What action he is taking to promote better co-operation between health authorities and social services. [34369]

What action he is taking to promote better co-operation between health authorities and social services. [34375]

Since taking office, my ministerial colleagues and I have devoted a great deal of effort to promoting a closer and better working relationship between health authorities and social services. The fruits of that effort were apparent this winter, in the brilliant success of both the health service and social services in dealing with emergencies.

Will my right hon. Friend join me in paying tribute to the work of Home Start, which has—through close co-operation between health authorities and social services, and with the help of volunteers—assisted many families in times of crisis? Is he aware that, in my own constituency, Doncaster Home Start is currently helping 54 families, and that 36 families are on the waiting list? Will he tell the House what assistance the Government will give to that very worthwhile organisation?

Home Start is a splendid voluntary organisation, operating on the boundary of the national health service and social services. Specifically, it provides help to families. The Government recognised Home Start's valuable contribution by deciding to provide it with a grant of over £1 million.

Is my right hon. Friend aware that, compared with the national average, Doncaster health authority has a very good overall record on reducing its waiting lists? In the light of last week's pledge by the Government—to reduce waiting lists by the end of April 1999, so that they are lower than they were under the Tories—does he agree that Doncaster's partnership between the health authority, social services and other parties has demonstrated that such partnerships are crucial in reducing waiting lists?

I certainly share the point of view expressed by my hon. Friend, and think that the most precious resources in the national health service are the million people who work daily to make the service a success. I am determined to take more notice of staff than the previous Government did. I also want to seek their advice. I am therefore taking unprecedented action by writing to everyone working in the health service, inviting them to let me have their ideas for improving the service. I have always believed that, if one wants to improve the way in which jobs are done, the first people to ask are those doing the work, rather than collections of overpaid management consultants.

Is it not a contradiction for the Government to speak glibly of co-operation, whereas coercion is the method that they have chosen for dragooning general practitioners into primary care groups?

We are not dragooning anyone.

Does the right hon. Gentleman agree that the important part of the partnership is between GPs, local hospitals and social services? Does he believe that, in rural areas, that relationship is extended by including cottage hospitals, which provide services over a wider area and deal with cases that would otherwise clog major hospitals? If the right hon. Gentleman is currently consulting staff, may I communicate a message from staff of the Ongar War Memorial hospital in my constituency? They would like that hospital to remain open, so that it can continue playing an effective part in providing care and medicine in a rural area.

I certainly bear in mind all the representations that are made, but it comes ill from the mouth of someone who supported the previous Government to talk about the threat to cottage hospitals, when that Government carried out an 18-year search-and-destroy operation on cottage hospitals.

Does my right hon. Friend accept that the partnership between local authorities and health authorities has led to initiatives such as NHS Direct, which he launched successfully in my area yesterday? Does he agree that that kind of partnership deal is the way forward for the health service?

Certainly. NHS Direct is a nurse-based helpline that will offer help and advice to people who, in the middle of the night, might be bothered about their own health or that of their child. In the pilot areas, people will be able to ring a 24-hour, nurse-based service for advice or reassurance or, if the nurse thinks it appropriate, immediate attention from an ambulance crew. That will be a big step forward. We are trying to sort out any wrinkles in the arrangements, but we are confident that the pilot schemes will work and bring great benefits. That is why we are committed to introducing NHS Direct to every part of England by 2000.

If he will make a statement on the number of patients in the area covered by the Oxfordshire health authority who have been waiting for operations for over a year; and what was the figure on 1 May 1997. [34370]

Available information shows all patients awaiting admission to hospital, not just those waiting for operations. Provisional figures show that on 31 December there were 963 Oxfordshire health authority residents who had been waiting more than a year. Figures for 1 May 1997 are not available.

The Minister of State will be aware that, during the last general election, the Labour candidate in my constituency dished out pledge cards to electors, which gave a firm promise that, if elected, a Labour Government would reduce waiting lists by 100,000. The reality is somewhat different. In Oxfordshire, waiting lists have gone up by 11 per cent. and, as the Minister has just made clear, as at 1 January, nearly 1,000 people had been waiting for more than a year, and more than 100 had been waiting more than 18 months. Given the trusts' accumulated deficits of nearly £7 million, when do the Government believe that waiting lists in Oxfordshire will start to fall? Is he confident that Oxfordshire will get a fair allocation of the money made available by the Chancellor last week?

