To ask the Secretary of State for Health what progress has been made towards full capitation funding of district health authorities; and if he will make a statement. [5611]

The health authority revenue allocations announced last Thursday show that in 1997–98, the next financial year, considerable progress will be made towards that goal.

Is my hon. Friend aware that North Essex and South Essex health authorities are further away from their capitation target than any other health authority in the country? I thank him for recognising that by announcing an increase of 2.6 per cent. in real terms in this year's settlement, but is he aware that that will still leave North Essex some £14 million short of its capitation target? That is likely to cause real difficulties. Can he therefore give me an assurance that, in future years, he will concentrate on giving extra resources to authorities that remain below their capitation target?

I am sure that it is not a great comfort to my hon. Friend to know that there is another health authority worse even than North Essex in terms of its distance from the capitation target. None the less, he will be aware that, in this settlement, we have achieved another £16 million towards a total of £370 million for North Essex, which brings it to 3.77 per cent. below its capitation target. I certainly give him the assurance that we will continue to make progress in that direction. Indeed, given what the Prime Minister and my right hon. Friend the Secretary of State for Health have said about real resources over the next few years, if another Conservative Government are elected, we will certainly make progress towards that end.

If the Minister is introducing a more equitable distribution of resources to health authorities, why is he introducing a challenge fund for the care of the elderly? Is it not a fact that all that will happen is that money will go to the best bidder and not necessarily to those with the most need? Is that not just another example of the Government's lottery of care for the elderly?

I am glad to be able to tell the hon. Lady that, as a result of the fairly small changes to the capitation formula, which we will incorporate in next year's figures, no less than 86 per cent. of total capitation funding will be related to needs.

Does my hon. Friend agree that hospital trusts operate within a number of former health districts that still receive below the national average for health funding? In particular, and as my hon. Friend knows, Scarborough district and Scarborough and North East Yorkshire Healthcare NHS trust have a deficit. Can my hon. Friend reassure me and my many constituents, and those of my hon. Friend the Member for Scarborough (Mr. Sykes)—[HON. MEMBERS: "Where is he?"]—that their needs will be met from the enormous increase in funding of £1.6 billion, which the Government announced last week?

Perhaps I can reassure my hon. Friends inside and outside the Chamber that, as a result of my right hon. Friend's decisions, North Yorkshire is now only 0.5 per cent. away from the target funding. I am sure that we will eliminate that shortfall in the next year of a Conservative Government.

To ask the Secretary of State for Health if he will make a statement on NHS hospital deficits last year. [5610]

Financial information for 1995–96 will be available later this month, following analysis and validation of the trust audited annual accounts by the national health service executive.

Does the Minister recall that the most recently published NHS accounts listed 13 NHS trusts in non-technical deficit and said that the NHS executive would take action to remedy those deficits? Is he further aware that, of those 13 trusts, 11 were still in deficit the following year and that the aggregate deficit had gone up from £10 million to £20 million? Is that not an indication that the internal market is putting trusts into deficit? What action does he intend to take to stop the closure of more trusts such as the Anglia Harbours NHS trust?

I recognise from the question an article that appeared in a newspaper close to the hon. Gentleman's constituency setting out his concerns, which I do not regard as justified. His concern is that those trusts that have a deficit cannot manage their way out of it.

Does my hon. Friend agree that the Secretary of State's announcement of £23 billion for health authorities last year may go some way to deal with a projected deficit slightly in excess of £100 million?

My hon. Friend is right. I repeat what my right hon. Friend the Secretary of State said when he was questioned in the health debate last week about first quarter returns for trusts: there is an estimated surplus this year of about £60 million. That proves, as my hon. Friend suggests, that this is a well-managed service with an increasing resource that has been given by the Government.

There has always been pressure on finance in the health service. In the past, a balance was always achieved. What is the difficulty now? Is the fact that some health authorities are now recording deficits the result of bad management or of someone trying to get ahead of someone else?

The hon. Gentleman is right to point to the fact that, over time, trust accounts must be balanced. That is happening. Trusts are obliged to balance their accounts on a following year basis. Trusts that have difficulty have made enormous progress towards eliminating deficits over time. That is precisely what we expect health authorities, which are purchasers, and trusts, which are providers, to do—and it is made all the easier because, this year, every health authority has been given increased spending in real terms.

