Pursuant to the letter from the Minister for Public Health (POH/3/5437/23) of 14 December 1997 on drug—resistant tuberculosis, what response Her Majesty's Government have had to its recommendation that while all patients should be closely supervised throughout their treatment, fully directly observed therapy is essential for those who are, or are suspected to be, poorly compliant with treatment, and for those with drug—resistant disease. [23413]

The Government have consulted widely on the best means to ensure effective treatment for people suffering from TB and particularly for vulnerable groups suffering from multiple drug-resistant TB. Both the interdepartmental working group on TB and the British Thoracic Society support the view adopted by the Government that directly observed therapy should be provided early in cases of patients suffering from drug-resistant TB where the patient is, for whatever reason, poorly compliant with treatment.

Why are we not supporting universal directly observed therapy for TB?

Ultimately, the judgment on whether therapy for people suffering from drug-resistant TB is provided is for the clinician. Clinicians decide whether treatment should be provided in this way.

If he will make a statement on new hospital provisions in the area of the Wakefield health authority, with particular reference to maternity services. [23414]

I understand that Wakefield health authority is consulting local people about proposals to reshape acute and maternity services. As the issue may be referred to Ministers for decision, I am sure that my hon. Friend will appreciate that it would be inappropriate for me to comment at this stage.

I thank my hon. Friend for that reply. As he knows, my constituents' major concern is the suggested closure of the maternity unit at Pinderfields hospital in my constituency. It is a first-class unit, highly efficient and most secure. It can offer a back-up service to any mother or child in danger or with problems. Does the Minister accept that there is much concern, especially in my constituency, but generally throughout the Wakefield area, about the threatened closure? Does he accept that there is a fair amount of unjust concern in respect of the health authority and major concern among my constituents? Will he visit the unit to see for himself its efficiency and the way in which it helps people? I have witnessed that, and I would like him to join me in experiencing it.

Any invitation to visit my hon. Friend's constituency is almost irresistible. I will certainly look at my timetable to see how we can accommodate his helpful suggestion. He is a doughty fighter for the NHS in his constituency. He understands that, in considering anything that comes to us from the health authority, we will ensure that his constituency and its surrounding area enjoy a high-quality, up-to-date NHS providing in a modern and responsive setting the treatment to which his constituents are entitled. He has my warm assurance on that.

If he will make a statement on the future of the pharmaceutical price regulation scheme. [23415]

The present pharmaceutical price regulation scheme ends in September this year. We are considering what the future arrangements should be. Our twin aims will be to keep down the cost of drugs for the NHS while helping to sustain the international success of the British pharmaceutical industry.

Does the Secretary of State intend that the renegotiation be completed, and the revised arrangements be in place, by October?

It is our intention—we may not succeed, but it is our intention.

Community pharmacists who serve neighbourhoods in my constituency are under threat from applications to site pharmacies in out-of-town supermarkets. If such applications succeed, those community pharmacies will go out of business and, if they do, many people without cars in those neighbourhoods will be disadvantaged, especially the elderly and lone parents. Will my right hon. Friend please look into the problem and try to help community pharmacists to withstand that threat?

We are certainly aware of the problem, but there is a balance to be struck. We want to retain as many local community pharmacists as possible and to encourage trained pharmacists to make a greater contribution to the national health service than they are making at present.

This is all waffle—the Secretary of State should look at his Government's Competition Bill.

If the hon. Member for South Dorset (Mr. Bruce) shuts up for a minute and listens, he will hear me say that there are substantial numbers of people who find it convenient to obtain the drugs they want when visiting the supermarket. The balance is one between two different types of convenience and it will have to be struck.

I appreciate that the Secretary of State wants to defend the pharmaceutical industry, but he must also bear in mind the fact that some of the supermarkets might pick and choose the type of drugs they want to sell, which would endanger the overall spread throughout the country. Will he bear that in mind when making his evaluation?