I can only presume that the hon. Gentleman was not around for the Budget or for my right hon. Friend the Chancellor's statement last week; had he been so, he would have been aware that the £500 million made available through the Budget will be targeted specifically at cutting waiting lists. As we have made absolutely clear, the top priority for the national health service for next year is to get waiting lists down. Waiting lists will be shorter by April next year than when we came to power. By the end of this Parliament, the pledge will have been fulfilled.

In respect of waiting lists in Oxfordshire and elsewhere in the country—

In Oxfordshire.

And elsewhere in the country.

No, only Oxfordshire.

I am very concerned about Oxfordshire. In respect of waiting lists in Oxfordshire, has my hon. Friend examined the possible connection between the activities of certain part-time consultants and their waiting lists and their private practice? Is it not a fact that if there were no waiting lists, there would not be private practice—in Oxfordshire?

As my hon. Friend has just shown, his knowledge of this country stretches well beyond Wakefield. He is terribly familiar with the problems of Oxfordshire and has due regard for the way in which the Government will be tackling them. I believe that the overwhelming majority of hospital consultants are performing well above the contract on which they are employed in the NHS. We rely on their endeavours now and will do so even more in the year ahead when we will expect them to do even more with the money that we will be making available to them.

I shall not pursue what I am sure was an unintended slur by the hon. Member for Wakefield (Mr. Hinchliffe) on the hard-working NHS staff in Oxfordshire.

It is a tired old record that we hear from the hon. Gentleman and his party. Whenever we put more money into the national health service, the Liberal Democrats decide that the only tactic is to leapfrog us. We should remember that, at the last general election, the Liberal Democrats were committed to investing an extra £540 million in the national health service. We have doubled that amount—that is how much is going into the NHS—and £320 million of the £500 million for the health service that my right hon. Friend announced last week is targeted at waiting lists. They are the top priority, and we shall reduce them because that is what counts for patients. In my view and that of my party, lengthening waiting lists merely dents public confidence in the ability of the NHS.

Does my hon. Friend know how many patients in Oxfordshire have shared the experience of my constituent, six-year-old Kristie Swift? Six months ago, she was told that she needed an operation. She was then told that she could not have it because her GP was not a fundholder, and was then informed that she could have it because the trust had made a mistake and her GP was a fundholder. Is not that typical of the hokey cokey bureaucracy with which patients have to deal under the two-tier system that we inherited from the Conservative Government? Will my hon. Friend speed Kristie's recovery by assuring her that she will be one of the last people to suffer from it?

My hon. Friend is absolutely right, not just about the circumstances in Oxfordshire, but about those throughout the country. In future, we want treatment to be given according to need alone. That is the founding principle of the NHS, by which the Government abide.

If the Secretary of State tells Oxfordshire health authority to make the reduction of waiting lists its overriding objective next year, is there not a serious danger that some other aspect of the service—probably drug budgets—will worsen? Can he promise hon. Members that drug budgets will not be reduced as a consequence of the waiting list initiative in Oxfordshire health authority?

The hon. Gentleman conveniently forgets one fact: the £500 million allocated in the Budget is on top of the extra £1.2 billion made available to the NHS in the previous Budget, which makes £1.7 billion more for the next financial year than the Conservative party promised.

Hon. Members will have noticed that the Minister dodged a simple and straightforward question. Is not his problem that waiting lists cannot improve without some other service worsening unless and until the NHS receives real annual increases in funding of more than 3 per cent. a year, as happened, on average, for the past 18 years? The NHS would have an additional £940 million next year if the Government had maintained that policy, and I would not have had to ask my first question.

The hon. Gentleman has a very bad case of wanting to have his cake and eat it. He complained when waiting lists were going up; now he complains when waiting lists are coming down. As we said at the general election, the Government want shorter waiting lists, and are pledged to deliver that. I remind him that, under the Conservative Government, waiting lists went on rising—year in, year out. Under this Government, they will continue to fall year on year, and as a consequence patients will be in a better position.

What was the cost to the NHS last year of medical negligence claims. [34371]

The cost of clinical negligence to the Department of Health in 1996–97 was £300 million, £235 million of which was a cost to the national health service that was largely made up of provision for probable future settlements. The remaining £65 million was a direct cash cost to the Department of Health under the existing liabilities scheme.