To ask the Secretary of State for Health what is the current level of spending on the national health service; and what it was in (a) 1979 and (b) 1989 in real terms. [5612]

National health service total net expenditure in England is planned to be £34.4 billion in 1997–98. At constant prices, the equivalent expenditure in 1978–79 was £19.6 billion, and in 1988–89 was £26.5 billion.

I thank my right hon. Friend for that very revealing reply, which emphasises, as nothing else would, the Government's continuing commitment to the nation's health. Does my right hon. Friend agree that the evidence for that increase in spending can be found in every trust hospital and every fundholder's surgery and is experienced by every member of the public who goes for treatment?

My hon. Friend is absolutely right. Those figures represent a 30 per cent. real terms increase since 1990—an increase of three quarters since 1979. Most important for the future is the Prime Minister's commitment to year on year on year on year on year real terms increases in NHS spending. In this morning's Daily Mirror, the hon. Member for Islington, South and Finsbury (Mr. Smith) wrote an article. He said:

"Labour will match the Tories' plan for funding the NHS—we are very serious about that"—

I believe that everyone will welcome what is a relatively generous settlement for the coming year, which has been secured by the Secretary of State and by the Government. The Secretary of State is correct to say that, even after this morning's speech by the hon. Member for Islington, South and Finsbury (Mr. Smith), the Government's financial commitment is considerably greater than the Labour party's.

I am grateful to the hon. Gentleman for his recognition of a "relatively generous settlement", as he called it, for next year but, with respect, he is wrong about future years. The Red Book shows a real-terms increase, to which we are pledged, for national health service expenditure in year 2 and year 3. The Labour party refuses to give such a pledge. The hon. Gentleman was too generous to the shadow health spokesman, whose pledge for next year is not to volunteer back to the Treasury health money that this Government have committed to the NHS.

Can my right hon. Friend confirm that the Government's commitment to the national health service allows the people of Dartford—

And Gravesham.

to look forward to the construction of a new district general hospital early in the new year? Will he accept my thanks and pass them on to his Ministers and other colleagues who have worked so hard to bring about that result?

I am grateful to my hon. Friend. I was as pleased as he was by the health authority's decision last Thursday. If and when the hospital is built, as we intend that it should be, I am sure that it will benefit the citizens of both Dartford and Gravesham. I look forward to the day.

Will the Secretary of State confirm, first, that he has cut capital spending on the health service by one third in the current year and next year and, secondly, that page 124 of the Red Book, which presents the control totals in real-terms figures, shows that, between 1998 and 1999, there is to be no real-terms increase in planned spending on the health service? Does not that show that the Chancellor has already torn up the promise given by the Prime Minister at the Tory party conference?

The hon. Gentleman is wrong on both counts. The Red Book makes it clear that the cash plans for the health service in year three are increasing faster than the GDP deflator. [HON. MEMBERS: "Real terms."] We plan for the health service in cash spending, as the hon. Member for Islington, South and Finsbury (Mr. Smith) is also committed to do. The cash spending for the health service in year three increases faster than inflation. Hon. Gentlemen might misunderstand me. Faster than inflation means real-terms growth. That is what the Government are committed to, what they have delivered for 18 years and what this Conservative Government will deliver in the next Parliament. The hon. Gentleman has only to wait and see.

Does my right hon. Friend agree that, notwithstanding the increase in the figures, one of the key points is the way that the service is delivered? It is more efficiently delivered now, so the pounds spent are spent on more people. I am particularly concerned about fundholding practices. The Opposition's position on fundholding is oblique. Will my right hon. Friend make it clear to the House that we seek to increase the number of fundholders, because fundholding has worked?

My hon. Friend is right to say that fundholding has worked. It is the option that has been chosen by almost 60 per cent. of GPs in England—because they believe that it is in the interests of their NHS patients that they should be come fundholders. My hon. Friend was wrong about the hon. Member for Islington, South and Finsbury. The hon. Gentleman made it crystal clear this morning that he intends to abolish fundholding—[HON. MEMBERS: "Hear, hear."] Hear, hear, Opposition Members say. If they really cared about health service patients, they would take the hon. Gentleman to one side and ask him why he intends, if he is ever given the chance, to deny to GPs working in the health service the option that they think is in the best interests of their patients. That is what the hon. Gentleman announced this morning: he does not care about NHS patients.

