To ask the Secretary of State for Health what plans he has for the use of the private sector in primary care provision in the NHS. [19161]

None.

Were not the Government's true intentions on primary care, as with so much of the national health service, shown in the original drafting of the National Health Service (Primary Care) Bill—that is, the wholesale privatisation of the service and the extensive involvement of the private sector, to the detriment of patients?

No. The hon. Gentleman is talking nonsense. I thought that he might have been rising to record the 6.9 per cent. increase in the number of general practitioners since 1978–79 in his local health authority, or perhaps to congratulate it on 60 per cent., of the local population being covered by fundholding, but no, he raises yet again another argument that we killed off both in Committee and on the Floor of the House.

Will my hon. Friend ensure that, in the coming general election campaign, three points will be made: first, the precise amount of savings made in the NHS by the use of the private sector; secondly, that every penny of those savings went towards patient care; thirdly, that there would be no chance of such money coming if ever the Labour party was to have a chance to govern?

I am happy to endorse my hon. Friend's points. Of course it is true that the Labour party still has an ideological point of view about any private sector involvement, no matter how new it may try to appear to the public. That would mean fewer services for patients.

Is the Minister aware that, in the past four years, the amount spent by fundholding doctors on getting patients treated in private hospitals has increased from £4 million to £66 million and that, at the same time, 144 trusts have gone into debt? Is that not further evidence of the Government's undermining of the NHS in favour of private health care, and that the Government's failure to safeguard the NHS shows why the people of Britain deserve better?

Perhaps it is about time the hon. Lady started to think about patients when she talks about health care and the quality of services that are being provided. Put into context, the figure she mentions is about 1.9 per cent. of fundholding budgets. It provides better care for patients and services that patients want. The whole nation will know that the Labour party would deny them those services if it were ever to be returned to office.

Does my hon. Friend know that Staffordshire social services department is deliberately preventing people from going into residential and nursing care in the private sector, contrary to the principles enunciated in my right hon. Friend Secretary of State for Health's excellent White Paper, and that the High Court has recently issued an injunction against that department because of the disgraceful way in which it is handling that function and responsibility?

I am grateful to my hon. Friend for that. He gets to the heart of who—Conservatives or Labour— will provide better services for patients. I have no doubt that he will be campaigning vigorously on that point and on the White Paper that my right hon. Friend has recently published on the matter, so that the electorate will have a clear choice. That choice will be in favour of this Government's policies.

To ask the Secretary of State for Health if he will make a statement on the levels of NHS dental charges. [19162]

All Governments since 1951 have accepted that patients who can afford to should make some contribution towards the cost of their dental care. National health service dental treatment is free to those aged under 18 and extensive exemption and remission arrangements protect vulnerable groups.

Why does not the Minister tell us that real dental charges have gone up by 245 per cent. since 1979? Those are not just arid statistics, but are based on my experience. I have just paid £350 for a crown. [HON. MEMBERS: "Ah!"] That may be funny for Conservative Members. If any of them want some free dental service outside the Chamber afterwards I should be more than happy to give it to them. I am now facing £600 of periodontal work that has to be done privately because it cannot be provided on the national health service. I can afford it because I have a job and I shall have a job after 1 May, which is more than can be said for some Conservative Members, but what about people on low earnings who cannot afford that? We have a toothless Government who are obviously determined to render the nation toothless as well.

I shall tell the hon. Gentleman what has happened in his constituency between 1991–92 and 1995–96. Perhaps he is not interested in that, but is interested only in what is happening to him. The proportion of adult courses of treatment provided free in his health authority has risen from 48.5 per cent. in 1991–92 to 59.5 per cent. We shall take no lessons from Labour on charging until the shadow Chancellor releases the hon. Member for Islington, South and Finsbury (Mr. Smith) from the shackles that have bound him on health service expenditure, meaning that Labour cannot match the Prime Minister's pledge for real increases in funding year on year on year on year on year during the next Parliament.

Will my hon. Friend remind the House and the former guardian of the Greater London council silver who introduced dental charges, and how many general hospitals would have to be closed if dental charges were abolished?