I will certainly bear in mind those very points, because they are the points that we have been making in our discussions with the various interested parties. However, as I said, there is a balance to be struck. We want to maximise the convenience of all potential users of pharmacies, and to encourage and extend the contribution that trained pharmacists can make. At the moment, I do not think that they are getting a great deal of job satisfaction out of some of their work and we are not getting a return on the substantial investment in their lengthy training.

What proposals he has to improve staff morale in the NHS. [23416]

The election of a Labour Government committed to the national health service that we founded was a great start in raising morale in the NHS. Since being elected, we have—unlike the previous Government—listened to the people working in the NHS. Their views and experience are reflected in the proposals in our White Paper, "The New NHS", which will make the NHS modern and dependable. Working with staff, we are combating assaults on staff, introducing family-friendly employment policies, combating racism and promoting health and safety at work. We have also lifted the gagging clauses on staff which were imposed under the previous Government.

Is my right hon. Friend aware that staff morale in my local health authority has been immensely improved this winter, due to the £1.6 million that the Government found for local health services? In Kettering, we have benefited from £93,000 for the expanded intensive care unit, which I had the great pleasure of formally opening the other week; £35,000 for extra staff in accident and emergency; £35,000 for the medical assessment unit; and £56,000 for the surgical assessment unit. Those are all positive developments which have affected staff morale in my local hospital. Will my right hon. Friend tell the House in what ways he will further involve local staff in all decision-making processes within the local health authority and the NHS?

I should start by paying tribute to all the hard work done by people working in the NHS in maintaining services during the Christmas and new year period and during this period, as winter pressures build up. We are determined to ensure that the staff working in the health service—the people who have developed a vast amount of precious experience—have their say in how things go on in future. That is why we are to establish a new task force to look at how to improve staff involvement, drawing on the direct experience of people currently working in the health service and also, quite properly, drawing on the experience of other, private sector businesses which have a good success rate in staff involvement.

What does the Secretary of State believe the effect on staff morale at the Whittington hospital in North London has been following the publication in last Saturday's Daily Mail of an article headed:

"How the NHS betrayed my Mum"?

It is nothing of the sort—and the chairman's post has been filled.

Is my right hon. Friend aware that staff morale has improved a great deal since the Labour victory on 1 May? However, all those in the national health service feel better when everyone is pulling their weight. Is my right hon. Friend aware that there is increasing discontent among staff and patients about the fact that doctors who are supposed to be national health service consultants spend far too much time—more than their contract allows—doing private work? That means a long wait for those whom they should be treating in the national health service.

It is certainly the case that the previous Government introduced what they called a full-time contract for consultants, which allowed them to work less than full time in the national health service.

The pressures on the health service—there are longer waiting times, and it was reported today that 10 per cent. of patients had waited for four hours on trolleys in accident and emergency—reflect the staff shortage that the Secretary of State knows exists. We are talking about 8,000 nurses, 1,500 hospital doctors and 1,000 GPs. Will the right hon. Gentleman tell the House that his Department, he as Secretary of State and the Government will, in the near future, take the one step that, more than anything else, will guarantee good morale in the health service? Will they accept, in full and without phasing, the recommendations of the pay review bodies, so that the NHS can get back to work and do its job, and so that doctors and nurses do not lose theirs?

The hon. Gentleman does not know what is in those recommendations, and he does not know what the Government's response will be. No one would wish to play down the significance of people's pay in relation to their morale, but—as staff tell me time and again—there are other important considerations, and we are addressing those important considerations.

Is my right hon. Friend aware that the casualty watch survey, to which the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) referred, got it wrong about the four patients in Halifax? They had not waited 17 to 24 hours. They were in an assessment unit in proper beds, being treated by proper nurses and proper doctors. The community health council has now admitted that it was wrong.

My hon. Friend refers to inaccuracies in the report relating to Halifax. We take any reports of such happenings extremely seriously. I have made it my business to investigate them all. One of those to which the British Broadcasting Corporation gave great publicity this morning referred to someone who, the BBC claimed, had waited 65 hours on a trolley at East Surrey hospital. That woman had come off an aircraft at Gatwick. She was believed to be suffering from malaria and was put in a separate room, which happened to be in the accident and emergency department, because it was believed by the people running the hospital that that was the best place for her to be isolated from the rest of the patients—to protect the patients and her. I do not know whether the BBC has given similar publicity to acknowledging that it was wrong.