To ask the Secretary of State for Health how many NHS services have been market tested. [5613]

The national health service executive market testing database has evidence of 86 services that have been market tested or are planned to be market tested.

Does the Minister recognise that the entire exercise has been characterised by a reduction in services throughout the NHS? In my constituency, an organisation called Trident, which was formerly known as Hospital Services, had to change its name to gain new contracts—hon. Members may speculate about why that was necessary. The contract is failing to deliver promised savings and there has been an attempt to reduce the number of hours worked by people in the service. A constituent who works as a cleaner with the Wolverhampton health service has been forced to clean using water with no additives. Does the Minister believe that market testing is justified in those circumstances?

I am afraid that the hon. Gentleman utterly misunderstands the purpose and benefits of market testing. He fails to see that market testing is improving standards, particularly in laundry and other hotel services. By enhancing standards, market testing is saving the health service between £100 million and £150 million, which is then used to provide extra health care for patients. The hon. Gentleman should support that initiative. In addition, the trust that has taken out the contract is more than happy with the service being provided. I suggest that the hon. Gentleman gets a better briefing from UNISON, which seems to be misleading him.

How much has market testing saved us in terms of additional operations in the health service? Have not efficiency savings led to a considerable increase in the number of patients who are treated through the health service?

I am extremely grateful to my hon. Friend, who puts his finger on the most important issue. Market testing is resulting in improved services and, since it began in 1983, it has saved the health service about £1 billion—about £100 million to £150 million a year. That means more hip and cataract operations and more acute service provision in the health service.

To ask the Secretary of State for Health how many general practitioners have expressed an interest in the Government's total purchasing initiative. [5614]

There are 82 national total purchasing pilots comprising 322 practices. We understand that many other sites have expressed interest in such pilots. We will consider how to respond to this in the light of the National Health Service (Primary Care) Bill, which is currently before Parliament.

I warmly welcome the growth in fundholding, and its extension via the total purchasing initiative, which is popular with GPs and patients. Given the success of fundholding, does my hon. Friend agree that it would be quite wrong to abolish it, as is proposed by the shadow health spokesman?

My hon. Friend is right. At least we have an end to the equivocation about replacing or evolving fundholding: we now know that the Labour party would abolish it. The advantages that have accrued to patients and to general practitioners from total purchasing pilots would be lost if the Opposition had their way. Unlike fundholding under this Government—which is a voluntary principle carried forward in the National Health Service (Primary Care) Bill before the House—Labour would force general practitioners into commissioning groups. It would become chain-gang commissioning, which is anathema to this side of the House.

To ask the Secretary of State for Health what representations his Department has received regarding possible changes in the role and functions of community health councils. [5615]

I have received a number of representations regarding the role and functions of community health councils, in connection with the report on the resourcing and performance management of community health councils, which will be published shortly, inviting comments.

Is it true that the performance of CHCs will be reviewed? If so, who will conduct the review and how will that be done? Is it not essential that CHCs continue to be the patients' representatives in the national health service?

I agree entirely with the hon. Gentleman's assertion that CHCs should continue to be the patients' representatives and put patients' complaints fairly and squarely to the relevant authorities. The review has been completed, and I shall publish the results shortly. There will then be a period of consultation when all can make their views plain on the contents of the report. I should add that the Association of Community Health Councils for England and Wales was represented on the steering committee of the review, and helped to choose the consultants who undertook that review.

Does my hon. Friend accept that one of the functions of CHCs is to help patients to make complaints? One of my local provider trusts sent out 35,000 invitations to households to attend its annual meeting. Only one patient and his wife attended. Does not that suggest that, contrary to the stories peddled by the Labour party, satisfaction with the way in which the national health service is working is very high?

Indeed it is. As my hon. Friend will be aware, the settlement, particularly as regards Kent, is another feather in the cap of my right hon. Friend, who has fought continuously for extra funds for the national health service.

To ask the Secretary of State for Health if he will make a statement on the number of people currently waiting for NHS operations. [5616]

Half of all admissions to hospital are immediate. The latest available provisional figures, for 30 September, show that 1,060,150 people were waiting for admission. Of people waiting for admission, four out of 10 will be admitted within one month, half within six weeks and more than two thirds within three months. Fifteen thousand people—one in 70—were waiting longer than 12 months.