Dental charges have been supported by Governments since the early 1950s. I cannot tell my hon. Friend how many hospitals would have to be closed, but £381 million would have to be recovered. Labour has recently reneged on what it had said about free eyesight tests. The public know what Labour would do about dental charges if it were ever elected to office.

Will the Minister be straight with the House and accept that not just in Wales, but throughout the country, there are constituencies with hardly any NHS dental service? The issue has been raised for the past four years. Is it not about time that he came forward with a plan to ensure that British people, on benefit or not, have access to an NHS dentist?

I do not know where the hon. Gentleman has been living. He has certainly not been following the affairs of this House recently. In the context of a growing dental service with more dentists and more treatments than ever, we have just given a Third Reading to a primary health care Bill that will address the problems of locating treatment in certain parts of the country. Access schemes have also been set in place, for which I hope health authorities in his constituency have been bidding. We have taken initiatives that have been endorsed by the House. I am glad to be able to point them out to the hon. Gentleman at this late stage.

To ask the Secretary of State for Health how many hospitals' chief nursing officers currently bear the title matron; and if he will make a statement. [19163]

The information requested is not available centrally. Job titles may have changed, but the principles of professional leadership remain and trusts can use the title matron if they wish.

I invite my hon. Friend to consult those who have matrons in their hospitals and others who have known hospitals with matrons. Is he aware that they are very glamorous people? Matron is a better and more meaningful title than any other for a chief nursing officer. Will he bring back the glamorous matron? We want her.

I am grateful to my hon. Friend. The first glamorous matron who comes to mind is Hattie Jacques; glamour comes in all shapes and forms. I think that my hon. Friend will agree that it is crucial that we have a management system which provides the most effective health care for patients being treated under the national health service.

To ask the Secretary of State for Health if he will make it his policy to require all general practitioners to become fundholders. [19164]

The general practitioner fundholding scheme is, and will remain, voluntary. With effect from 1 April this year, 58 per cent. of patients will be registered with a fundholding GP.

My right hon. Friend says that the scheme will remain voluntary. Does he agree, however, that fundholders are able to offer increased opportunities for treatment at their surgeries rather than at a hospital? I have visited the Barton-Upon-Humber surgery, which is a fundholding practice in my constituency. It is able to deliver patient care, ensuring that patients do not have to go 20 miles down the road to a hospital at Grimsby or Scunthorpe. The practice is able to offer what used to be regarded as cottage hospital treatment. Many treatments are now available from fundholders. Will my right hon. Friend think again about making the scheme available to all patients?

My hon. Friend is entirely right about the benefits for patients of the fundholding scheme. He quoted a typical example; there are many others throughout the health service. Over the next few weeks, the question for the Labour party is why it supports the abolition of a scheme that has brought about the benefits to which my hon. Friend referred. The hon. Member for Islington, South and Finsbury (Mr. Smith) is quite specific. A Labour Government would abolish fundholding. That would neuter Britain's GPs and be a major step backwards in the provision of health care. The burden is on the hon. Gentleman to explain why he wants the health service to take that gigantic step backwards.

Does not the Government's version of fundholding introduce elements of competition which undermine the principle of universality? Is not that principle founded on an injunction of 2,000 years ago, to bear each other's burdens? When will the Government put that into practice in the health service in the next millennium?

It is extraordinary that, when we introduce a scheme that improves care for the patients of fundholding doctors and which the majority of Britain's GPs adopt because they believe that it is in the interests of their patients, Labour's reaction is to want to abolish the scheme that has made those improvements possible. I simply fail to understand how the Labour party can say that the right way forward for the health service is to abolish a scheme that has brought about the improvements to which my hon. Friend the Member for Brigg and Cleethorpes (Mr. Brown) referred.

My right hon. Friend will be aware that, in Lancaster, all doctors have fundholding practices. Does he agree that, if the system were abolished, patient care in north-west Lancashire would be severely affected—and would be a lot worse?