With reference to the reply that the Secretary of State gave the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) some moments ago, does the right hon. Gentleman realise that when ward nurses compare their salary with his, they will be profoundly insulted? If he wants his earlier replies to be taken seriously, the one step that he could take today to improve morale in the national health service would be to respond to the call made last week by the Royal College of Nursing to accept the recommendations of the independent review group, when they come, as they were accepted by the previous Government. Does the right hon. Gentleman agree that such an assurance should be given today, or when it comes to nurses' pay, is it all generalities and humour?

When it comes to staging pay increases, the Tories are old stagers. They have been doing it for years. I do respond to certain calls from the Royal College of Nursing. The first speech that I made in this job to the RCN annual conference made it clear that we would abandon the previous Government's crackpot arrangement whereby there was a national agreement, and then staff and management had to negotiate about whether the staff would get 0.8 or 1.1 per cent. in a local agreement. That was a waste and totally stupid, as everyone had told the previous Government. We got rid of the arrangement, which is why I got a standing ovation at the RCN annual conference.

What is the current trend in hospital waiting lists. [23417]

If he will make a statement on progress in reducing hospital waiting lists. [23421]

As I have said before, the Government will ensure that by the end of this Parliament, hospital waiting lists are shorter than the record levels that we inherited from the previous Government—record levels that were rising faster than at any time in the 1990s.

My question was a short one, and that was not the answer to it. The right hon. Gentleman and his team hit the ground running when they took over the Department of Health, but surely he has realised by now that he is running in the opposite direction to the one in which he said he would go. Waiting lists are going up to record levels, and we had a report overnight about what was happening in accident and emergency departments, even though there is no flu epidemic as there was last year. The right hon. Gentleman has announced in the past week that he wants more people to go back into mental hospitals, and that he wants abortions to become easier, but he does not have the money needed because of the inflation that his Government have caused. What will he do about bringing down waiting lists now, not in five years' time?

I apologise to the hon. Gentleman if I did not refer to "the current trend" in waiting lists. I thought that I had explained that we inherited a record level, and that waiting lists were then rising faster than they had ever risen before. They are no longer rising faster than they have ever risen before. As I have said to the hon. Gentleman before, waiting lists are like a supertanker: it takes time to slow down the increase, it will take longer to stop it, and it will take even longer to turn waiting lists round, but turn them round we will.

May I remind the Secretary of State of the Labour party manifesto, which included the very simple promise:

"We will … End waiting for cancer surgery."?

I will not apologise for any of the things that the hon. Gentleman mentioned, and I certainly will not apologise for abandoning the eighth round of GP fundholding and transferring the £20 million that the previous Government had earmarked for the bureaucracy of fundholding, or for diverting £10 million into improved breast cancer treatment for women and £5 million into improved children's intensive care.

On the question of tackling waiting lists, will my right hon. Friend and his team accept the thanks of my constituents for the part that they played in progressing the planning process affecting the future of Wharfedale general hospital? However, will they acknowledge the increasing anger of local people at the way in which services at the hospital are being run down, including the proposed withdrawal of 60 acute beds? Will my right hon. Friend and his team do their utmost to ensure that Wharfedale general hospital continues to be a genuine general hospital, providing a wide range of services to the surrounding communities?

As my hon. Friend knows, I met a delegation from the Wharfedale general hospital recently. Although I am not supposed to issue edicts about the future of hospitals from the Dispatch Box, I think that I can safely say that it is unimaginable that that hospital should cease to be in Otley and cease to provide a wide range of services for local people. Those who are putting around stories to the contrary are misleading the local people.

Does my right hon. Friend agree that we should not keep it a secret that his Minister of State has a 40th birthday today? I am sure that the House will join me in congratulating him on his birthday.

