When he will announce the additional individual health authority allocations as outlined in the Budget. [38671]

I have announced today each health authority's share of the first £288 million of the extra funds that we have provided to reduce hospital waiting lists this year. Liverpool will get an extra £3,193,000. There is more to come.

I very much welcome my right hon. Friend's statement about additional funding for Liverpool. Will he confirm that that is in addition to the £11.4 million extra already announced for Liverpool health authority? What steps does he intend to take to ensure that the money provided by the Government is used for the purpose for which it is intended—reducing waiting lists?

I can confirm my hon. and numerate Friend's arithmetic. I am taking steps to ensure that every penny that is earmarked for reducing waiting lists will be spent on that alone.

Every health authority will welcome any additional money, particularly as the Secretary of State has signally failed to use the Red Book figure as the basis for negotiation to deliver an adequate return for the health service. Why does he not support NHS research and development? Why has he reduced the percentage of NHS money going to research and development—reversing the Culyer commitment—when he is proclaiming the importance of evidence-based medicine?

The right hon. Lady will know from the figures that we have published today that my initiative, using the money provided by the Chancellor in the Budget, will give her health authority an extra £3.4 million to reduce waiting lists in her constituency. Our principal target for the moment is to reduce waiting lists. The waiting lists that we inherited were too high.

They are higher now.

They are higher still now, but they will come down. The reduction will be greater than any seen in the history of the national health service, because the money will be spent on what it is intended for.

I greatly welcome the additional £3.5 million being allocated to Suffolk health authority, from which my constituents will benefit. I also welcome the announcement that the money will be used to cut waiting lists. How does my right hon. Friend expect the health authority to distribute the money? Will it take into account the length of waiting lists in different parts of the area?

Provided that they reduce waiting lists, I want to leave matters as much as possible to the initiative of those responsible locally. Their targets will be spelled out to them and made public in due course.

Will the new allocation to Lambeth, Southwark and Lewisham health authority remedy the situation of an elderly diabetic and cardiac patient who has contacted me? Last September he was given an appointment to see a diabetes consultant in April. That appointment has been cancelled, and he has been given a new appointment for June. In January he was given an appointment with a cardiac consultant for June—a five-month wait. That has been cancelled and he has been given a new appointment for October. Why should he have any confidence in the Secretary of State's stewardship of the NHS?

If the hon. Gentleman wants to raise individual cases with me, I am prepared to take them up and pursue them. If he is asking what Lambeth, Southwark and Lewisham is getting of the new money allocated to reduce waiting lists, I can tell him that it is £5.6 million. I think that that is a substantial sum. If the hon. Gentleman is going for specific cases, I can tell him that his health authority, Warwickshire, will be getting £2.8 million from the new allocation.

I know that the more than £2.2 million allocated to my constituency will be particularly welcome. Given that my right hon. Friend has said that we will be told the targets, and given that he has, I believe, said that money that is being held back will in due course be distributed, will he say on what grounds extra funding will be provided? I would certainly like to get on to my health authority to ensure that it meets the targets.

The initial share is simply intended directly to increase the number of operations. Some of the remaining money—more than £100 million—will be held back so that it can be used to make improvements in primary care, mental health or community services that would indirectly lead to a reduction in waiting lists. Various health authorities and trusts will be invited to say how much of that money they would like and how they intend to spend it.

If he will make a statement about the licensing of homoeopathic medicines. [38672]

Homoeopathic medicines marketed in the United Kingdom must either have a registration certificate under the homoeopathic registration scheme or a marketing authorisation issued by the licensing authority.

What will the hon. Lady do to ensure that the licensing system does not become an enormous economy of scale which will be used by large drug companies to exclude smaller firms which currently serve the market very well?

As the hon. Gentleman will be aware, the homeopathic medicine industry is regulated by European directive. There are some quite disturbing inconsistencies in the marketing requirements for products, depending on when they were licensed. Our concern is to ensure that no homeopathic product is marketed in such a way that unproven medicinal claims are inadvertently made about its effectiveness that would be misleading to the public.