Will the Secretary of State take this opportunity to welcome the Labour party's pledge to reduce the number of people on waiting lists—particularly for cancer operations—by 100,000? Will he recognise that that will benefit many of my constituents in north Wales, for which he is not responsible, and those who use Clatterbridge hospital in the Wirral? Will he take the opportunity today to recognise the pledge and support it in the House?

I do not support the pledge, because everyone who works in the health service knows that what the shadow health spokesman said at the Labour party conference is nonsense. To talk about a waiting list for cancer surgery is to talk about a waiting list that does not exist, and when the Labour party, which voted against the abolition of regional health authorities, talks about £100 million of administrative savings, it convinces nobody. The Government have delivered 25,000 more doctors and 55,000 more nurses to the NHS since 1979. That is why we are treating more patients. We have also cut the average waiting time for waiting list patients from nine months to four months. That is the reality of the Government's record on waiting lists.

Will my right hon. Friend confirm that the three major acute hospitals in Leicester, which serve his and my constituents, are doing very well at reducing waiting times for patients of all categories? Will he further use this opportunity to scotch the scare stories put around by Labour politicians in and around the city of Leicester that the three major acute hospitals are bound to be reduced to two because of a shortage of cash in the national health service? Will he confirm that there will be three hospitals in the city so long as it is necessary to have them and that, if the number does go down to two, patient care and waiting times will be very much to the forefront of his mind?

As every Leicestershire Member of Parliament knows—including Labour Members of Parliament in Leicestershire—because we have been told by Leicestershire health authority, there is no proposal to reduce the number of acute hospitals in the city of Leicester. It is blatant scaremongering to suggest otherwise. What is going on is a review of acute service provision in Leicestershire to ensure that we deliver the most effective and efficient health care that we can to the people of Leicestershire. That, I hope, is supported by hon. Members on both sides of the House.

My constituent, Mrs. Walker, who lives in Brinsworth, is 85 years of age. She was told in October that she will have to wait until 17 March 1998 for a hip operation at Rotherham General Hospitals NHS trust. Her surgeon told her that

"due to severe financial constraints"

"currently exceeding the number of orthopaedic operations for which it is funded".

That is the politics of Jennifer's ear. Labour really is bankrupt on health. Now the hon. Gentleman leaps to the Dispatch Box to take up a constituency case. If he writes to me, I will take it up.

May I welcome the progress being made towards the provision of more single-sex wards in hospitals? Will the national health service, in principle, seek to make a single-sex ward available to any patient who asks for one?

As my hon. Friend knows, we have set out clearly the health service's commitment to move towards single sex provision. It is in the patients charter. It is a clear requirement of the management of the health service to deliver the patients charter. We have monitored that requirement, and we shall continue to do so. I assure my hon. Friend that that is an important priority of the management of the health service.

To ask the Secretary of State for Health how often he meets the chairs of the NHS regional executive to discuss current regional health issues. [5617]

The Secretary of State meets regional chairmen regularly to discuss a wide range of regional and national issues.

Has the Minister raised with the chair of the Northern and Yorkshire regional health authority its failure to honour clear obligations given to Pinderfields hospital to compensate it for the loss of regional neuro-surgery provision to Leeds? The Minister knows full well that my constituents and those of my hon. Friend the Member for Normanton (Mr. O'Brien) were lied to and clearly misled during public consultation on this matter. He is directly responsible: what is he going to do about it?

The hon. Gentleman's health authority is over target and has ample resources. It received a further increase this year. The local health trust has a specialist eye unit and a skin graft unit, which are doing marvellous work. Wakefield is in very good shape.

When my hon. Friend meets the chairman of South Thames health authority, will he pass on the congratulations of the people of north-west Kent on last week's decision to develop the private finance initiative for Darenth Park hospital at a cost of £102 million, which answers my constituents' dreams?

I am delighted that Gravesham and Dartford are in such harmony.

Will the Minister assure the House that, when he next meets the chairmen of the NHS regional executive, he will set a timetable for making good the Government's promise to patients that they can expect to be treated in a single-sex ward? Does he recall the Prime Minister's admission at the Dispatch Box two weeks ago that the Government had broken that promise to patients? Would he care to explain to the House why a report on the performance of NHS trusts on the patients charter standard on mixed-sex wards—which he promised in April would be published shortly—has still not seen the light of day? Is that report being suppressed because its findings confirm the inhumanity of mixed-sex wards, and offer further proof that Tory promises to patients are not worth the paper that they are written on?