Does not every health authority and trust face rapidly escalating bills for medical negligence claims? Every pound spent on defending such claims is a pound less spent on patient care, which is unsustainable. Is not the way forward the clear separation of complaints against doctors from compensation for medical accidents and a no-fault medical injuries compensation scheme?

The Government do not intend to establish a no-fault compensation scheme; instead, we intend to drive up the standards of treatment in the national health service that lie behind so many negligence claims. We want to keep doctors out of court, and lawyers out of the operating theatre. We want a national health service in which doctors and nurses are in the driving seat, not judges and lawyers.

Will the Minister reconsider the plight of women who suffer permanent injury and disability as a result of radiotherapy treatment for breast cancer, who are represented by the campaign RAGE—Radiotherapy Action Group Exposure? Rather than insisting that negligence in the limited number of cases involved should be proved in the courts, will the Minister agree to compensation now, so that the matter can be settled without further agonising delay?

It is utterly cynical of the hon. Gentleman to seek to secure compensation on the Floor of the House. He will be aware that my hon. Friend the Minister of State has met representatives of RAGE a number of times. The Government's policy is clear: that compensation will be paid when negligence is established in court. That, we believe, is the right way in which to protect patients, and to safeguard the precious resources of the national health service for patient care.

In view of recent events in my local NHS hospital trust, is my hon. Friend prepared to consider tightening procedures for the employment of NHS staff?

If my hon. Friend writes to me about matters of particular concern in the context of medical negligence, I shall be happy to deal with them.

May I return to the question of accepting liability for harm done? The Minister will know that a great many haemophiliacs have contracted hepatitis C from blood donations. Her Department has already paid money to those who have contracted HIV, and I know that the Secretary of State met representatives of haemophiliacs in September last year and promised them a speedy response to the issues that they had raised. Will the Minister enlighten us about what has happened between last September and today, so that I can avoid being instructed—in another capacity entirely—by haemophiliacs to pursue a case against the Government?

My right hon. Friend the Secretary of State met representatives of the Haemophilia Society last year, and the content of that discussion is currently under consideration. As the hon. Lady is doubtless aware, my right hon. Friend recently announced the Government's intention to make recombinant factor VIII available to children.

Is the Minister aware of the distinction between cases in which there is clearly no answer to the question of liability in regard to medical negligence—cases in which the Government should come clean, admit that there has been negligence and dispose of the claims—and the variety of other cases of an individual kind in which negligence must be clearly established in accordance with the normal processes in the court? Is that not a valid distinction that the Government should take on board?

We fully take on board the scale of human misery that litigation causes in such cases, but it is important for the House to know that only 17 per cent. of cases taken to court succeed. In the 83 per cent. that fail, the only person who walks away with a cheque is the lawyer.

If he will visit (a) Barnet and (b) Edgware hospitals to discuss health provision in north London and south Hertfordshire. [34372]

We have no plans at present to visit either hospital.

Is the Minister aware that the trust concerned with Barnet and Edgware hospitals is proposing a programme of service cuts that will result in the loss of one quarter of in-patient beds? If that happens, there is precious little hope for an improvement in waiting lists or anything else for the residents of north London and south Hertfordshire. Despite all the talk of money and improvements in waiting lists, will the Minister take a look at the trust's financial situation and ensure that the service offered to my constituents does not fall below that offered elsewhere in the country?

I am aware of the concerns in the local community about the issue and the difficult position in which the health authority finds itself—having to sort out the legacy left by the previous Administration. The trust, the health authority and the regional office are working very closely to ensure the best possible outcome for the local community.

Will my hon. Friend take note that at least one good thing has come from what I am afraid I think was a mess over Barnet and Edgware: the establishment of a very progressive birth centre, which will be opening officially very soon? Will he wish that birth centre all the best, keep an eye on it and ensure that it does not become a temporary project, to be discontinued as soon as its value is proven, as is happening to so many useful maternity projects at the moment?

My hon. Friend makes an extremely good point. Thanks to all the efforts in the local community over the past few months, we have the option in the Edgware area of a high-quality community hospital, which will blaze a trail that many others will follow. Much work has been done, involving the community health council, some of my hon. Friends' local campaign groups and local GPs, to ensure that the best possible services are provided for the Edgware community.