I can confirm that my hon. Friend's figures for the extra funds that have been found for Dorset are as accurate as her recognition of the 40th birthday of my hon. Friend the Minister of State.

I join in congratulating the Minister on his birthday. I think that it makes him 10 years younger than the health service. I wish that I could say the same of myself.

I certainly received the report of the Turnberg review. I have been discussing it with my colleagues and hope shortly to publish both the report and our considered response to it.

Is not it the truth that the Turnberg committee was set up to resolve the Bart's problem and that it has not done so? It has not given the Secretary of State a convenient solution, so he will have to make up his own mind about it, but, because he is having great difficulty in making up his own mind, he dare not publish the report. May I remind him, while he is thinking about the Turnberg report, that when he set up the committee, he promised a moratorium on further rundowns and closures of London hospitals? Since then, Queen Mary's University hospital, Roehampton, and Edgware Community hospital have been run down to the point where they have effectively been closed as district general hospitals. How many more London hospitals do the Government propose to close?

As I wrote that policy commitment, I can tell the hon. Gentleman that we promised that there would be no hospital closures during the Turnberg review. There have been no hospital closures. I have read the Turnberg report and I have a good idea of the Government's response to it, but all I can say to the hon. Gentleman and his eager colleagues is watch this space.

What proposals he has for tackling prescription fraud in the NHS. [23418]

On 7 January, I announced a comprehensive programme of action, which includes plans to create a specific criminal offence of prescription charge evasion, improvements to prescription form security, the establishment of a hotline and internet websites for reporting suspected fraud and the forthcoming appointment of a fraud supremo to spearhead this initiative.

I thank the Minister for that reply. Is he aware that the national health service loses £90 million to £100 million a year through prescription fraud and that had the NHS had access to those funds, it could have carried out something like 14,500 heart bypass operations, 68,900 cataract operations or 22,200 hip operations? To put that in a local context, my local health authority, Bury and Rochdale, did not spend anything like £100 million on setting up a health aid line for patients. Does he agree that those who are defrauding the system represent a tiny minority and that the vast majority of health workers, doctors and pharmacists are doing a sterling, honest and realistic job and deserve our help and support?

My hon. Friend is absolutely right about the scale of the problem which is cheating the national health service of some £100 million every year. He is also right to say that the overwhelming majority of patients and NHS professionals are decent, law-abiding citizens who are simply doing an honest job. That is why we are determined to bear down on the few rotten apples who are not. Their activities not only defraud the taxpayer, but rob patients of resources that they deserve.

Does the Minister agree that one of the ingredients for tackling fraud, especially prescription fraud in the NHS, is to have a thriving chain of community pharmacies? Will he give the House an assurance that his Department will consider a remuneration package for community pharmacists to replace the threatened abolition of retail price maintenance in respect of over-the-counter medicines?

In addition to their role in dispensing medicines, community pharmacists have an important role to play—for example, in helping to crack down on prescription fraud. That is why we are entering negotiations with the pharmacy profession on introducing a new scheme whereby pharmacists are rewarded appropriately when they spot counterfeit or stolen prescription forms. We want to enhance their role in that and other respects.

I am sure that the Minister will agree that a simplified prescribing system would enable us all to crack down on prescription fraud. At the moment, those who benefit from free prescriptions in one area of medicine are able to do so in others. In other words, someone who requires one life-saving medicine can claim all prescriptions free, irrespective of his or her income. How much does that cost the national health service in a year?

I do not have the figure, but I am happy to write to the hon. Gentleman. The current system of prescription charge exemption is extremely complex and, in some cases, difficult to understand. The hon. Gentleman will be aware that, as part of the comprehensive spending review, we are considering how we can make the system easier to understand and simpler to administer. In addition, later this year, we shall be launching a major publicity campaign to try to get across the message to patients—who sometimes simply get it wrong—about who is exempt and who is not. In the meantime, the Government will not stand back idly and allow those who are defrauding the system to get away with it. They are cheating the system and robbing taxpayers and patients of money that should be going into patient care.