I am grateful for the Minister's supplementary answer. Does she accept that it is absurd that, if I buy arnica for my football bruising from a company that has the original product licence of right from the 1960s, the packaging tells me that the product is for bruising, whereas the packaging of arnica produced by a newer company cannot tell me that? Is it possible for the United Kingdom to seek a dispensation simply to allow companies to be able to offer the same information about homeopathic products?

My hon. Friend makes an important point. The European directive provides for member states to take action in relation to efficacy of products. Only France has so far drawn up guidelines, but, given the growing public interest in homeopathic medicine and complementary medicine more generally, I shall certainly want to study the issue closely.

If he will make a statement on primary care in Leicestershire. [38673]

In December, we published our White Paper "The New NHS", which sets out our proposals to develop a modern health service. In February, Leicestershire health authority issued a discussion document setting out the primary care locality arrangements in the county and suggested proposals for how those arrangements may evolve towards primary care groups.

The Minister must be aware that the Government are underfunding the NHS in Leicestershire—as compared with other areas—this year by about 3 per cent., or £13.4 million. In primary care, that is leading to disputes among general practitioners over scarce resources. As a direct result of the capitation-based approach to resource allocation, GP services in south Leicestershire will deteriorate. What would the Minister say to my constituents in Countesthorpe and elsewhere, where hospital waiting lists are higher this year than they were last, and where GP services are worsening owing to his Government's policies?

Frankly, I am surprised that the hon. Gentleman has raised that issue. This morning, I inquired about the position with the health authority, and I can tell him that GPs in his area are set to gain from the changes, just as the health authority has gained today following my right hon. Friend's announcement of an extra £4.8 million to tackle waiting lists.

Is not Leicestershire—like so many other parts of the country—doing extremely well under the new Government? Is it not important that Leicestershire and other health authorities should use the 50th anniversary year of the NHS not only to look back to their achievements but to look forward to what a dynamic and innovative health service can do for the citizens of Leicestershire—and do it better than ever before?

My hon. Friend is absolutely right. We have a heaven-sent opportunity in this, the 50th anniversary year, to look to the future and to produce a modern and dependable health service which is properly resourced and engages all family doctors, community nurses and all staff in providing an excellent service day in, day out. That is a sentiment we ought to hear from Opposition as well as Labour Members.

May I cautiously invite the Minister not to spend too much time or Government money on celebrating the anniversary of the NHS, but to make sure that there is sufficient provision within it to assist those who need it? As we are talking about Leicestershire, will he assure me that the new dispensation under his glorious Government will provide sufficient funds for physiotherapy services for my constituency? We are satisfied with our GP provision—we have a number of excellent practices—but, in Harborough, we are short of physiotherapists. Will the Minister assure me on that matter?

I am not sure whether the hon. and learned Gentleman has seen the light or not, but I will take his remark as a compliment. Physiotherapists, and therapists generally, provide an important service to the NHS. It is important to acknowledge that, in some parts of the country, there are problems in recruiting physiotherapists and occupational therapists. Unlike the previous Government. we will not sweep the problems under the carpet. We are doing what we can to tackle them—particularly by providing more training facilities and grants for those who want to take up that profession inside the NHS.

What plans he has to ensure the proper regulation of walk-in private GP clinics. [38674]

General practitioners involved in private clinics are subject to scrutiny by the General Medical Council in the same way as all other doctors.

Did not the recent survey in Health Which? paint a particularly depressing picture of people paying between £36 and £250 to see a GP who did not know them from Adam; who had no access to their medical records; who was not trained to the exacting standards of the NHS; who was not subject to a proper complaints procedure; and who was not registered with the local health authority? Quite apart from those concerns, is this not one more chilling indictment of the previous Government's mentality, which gave rise to this form of taxi-rank medicine?