If he will make it his policy to reinstate free eye and dental checks. [34373]

The question is being addressed as part of the comprehensive spending review of all Departments' expenditure. The review is being carried out in the context of the Government's clear election manifesto commitment that,

"if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone".

Does the Minister recall that, when her party and mine resisted the Conservative Government's efforts to introduce charges for dental check-ups and eye tests, one of the arguments that we used was that intervention could identify at an early stage diseases that could cause later problems? Does she still agree that that is a valid argument? By making necessary investment to restore free eye and dental checks, the Government could improve the general well-being and health of many, make savings in the long term and—conceivably—even reduce waiting lists. Will she repeal those Tory health taxes?

On the deliberations of the comprehensive spending review, the hon. and learned Gentleman will simply have to wait. It is however important that prevention is available wherever possible. Forty per cent. of people are eligible for free sight tests due to risk of conditions such as glaucoma and diabetes. It is extremely important that every encouragement be given to people to take up such eligibility.

Does my hon. Friend agree that the best way in which to restore all parts of the health service, such as free eye and dental checks, is to make sustainable increases in expenditure. rather than adopt the method proposed by the Liberal Democrats, which would serve only to raise expectations, which would later be met with cuts, as the magic penny would fail to deliver the kind of money about which they are always talking?

My hon. Friend is right. Spraying around spending commitments is the prerogative of a party that will always be in opposition. The people of this country did the best thing for the national health service by electing a Labour Government last year.

What targets he proposes to set for reducing deaths from suicide and undetermined injury. [34374]

What targets he proposes to set for reducing deaths from suicide and undetermined injury. [34379]

The Green Paper "Our Healthier Nation" sets out the Government's proposed mental health target, which is to reduce the death rate from suicide and undetermined injury by at least a further sixth by the year 2010.

I am grateful to my hon. Friend for that answer. Does he accept that suicide rates among the socially disadvantaged are higher than those in the rest of the population? Does he agree that taking appropriate action to reduce suicide rates would be one of the best ways of getting rid of the appalling legacy of health inequality that we inherited from the previous Government?

My hon. Friend is right to point out the impact of inequality, which affects that area of health like every other. We are particularly concerned that, while the overall suicide rate is decreasing, it is increasing among young men between 16 and 25. We are addressing that problem as a matter of urgency.

My hon. Friend has pointed out that the Green Paper says that we should address health problems by getting the social conditions right. Will he explain how we will tackle social conditions to reduce the suicide rate, which runs at 16 unnecessary deaths a year in north Derbyshire alone?

Socio-economic conditions, not least unemployment, have clearly contributed to the stress that impacts on young men, which inevitably affects their suicide rate. We aim to reduce that rate through economic regeneration. The health action zones will provide ample opportunity for that.

I warmly welcome the fact that the Government have chosen similar mental health targets to ours—our target was a 15 per cent. reduction in such deaths by 2000, while they have chosen a 17 per cent. reduction by 2010.

The right hon. Lady had an opportunity to review that legislation. She did not take it.

Does the Minister agree that mental health provision continues to be the Cinderella of the national health service? Does he further accept that care in the community is a mixed blessing and has been proven not to work in many cases? Will he ensure that Government policy focuses particularly on reducing loss of life among the young? Will he consider the example of VISYON—the Voluntary Initiative Supporting Youngsters' Ongoing Needs—which is an organisation in my constituency that seeks to help young people with mental health problems?

I should be happy to consider what we can learn from the hon. Lady's constituency to tackle the problem. My right hon. Friend the Secretary of State has made it clear that we believe that care in the community has failed large numbers of our fellow citizens. We are determined to get it right. We shall bring forward proposals on the issue in due course.

What resources he is making available to schools to celebrate the 50th anniversary of the NHS. [34376]

The Department has produced a national health service 50th anniversary education pack, which is available to schools and colleges throughout England on request.

Does my hon. Friend agree that, as part of the celebrations, schoolchildren should learn the history of the NHS in their area? Will she make resources available so that children in my area can learn about the history of Edgware hospital, which was closed by the previous Government in its 49th year, but which, thanks to the efforts of the local community, will be reborn in its 50th year as the new Edgware community hospital, with widespread local support?

I entirely accept that local history is as important as the proud history of the national health service created by a Labour Government 50 years ago, and rescued and renewed 50 years later by another Labour Government.

