What steps he is taking to improve access to general practitioners, with particular reference to areas with a low number of general practitioners per 1,000 population. [50976]

We have introduced a range of initiatives, such as a salaried general practitioner scheme, that will be beneficial particularly in areas with low GP numbers.

I thank the Minister for his response, which was encouraging. However, is he aware that simply to bring our patient waiting list sizes down to the national average, we have to increase the number of GPs by one third in Rotherham, by one quarter in Barnsley and by one fifth in Doncaster? Is he aware that increasing GP numbers is one of the central objectives of the health action zone in the South Yorkshire coalfields? Will he therefore tell me what operating freedoms he is considering giving to health action zones to tackle the problem of GP numbers, and when he expects to reach a decision on the matter?

I thank my hon. Friend for his question. Health action zones are currently working up their outline bids into full proposals, which we shall be examining very carefully. We want to ensure that the difficulties are plugged in all parts of the country, especially those with problems—which the Government have inherited—in recruiting GPs. I can tell my hon. Friend that his health authority has just agreed additional funding for a salaried GP post. I hope that that will be helpful. He will be aware that the Government have concluded negotiations with the British Medical Association to introduce a salaried GP scheme, and also to beef up the GP retainer scheme. As he will also be aware, many general practitioners have worked in, but left, the national health service. The Government want to recruit them back into work, for the benefit of patients.

I look forward—I say rather unexpectedly—to doing battle with the Minister in the next year. I know that he had high hopes of promotion, which he well deserves. I can only assume that the Prime Minister had given him an early pledge.

I had planned on saying that the hon. Gentleman's first remarks were unworthy of him, but perhaps they were not. The British Medical Association is wrong on the more substantive issue that he raised. Doctors do not grow on trees—they cost extra cash, which is precisely what the Government have provided in the comprehensive spending review. If we had not provided extra cash, we would not be able to recruit extra doctors or to give the go-ahead to a massive expansion in the number of GP medical students—which I hope that he will welcome.

Pursuant to his answer of 23 June 1998, Official Report, column 491, what representations he has received on methods of reducing clinical negligence litigation. [50977]

We have received more than 120 replies to our call for ideas on how to reduce the threat of litigation in the national health service. The replies have come from a wide range of sources, including the health care and legal professions, and the NHS and patients. My officials are currently studying the replies to identify key issues and ideas that we can develop.

Are Ministers at all uneasy about the way in which some lawyers—not all—seem to encourage clients to take litigation against medical practices, and about the natural reaction of doctors and their colleagues, therefore, to practices defensive medicine, which may not be in the best interests of patients as a whole? Over the summer, will my hon. Friend and her lawyers look carefully at the submission by Lord Justice Sir Philip Otton—a complex document that I have given to the Department in the hope that legislation can be brought forward to overcome an increasing and delicate problem?

My right hon. Friend the Secretary of State has already met Sir Philip Otton. We shall consider his proposals. We want to avoid patients being led to believe that they have grounds for legal action. The risk of defensive medicine follows. We want to ensure that lawyers are kept out of the operating theatres and doctors are kept out of the courts. That is good for patients.

What representations he has received on general practitioners' rights to information about the clinical performance of their local hospital. [50978]

What representations he has received on access by (a) general practitioners and (b) patients to information about the clinical performance of their local hospitals. [50989]

What plans he has to publish average clinical performance of hospitals by procedure. [50990]

A wide range of people, including general practitioners and members of the public, have expressed strong support for our proposals to give patients and GPs a clear right to know about how their local NHS hospital is performing. As a first step, we shall publish hospital-based indicators in the autumn.

Does my right hon. Friend agree that it is essential in the modern, dependable national health service that we are seeking to build that patients and GPs should have access to information about the performance of their local hospitals? Should not the right to know be our clarion call?

Yes indeed, I entirely agree with my hon. Friend. It is crucial that the information provided to GPs and local people is accurate, comparing like with like. Providing misleading information would be harmful not just to the hospital and the profession, but to the GPs and patients.

Is it not the case that knowledge and information are power? Extending information to patients empowers them. That must be right, because they not only use the health service, but pay for it.

It is certainly right in principle. People want, and are entitled, to know whether their hospital is performing up to national standards. People do not want to go shopping around and travel long distances for treatment, but they want to be assured that their local hospital is up to scratch. The information will help them.

Does my right hon. Friend agree that it is important that, when the information is published, on a hospital-by-hospital basis, improvements are made where there has been shown to be room for them? What role does he see for the Commission for Health Improvement in ensuring such improvements in the interests of patients and GPs?