Would the introduction of a national identity card scheme help to root out fraud?

Following the efficiency scrutiny report on prescription fraud, we accepted that patients who turn up and claim an exemption from the prescription charge should prove their entitlement to that exemption. That is important, and we hope that, through our discussions with the pharmacy profession, we shall be able to introduce those checks at the point of dispensing before too long.

What plans he has to ensure that the same access to treatment under the health service is available to every NHS patient. [23419]

We said in our manifesto that when people are ill, the national health service will be there to help, and that access will be based on need and not on the ability to pay. We meant that, and the steps set out in our White Paper, "The New NHS" will improve consistency. We shall work with the professions to produce national service frameworks and clinical guidelines, and we shall challenge and address variations not based on the health needs and wishes of local people. This gives maximum national consistency, while still allowing appropriate local and individual responsiveness.

I thank the Minister for that answer. Is he is aware that next week Age Concern is launching an age discrimination awareness campaign, specifically on the problem of health discrimination and access to health care for the aged? Will those guidelines ensure that, regardless of age, people will have equal access to treatment under the NHS?

I welcome Age Concern's work in this area. Our senior citizens are a valuable asset. They must be nurtured and cared for, and we are here to ensure that the NHS does just that.

I welcome the steps that have been taken so far. Is the Minister aware that people in some parts of the country have worse ill health than those in other areas? There is particular concern about the health of the people in Stoke-on-Trent and North Staffordshire compared with the whole of the west midlands. Will he consider carefully North Staffordshire's application to become a health action zone, so that we can ensure that people have fair and equal access to the national health service?

Health action zones will, indeed, help address the real problems of inequality in our society. They are new and innovative, and will ensure that we focus on the failure of previous Governments, especially the last Government, to tackle inequality. The Conservative Government banned civil servants from using the word "inequality". Civil servants can now talk about inequalities in the NHS, and, more than that, this Government will do something about them.

Does the hon. Gentleman accept that an increasing number of patients are turning to complementary therapies, because they find them effective? Does he also accept that there is a problem, because only a small number of general practitioners understand alternative and complementary medical treatments? Does he have any plans to rectify that? Is it true that the Department is about to set up an alternative health register, following the Secretary of State's discussions with the Prince of Wales?

We very much welcome the increasing developments in the field of complementary medicine.

Does my hon. Friend agree that equal opportunity for good health is as important as equal access to treatment? Does he share my concern about the gross inequality between different regions in morbidity and mortality; the chance of life itself? Will he confirm that, unlike the previous Government, one of this Government's top priorities is to tackle the health consequences of poverty?

We shall, indeed, tackle the health consequences of poverty. There is no doubt that a lack of jobs and poor houses contributes towards ill health. Sadly, the previous Government did nothing about that. The Minister for Public Health will shortly produce a Green Paper on this subject. I assure Opposition Members that it will address the issues that have been raised.

What plans he has to reduce bureaucracy in (a) North Essex health authority, (b) Essex Rivers Healthcare, (c) North Essex Mental Health Trust and (d) New Possibilities Health Trust. [23420]

In December 1997, I announced that, in 1998–99, an £80 million saving will be secured from reductions in management costs for investment in front-line patient services. Regional offices will shortly set targets for all health authorities and trusts to reduce management costs.

May I suggest to the Minister that further savings could be made if quangos were abolished and those trusts were amalgamated and brought under some form of local accountability—thereby releasing thousands of pounds into the front-line services that he mentioned? We have also the nonsense in which trusts operate side by side. I draw his attention to, for example, Colchester general hospital, which operates from a cramped site because the next-door NHS trust is busily selling off that site. Why do we not bring back the NHS under one control, so that it is the people's NHS?

That is a very radical approach for the hon. Gentleman to take, and a useful policy initiative at which we shall take a good, close look. Meanwhile, as he is aware, a process of trust mergers is under way across the country. However, those mergers will occur as a product of local discussion and local agreement rather than because of national edict. If local discussions are occurring in his area and if they produce a trust merger proposal that results in improvements in patient care, Ministers will examine the process very carefully. The acid test, however, is whether that type of structural change leads to improvements for patients.