Does the hon. Lady think that the Secretary of State is wise to celebrate the 50th anniversary of the national health service by closing Horncastle hospital, especially bearing in mind the fact that more than 2,000 school children are bussed into Horncastle every day from an extensive rural area, and that, if that much-valued hospital is closed, they will be more than 20 miles away from any other hospital, along difficult winding country lanes that are sometimes almost impassable in the winter months?

The hon. Gentleman asked me in particular about the Secretary of State's wisdom. My right hon. Friend is infinitely wise, as is evident from all his decisions.

Does my hon. Friend agree that an important part of celebrating the 50th anniversary of the national health service will be to remind the people of this country, especially the young people, which party established it, and which party opposed its establishment?

I recommend that hon. Members with an odd moment to spare read the report of the Second Reading debate on the National Health Service Bill, which makes my hon. Friend's point entirely clear: the national health service was created in the teeth of the opposition of the Conservative party.

Would not school children really have something to celebrate for the 50th anniversary if Ministers would stop pretending to have a better record on funding the national health service than their Conservative predecessors, and pledged instead to bring their funding up to the previous Administration's average increase of 3.1 per cent. per annum? That would be a pledge worth celebrating. Why does the hon. Lady not give it?

As we have improved on the Conservative Government's funding record on every count, that comment comes ill from the hon. Gentleman.

What proposals he has for reform of health service structures in South Humber health authority area. [34377]

Our plans for modernising the national health service were set out in the recent White Paper, "The new NHS", which envisages fewer but larger health authorities, more co-operation between NHS trusts, and the development of new primary care groups. As part of that process, we shall work with health authorities and the professions to determine the best configuration of local services.

May I express the hope that my hon. Friend will look favourably on the sensible proposals for reorganisation of the health service that the South Humber health authority has now finally produced? Those envisage reducing the number of provider trusts from three to two, setting up two primary care groups to take charge of community services, and putting mental health services, which have always been the Cinderella of the service both locally and nationally, under a wider provider, preferably from the north bank.

On the face of it, those proposals sound consistent with the policy directions set out in the White Paper, and I look forward to receiving the representations of the health authority. I assume that there will be a period of public consultation before the proposals are agreed. It is important that such proposals meet the needs of the local community, and I know that my hon. Friend and others of my hon. Friends have been in negotiations and discussions with the health authority and others over recent weeks, and I look forward to receiving their representations, too.

What targets he proposes to set for reducing deaths from cancer among people aged under 65 years. [34378]

A reduction in deaths from cancer among people under 65 will be achieved by improving access to treatment and the quality of treatment, and by widening the scope for prevention.

I thank my hon. Friend for that reply. Will she confirm that the death rate from cancer is twice as high among the unskilled as among professionals, and that one third of the people who die from cancer are under 65? Can she assure me that efforts will be focused on offering deprived communities extra health care and advice to ensure that we overcome the inequalities in health provision?

My hon. Friend is absolutely right. It is estimated that about a third of cancers are in some way linked to poor diet, and half of all those who smoke are likely to die of cancer. Against any measure, the poorer you are, the greater your chance of contracting cancer. That is why, as part of our drive to tackle health inequality and to improve healthy years of life, we will focus resources and efforts on the most deprived communities.

I welcome the Minister's early response on steps to help cancer victims, but, having almost deified the Secretary of State for his infinite wisdom, can she tell us what steps have been taken to help mortal man who may be afflicted with prostate cancer?

The hon. Gentleman may be aware of the proposals under consideration on the case for screening of prostate cancer. Recently, I was involved in discussions about the importance of an improved focus on men's health. It may not be a matter for discussion on the Floor of the House, but it was put to me that self-examination by men as a preventive step in relation to prostate cancer should be undertaken in the same way as women undertake breast examinations to detect early signs of breast cancer.

Does my hon. Friend accept that the great increase in smoking among young women in particular is a cause of great concern? We are waiting for the Government to launch a hard-hitting advertising campaign which goes on and on and on, until the consciousness of young people is raised to the real dangers of blighting their lives and their health through smoking. Will we see an early start to that campaign, as we are getting impatient?

My hon. Friend will be aware of the recent advertising campaign—which was successful and was well received among young people—on the risks of smoking, which targeted in particular young people aged 16 to 24. He is absolutely right; we are deeply concerned about the rise in the numbers of young people—particularly young women—who smoke. One in three 15-year-old women are regular smokers.