The crucial point is that local management and local doctors should know how their performance compares with national standards. If they are not up to the national standards, they should take steps to ensure that they get up to standard. The Commission for Health Improvement, while not quite a long stop, would not be the first organisation to be involved if the local management and local doctors were seen not to be responding to the information that had been made available. Until now, most of the information has not been available, even to the hospital trust boards.

I endorse a sensitive approach to providing information on clinical outcomes, especially considering the fact that some of the waiting list targets have been such a fiasco for the Government. What steps will the right hon. Gentleman take to reassure the research community, already affronted by the gratuitous cut in its budget, that a clumsy approach to naming and shaming, and hospital league tables, will not result in defensive medicine, a reluctance to take on difficult cases, and a stifling of innovation altogether?

I shall ignore most of the right hon. Lady's preliminary remarks. On the sensible point that she made about trying to ensure that we do not stifle innovation, it is true that if someone tries a surgical procedure for the first time there will be no standard for it, and it will be a riskier form of treatment than procedures that have been frequently carried out.

In Lancashire.

Yes, in Lancashire; I apologise. 1 must admit that, as a Yorkshireman, I always did think that Wigan was in Lancashire; it always seemed to be there when it played against Yorkshire rugby league clubs.

At the end of last week there were reports that the use of human albumin for transfusions may not be safe, and today there has been another report that the cervical cancer screening carried out by a London hospital has not been entirely safe. Given that last October Ministers said that we must have a national system of quality assurance for cancer screening, and that in December the Secretary of State announced the need for a Commission for Health Improvement to ensure that the whole country has the highest quality standards, can the Secretary of State today assure women in particular, but also all general practitioners and patients, that we will not have to wait any longer for a national system to ensure that transfusions, screening and all other services are of the highest clinical standard everywhere?

As the hon. Gentleman knows, we are trying—carefully, so as to carry the professions with us, because if we do not, no new system will work—to put in place measures to ensure that standards are maintained. As for his reference to the use of albumin, I can only describe the article in The Observer as a grotesque travesty of the situation. The information was supplied to the Chief Medical Officer; the Chief Medical Officer asked the people who prepared it, after consultation within the Department, to send it to the Medicines Control Agency; the agency considered it; the Committee on Safety of Medicines was informed and also considered it. As long ago as 28 May, the committee concluded that it did not consider that withdrawal of human albumin products was warranted, and advised that an expert working group be set up. That group has met, and decided that withdrawal of human albumin products was not warranted. As Secretary of State for Health, I have to consider carefully the advice of those who have been put in a position to give me advice on such matters; I do not have to respond to hysterical articles by ill-informed journalists in badly edited Sunday newspapers.

The Secretary of State will be reassured by the fact that I support what he says at that level, not only about medical advice but about other advice. May I press him to tell us whether, when he deals with the procedures, information will be circulated to general practitioners about new procedures, so that they can guide their patients to places where those are being carried out? May I also express the hope that the statistics will major not on mortality figures, but on successful procedures—and not only clinical procedures, because many other procedures are vital for good health?

I accept the hon. Gentleman's point. Mortality statistics are fairly straightforward, but statistics showing how well people do after an operation—if they have survived—are more difficult to calculate, evaluate and log in any system. We are going to enormous lengths to ensure that our proposals command the support of the profession; indeed, the first figures that we shall be publishing in the autumn command the support of those who are carrying out operations. If we could not carry them with us, the proposal would be absurd.

What proportion of the increased funding provided to his Department in the most recent public spending allocations will be allocated to reducing waiting lists. [50979]

We have already announced an extra £500 million to tackle waiting lists this year, which means that we have spent a total of £2 billion extra on the national health service since we came into office. Under the comprehensive spending review, the NHS will receive a further £18 billion for the next three years, including £5 billion or more for the NHS modernisation fund. We shall ensure that that money is linked to results so that, in the lifetime of this Parliament, we reduce waiting lists by 100,000 from the level that we inherited.

Will the Secretary of State explain why he and his colleagues conned the British public before the general election by saying that it would cost only £100 million to reduce waiting lists by 100,000?

We did not actually say that. At the most recent Health questions, I said, in response to an excellent question from my hon. Friend the Member for Bolsover (Mr. Skinner), that I was fairly confident that waiting lists had stopped rising in June. I can now say that the preliminary figures show that they fell by about 21,000 in June—what is more, they will continue to fall.

I thank my right hon. Friend for the additional £630,000 that Bedfordshire health authority is receiving to cut waiting lists, which is in addition to the £2.8 million that it has already received. The money will help local hospitals to perform another 4,000 operations and will be of enormous benefit to patient care generally as well as to reducing waiting lists.