My hon. Friend is entirely right. In his constituency, in Lancashire, and around the country, fundholding is delivering improved patient care not only to the patients of fundholding GPs, but to every patient of the health service, because it has changed the relationship between primary and secondary care, to the advantage of primary care.

As the system created as a result of the Government's reforms unfairly allocates money to GPs depending on whether they are fundholders and has produced a two-tier service for patients depending on whether their doctors are fundholders, will the Government modify it, which fundholders would willingly accept, so that, no matter which GP people go to, they have equal access to the health service, or will the Secretary of State go into the election defending a two-tier health service which is a national health lottery for Britain's patients?

I am going into the general election campaign defending a system of totally fair funding across all parts of the NHS—whether GP fundholders or not. I take it as significant that, on this question about fundholding, the hon. Member for Islington, South and Finsbury and all his hon. Friends have remained firmly seated. They are not prepared to engage in the argument about fundholding in Britain, because they know that they are on a loser.

Is my right hon. Friend aware that there is tremendous public support for GP fundholding in my constituency? Will he confirm that the Labour party's policies are contrary to the health needs of my constituents, and will work against them in the long term?

Once again, my hon. Friend is right. He highlights the fact that the Labour party adopts only policies that would impose a single bureaucracy across the entire country. The idea that there may be advantage in different approaches in different localities, reflecting the different choices of GPs and their patients, is utterly foreign to the Labour party. It will never win the argument, and is no longer even prepared to engage in it.

To ask the Secretary of State for Health what plans he has for use of the private sector in clinical services in the NHS. [19165]

To ask the Secretary of State for Health if he will make a statement on the use of the private finance initiative in respect of clinical services in the NHS. [19173]

The private finance initiative in the national health service is concerned with the provision of modern and efficient facilities for the delivery of NHS health care. It is not concerned with the transfer of NHS clinical services to the private sector.

How can the people of Britain believe the Secretary of State when they look at the PFI contract for the Royal Hallamshire extension in Sheffield, which includes the privatisation of radiology and pathology services? Do not they, like Opposition Members, know that the Tories cannot be trusted on the NHS? All Tories want is to get as much of it into the private sector as possible.

The hon. Lady will no doubt keep repeating the mantra, but she will cut no ice. People know that, over the past 18 years, we have delivered a broader range of high-quality care to all patients who need it. That is the commitment that the Conservative party has delivered, about which the Labour party is content only to talk.

Does not the Minister understand that, despite the secrecy about clinical services, the creeping privatisation is well known to people in the country? Once again, no reassurance has been given today that a future Conservative Government—heaven forbid—would not take the opportunity to privatise. Does he not understand that people know that, over the past 18 years, the Government have looted the wealth of those who created it and intend, through the internal market, to loot the health of public services by introducing private services? Will he try at least to give a positive answer instead of the same old corny comments on clinical services that he has given up to now?

The hon. Gentleman's slightly convoluted question might be clearer if he sought to explain the Labour party's policy on the hospital building programme to his constituents and people throughout the country. What the Government have set out is crystal clear. We have launched the PFI, which holds the prospect of long-needed hospital building programmes in Norwich, Dartford, Bishop Auckland, north Durham, Worcester, Calderdale, Bromley, Hereford and Carlisle. Labour's Front Benchers must explain to the people why they would put all those projects on hold.

Is my right hon. Friend aware that even the more socialist countries in the European Union allow and encourage independent health care organisations to supplement the statutory authorities' expenditure on health? Statistics on the proportion of gross domestic product spent on health show that we spend the same as other countries in the public sector; the extra that enables them to boast that they spend more than us is made up by independent care organisations, which are rejected by the Opposition.

My hon. Friend is right about the arithmetic. It is also worth reflecting on the point that British citizens have exactly the same opportunity to obtain private health care insurance as citizens of other countries, but a smaller proportion of the British find it necessary to do so because the national health service commands a confidence that comparable organisations elsewhere do not. The reality is that the British national health service is the world's most efficient health care system. An endorsement of that principle from the Opposition occasionally would make a welcome change.

