To ask the Secretary of State for Health when he next plans to visit Redbridge and Waltham Forest health authority to discuss the situation in local accident and emergency departments. [2172]

My right hon. Friend has no plans at present to do so.

Is the Minister aware that there is a serious crisis in accident and emergency departments in Redbridge and Waltham Forest health authority, that Whipps Cross hospital closed on 14 November and told doctors not to send people there, that King George hospital has regularly told ambulances to go away, and that some of my constituents have had to wait on trolleys for 10, 12, 14 or, in one case, 24 hours? In one case, a constituent was questioned about an incident by the police in front of other people in the area. Is not that a disgrace? When will the Government do something about the crisis in accident and emergency departments in Redbridge and Waltham Forest?

I understand the hon. Gentleman's point clearly because there are problems in those two hospitals in his constituency. However, he has exaggerated the problems. I can tell him that both the trusts involved are looking at the situation closely. They are taking short-term measures, and, to deal with bed management, are recruiting additional staff and so forth to cope with the problems. The problems are caused by a higher demand for A and E treatment throughout north London, which is also being examined by the trusts. The hon. Gentleman can be assured that things are improving.

I welcome my hon. Friend to the Dispatch Box in his new responsibility. Is he aware that the A and E service in the adjacent Barking and Havering area is already under strain as a result of the decision to concentrate casualty at Harold Wood rather than at Oldchurch hospital in my constituency? If the service at King George hospital, Ilford—the hospital to which many of my constituents will in future have to turn—is also to be terminated, that will result in an unacceptable reduction in standards of access in an emergency.

Again, I understand my hon. Friend's point. I would be very concerned if the A and E department at King George hospital were to close. I have no information to that effect. On the contrary, I understand that there is no intention of closing the A and E department at King George hospital.

Does the Minister accept that the picture which has just been painted is a national one? Accident and emergency departments are currently closing their doors because of a shortage of beds, and patients are waiting hour after hour on trolleys in corridors. The Minister should recognise that A and E departments are twice penalised by the internal market: a lack of bed space means that they cannot meet patient charter times, but because they cannot meet those times, purchasers are withholding payment. The Secretary of State has announced this morning the Government's so-called blitz on bureaucracy. Given that the Government created the internal market, will his announcement be followed by an apology to people who work in health and to the British people about the mess, and will he listen to what the British people want from the NHS, that is, proper patient care and not the privatisation that is creeping in at hospitals throughout Britain?

That sounded like a statement of Labour party policy in a nutshell. Labour Members have nothing more to say. The fact is that the hon. Gentleman in his calmer moments will surely realise that he is exaggerating. The hon. Member for Ilford, South (Mr. Gapes) was rightly referring to a situation in his constituency and that was perfectly fair, but in London as a whole 35 A and E departments are open 24 hours a day. Some £37 million have been spent over the past five years and things are definitely improving.

Does my hon. Friend accept that this is by no means a national situation, and will Opposition Members appreciate that there are some hospitals in the country that run their affairs efficiently? I have today heard from the head of the accident and emergency department in Lancaster that we have no problems because we treat our staff well and we have a good reputation. Other hospitals might try doing likewise.

I am delighted to hear it. As a Lancastrian, I am delighted that Lancashire is once again leading the country.

To ask the Secretary of State for Health what is the current percentage of general practitioners who have moved to fundholding status; and what is his estimate for the percentage of GP fundholders over the next two years. [2173]

To ask the Secretary of State for Health what steps he has taken to evaluate the impact of GP fundholding. [2175]

Independent evaluation has repeatedly demonstrated the benefits of fundholding. That is why the Government are committed to further development and expansion of the scheme. Over 39 per cent. of general practitioners in England are already fundholders and this is expected to rise to over 50 per cent. by next April, with more practices preparing to join in 1997.

I am grateful to the Secretary of State for his reply, which shows that by next year, half of Britain's GPs will have to operate like small business men. Can he answer a more important question? According to figures that he gave me last week, £66 million is now spent on the bureaucracy of administrating fundholders. That £66 million is almost exactly equivalent to the cost of the 15,000 hip operations on hospital waiting lists. We are all delighted this week that the Queen Mother came out so well from her operation. Will the right hon. Gentleman stop that money being spent on bureaucracy and give people on the hip operation waiting list some hope?

I am certainly not doing anything to undermine the development of the fundholding scheme. All the research that has been done on that scheme demonstrates that the extra administrative cost, which is certainly there, delivers improved value to national health service patients. The question is for the Labour party. Does it agree with its previous health spokesman that it should abolish fundholding, or with the present incumbent of that post that it is not a matter of abolition but replacement?