I am surprised that the hon. Lady took such a long time to ask a question that had just been answered by my right hon. Friend the Secretary of State. He has made plain the Government's commitment in the patients charter to move towards the elimination of mixed-sex wards. That is clearly in the public interest and in the interest of patients, and I am surprised that the hon. Lady thinks that we would renege on that commitment.

To ask the Secretary of State for Health what recent assessment he has made of health provision by St. Helier NHS trust. [5618]

The St. Helier NHS trust provides a comprehensive range of good quality services to more patients than ever before.

I thank my hon. Friend for his kind words about the magnificent track record of the St. Helier trust. Is he aware that, despite the Government's commitment of £1.6 billion extra resources to the health service, my local health authority of Merton, Sutton and Wandsworth is deeply concerned about a shortfall of £4 million, of which £1 million affects St. Helier? Will my hon. Friend consider a bridging loan so that we can maintain the excellent services that we have always had?

I am very grateful to my hon. Friend. As she will know, as a result of the £1.6 billion secured by my right hon. Friend the Secretary of State, Merton, Sutton and Wandsworth health authority has an increase in cash terms of £11.5 million, which is a real-terms increase of 1.64 per cent. I know that my hon. Friend has written to my hon. Friend the Minister for Health. I assure her that her letter will be examined carefully, although, obviously, I cannot anticipate the answer. However, she may be interested to know that, after the Budget, the director of finance at the St. Helier NHS trust said of the £1.6 billion extra:

"This is at the top end of my expectations. This means we will not have to make any cuts at all."

To ask the Secretary of State for Health how many managers there are in the national health service currently; how many there were in 1989; and if he will make a statement. [5620]

There were 26,700 managers in the NHS in 1995—the latest year for which figures are available. The figure includes 6,660 practice managers employed by general practitioners, and excludes managers who need to be qualified health care professionals to do their job. Directly comparable information is not available for 1989.

Is the Minister proud of the fact that the Government have cut the number of nurses by 50,000 and replaced them with 20,000 new senior managers? Does he accept that that simple fact reflects clearly the twisted priorities of the Government? Does he accept that those twisted priorities are the reason why more than 1 million people are waiting for treatment, dozens of trusts are on the verge of bankruptcy and ever more people are forced to sign up for private health insurance?

The Government are proud of the fact that there are 55,000 more nurses and 25,000 more doctors now than when we took office, and that we have cut waiting lists since implementing our reforms. In 1990, 200,000 people were waiting for more than 12 months, and that figure is now down to 15,000. Activity in the NHS is up by 33 per cent., whereas the total management figure, as a percentage of staff, is up by about 3 per cent. The NHS is built on those achievements, and the hon. Gentleman does no good by ignoring them.

Does my hon. Friend agree that the resources of the NHS are its staff, its equipment and its buildings? Does he further agree that it is how those resources are managed that will affect patients, and that, unless they are managed effectively and properly, all the qualified people in the world would not be able to assist patients?

My hon. Friend is right. He understands that the genesis of the changes to the national health service was the Griffiths report, in 1985–86, which revealed that there was a great management deficit in the NHS. The Labour party seems to think that an organisation that employs approximately 1 million people and has an annual budget in the United Kingdom of about £40 billion per annum can somehow run services on its own. That has proved not to be the case. As my hon. Friend said, more patient care is being delivered today than ever before, because of the structure and proper management put in place by the Government.

Is it not the case that if health services are reorganised as they were in Ayrshire—where three trusts and one board are now doing what one board managed to do previously—we shall have four times as many managers? Is that not a crazy way in which to run a health service?

I will say only that when we reorganised the health service to abolish regional health authorities—to cut out a layer of bureaucratic administration—the hon. Gentleman voted against it.

To ask the Secretary of State for Health what discussions he had about health care in Huddersfield during his recent visit to Huddersfield national health service trust. [5621]

I understand that discussions were concentrated on a number of issues, not least the excellent care provided to users by Huddersfield NHS trust.

Is my hon. Friend aware that my right hon. Friend the Secretary of State was able to see for himself some of the superb developments that are taking place as part of the £10 million investment programme being carried out by the Huddersfield NHS trust? Does that not simply demonstrate the Conservative Government's total commitment to the NHS in Yorkshire? Is he aware that I receive far fewer complaints about the local NHS in my part the world than about my local Labour-controlled council?