Is my right hon. Friend aware that the trade union Unison is wholly opposed to the private finance initiative in the NHS? Given the pecuniary relationship between that union and the offices of Labour Front Benchers, what credence does he give to the claim by the hon. Member for Islington, South and Finsbury (Mr. Smith) that he wants to speed up the PFI in health care?

The Opposition cannot work out their attitude to the PFI in health care. They say they want to speed it up; they also describe it as the privatisation initiative. We have heard this afternoon the Opposition's visceral suspicion of any suggestion that private capital and management can reinforce the delivery of NHS objectives. They oppose it before they hear the arguments. That is why the Government and the Conservative party, re-elected in the next Parliament, will deliver improvements in the national health service that the Labour party could never dream of.

Why does the Secretary of State not have the honesty to admit that the Tory agenda is a piece-by-piece privatisation of the national health service? Will he now confirm what he failed to say a few minutes ago—that, at the Royal Hallamshire hospital in Sheffield, radiology and pathology will be put out to the private sector? He and his colleagues have consistently refused to give a guarantee that they will not privatise clinical services. Will he give such a guarantee now? If he will not, and if the Tories are elected again, we will not have a national health service in five years' time.

That beggars belief. I gave the hon. Gentleman due warning, and he still comes to the Dispatch Box and calls the PFI privatisation. The last time he mentioned the subject, he said that Labour promised to speed up PFI deals. Now he calls it privatisation. The hon. Gentleman must sort out his ideas—and he does not have long in which to do so.

Does my right hon. Friend agree that it is staggering that two of the first three questions tabled by Opposition Members relate to complaints about the private sector? Does he agree that that says something about their priorities? The right priorities for the national health service are patient care, standards, and more money, which we will deliver.

My hon. Friend is right on every count. We have the commitment to deliver a growing health service, which the Labour party will not match. We have the commitment to deliver a properly managed health service, which the Labour party will not match. We also have the commitment to deliver quality of care to patients, which the Labour party regards as a boring detail.

To ask the Secretary of State for Health if he will make a statement on provision for mental health patients. [19166]

A range of policy initiatives have been taken that should enable health authorities, in conjunction with other agencies, to provide a comprehensive service for patients with mental health problems.

I thank the Minister for that response, but does he not accept that there is still work to be done centrally, to gain a better understanding of the needs of the nation and to plan strategy accordingly, and that part of that strategy must include a recognition of the need for more improvement in mental health care for children and adolescents?

I am grateful to the hon. Gentleman for that question. Yes, of course the Government and all in the national health service are determined to enhance and further to improve mental health provision for adults and children. As he will be aware, several initiatives designed further to enhance that care have been taken over the past few years. We are not complacent; we shall continue with that work. As for the treatment of adults with severe mental health problems, last month my right hon. Friend the Secretary of State published a Green Paper, to explore the options for moving forward to further improvement in the service.

About a month ago I went to a mental health seminar in Preston, where I was impressed by an initiative that has been taken up by one of the trusts to the west of my constituency, which I hope will be taken up in my constituency, too—a mental health helpline. As my hon. Friend will know, people who need help with mental health problems often need it at unsocial hours, not just between nine and five. Will he congratulate the people who volunteer to give guidance via the helpline, and encourage other trusts to take up such initiatives?

I am grateful to my hon. Friend for drawing to the attention of the House what sounds like an excellent idea—providing support and making available through the helpline counselling, advice and help for those in crisis and their families. I strongly recommend other health authorities and trusts to consider that example, and to see what lessons can be learned so as further to enhance support for the families of those suffering from mental illness.

To ask the Secretary of State for Health how many patients in the Manchester area have been waiting longer than 12 months for hospital admission. [19167]

Provisional figures show that, on 31 December 1996, 384 people resident in the Manchester health authority area had been waiting more than 12 months for admission to hospital.