If he will make a statement on the Government's policy on NHS trusts mergers indicating the estimated savings to the NHS from trust mergers in 1998–99. [34380]

Any merger proposal will be considered on its own merits, on the basis of demonstrable benefits to health and health care and savings in administration. We expect to see about £3 million in savings from mergers of national health service trusts next year, leading to longer-term savings of £10 million per year.

Will the Minister assure my constituents that there will be no hospital closures or bed reductions in advance of trust merger proposals, so that any administrative savings can be directed to front-line services?

That is precisely our commitment. Any money that comes out of administration and bureaucracy as a consequence of trust mergers will be reinvested locally for the benefit of front-line patient care. That is the right priority, which I believe both staff and patients support. We do not have a national blueprint for trust mergers, but we are prepared to listen to local proposals that come about as a result of local decision-making rather than of any national edict.

May I draw my hon. Friend's attention to the Nevill Hall trust proposal for a separate trust for north Gwent, as opposed to Gwent health authority's proposal for a single trust for the whole of Gwent? I assure him that the health authority's proposal would produce the savings that the Government want, reduce the number of trusts in Gwent, and maintain the integrity of Nevill Hall hospital as a district general hospital.

It is important that any trust merger proposal takes as its yardstick the improvement of services for patients—that is how trust merger proposals are judged. Moreover, they have to demonstrate that there will be administrative savings. We all know that the lunacy of the internal market led to the embedding of far too many trust organisations in the national health service, all competing against one another. Thankfully, a new spirit of co-operation is abroad in the national health service, which we expect to lead over time to fewer trusts rather than more.

Does the Minister accept that consultations—in east Kent, for example—are both led and controlled not by medical staff but by lay administrators, whose jobs, of course, are at risk from trust merger proposals? Will he assure the House that he will be robust in ensuring that, in any proposal for trust mergers, the vested interests of administrators do not override medical provision?

On east Kent, as on any other trust merger proposals, Ministers will examine carefully local proposals that have come about as a result of local consultation and local decision-making. As I said, we do not have a national blueprint that we want to apply to all areas. Different parts of the country have different needs, and it is right that different organisational structures should reflect that.

I congratulate my hon. Friend on his wise decision in approving the merger of acute health trusts in Lancaster, Kendal and Barrow, and of community health trusts in Lancaster and Barrow. Does he agree that those mergers will produce substantial savings in bureaucracy, which will build on the great strides that have been made in Lancaster in reducing waiting lists month on month since 1 May 1997? Does he also agree that there is now a real need to get on with the appointment of non-executive directors to maintain the impetus that has been created?

Wisdom is obviously contagious, which is useful to all Ministers. My right hon. Friend the Secretary of State is considering the issue of appointments to non-executive directorships; we expect to make an announcement in due course. I believe that the proposal for the Morecambe bay area is right for the people who live there, for patients and staff, and for the national health service. Thankfully, there will be a new spirit of co-operation in the Morecambe bay area, just as there is throughout the country.

If he will make a statement on NHS waiting lists. [34381]

If he will make a statement on NHS hospital waiting lists. [34383]

Waiting lists are far too long and must be reduced. Last Wednesday, following the Budget statement of my right hon. Friend the Chancellor of the Exchequer, I announced that the Government had found an extra £500 million for the health service for next year on top of the previously announced extra £1.2 billion, and that that sum would be devoted to reducing waiting lists by April next year to below the record level that we inherited from the Tory Government.

Is the Secretary of State aware that, in February 1997, West Suffolk hospital in my constituency had fewer than 5,500 on the waiting list, but that since 1 May the number has risen to more than 5,600? That is a result of the spending allocations for Suffolk being the joint worst in the Anglia and Oxford region. When will he stop the policy of moving money away from rural health authorities and into urban areas?

As the policy has not started, there will be no need to stop it. The only thing that has started is Opposition Members peddling stories that are not true. The only significant change in allocations was an item to recognise the additional cost that ambulance services in rural areas have to bear because of the distances covered, so rural areas are generally better off. Exactly half the increase in the number on the waiting list in Suffolk last year occurred in the first quarter of the year—the period for which the Conservative Government were entirely responsible.

The Secretary of State has publicly and disgracefully threatened to dismiss local health service chiefs if his targets for waiting list reductions are not met, although he has not provided them with the resources to meet those targets. Is that fair?