How does the Secretary of State justify ignoring clear evidence provided by GPs in my constituency of a two-tier system arising directly from fundholding?

The hon. Gentleman is behind the times.

Is not it scandalous that 36,000 of my constituents are, according to their doctors, receiving a second-rate service as a result of the status of their GPs? Is not it true, as one GP who wrote to me said—that letter has been seen by the Minister for Health—that those who deny the two-tier system arising from GP funding are talking a lot of twaddle?

My hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) was right. The hon. Gentleman is behind the times. First, of the five cases that he mentioned the last time that he raised the issue in the House—I am sure that the hon. Gentleman will welcome the fact—two have had their operations in less than 12 months and the other three are on a waiting list for treatment in less than 12 months at Pinderfields hospital. Furthermore, both the fundholding and the non-fundholding GPs joined Wakefield Healthcare last week to issue a jointly agreed statement which said:

"As far as Wakefield Healthcare and GPs, both fundholders and non-fundholders, are concerned there should be no difference in the way patients, whether they go to fundholders or non-fundholders, are treated."

Has my right hon. Friend seen a recent interview with the hon. Lady for Peckham (Ms Harman) in Doctor magazine in which she says of the Opposition's plans for fundholding:

"We don't call it abolition, we call it replacement."

No, I do not think that they will be remotely reassured. Every fundholding GP in the health service wants to hear what the Labour party would do if it ever found itself in government. The previous Opposition health spokesman said:

"We can live with a whole range and variety of models."

Is my right hon. Friend aware that an increasing percentage of GPs in Suffolk are in fundholding practices and that that is bringing benefits in the forms of increased personal counselling, chiropody for diabetics, and better diagnostic and physiotherapy services—all very much to the benefit of patients?

My hon. Friend is absolutely right. His experience in Suffolk is repeated throughout the health service. One of the two questions that I have answered jointly asked what steps I have taken to evaluate fundholding. My hon. Friend has offered a local evaluation, but it has also been evaluated by the National Audit Office, the Public Accounts Committee, the Fabian Society, the OECD and the health service research unit at the university of Oxford. They have all published evaluations of fundholding, and the only problem with them is that they have been inconveniently optimistic for the Labour party.

Since it is the intention to offer primary-led health care, do the Government intend to change FP10 to allow GP fundholders and others to provide new treatments for leg ulcers in the community rather than in the secondary sphere, which is more costly?

I shall certainly consider that specific proposal. We need to ensure that the maximum range of clinical care that can safely be delivered by practitioners in the primary care context is delivered. Such care has been provided throughout the country as a result of fundholding. If the hon. Gentleman has a specific idea, I should be happy to look at it.

Can my right hon. Friend confirm that the Isle of Wight has one of the highest percentages of GP fundholders in the country? Does he attribute that success to the fact that the Liberal Democrats opposed such a scheme before the election and then, after it, led the charge in forming a fundholding consortium on the Isle of Wight, which has given us such a high percentage of fundholders?

The Liberal party has had just as much difficulty as the Labour party in deciding its policy on the issue. Both parties forecast that there would be no support for fundholding when the scheme was launched. Both have found themselves embarrassed by the fact that, next year, more than half of all GPs in the health service will have opted voluntarily to join the fundholding scheme. My hon. Friend is quite right.

Can the Secretary of State tell me what the reaction of fundholders and other purchasers of health care in Birmingham will be when they look at the small print of the Budget? They will find that a promised 1.1 per cent. increase in funds will turn out to be equivalent to no more than a half per cent. increase, which will mean around £6 million cuts wherever health care is purchased. When the Secretary of State visits Birmingham next week, will he explain to the local people why their community services will be cut?

This is a question about primary care. One of the best bits of news in the Budget about primary care is that it allows for the continued growth of the family doctor service through the 4 per cent. real terms growth in resources available to it. I would have hoped that the hon. Gentleman might welcome that.

Many thousands of people in the Dartford constituency have benefited from GP fundholding. Will the Secretary of State confirm that the Conservative party is the only party that supports that scheme? The Labour party is totally opposed to it now, as it always has been.

My hon. Friend is absolutely right that the Conservative party, and its Government, is the only party committed to the development of fundholding. Every fundholding GP and their patients want to know the policy of the Labour Front-Bench team. When the Opposition appear before a fundholding audience they say that they recognise that the freedoms available under the scheme have produced improvements. They give a soft message to fundholding doctors, but once they get back into the television studios they say that they are committed to abolishing the scheme. What is their policy? We are waiting.