I thank the Minister for that reply, but I was asking about current figures rather than those for last December. May I tell him that, for the North Manchester hospital alone, 180 people have been waiting longer than 12 months for admission? Further compounding the problem, the equivalent of almost two wards in that hospital are bed-blocked because social services cannot accommodate the patients outside the hospital. As a result, 913 consultant episodes concerning patients who need attention have not taken place.

If the hon. Gentleman is concerned about bed-blocking, he should take his complaint to the Manchester local authority, which is in the firing line when it comes to doing something effective about it. Over the past few months, my right hon. Friend the Secretary of State has helped with measures specifically designed to reduce bed blocking, so I am surprised that Manchester has not done a better job.

Will not waiting lists in Manchester, at hospitals such as the Christie, be considerably helped by the building of the £5.8 million cancer unit at the Royal Preston, which will do a great deal to provide facilities for people in Preston? That will avoid their having to go to the Christie in Manchester, thereby improving the situation of patients both in Manchester and in Preston.

I am delighted that my right hon. Friend made that point. We are hearing a great deal about Lancashire today, and with good reason. Not only is a Caiman cancer unit being developed at Preston and Chorley; there are others at Blackburn and Burnley, Blackpool, Lancaster, and Kendal and Barrow. All represent new initiatives and are part of a clear programme to deal with cancer problems. I am delighted that Lancashire is taking the lead.

Will the Minister confirm that the Manchester figures are not unique, and that more than 1 million people are on hospital waiting lists nationally? That figure is increasing and it is the highest we have ever had. The health authority in Manchester has a current deficit of £1.2 million. We assume that that has be found from next year's budget, which will mean even longer waiting lists in Manchester. Is that not further evidence of the mess and turmoil that the Government have created in the national health service, and one of the many reasons why they should not be elected for a fifth term?

On the contrary, it is an extremely good reason why we should remain in power. Waiting times have improved: the average wait is down from nine months to four months. When Labour was last in power in 1979, one in four people had to wait more than 12 months. That figure is now down to one in 50 people. In 1979, 25 per cent. waited for more than 12 months, whereas, under the Government, the figure is now only 2 per cent.

To ask the Secretary of State for Health what plans he has to visit the Royal National Orthopaedic hospital, Stanmore, to discuss the future major development plans. [19168]

I shall be having a meeting shortly with the chairman and chief executive of the Royal National Orthopaedic hospital trust, which is working up a business case for the redevelopment of the hospital.

I thank my hon. Friend for the thoughtful way in which he has responded to the many submissions on the hospital's future that have been made in recent months and, indeed, years. I shall also be present at that meeting on Tuesday at 4 o'clock. The overwhelming opinion—local and wider opinion—is in favour of the hospital remaining on the same site. To allow the necessary funding to be made available in the future and to ensure that the excess of old buildings is reduced and that the modern footprint and curtilage is properly paid for, will he ensure that the regional health authority speeds up its authorisation decisions to get that money under way?

I am interested in what my hon. Friend says, and I look forward to that meeting. The business case is at a fairly early stage. I am conscious of the orthopaedic hospital's extraordinary record over many years. About 30 or 40 per cent. of all the orthopaedic surgeons in the country have been trained at the Stanmore hospital at one time or another. I am sure that my hon. Friend, who strongly supports the hospital, is very proud of that record.

To ask the Secretary of State for Health if he will make a statement on the rehabilitation services provided for the elderly. [19169]

New arrangements for national health service responsibilities for continuing health care, which includes rehabilitation and recovery services, were introduced in April 1996. Since that date, all health authorities have been required to have in place local policies and eligibility criteria for continuing health care.

Does the Minister agree that the Government have failed elderly patients by closing thousands of NHS beds for the elderly and by not, in spite of what he says, providing the convalescent and recuperative care beds required to allow people to stay in hospital until they are strong enough to return to their own homes? Does he also agree that the Government have turned the care of the elderly into a competitive marketplace, and have put price and profit before decency and dignity in old age?