My hon. Friend is absolutely right. The account in Health Which? of prescribing by a number of independent walk-in health centres made disturbing reading. It is not in patients' interests—which are the single most important thing—to go to a GP who does not know them, or their medical history, or what they are being prescribed. That is why our efforts are going into building a modern and dependable health service which is led by quality, combining technical excellence with the responsive and flexible meeting of patients' needs. In pursuit of that, my hon. Friend will join me today in welcoming the allocation of £4.2 million to drive down waiting lists for his constituents, honouring a promise made by the Government at the time of the election a year ago.

Will private GPs be able to make secondary recommendations? What is the Minister's view of the relationship between private GPs and the NHS?

With great respect, I think that I have made the situation absolutely clear. Our concern is with the interests of patients. It is not in their interests to shop around and to go to several different GPs. They will receive the best care by going to a GP who knows them and whose services and care are supported by state-of-the-art medicine, delivering health care to patients where they need it.

I am very disappointed that the Minister is ducking the question. Does she not agree that our experience with slimming clinics, some cosmetic surgery clinics, and now private walk-in clinics, is such that we need a regulatory mechanism that is more beefed up than that existing at present?

We do Keep any such development under close review, but the medical conduct of GPs who operate in those or other private clinic is a matter for the General Medical Council.

When he intends to issue consultation proposals to the NHS on commissioning specialist services. [38675]

The consultation proposals on commissioning specialist services were published on 8 April and issued to the national health service and to relevant professional and voluntary organisations. Copies are available in the Library. The document may also be viewed on the internet, on the NHS web page. Responses are requested by 1 June.

I welcome the statement. I am sure that the consultation can lead to substantial improvements in the quality of life in care for people with difficult conditions. Will the consultation also cover services that are needed by people with multiple sclerosis and motor neurone disease, who have very complex care needs, ranging from community to specialist, over a period? In my constituency, those needs are extremely well met at Favell house, which provides that seamless care from community to specialist medical treatment.

The consultation is designed to cover precisely that sort of complex condition. MS is one of those conditions that is well served by the voluntary and charitable sector, which will no doubt respond to the consultation. We look forward to hearing what it has to say.

Royal Shrewsbury hospital provides world-renowned specialist services. There is a proposal for its amalgamation with the nearby Princess Royal hospital in Telford. Will the Minister guarantee that he will consult locally to ensure that those specialist services stay in Shrewsbury?

The hon. Gentleman has been in the House long enough to know that consultation is very much a part of any proposal. Consultation will no doubt take place in the usual way, and, if it comes to Ministers, he will have an opportunity to make his views known.

Bearing in mind the fact that there is growing emphasis on devolution throughout the nation and that, at the same time, more specialist skills are needed for technical work in the health service, will the Minister give an undertaking that specialist services that serve the whole nation will be available?

We work closely with colleagues in the Northern Ireland Office, and the hon. Gentleman can be sure that what we propose in this instance will apply throughout the nation. Of course that will include Northern Ireland.

What proposals he has for extending the new deal to the NHS. [38676]

I wrote to health authority and NHS trust chairmen on 11 March, in a joint letter with my right hon. Friend the Minister for Employment, Welfare to Work and Disability Rights, about the benefits of the new deal, encouraging them to support the Government's welfare-to-work programmes. The NHS executive will shortly issue further guidance to NHS employers.

Given that the NHS is the largest employer in the UK, is it not sensible that it plays a part in the Government's new deal initiative? Furthermore, does my hon. Friend agree that the new deal provides a golden opportunity, given the concern about the shortage of nurses, for NHS trusts to attract back nurses who perhaps have been prevented by family commitments from going back to work in hospitals?

My hon. Friend is absolutely right. The NHS is in a position both to contribute to and to gain from the new deal. I am pleased to tell him that, when I visited Newcastle yesterday, I learned that the NHS in Tyne and Wear is already considering making available 100 health care jobs through the new deal. I expect that to be followed in other areas.

