To ask the Secretary of State for Health if she will make a further statement on the current reorganisation of the NHS.

The national health service reforms provide a stable and enduring structure to the health service which will enable it to respond flexibly to the changing needs of patients. I am pleased that good progress is being made in Committee on the Health Authorities Bill. We are completing the unfinished business of the reforms, streamlining management and cutting bureaucracy.

How did the reorganised national health service respond to the flexible and changing needs of Mark Dwan? Will the Secretary of State tell us why she had to see the Lord Chancellor and what was discussed?

There is great pressure on medium-secure beds. When the Labour party was in power, the Glancy report recommended medium-secure beds. By 1979, there were none. There are now 700, together with almost 1,000 other medium-secure beds. We are spending £47 million to produce an extra 600 next year. I shall be taking steps to make sure that the court authorities are aware of the way of making contact with those most directly responsible for the provision and arrangement of medium-secure beds.

My right hon. colleague will be aware that one of the parts of the national health service being reorganised is the blood transfusion service. She may be aware that a petition on this matter was presented to her office this morning. Unfortunately, she was too busy to receive it. She may nevertheless be aware that we have a quite outstandling blood transfusion centre in Lancaster and it would be criminal folly to abolish it.

I much regret that it was not possible to meet my hon. Friend, who is a great champion of the service. She will understand that, with the publication of new guidance on appointments to health authorities and trusts, it has been an extremely busy morning. There is, however, a distinction between improvement and management of the service and, of course, development of improved services for patients and making sure that blood donors have the best possible service. As she will know, the Under-Secretary of State, my hon. Friend the Member for Bolton, West (Mr. Sackville), has been closely involved in these matters and he and I will look carefully at my hon. Friend's recommendations.

Will the Secretary of State expand a little on the statement that was made earlier about the procedures being set out for the establishment of appointments to NHS organisations? Does she accept that some of us are disappointed that she has not accepted the advice of the National Association of Health Authorities and Trusts that there should be an independent element in that procedure? From my reading of the statement, I believe that there is no such element. Why has she set her face against that?

I hope that the hon. Gentleman will look at the guidance very carefully. Essentially, it puts into one manual best practice as it has been organised throughout the health service for some time.

Will my right hon. Friend join me in congratulating Mrs. Cathy Hull, the wife of the deputy Labour leader of Rochester upon Medway city council, on her recent appointment as a non-executive director and in wishing her a long and successful time in that position?

I certainly will congratulate my hon. Friend's colleague. People from all political parties as well as those with no political affiliations serve on health authorities and trusts. We want people with ability and commitment who share a vision of having the best health service in the world. Overwhelmingly, those who serve on health authorities and trusts work to achieve that goal. However, we need greater openness and public understanding of the work involved to encourage more people to come forward.

In the mad scramble to establish a market in health, what consideration has been given to the implications for other services, such as child protection? Will the Secretary of State accept that it is astonishing that the recent consultation document on general practitioner fundholding made no reference to the importance of GP fundholders liaising with local social service departments and with area child protection committees? Does she accept that the increasing practice of GP fundholders purchasing crucial services, such as health visiting provision, from outside their areas is completely undermining—as she, with her background, should know better than anyone else—child protection collaboration at a local level and that it may cost lives?

Of course the hon. Gentleman is right: collaboration between agencies is fundamental to service delivery in many areas, including child protection. However, I dispute the hon. Gentleman's knee-jerk attack on the market system. I can only quote Chris Ham who says:

"The old system of planning by decibels, in which those running hospital services exerted most influence, has been replaced by an arrangement in which health authorities and GPs are in a much better position to shape the direction of the service development".

To ask the Secretary of State for Health how many people in the London area are estimated to be registered with (a) two general practitioners and (b) more than two general practitioners; at what cost to public funds; and if she will make a statement.

The problem is being tackled at a local level by individual family health services authorities and the information is not available centrally. Dual registration affects the distribution of general practitioners' remuneration but not the overall cost.

Will my hon. Friend confirm that we meet in the high court of Parliament and that Parliament can handle questions to Ministers about beds, GPs and anything else? What is being done to improve the administration of the health service to ensure that people do not appear on more than one GP list? It is a waste of taxpayers' money which could be better spent elsewhere in the health service.