My hon. Friend is right. A substantial amount of time is wasted in hospitals when patients do not show up. We intend, through the new national health service charter—which will refer not only to patients' rights, but to their responsibilities—to draw attention to the fact that if someone does not turn up for an appointment, that harms not only them, but other people; moreover, it makes life difficult for hospital staff. We hope that, by publicising the damage that not showing up does to others, we can change the behaviour of those who have made hospital appointments or have had them made for them.

May I use my first question to ask the Secretary of State whether he will take this opportunity to join me in placing on record a tribute to the Kent air ambulance, which crashed a few days ago with the loss of three lives? Will he pay tribute to the work of Graham Budden, the pilot, and Tony Richardson and Mark Darby, the paramedics? Will he also pay tribute, not only to all those who manned the air ambulance and did such sterling work, but to the entire community in Kent, which raised the money for the ambulance and supported it faithfully throughout?

I certainly join the right hon. Lady in paying tribute to all concerned. I express my horror at what happened and my sympathy for the relatives and friends of those who died while trying to help others.

I am grateful to the Secretary of State.

The 7,000 extra doctors have to be paid for. But for the comprehensive spending review settlement, there would be no money to pay for them. Every year, medical schools produce approximately 3,400 new doctors, and we hope that the schools will continue to do so and that the doctors will find employment in the national health service. If the right hon. Lady wants to criticise us about the number of doctors available, let me remind her that it takes five, six or seven years to train a doctor. Any criticism of the numbers available today should be addressed to those who were in my office five, six, seven or eight years ago.

Try again matron.

May I invite the Secretary of State to try again? Just answer the question. Yes or no will do. Will the 7,000 doctors that the right hon. Gentleman has announced be over and above the normal increase, or is that the number that would have come anyway from medical schools and other sources?

The answer is no. Doctors coming from medical schools do not necessarily end up working in the national health service unless someone gives them a contract and pays them. Without the money, there would be no contracts, they would not be paid and they would not be working in the NHS.

Does my right hon. Friend agree that while it is important to put money into bringing waiting lists down—I congratulate him on doing so—organisation and sensible management are equally important? One of the most important factors in the driving up of waiting lists under the previous Government was the idiosyncrasies introduced by the internal market system. Does he agree that removing the internal market will go a long way towards smoothing the path of reducing waiting lists?

I agree with my hon. Friend. One of our objectives in getting rid of the competitive internal market is to get rid of the expensive paperwork involved, which is using huge amounts of NHS money that we would deploy to treat patients rather than to buy paper to shuffle around the world.

How he intends to involve the public in discussions about limits on the provision of drugs and treatments in the NHS. [50980]

The public will be involved in setting national standards for the NHS through the new National Institute of Clinical Excellence, and in developing national service frameworks. We have also made it clear that local commissioners of services should consult the public to ensure that services reflect local needs and wishes.

The Minister will recall that at his last Question Time we dragged from him the admission that postcode rationing exists, particularly for new drugs. It is also recognised that 3.7 per cent. growth across a Parliament will not provide for growth in drug expenditure. Does the Minister accept that the question is not whether rationing exists for treatment for multiple sclerosis, varicose veins, fertility and impotence, but when the Government will admit that that is happening and either fund the health service to avoid it, or engage the public and the taxpayer on how to meet demand for existing resources?

As usual, I am not sure what is the policy of Liberal Democrat Members. There is no question of information being dragged out of this Government. We have acknowledged that treatments and the drugs available vary unacceptably throughout the country. Equally, we have made it clear that we are determined to bear down on those unacceptable variations. We want greater national consistency, based on more informed clinical judgments. The hon. Gentleman argued a few days ago from the Liberal Benches that the NHS needed 3 per cent. real-terms growth in expenditure. We have gone above 3 per cent. and 4 per cent. and for the next three years it will be 4.7 per cent. What does the hon. Gentleman want? Is 4.7 per cent. good enough or not?

Will my hon. Friend ensure that debates about the availability of drug treatments focus not merely on the cost of the drugs but on the benefits? I am thinking, for example, of the new drugs for HIV, where there has been much focus on the cost but not as much on the long-term benefits, including the economic benefits of people being able to get back to work. In the argument about whether drugs should be available for a particular treatment, we want to avoid setting one group of patients against another, as has happened in the past.

My hon. Friend makes two good points. On the first point, like previous Health Ministers, we get lots of advice from economists and others who say that we need to bear down on the NHS drugs bill, as though drugs were a bad thing, which is a naive assumption. If drugs mean easier, better and quicker treatment for the patient instead of going to hospital, that is a good thing and if it means growth in the NHS drugs bill, we should welcome it. On the second point, we want a more rigorous assessment of what is cost effective and clinically effective, particularly when drugs come on to the market.