When the first national survey of patients and user experience will be carried out in the NHS. [38677]

When the first national survey of patients and user experience will be carried out in the NHS. [38685]

The first national survey of the experience of NHS patients, users and carers will be carried out later this year.

Is not the best way of getting patients and staff more involved in an organisation to give them a voice in it? Is it not especially important, given the massive injection of resources that the Government have put into the health service recently, to give people that say and ensure that the money is spent correctly? North Cheshire has already been allocated £6 million for 1998–99, with an extra £1.9 million to reduce waiting lists, which was described by the chief executive of North Cheshire health authority as

"a huge sum of money".

I certainly welcome any such statements. We certainly need to listen to the people who work in the national health service, which is why I made it my business recently to write to every single person working in the service to ask for comments on the service generally and on local matters.

Is this not an excellent and fitting way in which to celebrate the 50th anniversary of our national health service, created by a Labour Government? Will not a new, dependable, modernised health service be created by this new Labour Government to take us into the next 50 years?

I endorse everything that my hon. Friend has said. It is always worth repeating for the record that the Tory party voted against the establishment of the national health service. People need reminding of that from time to time.

After the rough ride that the Secretary of State got at the Royal College of Nursing congress last week—

Were you there?

No, but I was there the next day.

All I can say in response to the hon. Gentleman's usual whingeing, moaning contribution is that the figures announced today show that the health authorities serving seats represented by Liberal Democrat Members are getting an extra £73 million to help to deal with waiting lists. People—I refer not to constituents but to the whingeing, moaning Liberal Members of Parliament who purport to represent them—should show some gratitude.

Will the survey of user experience include women raped on mixed wards in acute psychiatric units? Will the Minister explain why new units with mixed wards are still being built in London, despite the opposition of a range of mental health charities? Is it not disgraceful that last Friday the Government again blocked the Mental Health (Amendment) (No. 2) Bill, which would prevent users unfortunate enough to go into an acute psychiatric unit from having such horrifying experiences?

It is news to me if new mixed wards are being opened. If they are, I will put a stop to it.

I welcome my right hon. Friend's last remarks, and the national survey. Does he none the less agree that, although such national surveys are extremely useful and welcome, they cannot replace certain pilot schemes that enable deeper evaluation to be made of some treatments? Does he accept that a number of such schemes have been conducted in maternity services? Will he make sure that, having received good evaluation, including favourable responses from users, health authorities and trusts will listen to the results of those evaluations?

What we propose is intended to supplement the current evaluations and pilot schemes. The object of the exercise—pilot schemes and evaluations as well as the national survey of opinion—is simply to identify the things that are right and ought to be encouraged and the things that are wrong and should be discouraged, and in that way to improve the performance of the health service. That is what everyone in the country wants, and all the 1 million people working in the health service want.

If he will make a statement on the financial provision for GP prescription budgets. [38678]

Nearly £4.4 billion has been allocated to health authorities in England to cover the cost of drugs and medicines prescribed by general practitioners this year.

Does the Minister agree with some practitioners that setting cash limits on prescription budgets will detract from their freedom to act in the best interests of their patients and in accordance with their best clinical judgment? Does he agree that it could lead to a loss of morale, especially in the GP profession; might harm recruitment; and might prevent the best relations between doctor and patient from being established? Does he accept that it should be for the GPs to prescribe what is best for their patients?

The answers to the hon. Lady's questions are no, no, and yes. Yes, of course it is for the family doctor to decide what is in the best interests of the individual patient, but I did not hear any howls of protest from Conservative Members when the previous Government cash-limited drug spending for 50 per cent. of GPs by introducing the GP fundholding scheme. There were no protests then, so why the protests now?

Has my hon. Friend guaranteed the clinical judgment of general practitioners?