My hon. Friend is quite right: dual registration causes damage. It causes difficulties in assessing local health needs, and that is why we must work to solve the problem. It also means that some general practitioners receive funding, over and above that of their counterparts, which they do not deserve. However, I assure my hon. Friend that that does not increase the sum of global public expenditure. In my hon. Friend's own area of Ealing, Hammersmith and Hounslow, a list inflation team has been established to complete a number of important checks, which will, I hope, move towards the elimination of that problem.

To ask the Secretary of State for Health what savings she expects to result from the abolition of Trent regional health authority.

By 1997–98, the total annual savings solely from the abolition of regional health authorities are expected to be in excess of £100 million.

Will my hon. Friend confirm that the number of patients waiting for more than a year has fallen by 4,200 in the last quarter and that no patients in the region are waiting longer than 18 months? Will he assure me that any savings that he makes from the abolition of the region will be reinvested in increasing the standard and speed of patient care?

Yes. I congratulate Trent region on its many achievements, which will be further augmented by its share of the £100 million a year that will be saved from the abolition of the regions. Why the Labour party should wish to oppose the abolition of the regions and take that money away from patient care, heaven alone knows.

The Minister must be aware that, since the reorganisations introduced by the Government in 1979, administration has increased enormously. No one believes that the £100 million will be put into health care to reduce the waiting list. Why does not he get back to the good old days, when 3.5 per cent. of staff in areas such as Doncaster were administrative staff? That is the service that people want to have, not quangos on quangos.

On the good old days, I can tell the hon. Gentleman only that we are treating many more patients than we did in those days; people are living longer; infant mortality is lower; and waiting times are smaller. Let him choose which he prefers.

To ask the Secretary of State for Health whether she intends to include asthma as a condition for special attention in "The Health of the Nation".

"The Health of the Nation" White Paper designates asthma as a strong contender for key area status. Further consideration would be necessary before national targets could be set.

What further information does the Minister need than the continuing rising incidence of asthma, and its links with atmospheric pollution from vehicles, factories, and so on? Why will he not take notice of the excellent example set by the Welsh Office, which has set achievable targets for the reduction of asthma, included as a key area in "The Health of the Nation"? Let us start to cure children and others who are suffering from that dreadful illness.

We, too, take that matter very seriously. Of course, we are interested in what our Welsh colleagues are aiming at and are able to achieve. The hon. Gentleman will be aware that we have a major research programme into asthma. Causes are unknown; triggers are known. We want to see which triggers can be tackled, and whether we can find causes. The hon. Gentleman will know that, during 1994, we invested some £5 million in new research, and some 14 projects are under way. As and when they come to fruition, we will, perhaps, be in a better position to set realisable targets. In the meantime, of course, our GPs are working to great effect in helping sufferers from asthma to manage their illness.

Does my hon. Friend not realise that five people a day die from asthma and that it is the one major disease to which reference should be made in "The Health of the Nation"? If it can be done in Wales, for goodness sake we should be able to do it in England.

My right hon. Friend puts a strong case. It is something which, as we have said, has been identified as a potential key area. But there are criteria for our health of the nation key targets: first, the fact that it is a major cause of preventable death and avoidable ill health that is certainly met; secondly, which effective interventions are possible—that is partially met; and thirdly, that it is possible to set targets.

"The Health of the Nation" talks about tackling the variations in health between groups in the population. Is it the Government's view that poverty is a health issue?

If the hon. Gentleman has read the latest edition of Doctor, he will have noted that a number of doctors have identified different asthma triggers, ranging from housing to harvesting and from smoking to factory dust. All those elements can cause asthma, and in all those contexts prevention is possible. Individuals can change their life styles, doctors can help asthma sufferers to manage their condition and school nurses can play an enormous part in helping children to cope, and helping teachers to help children to cope.

To ask the Secretary of State for Health what steps she proposes to take in response to the report of the advisory group on osteoporosis; and if she will make a statement.

My noble Friend Baroness Cumberlege announced on 31 January that we had accepted the advice contained in the report of the advisory group on osteoporosis.