The waiting list reduction target that I announced at the Dispatch Box last Wednesday, to be funded by the extra money that I announced at the time, was not conjured out of the air by Ministers: it was the product of the considered view of the chief executive of the national health service. The British Medical Association, representing doctors, and the National Health Service Confederation, representing board members and managers, confirm that it is a realistic target. It must be taken seriously by everybody in the national health service. It is in the interests of patients and of the service that targets should be met, and I am making it clear to all concerned that they will be met.

I applaud the Government's policies to reduce waiting lists, but what assistance does the Secretary of State intend to give to NHS trusts in financial difficulties? Will he take into consideration the representations that I have made to him in writing on the future of the minor injuries unit at Jarrow hospital?

My hon. Friend will know that I cannot give him an off-the-cuff answer on the future of the minor injuries unit in Jarrow, and he would not expect me to; but I can tell him that most of the debts that health authorities face are the hangover of the debts that they faced under the previous Government—except that, generally speaking, the amounts are a lot lower. I am making it clear to the non-executive directors, chairs and chief executives of every health authority and trust that not a penny of the extra money for targeting on waiting lists is to be spent on anything else. The people who think that they can divert the money had better think again.

Does my right hon. Friend agree that not only have we put in an extra £1.7 billion, but we have had to face the fact that the Conservatives in government wasted a huge amount that could have gone towards cutting waiting lists on the introduction of the marketplace in the health service, and that that led to the increasing waiting lists that we have inherited? We are now promoting co-operation, and, in addition to the extra resources, we have the capacity to make the money work better in the NHS. Is it not a disgrace that Conservatives Members should now be hopping up and down, when they could not deliver on behalf of the people of this country in all their 18 years in government?

I accept all the points that my hon. Friend has made. During this winter, which is just coming to an end, the NHS and people working in social services have amply demonstrated to everyone that, given targeted additional resources, they can deliver the targets laid down. On the basis of the confidence that I have developed in the capacity of the health service to do that, we have found an additional £5 million, which is to be targeted on waiting lists and will not be diverted for any other purpose.

Given that the whole country now knows that, if the Labour party had been really honest, its election "early pledge" would have read, "Waiting lists will be shorter, but not yet," or, "Waiting lists will be shorter, but not for years," does the Secretary of State accept the view now widely held among the professionals he quoted and informed journalists—the view that my colleagues on the Liberal Democrat Benches have held for years—that waiting lists and times will not come down significantly and the NHS will not escape a profound financial crisis until it receives at least a 3 per cent. a year increase in real terms?

I do not know who these people are in the professions, and as for "informed journalists", that is almost a contradiction in terms. The fact of the matter is that I have talked to the leaders of the professions, and they are confident that the £500 million—

Is it enough?

The hon. Gentleman was on his feet speaking for about five minutes and now wants to continue bleating on.

Will my right hon. Friend tell us how he envisages that the extra £500 million will be put to use to cut the waiting lists in the Birmingham area?

It will be straightforward. It will be spent on more operations, more work by doctors and more nurses employed in the Birmingham area, on more effort in the Birmingham area to stop people who would be better off at home from having to go into hospital, and on more concerted effort to get out of hospital people who are better off at home. All that will be happening in real terms to real people, carried out by real doctors and real nurses, in real Birmingham.

If he will list those health trusts which make available facilities for which patients pay hotel charges; and if he will make a statement. [34382]

All basic services, such as catering, cleaning and laundry, are free of charge to national health service patients. Information is not held centrally on extra services that they may be offered—for example, bedside television.

I am grateful to the Minister for that reply, but does he not feel that the national health service as a whole should he able to maximise the use of facilities to provide additional resources for patient care? Hospitals are being closed, wings are being decommissioned and beds are going out of commission. There is a growing need for facilities for people who for reasons of their own require a private room and facilities. Would it not be good for the health service if it could offer that facility—without in any way creating a two-tier system, to which I am 100 per cent. opposed?

The hon. Gentleman deserves to be heard with respect, because he has on occasion stood on his own among Conservative Members in defending the NHS. Nevertheless, he will understand that it is vital that any extra income-generating proposals from trusts must concern optional extras, and they must be just that: optional and extra.

Will my hon. Friend comment on the huge amount of debt owed to the NHS by people in the private sector who have not yet coughed up their full whack?

It is important that anyone who owes anything coughs up.