My hon. Friend is right to identify the £10 million that has been invested over the past 18 months in hospital facilities in the Huddersfield area, including a new neurology ward, the Greenlea oncology suite, a relocated intensive care unit with new dedicated facilities and the refurbished orthopaedic out-patient department. I am sure that my hon. Friend agrees that it is no wonder that he gets fewer complaints about his excellent local national health service provision than he does about his local authority, because people are led up to the back teeth with the shroud waving, moaning and carping of the Labour party.

When the Secretary of State visited Huddersfield and met the impressive team that runs the trust, did he mention page 124 of the Red Book—a page which I am sure that the Minister knows off by heart? In particular, did he mention the lines that refer to health, of which the NHS budget forms a part? The total health budget from 1997 to—

Reading.

Order. I am sure that the hon. Gentleman is not reading, but if he is, I am sure that he will stop it.

The figure for next year is 33.4. For the year after, it is 33.2. That is a real terms reduction of 0.2 over 12 months, according to the Red Book. Will the Minister explain how it is possible to construe that reduction in real-terms expenditure over 12 months, shown in a Government document, as an increase?

The hon. Gentleman is obviously trying to help the hon. Member for Islington, South and Finsbury (Mr. Smith), who failed last night and again this morning. There is a straightforward answer to the question; there is no secret about it. He will see it confirmed if he continues to look through the Red Book. There will be a real-terms increase in spending on the national health service. The fall in the figure—[Interruption.] If the hon. Gentleman listens, he will get the answer. The fall in the figure is accounted for by the community care money being transferred to the Department of the Environment budget. If the hon. Gentleman looks at that budget, he will see the money there.

Is my hon. Friend aware that the Dewsbury Healthcare NHS trust, which serves my constituency, has a long history of low funding? Is he further aware that, since its inception, the Calderdale and Kirklees health authority, based in Huddersfield, has done nothing to redress the balance?

I am grateful to my hon. Friend for drawing the problem to my attention. She will be aware of the record increase, in the context of total national health service funding, in last year's budget.—[Interruption.]

Order. The House cannot hear the Minister unless he uses the microphone.

I am extremely grateful to my hon. Friend for drawing the problem to my attention.

To ask the Secretary of State for Health if he will publish information about surgery outcomes on a hospital-by-hospital basis. [5622]

We are working with the professions to develop information on outcomes. It is essential that information is robust, meaningful and unlikely to mislead before any decision is taken on publication.

Is it not about time that we had some patients charter standards on quality? Why is the Minister still considering what to do on the issue when the Scottish Office is already publishing information about clinical outcome indicators on a hospital-by-hospital basis? If the information can be published in Scotland, why can it not be published in England, so that local people can make judgments about the quality of their hospitals?

I do not remember Labour Members, who now seem keen about publishing outcomes information, being so keen when we started publishing the information in Scotland. We are piloting and evaluating a range of indicators aimed at giving patients better information about the quality of their treatment. Information will be available within the NHS during next year and will be published in a form accessible to patients in 1998. I hope that the hon. Gentleman remembers that that is only one part of the task on the issue of quality that he raised. We are also looking at clinical audit and effectiveness, investing large amounts of money in improving both.

Does my hon. Friend agree that the move away from the old, unwieldy health boards with 20 or so members to small, compact trust hospital management groups has done much to introduce local factors, which have allowed surgical outcomes to be much improved?

That is right. My hon. Friend has touched on an extremely important point. The accountability of the NHS has been improved by the changes that the Government have brought about, and that allows us to look at such quality issues.

To ask the Secretary of State for Health when he last met the Association of County Councils to discuss services for mentally ill people. [5623]

The Secretary of State meets regularly with the local authority associations, including the Association of County Councils. The last such meeting when mental health issues were discussed took place on 18 September.

Does the Minister really believe that the Government bear no responsibility for the number of mentally ill people who are homeless—living on the streets or in hostels—or for the fact that one in every six mental patients who are discharged from hospital are readmitted within 90 days as emergency cases?

I am rather disappointed that the hon. Gentleman did not have the grace to acknowledge the work that is being done through the record increases in spending on mental health—on the rough sleepers initiative, the mental illness specific grant, the mental health challenge funding and all the other initiatives—to help those with mental illness.

To ask the Prime Minister if he will list his official engagements for Tuesday 3 December. [5640]

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.