Is my hon. Friend aware that the report's publication and the Government's acceptance of all its recommendations have been warmly welcomed? He will know that one woman in four is affected by the complaint. Is he aware that a survey carried out by the National Osteoporosis Society suggests that only one tenth of sufferers are receiving treatment?

My noble Friend wrote to the chairmen of all health bodies at the time of the report's publication, bringing it to their attention and making the specific point about bone densitometry.

To ask the Secretary of State for Health what factors are taken into account in decisions about the relocation of accident and emergency departments.

Decisions on local accident and emergency services are made on the basis of the most appropriate service for local needs.

I thank my hon. Friend for that reply. Although we should all like accident and emergency services at the bottom of our gardens, would it not be better for the health of the nation to have specialised centres run by teams with the facilities and expertise to provide such services, backed up by paramedic teams who can deliver people in a stabilised condition as soon as possible? Small localised services could deal with the walking wounded, as has been suggested in south-west Hertfordshire.

My hon. Friend is right in principle. There are a number of facilities that can meet such needs. The introduction of minor injuries clinics has provided a helpful source of immediate treatment; the experimental trauma centre in Stoke-on-Trent, which is being assessed, deals with major trauma; and accident and emergency services now have more paramedics who can stabilise people at the scene. All those developments in accident and emergency care should be evaluated, and should inform long-term decisions.

The Minister should be aware that the relocation of the accident and emergency unit at Broadgreen hospital in my constituency has been speeded up because hospitals have been unable to recruit enough senior house officers. What does the Minister propose to do to assist hospitals in such circumstances? Changes in the training of doctors are making available senior house officers scarcer, and the reduction in junior doctors' hours—welcome though it is—has been carried out in a way that has caused a crisis in accident and emergency units throughout the country.

The hon. Lady is right to point to stories that have appeared about shortages of junior doctors in accident and emergency units. There are several reasons for that. It partly reflects the normal change in the February turnaround of contracts. That is not unusual or unknown, and can be addressed in a number of ways. For example, management can adopt a more flexible approach to the way in which accident and emergency units are run. It is also important for specialist surgeons in hospital teams to contribute fully. The Government have made an effective contribution by increasing the number of accident and emergency specialists considerably since 1988: accident and emergency is now the largest growing hospital specialty in the country.

I accept the need for and the benefits of large A and E departments, but does my hon. Friend agree that it is vital that A and E departments, especially those in London, should stay open 24 hours a day and should not close their doors temporarily, thereby putting pressure on other A and E departments?

My hon. Friend is right. It is important that the widest range of facilities is available, especially across London. I counsel him, however, to consider what is termed a closure. For example, I read in a report this morning that ambulances had temporarily not been going to Homerton hospital. However, I noticed that the A and E department there was still open to treat patients for something as serious as, for example, stabbing. I counsel him, therefore, to consider carefully the definitions in these matters.

Should not the proximity of A and E departments to blood transfusion centres be one of the factors to be taken into account in the relocation of those departments? The Minister will be aware of the petition that was delivered to his Department this morning. It contained 500,000 signatures calling for the reversal of the policy to close five blood transfusion centres. Today, of all days, should not he join the Have a Heart campaign, reverse that policy and consider better and more constructive ways of improving the blood transfusion service?

The hon. Gentleman is rather ingenious at getting a bite at a different cherry under this question. Of course, all matters in relation to the provision of the blood transfusion service are extremely important. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville), who has responsibility for these matters, takes great care to consider all the arguments.

Is my hon. Friend aware that great concern exists in north London about the future of A and E provision, especially at North Middlesex and Chase Farm hospitals? Will he give those of us in north London an undertaking that no decision will be taken until neighbouring purchasers are made to co-operate over A and E provision, not just in north London but throughout Hertfordshire and Essex? Grave concern exists that we will find ourselves with no A and E provision because of competing authorities.

I am pleased to have the opportunity to reiterate to my hon. Friend the undertaking that my predecessor, my right hon. Friend the Member for Peterborough (Dr. Mawhinney), gave to the House. It states that, where there is a reconfiguration of A and E services, similar, if not better, facilities should be and must be in place.