Yes. As my hon. Friend is aware, we have put family doctors and community nurses in the driving seat. We have removed the artificial barriers between prescribing budgets and referral budgets which, in the past, have got in the way of allowing the family doctor to make the right decision for the patient. We have done no more and no less than increase GP freedom.

It was good to hear the Secretary of State say that survey after survey showed how happy people were with the NHS. He was clearly referring to the British social attitudes survey. There has not been one since the election, so presumably he was referring to people's happiness with the health service when it was being run by us.

On his first point, I remind the hon. Gentleman of what he said in Birmingham recently about the previous Government's record on the national health service. He said that they had failed and that the British people had given their judgment on that. Let us be clear about the facts.

Can my hon. Friend confirm the excellent comments made by my right hon. Friend the Secretary of State for Health at an Association of the British Pharmaceutical Industry event last Thursday evening? He made a well-received speech, in which he rightly said that we would ensure that money spent on pharmaceuticals and on drugs was used most effectively. His concern was not about budgets, but about effective treatment for patients.

My hon. Friend is absolutely right. The new system that we shall introduce will allow the individual family doctor to decide what is best for the individual patient, without there being any artificial barriers in the way. That may mean that there will be an increase in drugs spending in some GP practices; elsewhere, it may mean an increase in referral patterns to hospital. The key fact is that, in future, decisions will be taken in the best interest of the patient.

How many applications from the south-west of England have been approved under the investing in dentistry initiative. [38681]

Since the investing in dentistry initiative was announced last September, my right hon. Friend the Secretary of State has approved 46 funding requests from the area covered by the south and west regional office of the national health service executive.

I thank the Minister for that reply and warmly welcome the initiative, if it provides wider access to NHS dentistry. Will he continually audit the evenness of the spread of availability across the country, and ring-fence any moneys that are unspent from the allocation, and ensure that they are available for dentistry? Will he also ensure that my constituents, some of whom have rung me in desperation about finding a dentist within reasonable travelling distance who will provide NHS treatment, are satisfied that there is such provision in their area?

We have received two investing in dentistry applications from the hon. Gentleman's constituency. Both have been approved. We have allocated an extra £50,000 as a consequence, and an extra 4,000 patients in his area will have access to NHS dental care as a result. We want the NHS dental service to be available across the country as part and parcel of a modern and dependable health service, not an add-on or an afterthought. That is why we are tackling access problems through investing in dentistry and through other initiatives. They are working well to date, and we shall continue to monitor to ensure that they work well in the future.

Is it not a fact that, in the south-west and in the north-west, the Tory party—

Order. We are not concerned about the north-west. I was waiting for someone to widen the question, which is about applications from the south-west of England.

Is not it a fact that people in the south-west cannot get NHS dental treatment, and cannot move anywhere else in the country to get it, because the Tory party destroyed the dental service in the south-west and throughout the country?

Throughout the south-west and in other parts of the country, we are taking action to tackle the availability problems that are a legacy of the previous Government's rundown of NHS dentistry. Through investing in dentistry, we are making NHS dental services available to an extra 250,000 people across the country who otherwise would not have access to them. That is a good start, but we want it to continue.

When he expects waiting lists will be reduced by 100,000 from the 1 May 1997 levels. [38682]

As I made clear on 18 March, we are committed to reducing waiting lists to 100,000 below the record levels we inherited by the end of this Parliament.

I thank the Secretary of State for his reply. Can he give an assurance that, following the welcome additional money now being used to reduce waiting lists, there will be no further cases of the sort reported to us as constituency Members of Parliament, wherein clinicians have been leaned on by administrators to distort their medical priorities in order to treat politically more embarrassing 18-month waiting list cases?

I would not have thought that any clinician worth his or her salt would allow themselves to be leaned on. If they allowed their judgment to be clouded in that way, that was their fault and they must answer to their conscience, their profession and their patients.

As part of the strategy to bring down hospital waiting lists, will the Secretary of State consider approaching the South Essex health authority and Basildon and Thurrock General Hospitals NHS trust to find out whether the spare capacity in wards at Orsett hospital can be used not only for my own area of Basildon and Thurrock, but for the wider regional need to reduce hospital waiting lists?