What advice can my right hon. Friend give to the many constituents of mine and of other hon. Members who are excellently served by innovative and increasingly comprehensive GP fundholders, in the light of Labour's repeated pledge to destroy such practices?

My hon. Friend is right about the helpful changes that have been made to the health service over recent years. More than 4 million extra patients have been treated since 1979—a million since the reforms began. There is no doubt that the reforms, including GP fundholding, have been an enormous success. I very much regret that the Labour party cannot accept what is successful and, instead, threaten it.

Will the Prime Minister say clearly, without any qualification, that his statement of 3 April on behalf of the Government that at the next election he will not rule out the option of joining a single currency in the next Parliament, remains unequivocally the position of the Government?

That remains unequivocally the position of the Government.

It is right to give the Prime Minister credit for such a clear reply. Let us see whether we can get another little clear reply. Can he tidy up one small loose end? Does he agree with the Deputy Prime Minister's statement on the radio at lunchtime, when he said of that position:

"We are not going to change our position in the election campaign or in this Parliament"?

My right hon. Friend said that; that is our position.

The assurances gained by my right hon. and learned Friend the Chancellor of the Exchequer in Brussels yesterday are to be warmly welcomed. Does my right hon. Friend think that it is now important that those assurances are written into the treaty of Rome, given the experiences that we have had with the European Court of Justice and the way in which it has interpreted the treaty of Rome? Will he press for such amendments at the Dublin summit?

As my right hon. and learned Friend the Chancellor said to the House the other day, the elements of the stability pact would not affect the United Kingdom unless we were part of stage 3 of economic and monetary union. As my right hon. and learned Friend will tell the House in his statement shortly, our position is legally protected under the treaty, but we intend to ensure that the detailed regulations leave no room for ambiguity.

Ordinary people in Britain will pay more tax under the Conservatives at the next election than they paid under the Conservatives at the last election. The Treasury figures show that, the Treasury's Red Book confirms it and Treasury Ministers admit it. Why is the Prime Minister the only person left in Britain denying it?

I am afraid that the right hon. Gentleman is misleading the House and I shall explain gently to him how. If one earns more, one pays more tax. That is certainly true but, as my right hon. Friend the Chief Secretary made clear, if we had not changed direct taxes at all since before the election, a family on average earnings would have paid more next year under the old regime than they will as a result of our tax cuts. The increase in taxation is a result of increased earnings. Unless the right hon. Gentleman would like marginal earnings to be untaxed, that is inevitable.

Has my right hon. Friend had the opportunity to read the bulletin of the Bury and Bolton chamber of commerce, which reports a dramatic upturn in business confidence and business activity in my constituency? As it is the chamber's Christmas lunch on Friday, which I shall attend, will my right hon. Friend send my constituents a message of congratulations on that achievement and his best wishes for a new year of greater prosperity under a new Conservative Government?

The strict answer to the first point about whether I have read the bulletin is no, I have not, but it clearly provides comforting reading. There is no doubt that the economy is improving, unemployment is falling, growth is continuing and manufacturing is doing extremely well in Bury and Bolton, and across the country. That is the result of the policies that we have been following, and we shall continue to follow them.

To ask the Prime Minister if he will list his official engagements for Tuesday 3 December. [5641]

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

Given that the Government have now been forced to admit, contrary to what the Prime Minister said to the right hon. Member for Yeovil (Mr. Ashdown), that the Budget was a tax-raising Budget, and given that changes to direct tax mean that income taxes have gone up, will he now take down his untrue posters that falsely claim that honest John has given lower income tax?

All I can say to the hon. Lady is that she should read the answer I gave to the right hon. Member for Yeovil (Mr. Ashdown) and she will find that the premise of her question is wrong.

Will my right hon. Friend support an inquiry into economic incompetence in local government and will he start that inquiry with the London borough of Enfield, which in this year alone has failed to spend £5 million on housing maintenance and £1 million of single regeneration budget money, due to be spent on industrial renewal in my constituency? Is that not another example of new Labour, new incompetence?

There are many examples of that and it might be difficult to inquire into all of them. In view of my hon. Friend's remarks, I shall draw the situation to the attention of my right hon. Friend the Secretary of State for the Environment.