Does the Minister understand that—although he talks tough on cutting costs—he is proposing to add a new dimension of bureaucracy with the White Paper's primary care commissioning units? What will be the cost of that new bureaucracy? Has his Department calculated the cost? If so, what is it?

The answer is that we shall be cutting bureaucracy by £1 billion during the course of this Parliament.

What proposals he has for promoting shared responsibility between NHS trusts for local services. [23423]

The plans in the recent White Paper "The New NHS" herald the end of competition within the national health service. We plan to introduce a new statutory duty of partnership that will clearly set the requirement for NHS trusts to work together with each other, with other health service organisations and with other local agencies responsible for promoting good health.

I welcome my hon. Friend's answer. However, does he share my concern that the South Essex health authority—despite the extra £17 million that the Government have given to it—is still implementing wide-ranging cuts in front-line services? If health authorities and trusts will follow the line described by the Minister, they could raise the necessary money by efficiency savings and not by cuts.

When any of those issues are discussed locally, it is important that the consequences for patient care are thoroughly investigated. The Government want big improvements in efficiency and quality in all parts of the national health service—which is why we will be bearing down on bureaucracy and why we are introducing a new performance framework to measure how individual trusts and health authorities are performing. In short, we will be expecting trusts to be comparing rather than competing.

Is the Minister aware that the Kent and Canterbury hospital in east Kent has developed services with two other hospitals—William Harvey hospital, in Ashford, and Queen Elizabeth the Queen Mother hospital, in Margate—which have reached a standard that the Royal Colleges greatly applaud? Is he further aware that the East Kent health authority now proposes to destroy the central hospital in that co-operation? Will he give an assurance that when, as is certain to happen, the community health council applies to the Secretary of State for a review, he will take those admirable developments—which he commends in principle—into account?

As the hon. Gentleman is aware, consultation is currently under way in east Kent, led by the health authority. If, as he expects, any of the area's community health councils object to the results of that consultation and they land on Ministers' desks, of course we will take a proper and full assessment of the consequence for patient care.

When he expects to announce the results of the review of the NHS with particular reference to waiting lists. [23424]

On 18 November, my right hon. Friend the Secretary of State announced a wide-ranging programme of action to ensure that fewer patients are waiting for admission to national health service hospitals by the end of this Parliament. The review of the NHS, to which my hon. Friend referred, is part of the Government's comprehensive spending review. In his statement to the House on 11 June, my right hon. Friend the Chief Secretary to the Treasury advised that the review would take around 12 months to complete.

Does my hon. Friend agree that, to turn this supertanker around, he will need money? Does he accept that, over the past few months, the NHS has received money over and above that included in the Tory spending limits—which I recommend as a good idea? Will he ensure that, in order to get waiting lists down, he takes account of the fact that there is already an extra £10 billion of tax income in this financial year? Will he tell his right hon. Friend the Chancellor of the Exchequer that the NHS wants a big slice of that? While he is talking to the Chancellor about using some of the money, will he also tell him that, instead of phasing in pay awards for nurses and others, he should pay them, like Members of Parliament, in one fell swoop?

I am sure that my right hon. Friend the Chancellor is aware of my hon. Friend's views. My hon. Friend will be aware that, since the general election, the Government have invested an extra £1,500 million in front-line patient care. As he is also aware, the Government are committed to real-term increases in NHS funding not just next year but each and every year.

The Minister is well aware that it has been increasingly difficult to get people who suffer from mental illness into hospital for appropriate care. It has been even more difficult to get people into hospital who require long-stay care for the treatment of mental problems. I congratulate the Secretary of State on the courage that he has shown finally to change the policy on community care for those suffering from mental health problems and disability, which is so often associated with mental handicap. Will the proposals that he hopes to put forward, which I appreciate will cost money, enable people with appropriate problems to gain access to hospital care and long-stay care if they need it—totally in accordance with the wishes of organisations such as SANELINE, which campaigns so well for the mentally ill?