To ask the Secretary of State for Health what representations she has received from Dr. John Yates regarding his study of consultants' waiting lists; what action she has taken; and if she will make a statement.

I am aware of receiving no recent representations, although I am familiar with Dr. Yates's work of old. The action that we have taken is to establish national health service trusts, which are now in a far more effective position to ensure that all NHS consultants fulfil their obligations to the health service. As for waiting lists, I commend to the hon. Gentleman the new quarterly figures published today, which show waiting times continuing to come down and excellent progress towards our new patients charter target of a maximum 18-month wait.

Is not the state of affairs disclosed by Dr. Yates's work scandalous? Why is the Secretary of State's Department so reluctant to face up to the issue of consultants who maintain dual waiting lists? Would not the best way to dispose of the corruption that surrounds dual waiting lists which are maintained by some consultants be to make them choose between working full time for the national health service and working full time privately?

The hon. Gentleman shows how divided his party is. His party leader says that he thinks that the new Labour party should be a model of collaboration between the public and private sectors, but the Labour party's vindictive loathing of the private sector is almost the only area of agreement in its non-existent health policy. Our commitment and our achievement have been to manage NHS consultants very much better, and to agree job plans, ensuring that the NHS comes first and that improvements are made in the service. The west midlands, where John Yates works, is now a model to be followed, promising a nine-month guarantee in relation to treating patients. Let us not have a vendetta against the private sector; let us manage NHS consultants to have the best possible NHS.

Does my right hon. Friend agree that the most effective way of ensuring that NHS consultants fulfil their obligations to the NHS is through strong local management? Is that not precisely what trusts are achieving? Does she further agree that local pay for consultants will offer an even stronger way of ensuring that the service is a good one?

As ever, my hon. Friend is absolutely right. If John Yates did anything, he wrote a testimonial about why good NHS managers are necessary in a modern health service. Instead of denigrating the private sector and NHS managers, the Labour party should consider in more practical terms how we can maximise the ability of all members of our team so that they provide the best possible service. The move towards local pay, heralded last week in the review body reports—which I am pleased that we were able to accept in full—will ensure even greater effectiveness in enabling people to maximise their contribution to the NHS.

To ask the Secretary of State for Health what has been the total combined cost of establishing trust hospitals during the period 1991 to 1994.

This information is not held centrally. However, a total of £109,436,000 was made available by the Department of Health to regional health authorities towards the consultation costs, start-up costs and conveyancing costs incurred by units applying for trust status during the period 1991–94.

It is interesting that the Minister has not taken this opportunity to confirm figures released by his Department in December which show that the cost of setting up the trusts in England alone was £103 million. That must be added to the £1 billion wasted over the past five years on providing extra administration and bureaucracy. Is it not true that all that money could have been spent on treating every one of the 1,071,000 people currently on waiting lists?

I must refute entirely what the hon. Lady says. This is a worthwhile investment in bringing about a substantial change in a structure which now delivers more health care than ever before. Reforming institutions so that they spend properly and sensibly is no different from building another unit to treat people. The truth is that trust hospitals have been a huge success. There are now 419 across the country and nearly every unit will be a trust after the fifth wave has gone through. Although the right hon. Member for Derby, South (Mrs. Beckett) continues to refer to trusts as some kind of abomination, it is remarkable that there is no sign that the Labour party intends to do anything to reverse the process.

Is it not true that since hospitals became trusts far more people have been treated with more complicated operations and treatment so that any cost involved is money well spent? Is my hon. Friend aware of the concern being expressed by patients about the Labour party's threat to get rid of trusts, which would inevitably reduce the opportunities for treatment?

My hon. Friend is right. It is intriguing that, although the right hon. Member for Derby, South refers to trusts as abominations, she does not intend to do anything about them. I heard the sedentary remark made by the hon. Member for Bolsover (Mr. Skinner) who, according to "Breakfast with Frost", clearly has more than one finger in the pie of Labour party policy. He said that there is a hidden agenda, so perhaps the right hon. Lady is about to find out. Trusts have outperformed all other hospitals in increasing the number of patients treated; as a result, we are now treating 122 patients for every 100 treated in 1990.