To ask the Prime Minister if he will list his official engagements for Tuesday 3 December. [5642]

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

I refer the Prime Minister to the comment of the Chief Secretary to the Treasury on Sunday—that direct taxes have risen during this Parliament—and to his own comment a few moments ago that direct taxes have risen only because earnings have risen. Will the Prime Minister accept the figures produced independently by the House of Commons Library, which show that, during the course of this Parliament, families on average earnings will not only pay more in direct taxes absolutely, by more than £2 a week, but—as a proportion of their earnings—their direct taxes will rise from 20.2 per cent. to 20.7 per cent? Will he now accept that the Chief Secretary was right to make those comments on Sunday, and will he withdraw his statement that the Government have kept direct taxes down, as it is simply not true?

People who are receiving larger incomes and are moving up the tax bands of course distort the figures. The reality is that people will be £1,100 better off next year, allowing for tax and inflation, than they were before the last election. The hon. Gentleman and his hon. Friends do not like that and, under Labour, no one would be richer but everyone would still have to pay more tax, as is inevitably the case under a Labour Government. Everyone knows that there would be higher tax rates under Labour, and I do not know how the hon. Gentleman has the effrontery to pretend otherwise.

To ask the Prime Minister if he will list his official engagements for Tuesday 3 December. [5643]

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

As First Lord of the Treasury, my right hon. Friend is responsible for providing much of the finance for local government. Is he aware that many local authorities with high council taxes give poor services to their constituents? Does he agree that those who cannot run Islington or Hackney are incapable of running the country?

New Labour hopes to produce a revolution in government, but I am astonished that it has utterly failed to do so in the element of local government that it already controls. There are a large number of examples of inefficiency that one could give, including a council that has not collected 20 per cent. of its council tax, is owed £16 million in arrears, has a debt of more than £800 million, pays interest of £91 million, has the sixth-highest council tax in the country and has the worst education results. That council should be well known to the Leader of the Opposition—it is his council in Islington.

To ask the Prime Minister if he will list his official engagements for Tuesday 3 December. [5644]

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

The Prime Minister boasts about 25 tax cuts. Will he confirm that, to qualify for them, a taxpayer must—among other things—be a small company, drive a vintage car and be dead?

The hon. Gentleman is very amusing, but wrong.

To ask the Prime Minister if he will list his official engagements for Tuesday 3 December. [5645]

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

Will my right hon. Friend confirm that my right hon. and learned Friend the Chancellor of the Exchequer has cut some 25 taxes in the previous two Budgets, and that, since the last general election, the average family now have some £1,100 more to spend? Do not such facts show the contrast between the Conservative and Labour parties?

I agree with my hon. Friend. The reality is that the basic rate of income tax is at its lowest level for 60 years.[Interruption.]

Order. The hon. Member for Ceredigion and Pembroke, North (Mr. Dafis) will remove himself for the remainder of this day's sitting—I will have order in this Chamber—I am cautioning the hon. Gentleman. I will have no more of that in the Chamber.

As my hon. Friend the Member for Southport (Mr. Banks) intimated, we now have the lowest basic rate of income tax for 60 years and people's living standards are rising. There is no doubt that Labour's appetite for European-style regulation would provide European-level taxes.

To ask the Prime Minister if he will list his official engagements for Tuesday 3 December. [5646]

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

Can we cut out all the claptrap? The top 10 per cent. of earners in this country have done very well, and people earning more than £64,000 are not paying higher taxes under the Tory Government. But the poor people—the most disadvantaged in our society—have seen their incomes fall and their tax demands go up. Is that fair? Should not the broadest backs bear the heaviest burden?

If the hon. Gentleman wants to cut out claptrap, he should remain seated in future. The reality is that, as they were at between 83p and 98p when the Conservative Government came to power, it is hardly surprising if those upper rates of taxation have fallen. At the moment, one in four taxpayers—28 per cent., to be precise—now pay tax at only 20p in the pound and we seek to bring more people within that rate, so that the basic rate becomes 20p in the pound. That is a fair tax system, and we are delivering it.

On a day when the Palace is graced with the presence of the forces' sweetheart, Dame Vera Lynn, will my right hon. Friend send a message of good will to everyone in the British armed services who will be serving abroad over Christmas, and will he pay tribute to our armed services, which are the most professional in the world?

I am happy to pay tribute to our armed forces, both abroad and at home, and I am delighted to see that, on this issue at least, I have the whole-hearted support of those on the Opposition Front Bench.