I am grateful for the hon. Gentleman's kind words about the recent announcement by my right hon. Friend the Secretary of State. Sometimes, there has been naivete about the potential benefits to all patients of care in the community. Of course, for some patients, the policy works, and works extremely well. But for others, it does not, has not and will not work. That is why we must strike an appropriate balance between care in the community, intermediate care, 24-hour nurse care, and, where it is needed, acute care in hospitals for severely ill patients.

Is my hon. Friend aware of the sort of situation that was described to me by a consultant in my local hospital? He told me that he had to refer 300 patients back to their doctors for foot and ankle treatment because, under the guidelines laid down by the previous Government, he was simply not allowed to increase the waiting time for such patients. Is he aware that that means that there is a huge unmet need, which is one of the reasons why the Government will have many problems in trying to reduce waiting lists? Should not we really be blaming the Conservatives for not meeting the demand when it was needed?

My hon. Friend is absolutely right. The Government inherited a very difficult position on waiting lists, which, as we have made clear from day one, will take time to remedy. We are committed to having fewer people waiting for hospital treatment by the end of this Parliament. In addition, we shall make progress year on year towards achieving that objective. For example, by the end of March, we shall eliminate the need for anyone to wait more than 18 months for hospital treatment. We shall then set further targets for improvement. There will be incremental improvement every year towards our objective of having fewer people waiting for treatment.

What are the Government's plans for developing community hospitals. [23427]

We want to promote a health service close to home. In some places, that will involve community hospitals providing a wider range of services. However, they must have high standards and they must provide good value for money. Our White Paper proposals will make it possible for primary care groups to run such local hospitals if they decide that that is best for the patients in their area.

I thank the Secretary of State for that answer. Does he accept that there continues to be widespread concern throughout Cornwall about the health authority's proposal to close four community hospitals, which are a vital part of health care provision in a largely rural area? They provide good quality care that is accessible to a large proportion of the population.

I understand the concerns of people in Cornwall about the health authority's proposals to close four community hospitals. At one point, the health authority, with the support of the Liberal Democrats, said that the problem was caused by the Government keeping the authority short of funds. In an outburst of honesty, the chief executive then admitted on television that he would like to close the hospitals whatever the level of funding. I cannot issue any pronunciamento on the future of those hospitals. If the community health council decides to object, the decision will be a matter for me. I have made it clear that we would like to promote community hospitals because we want people throughout the country, not just in Cornwall, to be able to turn to an efficient, effective, high-quality health service that is close to home. We do not want people to have to travel vast distances for relatively straightforward treatment.

Will my right hon. Friend take this opportunity to correct some misinformation given out by the Conservative Front-Benchers during this Question Time? Far from being in doubt, the future of Edgware hospital is secure. Does my right hon. Friend agree that the 120-plus organisations and individuals who took part in the Edgware review, which has been sanctioned by the Department of Health, deserve our congratulations? Edgware will be a model community hospital for urban areas and the community will stay involved while the plans are being implemented.

I entirely agree with my hon. Friend. I pay tribute to all those involved locally and in the Department, including the 40th birthday boy, my hon. Friend the Minister of State, who has contributed to sorting the issue out. A trail-blazing effort has been made in Edgware to create a community hospital in an urban area providing first-class services that local people want.

Does the Secretary of State agree that the views of the community, particularly those of the primary carers—the general practitioners—should play a particularly important role in his decision on the future of the Kent and Canterbury acute hospital and the Whitstable and Tankerton community hospital? Does he further agree that the community has every reason to have sent me 630 letters already, which I have sent on to him, on the future of the two hospitals?

I shall bear all representations in mind, but there are a few crocodile tears from Conservative Members. Most of the closure proposals come from boards dominated by chairmen and non-executive members appointed by the previous Government. I am glad that some of them are no longer there.

What proposals he has for boosting the role of nurses in the National Health Service (Primary Care) Act 1997 pilots. [23428]

The National Health Service (Primary Care) Act personal medical services pilot scheme offers considerable opportunities to boost the role of nurses in the development of primary care and community health services. For the first time, nurses can lead in the delivery of primary care services, including employing general practitioners.