Is the Minister aware that this is only one example of the widespread concern about whether costs in the health service changes are accurately assessed and, much more to the point, about whether the money is being properly directed, whether we are talking about the establishment, merger or even closure of trusts? Is he aware, for example, of the great concern felt in London about the proposals to close Bart's hospital, the consultation period for which is shortly to come to an end? The Minister said a moment ago that the money spent was a worthwhile investment in substantial changes. Does he not recognise that most people see this as just another example of public money being used to turn a good public service into an expensive private business in which the people at the top rake it in, the people at the bottom are exploited and the taxpayer pays more and gets less?

The public who are now spending less time on waiting lists and passing through trust hospitals in greater volumes than ever before have reason to be grateful for these investments. I should also point out to the right hon. Lady that the scale of costs of starting up trusts is relatively small. For example, the cost of setting up the Homerton hospital trust was some £215,000 over quite a lengthy period and covering quite a number of functions which would probably have been undertaken over time by the previous hospital. It is a pretty small amount and an extremely good investment, and there is improved health care to show for it across the nation.

To ask the Secretary of State for Health what is her policy in respect of the location of (a) nurses' residences and (b) the mentally ill, with particular reference to (i) Addenbrookes hospital and (ii) Fulbourn hospital in Cambridgeshire.

It is for the Addenbrookes national health service trust to decide how best to provide residential accommodation for its staff and for its patients.

Is my hon. Friend aware that the proposed move of acute psychiatric cases from Fulbourn hospital to Addenbrookes is opposed on environmental and medical grounds by patients, by those who care for the patients and by nurses, and it is also opposed by the staff at Addenbrookes, who believe that it will cause serious disruption which will affect patients and the public? Will he therefore please urge serious reconsideration of the matter?

I am grateful to my hon. Friend for drawing the matter to our attention. I understand that, in fact, it is proposed to transfer three wards. It is, of course, for the trust to judge. I also understand that the community health council has agreed the move. However, my hon. Friend is quite right: it is important that patients, carers and staff—and, indeed, Members of Parliament—are consulted wherever possible and their views taken into account. I will certainly draw my hon. Friend's comments to the attention of the trust. At the same time, I hope that he will join me in applauding the trust for its work in mental health in hospitals and in the community and, indeed, for the work that it is doing to improve security for its residential staff.

To ask the Secretary of State for Health how many patients were treated in national health service hospitals in the most recent year for which figures are available; and what were the comparable figures for 1978.

There were 10.1 million episodes of care carried out in NHS hospitals in 1993–94. In 1978, the equivalent figure, calculated on a comparable basis, was 6.5 million. That is an increase of 55 per cent. I invite the House to congratulate NHS staff on that achievement.

Does my right hon. Friend agree that those figures provide clear evidence of the improvement of the national health service under the present Government? Will she confirm that the North Staffordshire hospital trust has made a significant contribution to that improvement?

My hon. Friend is absolutely right. Every time patients are asked their views of the NHS, they report extremely favourably. Indeed, a substantial increase in those who reported favourably on the NHS was found when it was measured last. As my hon. Friend rightly says, his local trust has played a magnificent part. I was just looking at its figures. There has been a three and a half times increase, for example, in day surgery and a huge range of quality improvements. The trust provides an excellent service for local people in what I know is an area of considerable need.

As the Secretary of State has asked us all to pay tribute to the staff of hospitals, which we gladly do, will she explain why the Wirral hospital trust is currently attempting to introduce something called a generic support worker so that domestics will be expected to conduct administration and clerical work, help clinical procedures and clean the wards, all for £3.50 per hour?

The challenge for the health service is to ensure that all those who work in it are able to look flexibly at their activities so as to ensure that we get the maximum possible quality and quantity of patient care. The hon. Lady will know that last week we were able to support in full the recommendations of the review body for a fair reward for NHS staff, who have seen their pay increase, I am pleased to say, more over the past six years than it has for people in the private sector.

To ask the Secretary of State for Health what is her policy towards the private health care sector; and if she will make a statement.

We welcome effective co-operation between the NHS and the independent health care sector wherever it benefits patients.