I presume, Madam Speaker, that I am supposed to ask a question rather than answer one. The Secretary of State has acknowledged that one of the effects of GP fundholding has been extra administrative costs. Is not it the case that as a direct result of the Government's NHS reforms the cost of NHS bureaucracy is an extra £1.5 billion every year? That money should be spent on patients, not on paperwork. I welcome the publication of the NHS bureaucracy league tables, which the right hon. Gentleman made available this morning, but can he explain to the House why it is that the worst health authority in the country—the one that spends most on bureaucracy—is Huntingdon, the Prime Minister's constituency?

The hon. Lady might have welcomed the fact that in that same health authority there is to be a 10 per cent. reduction in administrative costs next year. As she raised the subject, she might also have welcomed the fact that the announcements I made this morning represent a shift of resources out of grey suits into white coats of £280 million next year. There will be £280 million extra next year for the treatment of patients. When will the hon. Lady welcome that?

Is my right hon. Friend aware that by April next year 100 per cent. of my constituents will be treated in GP fundholding practices? Does he agree that that is the result of decisions by GPs in order to give their patients the best possible level of primary health care services? In the light of that, is it not an absolute disgrace that the Labour party proposes either to abolish or emasculate GP fundholding?

I could not agree more with my hon. Friend. GPs in his constituency have chosen to operate a completely voluntary scheme because they believe that it will improve care to their patients. In that they agree with the Fabian Society and a wide range of other commentators who have looked at the scheme. We are still waiting for an answer from the Opposition Front Bench as to why they will not support the scheme.

To ask the Secretary of State for Health when he last met the Pharmaceutical Services negotiating committee; and what was discussed. [2174]

Officials regularly meet the Pharmaceutical Services negotiating committee to discuss issues that affect community pharmacy contractors. Ministers meet the committee whenever it is appropriate.

I am sure that the Minister will have heard about the committee's anxieties and the cash flow problems that pharmacists are facing because his Department is an extremely bad payer. As he must be aware, small pharmacists in particular are concerned that they are not receiving within a proper time scale payment for prescriptions that they have already dispensed. That is making it impossible for them to solve their cash problems and they are creating redundancies. Should the attitude of the Minister's Department and the Government be causing redundancies at a time of massive unemployment? The Minister should stop his Department being such a bad payer and get on and pay the people the money that the Department owes them.

I read the briefing note that the hon. Gentleman is clearly using. It misses out a fact that perhaps the pharmacists did not discuss with him—if he had discussions with them and did not just read the note. A voluntary agreement that was negotiated with the pharmacists has been in place for some time. It sets out how the payments are structured so that they can be made as quickly as possible after the Prescription Pricing Authority has processed them. That agreement was highly welcomed when it was put in place and I am delighted to tell the hon. Gentleman that it is being honoured to the letter and payments are being made in the context of the agreement. Of course I recognise that pharmacists are business men and have to run their businesses in a proper way. They make a valuable contribution to the community and if there are any ways of taking that forward that we can discuss with them, I am always happy to do so.

Does my hon. Friend agree that, like all other interest groups, pharmacists have a legitimate case? If the Opposition take up the arguments of every interest group in the community and ask the Government to pay 100 per cent. of their claims, public expenditure is bound to get out of control. Although it is certain that the Opposition will temporarily become popular with farmers, lawyers, civil servants and every other interest group that wants to get its snout into the public trough, that is a clear indication that public expenditure under Labour will get grossly out of control.

My hon. Friend is absolutely right. Every time that there is a request for additional funding, the Labour party accedes to it in the same breath as it suggests that taxation can be brought down, but those attitudes are incompatible. Unlike Labour, the pharmacists are always responsible when entering discussions. Last year the global sum from which they were paid was increased by some 2.5 per cent. The pharmacists also agreed to a change in the structure of the payments made to them, so that we can ensure that more payments go to pharmacists who provide more professional services. That was a welcome way to approach added public expenditure for added value. Labour says that payments should go up for no reason.

Is the Minister aware that many people on regular prescriptions complain that chemists are giving short weight—that the doctor writes a prescription for 30 tablets but that the chemist dispenses only 24 or 26 tablets? People on regular monthly prescriptions are having to pay as much as one month extra per year because of that short measure. The pharmacists blame the packaging. Nevertheless, many members of the public feel cheated when they have paid more than £5 for a prescription but receive too few tablets. Will the Minister get together with the pharmaceutical and packaging industries to ensure that the customer gets what he pays for?

Rather curiously, the hon. Gentleman asked a question that might have more point in six months' time, as we introduce patient pack prescribing—which is in its early days and has not yet been generally introduced. Pharmacists must dispense the appropriate medicine according to the doctor's prescription. That will be the case when patient pack prescribing is introduced. It will ensure that the patient is given the appropriate amount of medicine to treat the symptom for which he sought a prescription from the doctor.