I do not pretend to be an expert on every hospital in the country, and I am sure that those in charge in that area, having had it made clear to them by me that they are to get their waiting lists down, will take every sensible step to get them down. In this case, they will be assisted by the £3.8 million that is going into my hon. Friend's area, which takes the total extra money that we have put in to £18.5 million over and above what the Tories intended.

Does the right hon. Gentleman recall that, in its document "Labour's Early Pledges" and, indeed, in the general election manifesto, the Labour party promised immediate action to reduce waiting lists by 100,000? Is it not a fact that, 12 months on, waiting lists have actually increased by 100,000? Although no one doubts the sincerity of the right hon. Gentleman's commitment to the national health service, is not the truth of the matter that, in the general election campaign, the Labour party made promises about waiting lists that it knew it could not possibly keep, because it did not want political honesty to get in the way of a successful electoral outcome?

Talking about casual promises, we could reasonably interpret the hon. Gentleman's remarks as a rejection by their elected representative of the £6 million extra that is going to the two health authorities serving his constituents. The casual ad hoc sums to which he refers are apparently of no consequence to the hon. Gentleman, but I am sure that many of my hon. Friends would welcome them being spent in their area. We are serious about getting waiting lists down. The people of this country are sick to death of waiting lists, year in, year out. It is not the fault of the people working in the health service, but the fault of successive Governments. We have to bring waiting lists down and we are going to bring them down.

Instead of wasting too much time listening to hypocritical claptrap from the Tories—they had their chance and they blew it—will my right hon. Friend bear in mind that he probably has the biggest nut to crack in getting down waiting lists, and that £500 million was set aside for contingencies in the Budget a few weeks ago? Will he consistently remind the Chancellor of the Exchequer that we need to keep the promise to get waiting lists down, and that it will need a lot of money? A lot rests on it, so let us make sure that we get our hands on all the cash available to do it.

My hon. Friend knows that both he and I set a great deal of store by propriety. He knows that I have discussions with the Chancellor and the Prime Minister, and that it would be wrong for me to disclose their contents, but we have been successful in obtaining an extra £500 million to be spent on reducing waiting lists this year, and I expect that sufficient sums will be forthcoming to reduce them by 100,000 or more before the end of this Parliament.

When he next expects to meet the Royal College of General Practitioners to discuss the structure of primary care groups; and if he will make a statement. [38684]

We have regular meetings with general practitioners and other primary health care representative bodies, including the Royal College of General Practitioners. The development of primary care groups is just one among a number of issues that we have discussed. These professional bodies are supportive of the Government's plans to develop a modern and dependable national health service.

Will the Minister confirm that it has emerged from meetings with those professional representative bodies that the problems of recruitment and retention of general practitioners are severe and growing? To meet those needs, will he therefore extend to general practitioners the commitment that the Secretary of State gave to the nursing profession—that the Government do not propose to stage future pay awards?

As the hon. Gentleman is aware, there are problems with the recruitment and retention of GPs in some parts of the country. As he is also aware, the Doctors and Dentists Review Body recommended to the Government—and we have accepted the recommendation—that an extra £60 million be found to tackle some of those problems in the course of the next year or so. We shall discuss those recommendations with the professional organisations, including the British Medical Association, and no doubt target those resources to tackle the hard core of recruitment and retention problems that are encountered in some parts of the country.

When the Minister consults the Royal College of General Practitioners, will he remind its members that the formation of primary health care groups that include people who work in and for the national service and those who are contracted to it will not only improve health care, but prevent ill health? Everyone who is concerned about ill health in this country should join in welcoming that.