I am grateful to my hon. Friend for that answer. Does he welcome the increasing extent to which trusts and health authorities are taking advantage of the facilities and expertise of the private health care sector to treat NHS patients, as is happening at the Oaks hospital in Colchester? Does he agree that that leads to a more efficient use of resources and benefits not only patients, but the NHS as a whole?

Yes, wherever the private sector is able to offer expertise or better value for money, we must take advantage of it. To do otherwise would be to disadvantage NHS patients.

Is the private sector in health care being limited to l per cent.?

The private sector often gives very good value for money. Where that occurs, it would be quite immoral not to take advantage. If we followed the Labour party's advice and refused to do that for ideological reasons, only patients would suffer.

Will my hon. Friend the Minister find time today to consider the private Sandringham hospital which is located adjacent to the local NHS trust hospital in my constituency? Is my hon. Friend aware that the Sandringham hospital is paying a substantial rent to the NHS trust as well as sharing key medical facilities? Is that not an example of the need for a partnership between the public and private sectors? Will my hon. Friend educate his opposite number and explain that the partnership means saving money for the NHS, treating more patients and getting money at the sharp end?

There are many examples of good co-operation and I am glad to add the Sandringham hospital to that list. We certainly encourage health authorities and trusts to find whatever ways they can to take full advantage of the expertise that the private sector has to offer.

To ask the Secretary of State for Health when she expects to publish a response to the review of mental health nursing.

The chief nursing officer did so on behalf of the Government in March 1994.

In the Government's response, what have they published with regard to recommendations 8 and 20 which suggest that care plans should be developed with the mentally ill on the basis of their needs and wishes and not for the convenience of the service, and that therapeutic units in ordinary district hospitals are often not appropriate? Does the Minister recognise that the serious underfunding of community care for mentally ill people has meant totally inappropriate situations and continuing crises of confidence in the care of the mentally ill which are extremely serious for the future care of people in those district hospitals which are inappropriate?

The Government's commitment to that report is highlighted by the response of the chief nursing officer, the most senior nurse in the country, by my right hon. Friend the Secretary of State's foreword to that report and by the fact that the Department of Health has been running seminars and conferences around the country, including one today in Birmingham involving users of the service. That seems to be the direction in which the hon. Member for Sheffield, Hillsborough (Mrs. Jackson) is trying to lead us because it is the users and their interests which are important. The report points to that and to nurses having a role in providing information and showing the options to people. With regard to therapeutic centres, that is something to which we have drawn the attention of providers. As for resources, £2 billion this year into mental health services cannot be bad.

Bearing in mind the review undertaken by Sir Louis Blom-Cooper into the Edith Morgan unit and mental health provision in Torbay in my constituency, does my hon. Friend agree that there is a gap in the current law in respect of people who are a danger not just to themselves but to others and, indeed, particularly to people who provide mental health care, and that it is high time for a review of the law to ensure that there is suitable accommodation precisely for those dangerous individuals?

Yes. Sir Louis identified two gaps: first, understanding of the existing law so that the provisions of the Mental Health Act 1983 are used to the full and, secondly, a particular gap in respect of revolving-door cases of the severely mentally ill who might be at risk in the community. That is why we shall shortly be introducing a new mental health Bill which will include a measure on supervised discharge orders. I am sure that my hon. Friend the Member for Torbay (Mr. Allason) will be the first to welcome that and the first into the Lobby with us.

To ask the Secretary of State for Health what factors she takes into account when allocating resources within the NHS budget; and if she will make a statement.

NHS spending in England in 1995–96 will rise to £32 billion, a further increase of £1.3 billion. The underlying principles in deciding how that budget is spent are that access to a comprehensive health service should be available to all on the basis of clinical judgment and that money is allocated according to health need.

Does the Secretary of State not realise the total inadequacy of that answer when we consider the millions of people who are being denied quality of life and have reduced life expectancy because of poverty? Is she aware that Government-imposed poverty is reducing the life expectancy of millions of people? Is that not a direct result of NHS market forces which are rationing health care on the basis of poverty?

That question is quite ludicrous, particularly coming from the hon. Gentleman with the record in his constituency. We are committed to the improvement of people's well-being and the reduction of unemployment. Average incomes have increased by more than a third. In the hon. Gentleman's constituency, the money that goes to the health service has increased by more than 30 per cent. in the past five years, partly because resources are targeted at areas of greatest need.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 February.