Will my hon. Friend join me in paying tribute to the important role played by pharmacists in helping people with self-medication, which contrasts sharply with Labour's health policies—which are all diagnosis and no prescription?

My hon. Friend is absolutely right. Community pharmacists play an important role in providing medical care, and it is one that we are extremely keen to encourage through the payment of the professional allowance for displaying pharmacy practice leaflets and health promotion literature. Pharmacists, as health care professionals, are keen to develop that important role.

To ask the Secretary of State for Health if he will make a statement on his Department's progress towards the use of specialist breast units for the treatment of breast cancer. [2176]

The Calman report forms the basis of our strategy for the development of cancer services. We have charged regional directors with the task of taking that forward and, where necessary, reconfiguring services to treat common cancers, including breast cancer, in specialised units.

Given that the Calman report regarded as urgent the move to specialist breast cancer care units, which was endorsed by the Health Select Committee report, is sufficient urgency being shown by the Department? I think not. Is not it important that the Government move rapidly to establish a network of such units, so that the fears that haunt many women in this country can be allayed by the provision of prompt, effective and thorough treatment in every area? Is not that absolutely necessary? Why are the Government so dilatory in moving to that position?

The hon. Gentleman is uncharacteristically ungenerous in not acknowledging the work being done by the NHS. Calman reported only in April, since when regional offices have been working on the recommendations. Calman set out a structure of primary care refering to cancer units for diagnosis and treatment and cancer centres at which rarer types of cancer—and particular specialist services, such as radiotherapy—would be available. The hon. Gentleman needs only to look in his own back yard. The United Leeds teaching hospitals have developed fine services that include a specialist unit. That is the way forward for Leeds, and the hon. Gentleman might have paid tribute to that development. We are looking to see how to develop services throughout the country for the benefit of patients.

Will my hon. Friend join me in paying tribute to the Royal Marsden hospital in Sutton, in my constituency, which offers an excellent breast cancer service with particular expertise in early detection and palliative care? Does my hon. Friend agree that some of the extra budget allocated by the Chancellor should go to that superb service?

I am happy to pay tribute to the Royal Marsden, and I was able to do so yesterday because I was at the Queen Elizabeth II centre when it received a charter mark award. I congratulate the hospital publicly again today. My hon. Friend is right to draw attention to the resources that my right hon. Friend the Secretary of State for Health has negotiated with my right hon. and learned Friend the Chancellor of the Exchequer—£1.3 billion more for the coming year; a 1.6 per cent. increase in real terms. I have no doubt that some of those resources will lead to further improvements in our cancer services.

In view of the concern about high mortality rates for breast cancer, will the Minister reaffirm the Government's commitment to ensuring that a reduction in the mortality rate for breast cancer is a key part of the "Health of the Nation" strategy? Will he also confirm that he is satisfied with the progress that is being made to achieve the target of a 25 per cent. reduction by 2000? Will the Minister outline what steps he has taken to monitor progress at the district health authority level; and does he agree that the development and publication of local targets at DHA level is vital if the "Health of the Nation" strategy is to mean anything?

There were about five questions there. I have already announced that our regional offices will examine the configuration of services, and will build on that. Of course we stand by our "Health of the Nation" targets. Progress has been made, and we want to see more. That is why we are developing services; why we are investing in services; and why much research is being done. I pay tribute to the range of research conducted by Government and by the voluntary sector and pharmaceutical companies.

To ask the Secretary of State for Health if he will make a statement about the change in (a) infant and (b) perinatal mortality rates in the last 15 years. [2177]

Infant and perinatal mortality rates are at their lowest levels ever. Deaths of children aged under one year—the infant mortality rate—fell by half between 1979 and 1994. Stillbirths and deaths of babies less than a week old—the perinatal rate—fell by nearly 40 per cent. over the same period.

I warmly welcome my right hon. Friend's reply, which reveals a staggering reduction in the number of fatalities. Does he agree that that is due principally to three factors; first, the great advances in medical technology; secondly, the increasing skill of our doctors and nurses; and, thirdly, the vastly increased amounts of taxpayers' money put into the national health service? Does my right hon. Friend agree that those figures underline the increased quality of infant health care, like so many other NHS services, for the benefit of the whole nation?

My hon. Friend is precisely right on every count. Those indicators are interesting, because they are some of the relatively few health outcome indicators that are directly comparable with those in different countries. Such indicators tell heavily in favour of the good value and efficient health service delivered by the NHS, which has been consistently supported by the Government and which we shall continue to support.