My hon. Friend is absolutely right. Throughout the country, family doctors and community nurses are enthusiastically embracing the idea of primary care groups, for two good reasons. First, it puts them in the driving seat in shaping hospital services and other local health services, and gives them far more leverage, influence and power than they have ever had. Secondly, the primary care groups go with the grain of the more recent developments in the NHS, where family doctors are coming together and overcoming the divisions of the past—especially the sole legacy of the previous Government to the national health service. The previous Government left the GP community split down the middle between fundholders and non-fundholders, but that is being brought to an end, because we want those in the NHS, including those in primary care, to work together as one.

What plans he has to increase public accountability in the NHS. [38686]

Since we took over, we have opened trust board meetings to the public, and removed the gagging clauses on staff. We have appointed people more representative of the communities that they serve. For example, more than half the appointments are of women, and we have doubled the proportion of black and Asian representatives.

Does the Minister agree that a strong body of opinion in the Labour party would like some democracy to be introduced to the people's national health service? May I suggest that we should do away with quangos? I invite the Minister to consider the three trusts in my constituency, plus the area health authority, in which all four chairmen are Conservatives, two of whom have been rejected by the electorate. Is it not the case that the present Government are just providing retirement jobs for defeated Conservatives?

On the hon. Gentleman's last point, I do not think that that has been the main burden of the Conservative attack on the people whom I have appointed. I thought the point was—I may have missed it slightly, but I do not think so—that I was heaving out too many Tory deadheads. However, I may be wrong. The hon. Gentleman appears to think that he is an expert on the internal affairs of the Labour party.

He is a retread.

I understand that the hon. Gentleman was once a member of the Labour party, and he remains an expert on it. However, I assure him that there is no substantial body of opinion within the Labour party seeking a wholesale change to the national health service. Labour Members want to see that service working. When it comes to elected representatives, I do not think that there is a council in this country comprising 50 per cent. women members or 9 per cent. black and Asian members. Those percentages certainly apply to my appointments to the national health service.

What can members of the public do when they suspect that their relatives are being over-prescribed neuroleptic drugs in residential homes? There is a wealth of evidence to suggest that anti-psychotic drugs are being administered to make the homes easier to run rather than to benefit the patients. Will the Secretary of State aim to reduce costs and damage to patients in the health service by avoiding the over-prescription of not only neuroleptic drugs, but antibiotics?

We must aim to ensure that the right people are prescribed the right drugs in the right amounts at the right times so that there is no over or under-prescribing, or people getting no prescriptions at all. That is our target. As to people in one institution or another being treated badly, the fact that we have opened trust board meetings to the public and removed the gagging clauses on staff should provide substantial new protections.

Does the Secretary of State believe that he increased public accountability by announcing yesterday to a private NHS meeting his plans to create a single health authority for London, which will take over the role of the North Thames and South Thames NHS executives? How did that increase public accountability? Should not the Secretary of State have done us the courtesy of making that announcement to the House of Commons? Ought he not to have borne in mind the implications that the announcement would have for NHS trust hospitals, such as Mount Vernon in my constituency, which straddles the Greater London boundary? Furthermore, what is the future of the home county areas that are currently administered by those two executives?

If my announcement yesterday to a private meeting was a secret, it was one of the worst-kept secrets in the national health service. Sir Leslie Turnberg proposed a London-wide health region in his review, which we published. It was endorsed in the Government's written response to that review, which we also published and which I introduced with a statement in the House. I went no further than saying that we should get on with it a bit more quickly than we intended originally.

Does the Secretary of State accept that accountability goes further than appointing people to positions in the NHS? It includes NHS systems that people understand readily. Will the Secretary of State encourage health authorities and trusts to adopt the standards of the King's Fund and the equivalent of International Standard Organisation 9000—which, incidentally, the authority in my constituency has just been awarded? Will the Secretary of State take on board my comments, and congratulate my authority on taking that action?

I am happy to congratulate the Wolverhampton authority. Like many others in the west midlands, it is innovatory and dedicated to looking after local people better. The previous Government changed the arrangements in the NHS for consultation and for complaints. For good or ill, those procedures should stay in place for a while for us to see how well they work, rather than our deciding to rip them up without examining the evidence. We want far more genuine consultation in future.