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.

Last Tuesday, the Prime Minister said that a single currency was a constitutional issue. Last Thursday, the Chancellor said that it was not. Will the right hon. Gentleman now tell us who is right?

I have told the hon. Lady, I think, directly, and many people in the House precisely what the position is as far as a single currency is concerned, and I have also told people exactly how we propose to approach it. There will be no single currency involving the United Kingdom in 1996 or 1997. When and if it arises at a later stage, whether 1999 or thereafter, we will examine both the economic implications and the other implications, and we will then make a judgment on the national interest.

Will my right hon. Friend confirm that the Government are determined to protect the country from terrorism, drug smugglers and a tidal wave of economic refugees into this country?

I should say to my hon. Friend that in recent years we have seen a very welcome improvement in race relations in this country and I do not wish to see that put at risk in any way. Raising fears about immigration tends to put that at risk. For that reason, I am entirely determined to maintain our fair but firm immigration policies, and that means that we shall retain our border controls.

Following the Prime Minister's welcome commitment last Thursday to reducing inequality, may we now put it to the test? As the national electricity grid is an absolute monopoly subject to no competition, will the right hon. Gentleman act against the excesses of the few regional electricity chiefs who stand to make £50 million out of share options on the back of it?

I have to say to the right hon. Gentleman that I find much of his opposition to share options rather synthetic since a good deal of his leadership campaign was financed out of the proceeds of share options.

So the right hon. Gentleman is prepared to do nothing on that. Let me now put this to him: as there still remain about l million long-term unemployed and the Government are proposing a £50 million cut in help to the unemployed, will he therefore act in respect of that?

I notice that the right hon. Gentleman did not respond to the earlier point. As for his general concerns about poverty, perhaps I can help him by filling in some of the facts that he overlooks. As he will know, and as there are ample statistics to show, the vast majority of people are better off. Average income has risen by more than one third since 1979, the average income of all economic groups and family types has risen, vulnerable groups have been protected and average incomes are up by more than 10 per cent. for poorer pensioners, and up for the unemployed as well as for those in full-time work. Those are the results of the Government's actions, and they exceed by far the results achieved by any previous Government.

So the Prime Minister is prepared to do nothing about that either. Whatever he says about reducing inequality, he will do nothing about greed at the top and nothing about protecting the unemployed at the bottom. Are the British people not right to conclude, therefore, that his commitment to reducing inequality will be seen in time as just one more easily made, easily broken Tory promise?

I look forward to the day when the right hon. Gentleman listens to the answer before continuing with his question. As "Social Trends" is a publication often cited by Opposition Members, perhaps they will take notice of the information available in the latest edition, which states that the income of recently retired pensioners has increased by just over a half in real terms since 1981, and the real income after tax of a lone parent on the lowest decile of female earnings and with two children rose by 50 per cent. between 1981 and 1993. Why do we never hear about the reality of what has happened rather than the accusations without base which come from the right hon. Gentleman?

If European institutions produce measures to dismantle our external immigration controls, and those measures are subsequently supported by the European Court, how will my right hon. Friend maintain our external controls?

As I told my hon. Friend the Member for Ribble Valley (Mr. Evans) a moment or so ago, we believe in our right to maintain controls. My predecessor set out our determination and received a solemn declaration to that effect some time ago. Let me make it clear that we shall argue strongly for the maintenance of that position and shall take whatever steps are necessary to that end. I will tell my hon. Friend the Member for Northampton, North (Mr. Marlow) about that declaration: it was solemnly entered into by all the Heads of Government of the other European countries. They pledged their word, and I intend that they will keep it.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 February.

I refer the hon. Gentleman to the reply I gave some moments ago.

Is the Prime Minister aware that, following the Government's deal with Trafalgar House to kill off Northern Electric this morning, the resulting free-for-all in electricity companies has caused electricity shares to rise by 10 per cent. in a Valentine's day orgy on the stock exchange, while there has been a Valentine's day massacre of job security in the north? Does the right hon. Gentleman agree with the Confederation of British Industry that growing unfairness in society affects not only jobs but competition and business?