Has the Secretary of State had a chance to look at the King's Fund's recent publication, "Tackling Inequalities in Health", which confirms—as is to be expected—that over the past 10 years there has been a widening gap between the rich and the poor, and that that gap is reflected by widening differentials in mortality rates for adults and infants? If that is so, what is the Department of Health doing to ensure improvements in health nationwide by increasing equality in wealth and income for all citizens?

I talked yesterday about some of the things that we are doing to ensure that we deliver, nation wide, the objectives of the national health service. The establishment of proper purchasing arrangements for the health services within the reformed management is designed precisely to target resources on health need. The Government's commitment to weighted capitation— I announced a further step towards its delivery yesterday—is also intended to eliminate variations. That commitment is precisely directed to answer the hon. Gentleman's concerns.

Does my right hon. Friend agree that it would be welcome, fair and right if the media sometimes concentrated on the remarkable advance that has been made in this part of the health service as in others, and that tiny babies are saved today who would not have had a hope of life even 10 or 12 years ago?

My hon. Friend is entirely right. It is a dry statistic that tells a very human story of which anyone interested in the NHS should be proud. It is a comparison between health care in Britain and health care in virtually every other developed country and it tells in favour of both our national health service and the Government's support for it.

Although the overall fall in death rates is clearly welcome, will the Secretary of State explain why last year both the South Tyneside and the Sandwell health care NHS trusts had a perinatal mortality rate of 13.7 per 1,000 live births, while in Kingston and Richmond the rate was just 3.4 per 1,000 live births? Will he also confirm that, if all infants and children enjoyed the same survival rates as those in social classes I and II, up to 3,000 deaths a year might be prevented? Does that latter figure not show that the price of widening social and economic inequality under the Government is being paid for in the health of poorer people?

What the hon. Gentleman does not cover is two facts: first, that health outcomes are improving for all social classes in Britain; and, secondly, that the Government have put in place reformed management of the health service, precisely to ensure that health resources are targeted at health need. It is precisely for that reason that we changed the management of the health service. Since the hon. Gentleman raises the subject, I assume that he would now like to welcome that.

To ask the Secretary of State for Health if he will make a statement about the development package recently announced by the Huddersfield national health service trust. [2178]

I very much welcome this £10 million development programme. It will provide improved health care facilities for the people of Huddersfield, in the context of a modern health service.

Does my hon. Friend agree that this £10 million development programme, across a range of health facilities in my local hospital, represents a remarkable investment in improved health care for the people in and around Huddersfield and is the sort of good news about which we never hear from Opposition Members? Is he aware that I get far fewer complaints about my local hospitals than, for example, about my local Labour council?

I am not surprised to learn of the content of my hon. Friend's postbag, because he does indeed have an excellent local hospital. May I, in the words of the trust chief executive, point out that

"Never before have we had so many new developments planned on this scale … together, they form a major step forward for patient care"?

Does the Minister accept that what happens in Huddersfield impacts on Calderdale, because they share the same purchaser? Is he aware that the development about which he talks means that in Calderdale we will lose 300 badly needed beds?

Yet again, we have the hon. Lady complaining about investment in the health service which will benefit the whole range of the population that this hospital trust serves. Of course we understand that it is up to local health authorities to decide where they purchase their health care; now they will be able to do so on behalf of my hon. Friend's constituents and those of the hon. Lady. Those people can be served by this hospital through updated facilities in which £10 million is being invested. I would have thought that the hon. Lady might welcome that.

To ask the Secretary of State for Health what representations he has received about making an ex gratia payment to haemophiliacs infected with hepatitis C. [2179]

Representations include seven earlier parliamentary questions, and five early-day motions. There was also an Adjournment debate initiated by my hon. Friend on 11 July and a short debate in another place. Ministers have received 291 letters.

I congratulate my hon. Friend on his promotion to the Department of Health. Since his promotion, has he had a chance to read the impact study produced by the Haemophilia Society, which has been made available to his Department, which demonstrates the physical, financial and emotional hardship suffered by haemophiliacs? As the cause of that hardship, infected blood products, is the same as that which passed on the HIV virus to haemophiliacs, should not the Government's reaction be the same?

First, I congratulate the Haemophilia Society on its sensible review and my hon. Friend on his relentless questioning over many years, which has already achieved quite staggering results. I have not yet read the full review, but I shall do so as a matter of priority and I shall obviously take its conclusions most carefully into account.

Does the Minister realise the stress caused to the families of individuals, such as a 13-year-old youngster in my constituency, who not only have to cope with haemophilia but have now been totally devastated by having to cope with the effects of hepatitis C? Please may we have an early and sympathetic decision to bring some hope to those families?