No, I do not agree with a word of what the hon. Lady has said, because it is totally divorced from the truth. She seems to forget that the continuing care challenge fund has provided £16 million in the current year, and will next year provide £20 million, plus £40 million of matching funds from local and health authorities, including £11 million for rehabilitation and recovery services. The gimmick that the Labour party has announced in the past month on recuperation is ridiculous. It proposes a pilot scheme costing £500,000, which is the amount that my right hon. Friend the Secretary of State is giving, through the continuing care fund, to the constituency and health authority area of the right hon. Member for Sedgefield (Mr. Blair). That excludes the rest of the country, which will receive the other money.

Would not more resources be available for rehabilitation services and care in the community if local councils, especially those controlled by the Labour party, were prepared to make more use of private residential homes, rather than boost bed usage in their own homes? That costs the taxpayer a lot of money, which could be better used to provide care for more elderly people in the community.

My hon. Friend is right. It has been shown that, on average, a place per person per week in a local authority-owned home in England costs £40 more than a place in the private sector. It seems odd that the Labour party is so antagonistic towards getting better value for money while providing the highest quality of care for the elderly, so that more money can be saved and ploughed back into care for the elderly.

Does the Minister accept that 9,000 NHS beds for elderly people have been lost since 1990—beds for nursing care, rehabilitation and convalescence? Are not old people in need of care simply seen as bed blockers by hospitals driven to maximise their business income? How can this Government, who have abandoned health care for old people to the market, be trusted with the NHS for a fifth term of office?

The hon. Lady seems to be divorced from reality. The Government's policy is being implemented day in, day out—despite the smiles of the hon. Member for Rother Valley (Mr. Barron), who should realise that this is not a funny subject. Care for the elderly is at the highest level possible and record amounts of money are being spent. It is time local authorities—which are mostly Labour-controlled—started to work with health authorities in using the continuity care challenge fund money to undo the problems of bed blocking and finding proper care for the elderly, who deserve it.

To ask the Secretary of State for Health if he will make a statement on his plans to improve patient care in the NHS. [19171]

Over the next five years, my right hon. Friend the Prime Minister has pledged that we shall increase the real resources available to the national health service year on year on year on year on year. We challenge Labour to match that pledge.

The House must warmly welcome the commitment given by the present Conservative Government to increase spending for every year of the next Parliament if they are re-elected. Does my right hon. Friend agree that it is not just the amount of money spent on health care that is important—we spend a great deal— but the level of service provided? That service has made the United Kingdom national health service the very best in the world. The Opposition have failed to match our pledge on resources, and they would fail to deliver the best service in the world as well.

My hon. Friend is right. It is not simply a pledge year on year on year on year on year through the next Parliament. It is the 18 years since 1979—I will not say it 18 times—in which the Government have increased the resources available to the NHS year on year. We have delivered a growing NHS, and a wider range of care is available to patients. More patients are being treated and better-quality care is being provided. That is the Government's record on the NHS and we are pledged to project it through the five years of the next Parliament. The problem that the hon. Member for Islington, South and Finsbury (Mr. Smith) has with Mr. Charlie Whelan is that the hon. Gentleman is unable to match the pledge that my right hon. Friend the Prime Minister has given for the next five years.

Is the Secretary of State aware that plans for patient care at the North Staffordshire hospital trust have been brought into question by the resignation of the chief executive, Mr. Stuart Gray? The reasons for that resignation are clouded in secrecy. Will the right hon. Gentleman institute an urgent investigation into that departure in the public interest, so that the real reasons can be established?

Changes in trust management are matters handled in the first instance by the trust's board. What the hon. Gentleman has to explain to the citizens of north Staffordshire—as all Labour Members must explain to their constituents—is how Labour can even begin to talk about support for the NHS when it is not prepared to match its words with real commitments. The Conservative party has shown real commitment in action. The last Government to cut the resources available to the national health service was the Labour Government between 1974 and 1979. Health resources in 1979 were lower than in 1976. The Labour party must explain its record and explain how it turns its words into action.

Does my right hon. Friend accept that one of the best ways of improving patient care is by increasing the number of general practices that are fundholding? What does he make of the remarks of the hon. Member for Islington, South and Finsbury (Mr. Smith) on one day that he would abolish fundholders and on the next, to a different newspaper, that he would not? Which Mr. Smith should we believe—or do they both have Sun-stroke?