As the hon. Gentleman will have observed over the last couple of years, competition in business has been creating jobs, not losing them, which is why unemployment has dropped by more than half a million.

Rubbish.

The hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes) has apparently not noticed the drop of half a million in unemployment, so I will tell him that it has dropped right across Scotland, which he cares about, as well as in England, in Wales and in Northern Ireland. If the hon. Gentleman has not understood even that, I can understand why he is on the Opposition Benches—because he understands nothing.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 February.

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

Has my right hon. Friend seen the report that tourism in Northern Ireland has doubled since the ceasefire was announced? Does he agree that that reflects in an important way the outcome of the peace process?

I am aware of the remarkable increases in tourism. There have also been remarkable changes in the life styles of the people in Northern Ireland and in the success of large and small businesses in Northern Ireland. I believe that those are results of the ceasefire, which I hope we shall be able to turn into a permanent peace.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 February.

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

Does the Prime Minister recall that last Thursday in the House he gave an undertaking to commit the Government to fighting injustice and inequality? Will he now, as a first step, take the opportunity to reintroduce wages councils and, as a second step, abolish the jobseeker's allowance?

I will not give the hon. Gentleman that undertaking, because I do not believe that wages councils acted in the interests of people who were low paid. I believe that they kept a lot of people out of work who might otherwise have been in work. I accept that the Government have a responsibility to help the poor, and we have sought to do that. That is why extra help of more than £1 billion since 1988, over and above inflation, has been provided to help low-income families. That is the point that I invite the hon. Gentleman and his right hon. and hon. Friends to concentrate upon.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 February.

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

Is my right hon. Friend aware of the decision of the parents of pupils at 88 schools in Kent who voted overwhelmingly for the schools to become grant maintained? Will he congratulate those Kentish parents on their choice? Does he welcome the fact that they had the choice in the first place—a choice exercised by the Leader of the Opposition and a number of Labour Back Benchers—or does he consider that choice to be wicked?

I believe that every parent should have the right to choose what is best for his or her children, and I have no criticism of any parent who does so. I simply ask that all parents should have the same choice.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 February.

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

What does the Prime Minister suggest that I could do to help my constituent, Jane Pepper, who gave up a secure job in the civil service last year to attend an access course for university? She secured three offers of places, but is now having to give them up because she loses £5,000 as a result of the Government's penny pinching in cutting the mature students' allowance. Leaving aside the waffle that the Prime Minister usually gives us, what advice can he give to Jane Pepper and the thousands of other people who missed out on higher education the first time around and are now having the door slammed in their faces again?

The hon. Gentleman knows that the number of people going on to further and higher education has increased dramatically. When the hon. Gentleman's party left office, one in eight of our children went to university. The figure is now one in three, and it is increasing.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 February.

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

Does my right hon. Friend agree that the rather disappointing performance of the English cricketers in Australia illustrates the need for more competitive sport in our schools?

I should certainly like to see more competitive sport in our schools, and we intend to ensure that there is more. Beyond that, we must ensure that there is a much better sports environment through the clubs, so that there is a proper throughput from school to club level and to more senior levels in sport. I intend to do what I can to bring that about.

To ask the Prime Minister if he will list his official engagements for Tuesday 14 February.

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

Is the Prime Minister aware that last week a senior manager at Guy's hospital in London had to telephone 24 hospitals to arrange cover for patients needing acute and intensive care beds? Does he accept that patients' lives are at risk because of the shortage of beds in London? Will he instruct the Secretary of State for Health that no further bed closures should be allowed?

If the hon. Lady had wished me to comment on that, no doubt she would have given me earlier notice of the question. Often enough, there have been cases in which a direct answer could have been given if information had been provided, and often enough I have examined matters subsequently and found them to be a touch different from what had been suggested on the Floor of the House. I have no doubt that my right hon. Friend the Secretary of State for Health will have heard what the hon. Lady had to say.

Is not the situation with regard to the single currency quite straightforward—that if my right hon. Friend remains Prime Minister we will not have a single currency, but if the Leader of the Opposition becomes Prime Minister we will?

As I have indicated to my hon. Friend on previous occasions, I will make a judgment on what I believe the national interest demands. If it demands no, I will say no.