I assure the hon. Gentleman that the problem will always receive sympathy from me.

To ask the Secretary of State for Health if he will clarify the criteria used to assess voluntary groups providing high standards of care in residential settings for those with challenging behaviour, in respect of the application of necessary minimum levels of proper discipline and restraint. [2181]

Regulations require that the owners and managers of homes should both safeguard and promote the welfare of residents. We expect statutory authorities to ensure that service providers should have clear, written policies on the management of people who may cause harm to themselves or others.

Does my hon. Friend agree that it is not an easy job to look after the severely mentally handicapped, and that common-sense disciplines should prevail over fashionable, impractical social services' ideologies which are certainly not in the best interests of the residents themselves?

My hon. Friend is entirely right. When we are talking about difficult to manage individuals, we must ensure that the restraint and control used are sufficient to prevent a person from hurting himself or herself, other people or property. That is common sense, which must always take precedence over political correctness.

To ask the Secretary of State for Health what plans he has to privatise the role of the Human Fertilisation and Embryology Authority. [2182]

None, Madam Speaker.

Is the Minister not concerned that access to in vitro fertilisation is so variable around the country, and barely exists at all in my part of Devon? Instead of talking about privatisation and hiving off, what action does he intend to take to ensure that that authority makes that vital service available to young couples throughout the country?

The hon. Gentleman accuses me of talking about privatisation, but when he asked me what plans I had for privatisation, I said none. That is hardly an accusation that can be made to stick. With regard to the development of IVF, I should have hoped that the hon. Gentleman might welcome the fact that that is a new science which has been developing fast within British hospitals and which is being made available by different health authorities in different parts of the country to the people of their areas. We have always made it clear that that is a matter for local decision making within individual health authorities, reflecting the health priorities of their districts.

Does my right hon. Friend accept that there can be little public confidence in a body whose members and employees are involved with and generate their income from destructive experiments on living human embryos? Is it not a positive disgrace that not one person has been appointed to that authority who believes in the sanctity of human life and who reflects the majority view in Britain that such experiments are repugnant?

Strong views on the subject are held on both sides of the argument, the resolution of which, as the House knows, was achieved by a free vote during the passage of the legislation. The authority's membership is intended to reflect the necessary scientific expertise and the commitment to apply proper ethical standards to the use of that science. My hon. Friend may not like every member of the authority, but I hope that she will at least endorse the objectives that guide the authority's deliberations.

To ask the Secretary of State for Health what assessment he has made of trends in the numbers of emergency admissions to hospitals. [2183]

The number of emergency admissions to hospital increased by an average of 3 per cent. each year in the five years to 1993-94. That is broadly in line with the increase in total admissions.

Is the Secretary of State aware that staffing levels in Bradford royal infirmary's accident and emergency department are far worse than those in any comparable department in the country? Has he any intention of meeting regional and district health authorities to set minimum staffing levels so that patients charter standards are met?

Patients charter standards define the standard that a patient is entitled to expect when he or she approaches the health service for care, whether through an accident and emergency department or through any other department. It is obviously the responsibility of trust management, in consultation with the health authority, to make certain that those standards are delivered. I am sure that that will be the guiding principle in Bradford, as in every other part of the country.

Does my right hon. Friend agree that those figures demonstrate the need for hospitals to have proper systems in place to ensure the prompt admission and speedy discharge of patients? Is it not vital for social services departments up and down the country to get their act together to ensure the proper discharge of elderly patients into the community?

My hon. Friend is entirely right. The relationship between the health service and social services departments in every part of the country is the key to the delivery of the objectives of both the health service and social services departments, and it is given a high priority throughout the health service.

To ask the Prime Minister if he will meet a delegation of general practitioners from Lichfield to discuss the future of fundholding. [2202]

Fundholders' views on developing the success of the scheme are always welcome. Any detailed recommendations will, of course, be considered.

I am grateful to my right hon. Friend for his answer. Is he aware that every general practitioner in Lichfield will be a registered fundholder? The reason is that those GPs believe in the Conservative party's crusade for choice: they believe that it is right for them to be able to choose the consultant and the hospital that are right for them. Does my right hon. Friend realise that they are appalled at the Labour party's plan to abolish fundholding? Does that not give the lie to Labour's crusade for schools, which is evidently empty rhetoric—just another empty soundbite?

I agree with my hon. Friend that GP fundholding has improved patient care and increased patient choice up and down the country. An increasing number of doctors are choosing to become fundholders, and I welcome that, in Lichfield as elsewhere.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 December. [2203]

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.