Unfortunately for Britain's patients, but fortunately for the Conservative party, the hon. Member for Islington, South and Finsbury (Mr. Smith) has since made it clear which of those policies he supports: a Labour Government would abolish fundholding. Because Labour is committed to the abolition of a scheme that has delivered real improvements to patients, the question about how to deliver real improvements to the patients of the national health service can have only one answer: re-elect a Conservative Government.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 March. [19191]

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.

The Prime Minister yesterday made the uniquely personal decision not only to have a general election on 1 May and to dissolve Parliament on 8 April but that Parliament should be prorogued and sent away this Friday. [Interruption.] Is it not obvious that one of the reasons for that decision and for the unprecedented gap between prorogation and dissolution is that— [Interruption.]

Order. This is so time-consuming. Come on, Mr. Hughes: spit it out.

rose—[Interruption.]

Order. There is no point in waiting for silence: the hon. Gentleman will not get silence. Produce your voice, Mr. Hughes.

One of the reasons for that decision is that the Prime Minister knows that the report of the Parliamentary Commissioner for Standards on cash for questions will be ready on Monday or Tuesday. That report will therefore not be seen by hon. Members in this Parliament and will be hidden until after the general election.

One of the reasons for making the announcement on Monday and arranging for Parliament to be prorogued on Friday was to give the hon. Gentleman time to finish his question. As for Sir Gordon's report, I have no knowledge when it will be presented.

Following his successful visit this morning to the headquarters of the McLaren formula 1 team in my constituency, does my right hon. Friend agree that what counts is not who is ahead at the first corner, but who has the skill, expertise, stamina and nerve to see the race right through to the winning post?

I entirely agree with my right hon. Friend. The purpose of going to see the McLaren team was rather wider than that. I wanted to draw attention to a tremendous British success story, of which there are many. McLaren and the British motor industry have been a huge success. Of the 20-odd cars that lined up at Melbourne for the grand prix won by David Coulthard, 20 would have been built in the United Kingdom.

Does the Prime Minister agree that a situation where two thirds of health authorities and one third of hospital trusts are in deficit to the tune of £300 million is grave, and potentially disastrous for many parts of the national health service?

I find it odd for the right hon. Gentleman to talk about funding in the health service, since he has declined to increase funding, whereas we have given a commitment to do so. In any event, the figures that he uses are blown out of all proportion. The forecast deficit is a relatively small fraction of the national health service budget and, of course, in less than two weeks' time, funding for the national health service will rise by £1.6 billion, a multiple of the deficit to which the right hon. Gentleman refers.

Is the Prime Minister aware that many health authorities have deficits this year that will not be met by real-terms growth next year? To give one example, in north Essex, the deficit is £10 million and the real-terms growth that he is promising is only £9 million. He is not keeping the promise that he says he is making. He may believe that this is a matter of no account whatever, but is he aware that non-emergency surgery is being cancelled up and down the country, that accident and emergency departments are closing, that waiting lists are up and that there are bed and staff shortages in many parts of the national health service? Is that not a real tragedy, and disgraceful handling of the NHS?

Some time ago, the answer to the question whether the NHS was working was set out by the shadow Foreign Secretary as whether more people were treated, and treated well. Since then, an extra 1 million people are being treated, and treated well, in the NHS. The number of consultants in accident and emergency departments has risen by 40 per cent. over the past few years. The right hon. Gentleman does not mention that. He does not mention the fact that we have committed increased resources over and above inflation to the national health service every year since 1979, and will do so throughout the period of the next Parliament. That is a record that would not have been met by any previous Government, and cannot be met by any other Government, because they would not have delivered the growth in the economy that we have achieved.