In light of the fact that community health councils are publicly accountable in a way that district health authorities are not, will the Secretary of State take particular note of the views of Canterbury and Thanet community health council if, as appears likely, it refers to him East Kent health authority's dreadful proposals to close the Kent and Canterbury hospital? Following his answer to my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson), will the Secretary of State confirm that there is no danger of East Kent suddenly moving regions, in the middle of an already fraught consultation?

East Kent is fairly likely to stay where it is. I know about the history of the Goodwin lands becoming the Goodwin sands, but Kent is probably fairly safe for the immediate future.

What action he proposes to improve consultation with staff within the NHS. [38687]

We have made clear our commitment to involve national health service staff in decisions about how the NHS is run. We have set up a task force to identify and explore new approaches to staff involvement, and my right hon. Friend the Secretary of State has written to every individual working in the NHS, seeking his or hser views on examples of what has or has not been shown to work in practice.

Does my hon. Friend agree that consultation with staff in the NHS is vital if we are to rebuild the NHS and get the NHS that we want? With reference to the task force that the Government have set up to consult staff, is it not significant that it includes not only senior managers and doctors, but porters, so that the forgotten army of the NHS is represented and can express an opinion on the future development of the NHS?

We have made clear our intention that the 13-strong panel that has been set up as the task force should include porters, nurses, doctors, managers, a national union officer and representatives from outside the industry, all of whom are making a valuable contribution to the work of the task force. It is a matter of recognising the skills that exist in the NHS and using them.

When the Minister next consults NHS staff, what estimate will he give of the size of waiting lists this time next year?

We need no lessons from Conservative Members about consulting NHS staff. As they know, we see NHS staff as our greatest asset—one that they wasted when they had the opportunity to use it.

Will the Minister ensure that in consulting NHS staff, some attention is paid to finding out their views and opinions on issues affecting black and ethnic minorities? After the second world war, women of Afro-Caribbean descent played an important role in building up the NHS. In my view, their contribution has never been sufficiently recognised.

My hon. Friend has shown considerable commitment to ensuring that the contribution of Afro-Caribbean and Asian men and women to the NHS is recognised, and we shall celebrate it in the course of this 50th anniversary year. I was pleased to have the opportunity of visiting, with my hon. Friend, a hospital in her constituency, showing that the Government consult all staff and recognise the manifold contribution of all those who, over the years, have built the NHS into something we should be proud of and something that Labour Members are determined to protect.

If he will make a statement on his plans for releasing £s1 billion from NHS bureaucracy; and when he expects this target to be met. [38688]

The Government have already taken action to reduce bureaucracy in the national health service. By the end of this year, £240 million that would otherwise have been spent on bureaucracy will be released for patient care. Building on that, the White Paper "The New NHS" sets out a programme of action to release £1 billion from bureaucracy by the end of this Parliament.

I am grateful to the Minister for that reply. How does he square his rhetoric about cutting bureaucracy in the health service with the intention in the White Paper to create a national institute of clinical excellence, a commission for health improvement, a primary care group, an advisory committee on resource allocation and a capital prioritisation advisory group? What is his estimate of the likely annual cost to the national health service of the flotilla of pen pushers that he proposes to create?

I know that the hon. Gentleman has a reputation as a zealot for all things Conservative, but I would have thought that even he would have drawn the line at protecting and defending bureaucracy at the expense of patients. We want to establish a national institute for clinical excellence and a commission for health improvement to improve the quality of services to patients. I hoped that that would command support not only from Labour Members, but across the House. I can tell the hon. Gentleman that we intend to release £1 billion by cutting the number of commissioning bodies from around 4,000 to as few as 500, and by ending extra-contractual referrals, the annual contracting round and the absurd system of individual invoicing introduced by the Conservative Government.