. Will he continue his efforts diplomatically within Europe to ensure that we in Britain win the argument that there is no contradiction between paying people high wages and seeking to reduce the costs of employing people generally?

I agree with my hon. Friend about that. I believe that that view is increasingly being taken by Governments and by employers right the way across western Europe and elsewhere. There is no doubt that the higher the sum total of costs, the larger the resultant level of unemployment will be both in Europe and elsewhere. At present, there are 18 million citizens unemployed across Europe. Estimates are that in Europe as a whole that may be 20 million in a year or so. We all need to look to see how we can get those costs down and people back in work.

I am sure that the Prime Minister is well aware of the revulsion and outrage felt throughout the whole of the nation when it learned of the appalling tragedy of Saturday's bombing in Belfast. The violent and horrific aftermath, which has cost even more lives today, can only deepen and reinforce those feelings. Is it not absolutely clear that the response that the House of Commons must give to those who seek to impose their will by the bomb or the bullet is that they will not succeed in undermining this nation's total commitment to the democratic process?

I am grateful to the Leader of the Opposition for making that clear. The whole House will agree with him in those sentiments, as I do without reservation. The perpetrators of sectarian violence have committed cold-blooded and premeditated murder. Let me say to the House that they will be hunted down and they will be subject to the full severity of the law. That applies equally to those responsible for the outrage in the Shankill road and to those responsible for the murders in west Belfast just a few hours ago. Such murders will have one effect and one effect only: they will deepen the bloodshed through revenge killings, and there will be more deaths, more misery and more years before Northern Ireland can return to the peaceful democratic future that everyone in the House wishes to see it have.

To ask the Prime Minister if he will list his official engagements for Tuesday 26 October.

I refer my hon. Friend to the reply I gave a few moments ago.

Is the Prime Minister aware that many Conservative Members were extremely pleased that he raised the question of the general agreement on tariffs and trade during the recent Cyprus summit? Will he find time today to contact the French members of the European Commission and tell them to spend less time worrying about creating a federal Europe and more time trying to persuade their Government to sign up to GATT?

We had a substantial discussion on the Uruguay round at the Heads of Government meeting in Cyprus over the past few days. What was striking about it was that with some 50 countries there—some large and some small, some agricultural and some industrial—from every part of the globe, there was total unanimity on the desirability of agreement in the trade talks, and agreement by 15 December this year. We agreed at the summit to dispatch a small mission of Ministers from countries in different parts of the Commonwealth to call in on a number of capitals and make it clear how important we consider the trade talks to be.

The Prime Minister will know that he has the backing of those in all parts of the House in his call for restraint to break the vicious cycle of tragedy and violence in Northern Ireland. He is right in saying that no British Government should ever be prepared to speak to those who will not abandon the bullet and the bomb. But does not effective action against terrorism also depend on the proper co-ordination of intelligence? Does the Prime Minister recognise that confusion between intelligence gatherers in Northern Ireland, and the fact that there are two lead agencies, on the mainland and in Northern Ireland, may lead—as it has in the past—to rivalry and squabbling, which undermine the battle against terrorism? Will the Prime Minister address that matter?

We keep our counter-terrorist arrangements under very close review. The Security Service now devotes around 40 per cent. of its total effort specifically to countering Irish terrorism. There have been considerable successes, although it is in the nature of these matters that the successes are not often public, whereas the failures are all too public.

To ask the Prime Minister if he will list his official engagements for Tuesday 26 October.

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

Does. my right hon. Friend agree that police officers should not be hampered in their fight against crime by the burden of excessive bureaucracy and paperwork? Will he join me in congratulating the Home Secretary on his announcement that the amount of form filling will be seriously cut?

I can agree not only with my hon. Friend and my right hon. and learned Friend the Home Secretary, but with the recommendations of the Sheehy report in this respect. Like all right hon. and hon. Members, I want to see police officers fighting crime on the streets, not dealing with paperwork in their offices. My right hon. and learned Friend the Home Secretary last week accepted proposals which, once fully implemented, will cut paperwork in half. They will also put something like 2,300 policemen back on the streets, where all of us wish to see them.

Will the Prime Minister explain why the Government are this week to announce the winding up of the development corporation in my constituency, at a cost of £16·5 million, given that we have had announcements of some 700 job losses at Jetstream in Prestwick this month and of some 320 job losses in my constituency today? What logic is there behind the Government's decision?

The hon. Gentleman will know that, uniquely in western Europe at the moment, we are now in a position where unemployment has stabilised and is gently beginning to fall. In case the hon. Gentleman has not noticed, unemployment has fallen in six of the last eight months, by a total of 84,000. It is falling against a trend of rising unemployment elsewhere across the European Community and it is now below the European average, despite the predictions of some Opposition Members some months ago. The hon. Gentleman might have addressed the reality of what is happening for once.