Does the Prime Minister agree with me, and with all the other users of the Great Western main line from Paddington to south Wales and the west of England, that the signals for railway privatisation are now firmly stuck at red? Now that the consortium Resurgence Railways, led by the Prime Minister's Huntingdon Tory crony, Mike Jones, has been rejected because it cannot raise the money, and the second-choice preferred bidders—led by the present management team at Western Region—cannot raise the money either, should we not be singing the old song "Let's call the whole thing off"?

That was rather contrived, I must say. Rail privatisation is going ahead, for one simple reason: it will deliver a better service for rail passengers. If the hon. Gentleman and his hon. Friends really think that, over the past 40 years, the public have had the rail service that they would like, I do not know where he has been.

Does my right hon. Friend believe that, if he appointed Scottish-based Members of Parliament to key Cabinet posts such as Chancellor of the Exchequer, Foreign Secretary and Chief Whip, and then proposed to set up a Parliament in Edinburgh that failed to address the West Lothian question, that would be good for the Union of the United Kingdom and for relations between Scotland and the rest of the UK?

I do, of course, have a number of very distinguished Scots in my Cabinet and in my Government, but I certainly agree with the thrust—[Interruption.] Not at the moment, it is true. My right hon. and learned Friend the Chancellor is distinguished, but he is not a Scot. The thrust of my hon. Friend's point is surely right—if the devolution plans proposed by the Opposition parties were to proceed, they would undoubtedly lead to conflict between Scotland and other parts of the United Kingdom. I hope that, even at this late stage, the parties advocating those policies will consider what they would mean in practice both for Scotland and for the rest of the United Kingdom and will decide that extra taxation for Scots alone is not a way to improve the prosperity of Scotland.

Does the Prime Minister agree, as the Government's report "Lifetime Learning" which was published today confirms, that Britain's skills and education attainments are nowhere near where they should be? Rather than encouraging a small number of children to leave state schools for the private sector, should we not be raising educational standards for the 7 million children who are educated in the state sector, many of whom do not get the education that they deserve?

Of course, as the right hon. Gentleman knows, we have produced a whole series of plans to raise educational standards over recent years, many of which, alas, have been strongly opposed by the right hon. Gentleman and his hon. Friends. If the right hon. Gentleman wishes to know where in the education sector there is failure, he might look at Hackney for example. [[HON. MEMBERS: "Islington."] I shall come to Islington. The right hon. Gentleman might look at Lambeth, where the secondary schools are so bad that the Office for Standards in Education has to inspect every one of them. He might, of course, look at Islington, which has just come absolutely bottom in the table of GCSE results. What is consistent among all those is that they are all Labour-controlled education authorities.

Will my right hon. Friend take this opportunity to congratulate SCM Chemicals in my constituency, a subsidiary of the Hanson Trust group, which yesterday announced a massive expansion of its titanium dioxide plant? Is that not clear evidence that international investment is making my constituency the chemical capital of the world?

My hon. Friend is a formidable advocate for his constituency and his constituents. I hope he will agree that Government policy as well as his advocacy might have played some part in bringing that investment to his constituency.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 December. [2204]

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

Will the Prime Minister explain to the people of Cornwall and Devon why they should accept the Government's conclusions today that Government spending in the region compares favourably with that in the rest of the country, when every independent report shows that spending in the region is 10 per cent. less Department by Department, education to industry, than that in the rest of the country, despite high unemployment, low wages and a high cost of living?

As I think the hon. Gentleman knows, we have a number of measures to deal with those problems in the west country and elsewhere, and it is extremely important that those problems are dealt with. We are determined to address them and to improve the living standards and opportunities for people in the west country. That is what we have been doing and what we shall continue to do. It is pity that the hon. Gentleman seeks to denigrate every effort that is made.

Has my right hon. Friend seen reports of the disgraceful intimidation and browbeating that is going on in Hurworth in my neighbouring constituency where the Labour party is trying to prevent a local school from opting out? Apparently, the whole affair is being organised by none other than the Leader of the Opposition, aided by the hon. Member for Darlington (Mr. Milburn.)

I believe that any form of intimidation of parental choice is to be condemned. Parents have a natural and a legal right to decide whether they want the school to which their child goes to opt out and they should be able to exercise that right without intimidation, either by the education authority or by anyone else. If there is evidence of that, I hope that those implicated in it will examine it without delay.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 December. [2205]

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

My question concerns the appalling human rights abuses in Nigeria, together with reports in the press today of confidential information from Home Office files being leaked to Tory central office and thence to the press. Will the Prime Minister order an immediate inquiry into those leaks and further assure the House that there will be no deportations to Nigeria of people at risk from that murderous regime?