The contrast is between the Prime Minister's complacency and what people know is happening in the national health service the length and breadth of this country. Is it not the case that in, the past six years, there has been an increase in administration costs of more than £1.5 billion a year, with 20,000 more managers and 50,000 fewer nurses? Is not the truth that the real challenge of the national health service is how to get money out of invoices, contractors, managers, company cars and pen-pushers and into front-line patient care so that we can rebuild the national health service that the Labour party created?

There are elements of what the right hon. Gentleman had to say with which I would agree. That is why we support compulsory competitive tendering, which he does not support; that is why we cut a whole tier of management that he voted to keep; that is why we have cut management costs by 10 per cent., £340 million, in the past two years. He cannot do that.

When my right hon. Friend comes to choose his new Cabinet on 2 May—[Interruption.] Listen to the page three boys shriek, Madam Speaker. I remember when they were shrieking in Sheffield the week before the last general election. I should like to hear them shriek after this election, every single one of them. What would my right hon. Friend say if all that he had to choose from after the election was a group of failed teachers, a bunch of ex-trade union officials, one television director and a bar steward? That is all that the right hon. Member for Sedgefield (Mr. Blair) has to choose from.

I think that it would be a kindness to protect the right hon. Gentleman from ever having to make such a choice. Who is meant by the bar steward, I cannot imagine.

To ask the Prime Minister if he will list his official engagements for Tuesday 18 March. [19192]

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

How did the Prime Minister have the audacity at the weekend to tell Tory central council that his type of Conservatism aimed to help the struggling classes—the have-nots? In 18 years of Tory rule, what did his Tory party ever do for the homeless, the sick and the disabled? The Prime Minister is not only past his sell-by date, he is well beyond his use-by date. It is time he went.

The hon. Gentleman is unusually animated on this occasion, for reasons that I do not understand. I suggest that he asks the millions of council tenants who would never have become home owners but for the activities of the Conservative Government or the millions of people who now have savings, shares and pensions that are owned by them rather than held by a Labour Government, as they were in the past, on their behalf. We believe that, in the late 1990s, people should have the right to personal ownership for themselves and their families, and that is what we are building. We apply that to everyone, not just middle-income earners such as the hon. Gentleman.

Did my right hon. Friend see the reports at the weekend that 40,000 people took to the streets of Paris to protest against the rising tide of European unemployment? Can he explain to the House why the same thing has not happened here and what will be the quickest way of making it happen here?

I saw that, and I have also seen the trend in unemployment in many countries across Europe. The Labour party is keen that we should sign up to a 48-hour week, the minimum wage and the social chapter. Perhaps Labour Members should hear what the United States Chamber of Commerce had to say about the 48-hour week. It has just told the Irish Government:

"It is no exaggeration to say"

"the single most negative change in the last 20 years."

To ask the Prime Minister what plans he has to pay an official visit to a London NHS hospital to discuss the operation of casualty units. [19193]

We have made an extensive investment in recent years in London's accident and emergency services as part of a £400 million capital investment to provide the highest-quality and up-to-date facilities. I hope to have the opportunity to see some of them before too long.

When the Prime Minister finally gets around to visiting a casualty unit in a London hospital, what answer will he give to staff who have seen one in seven of all the acute beds in London lost, 12 of the 46 casualty units closed, huge waiting lists, people waiting on trolleys, loss of morale among staff and the recent resignation of the consultant in charge of the casualty unit at Queen Mary's University hospital, Roehampton, who left because he could no longer run it within the budget provided and did not feel that he was giving people a decent service? Is that not the reason why nobody trusts him and his Government on the future of the national health service and will accordingly vote him out?

I think that the first advice that I would give them is not to vote Labour, because they are getting more money from this Government than they would from any putative Labour Government. I would tell them that the number of consultants in A and E departments has risen dramatically by 40 per cent. I would tell them that the number of nurses appointed had risen by 21 per cent. I would tell them that more patients are being treated. I would tell them that the hon. Gentleman is living proof that old Labour lives, because, while the Labour Front Benchers are saying that they will not raise taxes, he is saying:

"What … many"—

"have been talking about is the need to raise taxation for the above average income people in order to pay for the rest. I see a moral justification for that and I think it is the right thing to do."