To ask the Prime Minister if he will make an official visit to Brixham, south Devon, to discuss the future of the fishing and shellfish industry.

I have no immediate plans to do so. However, my hon. Friend the Minister of State, Ministry of Agriculture, Fisheries and Food has made widespread visits to ports, including Brixham, to consult fishermen.

The people of Brixham are well aware of the Government's commitment to the west country, what with assisted area status for Torbay and an application to the European fund for 5b status for Brixham. But when my right hon. Friend the Prime Minister comes to Brixham, will he meet fishermen and assure them that he will not be pushed around by the Portuguese or Spanish, who want to seize our fishing stock and want more fish from our sovereign waters? Will he tell fishermen that he will not introduce a conservation measure until other European countries have similar conservation measures and until their policing of them is as good as ours? Finally, will he take a cup of tea at the Melville hotel so that he hear from Brixham's hoteliers that if he reduced rules and regulations on the hotel industry it would do more for tourism than anything else?

I will look forward not only to a cup of tea but, I suspect, something stronger by the time we have dealt with that agenda. I recognise the industry's concern about access for Spanish and Portuguese vessels. The Commission's proposals for rules from 1996 have now been announced, and we have made it clear that they must not lead to an increase in fishing effort. I attach great importance to strict observance of Community rules, including quotas. We therefore welcome the control regulations, which will help to ensure consistent enforcement. One of the areas of the Maastricht treaty perhaps not generally recognised by everyone is that it now gives greater power to ensure that everyone across the Community obeys Community regulations and can face substantial fines if they do not do so. [Interruption.] Hon. Members below the Gangway may scoff. They simply prove, as I have always suspected, that they have never read or understood the Maastricht treaty.

I now call Mr. Jim Marshall: it is a closed question.

Does the Prime Minister recall the speech that the right hon. Member for City of London and Westminster, South (Mr. Brooke) made on 9 November 1990, in which he said that the British Government have no selfish strategic or economic interest in Northern Ireland—

Order. I indicated to the hon. Gentleman that it is a closed question. It deals with Brixham, south Devon and the fishing industry. We must move on to Mr. David Sumberg.

To ask the Prime Minister if he will list his official engagements for Tuesday 26 October.

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

Is my right hon. Friend aware of a proposal by the Department of Transport to build a new six-lane motorway adjacent to the existing eight-lane M62, which cuts through my constituency? This proposal would involve the demolition of more than 350 homes. It is creating widespread housing and planning blight and is regarded by me and the whole community as an environmental disaster. Will my right hon. Friend tell the Department of Transport to withdraw the proposals forthwith?

I understand the concerns expressed by my hon. Friend and I know how vigorous he has been in expressing them on behalf of his constituents. I can undertake that the Department of Transport will take into account the views that have been expressed to me by my hon. Friend, and those of his constituents.

To ask the Prime Minister if he will list his official engagements for Tuesday 26 October.

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

Given my right hon. Friend's support and commitment to the people of the south-west, can he give any encouragement to our wish to see a slowing down in the programme of implementation of EC water directives and a lowering of future water charges for the hard-pressed people of Devon and Cornwall?

As I think my hon. Friend knows, we are seeing what scope there is to apply the directives more flexibly and to minimise the cost that would otherwise fall on the water user in the south-west. We are therefore inviting our Community partners to re-examine priorities in the detailed implementation of the urban waste water treatment directive and also to consider whether the timetable for meeting the obligations is consistent with the current economic conditions in the Community. There is no quick or simple answer to this matter, but I can assure my hon. Friend that we are continuing to explore all avenues to try to minimise the costs that would otherwise arise.

To ask the Prime Minister if he will list his official engagements for Tuesday 26 October.

I refer the hon. Member to the answer I gave some moments ago.

The Prime Minister talks about a recovery being under way, led by this country. How can he tell us that we must face reality when, in reality, jobs are haemorrhaging in our constituencies every day? The Primė Minister is aware that a steel works is to close in my constituency, with the loss of 260 jobs carried out by the most flexible operatives in the country, if not the world. What words of comfort has the Prime Minister for those people who have been thrown on the scrap heap?

The hon. Gentleman needs to understand that unemployment is falling in this country, whereas it is not falling in other countries. Unemployment fell last month among both men and women in every region and in every part of the country. That month's decrease confirms the underlying strength of the economy. As the hon. Gentleman perhaps does not know, long-term unemployment has fallen over the last six months; long-term unemployment over longer periods has fallen; vacancies have risen; and the work force in employment have also risen. There is still a long way to go to get unemployment at the levels we would wish to see, but those Opposition Members who were keen to forecast 3·5 million unemployment just a few months ago had better stand up and admit now that it is under 3 million and falling.