As the hon. Lady knows, our position on Nigeria is clear and, in company with others, we set that out clearly at the Commonwealth conference. The case in today's newspaper to which she refers was one where the applicant or his representative had chosen to make public details of their cases and allegations about their consideration. In those circumstances, the Home Office gave information that was necessary to set the record straight in response to telephone inquiries that it received and, subsequent to the information being given by the Home Office, it was also used by others.

Will my right hon. Friend take time today to consider the outstanding success of Operation Christmas Cracker? Is he aware that some 12,000 police officers in 40 force areas today made a number of staggered raids in which more than 2,000 suspects were arrested, and recovered property ranging from bicycles to reptiles? Does he agree that that is one of the best Christmas presents that people could have?

I am grateful to my hon. Friend, who touches on a matter that is of importance to everyone. I certainly welcome the priority given to today's operation, which involves some 40 police forces and has occasioned more than 2,000 arrests. There is no doubt that, over the past couple of years, innovative policing methods have made a distinct impact on the crime level, and we are now beginning to see the crime statistics fall. It is policing of that sort that can give people considerable reassurance. [Interruption.] Opposition Members may scoff about crime falling, but it is a matter of importance to the public out there.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 December. [2206]

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

Has the Prime Minister seen the astonishing reports in the press that the official video of the party conference has been doctored to make the party chairman appear good, and to play down the popularity of the Secretary of State for Defence in the party? If the Conservative party cannot tell the truth about its own conference, is it any wonder that no one trusts it on tax?

From the party that has more spending pledges and higher tax in the pipeline than anyone else, I find that ironic. On the newspaper reports, the hon. Gentleman should look at reality, not newspaper reports.

Is my right hon. Friend aware that high-quality textiles from Yorkshire were used in the new James Bond film? James Bond may be ruthless in what he does to his enemies, but he is also particular about what he wears. Will my right hon. Friend join me in congratulating the three west Yorkshire textile companies that were involved in that project?

I am certainly happy to congratulate west Yorkshire and the textile industry and I hope that, as a result of that extra advertisement, they will sell far more of their textiles at home and abroad.

To ask the Prime Minister if he will list his official engagements for Tuesday 5 December. [2207]

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

The Prime Minister describes himself as a one-nation Tory. Will he therefore tell us which is fairer—abolishing capital gains and inheritance taxes or implementing a starting rate of income tax of 10p?

I see that the shadow Chancellor is here. One of his hon. Friends, also a Front Bencher a year or so ago, referred in very scathing terms to precisely the sort of proposition that the shadow Chancellor made. It is a gimmick and the shadow Chancellor knows it. What is fair is to lower the basic rate of tax to 20p, which is what we are doing by raising thresholds so that one in four people now pays tax at 20p, by cutting the tax on savings for all basic-rate taxpayers so that they only pay 20p, and by reducing the basic rate of tax.

On a point of order, Madam Speaker, of which I gave you prior notice. You will have just heard the Prime Minister refer to what appears to be a major change in the long-standing policy of the Home Office not to disclose to a third party confidential information concerning anyone involved in immigration or asylum applications. In view of the disclosure by Conservative central office of information concerning a Mr. Igbiuidu, a Nigerian national seeking asylum in this country, could you, Madam Speaker, arrange for the Home Secretary to make an early statement about what changes the Home Office has made in its policy of not disclosing information about individual applications?

I appreciate the fact that the hon. Gentleman kindly gave me notice of his point of order. I certainly heard the Prime Minister's response today. I understand that the information was released by the Home Office. I, as Speaker, have no responsibility for the actions of Government Departments, but even so I took the opportunity this morning to look at the matter and I can tell the hon. Gentleman that it is precedented.

On a point of order, Madam Speaker. I ask you to look in the Official Report tomorrow at question No. 1 to the Prime Minister, tabled by the hon. Member for Mid-Staffordshire (Mr. Fabricant). He asked a closed question. We all understand the ground rules. A closed question prevents any supplementary from being asked, other than in relation to the subject matter of the question.

rose—

Sit down. I am taking no further points of order on this matter. Indeed, it was not a point of order anyway. I am not responsible for the answers given by Ministers. We shall now get on with the business of the House.

On a point of order, Madam Speaker. Many of us could not hear what you said in response to my hon. Friend the Member for Bradford, West (Mr. Madden). For clarification, could you tell us whether you said that the procedure was precedented or a precedent?

It is precedented. If the hon. Gentleman would like to come to see me I will give him the information.

On a point of order, Madam Speaker. May I draw to your attention the happy fact that, after 15 months, I am back in service?

It is a pleasure to see the hon. Gentleman back. I shall look for quality contributions from him in future.