I thank my hon. Friend for that answer. Will she confirm that this is the first time in the history of the national health service that nurses have been given the green light—by the new Labour Government—to run primary health care in that way, as in the new minor injuries unit at the Gravesend and North Kent hospital in my constituency? Does she agree that giving nurses that major role will result in an improvement in the quality of primary care services?

My hon. Friend is right that the measures taken by the Government in approving pilot schemes under the National Health Service (Primary Care) Act put nurses in the driving seat. That is good for nursing and good for patients. It would not have happened had it not been for the insistence of those who are now in government, when they were in opposition, that the provision be extended to nurses. It was the joint efforts of the present Government, when in opposition, together with nursing organisations, that delivered that good deal for nurses, which is also a good deal for patients.

The Observer tells me that I have the honour to represent the healthiest constituency in Britain, and I would like to keep it that way.

I am your constituent.

Indeed, Madam Speaker—an example of good health, if I may say so. In that respect, we especially value the role of nurses, including those employed in the community health trust to provide health visiting and school nursing services. In advance of the publication of the Green Paper on public health, will the Minister act to prevent redundancies next week in that community health trust, because they would diminish the universal screening services that it provides, which we regard as of considerable importance to the maintenance of public health in the area?

The hon. Gentleman will be aware that at the request of my hon. Friend the Member for Cambridge (Mrs. Campbell), I recently met staff and representatives of the Lifespan trust to discuss some of the difficulties that they were facing. I understand that the trust has recently announced that although it has accepted some requests for voluntary redundancy, the need for compulsory redundancies has been averted through staff turnover and redeployment. The trust has reviewed children's health services and is implementing a new model that will be responsive to identified clinical needs.

What action he is taking to support the work of the social exclusion unit. [23429]

The work of the social exclusion unit is being supported right the way across Government, by all Departments. Our Department is working closely with the unit as it tackles its initial priority areas, and many other departmental initiatives within the Department—those relating not only to health but to personal social services—have a direct bearing on the wider issues of social exclusion. We shall continue to work on those and to take matters forward with the health action zones, and with our work on drug and alcohol misuse and on family support and early intervention. That is all about tackling the underlying causes of social exclusion, which were too long neglected by the Conservatives.

I thank my hon. Friend for that reply, but may I draw to his attention the fact that my constituents in St. Helens have been left with a legacy of Tory Government reforms that mean that they now have a two-tier health service, with whole areas of poverty-stricken communities excluded from really good health services? What action does the Minister intend to take to ensure that resources are made available to communities such as St. Helens?

We recognise the needs of communities such as St. Helens. Indeed, I was up in my hon. Friend's part of the world only last Friday, and what is happening there is that we are beginning to see the spirit of co-operation replacing the ethos of competition and division that characterised the Conservatives' period in government. It is all about co-operation, not competition. The Government will take forward that agenda, which is welcomed by the people of this country.

Does the Minister agree that ambitious public health targets are of the greatest value to the poorest and neediest people in society? Will he therefore give an assurance that his Government are not considering any watering down of the ambitious public health targets under "The Health of the Nation" strategy established by the previous Government?

We need no lectures from Conservative Members about public health. They did sweet FA about public health when they were in government. We are tackling the issues.

Does my hon. Friend agree that poor health in constituencies such as mine is the result of poverty, unemployment and poor housing? Will he applaud the initiatives already taken in my constituency, and especially in the Vauxhall area, where health and social services workers are making joint efforts to improve health? Will that encourage him to award Liverpool the status of a health action zone?

The sting is in the tail. We must indeed bear down on inequality across Government, focusing the activities of Departments and recognising that when one Department takes a lead others will have a role to play. That is what it is all about. My hon. Friend the Minister for Public Health is promoting the work of the social exclusion unit, right the way across the ministerial team, recognising that our work needs to be linked with the good work done by other Departments. That is how the Government will take forward the agenda.