Hon. Members will agree with what the Minister has said, together with what the Secretary of State said about innovation and making general what has been shown to work. On the limiting of treatments, may I ask the hon. Gentleman, in a non-partisan way, whether he recognises that delays in non-emergency treatment for cataracts and hip operations, for example, affect the elderly in particular? Will he consider publishing for each health authority the instructions to hospitals in their areas on necessary delays for waiting lists? West Sussex has the highest proportion of elderly people and the waiting time is 17 months.

First, on the general point, the hon. Gentleman will be aware—I hope that he and his party now accept this—that as we bring down waiting lists, which we are doing, waiting times for individual patients will also come down and I hope that he welcomes that. I will look into the situation in his area. I am aware of the problems there because he has seen me about them, in particular the increased demand that can arise from a higher than average elderly population. I will be pleased to look into the specific concerns that he expresses.

If he will make a statement on how national health service dentists are paid for root canal work. [50981]

Root canal treatments are included as items of treatment in the statement of dental remuneration for which dentists can claim an NHS fee.

Well, I am grateful for that reply, as far as it went. Does the Minister agree that the fees payable to dentists for root canal work, at £24 for an incisor operation and £58 for a molar operation, which takes about two hours, are completely inadequate? Does he agree that dentists can undertake those operations only at a loss to themselves, if they are reputable and competent, and that recent studies show that in many cases dentists are undertaking such operations speedily and unprofessionally, which is resulting in low standards with further operations sometimes being necessary thereafter? What is he going to do about it? Before he replies, may I point out that dentists and patients in my constituency do not want to know what happened last year and the year before, but what will happen next year and the year after?

I am sure that they do not want to know what happened last year and the year before. The hon. Gentleman will be aware that an independent review body deals with fees for procedures performed by dentists. We submit evidence to that body, as other Governments have; dentists submit evidence too, and the body recommends the fees that it considers appropriate. Over the past few years, the doctors and dentists remuneration review body has made recommendations for increases in fees well above the rate of inflation.

It may come as a surprise—although it should not—to some Opposition Members to learn that the more important question in some parts of the country is whether one can receive root canal treatment on the NHS. What steps is my hon. Friend taking to ensure better availability of NHS dental treatment in the poorest areas to provide such important procedures as root canal work?

The Government have taken a significant step forward on that. My hon. Friend will be aware that we inherited great difficulties with access to NHS dental services in some parts of the country. We have introduced a new investing in dentistry scheme, which is already bringing home the bacon because it is recruiting dentists back to the national health service. As a consequence, 250,000 extra patients now have access to NHS dental services which they would not have had under the previous Government.

What estimate he has made of the number of people awaiting out-patient consultations on (a) 1 May 1997 and (b) 1 May 1998. [50982]

Information on the number of people nationally awaiting out-patient consultations is not available centrally. However, information on first out-patient appointments shows that at March 1998, 81 per cent. of patients were seen within 13 weeks of general practitioner written referral and 96 per cent. were seen within 26 weeks. That compares with figures for March 1997 of 83 per cent. and 97 per cent. respectively.

At Stoke Mandeville hospital, which serves thousands of my constituents, there has been an 88 per cent. increase in the number of people waiting for out-patient appointments for between 13 and 26 weeks since the Government came to office. What proportion of the alleged fall in waiting lists—which is, as yet, unpublished—is due to an increase in the waiting list to get on the waiting list?

We have made it crystal clear that our targets on waiting lists should not be achieved at the expense of out-patient appointments, and we shall implement that policy. I hope that the hon. Gentleman will give credit to, indeed thanks for, the additional resources that have been made available in his constituency which have provided 51 extra beds, which would not have been available if the hon. Gentleman's party were in government, and 4,280 extra treatments. It is time we received some gratitude from Opposition Members for those resources.

Is my hon. Friend aware that part of the £2 million awarded to Barnet health authority to tackle waiting lists will be used to increase out-patient sessions at Edgware hospital, which the previous Government closed? Does not that show that this Government are trying to restore health services to the area, unlike the Conservatives when they were in government?

My hon. Friend has performed a sterling service for Edgware hospital in his constituency and in north-west London generally. It is good news that the hospital is now delivering the new, modernised health service for which the people of his constituency and many others voted.

Will the Minister acknowledge that what matters to patients is the total waiting time from GP referral to treatment? Will he further acknowledge that reduced numbers on the waiting list for surgery will be a pyrrhic victory if the waiting list to get on the waiting list is getting longer? Will he therefore arrange for data on the total out-patient waiting lists in the UK to be collected and published with in-patient waiting lists in future?

Those data were never available under the previous Government, and they will not be available under the present one. What counts is that we should shorten waiting lists across all fronts. Out-patients and in-patients alike will benefit from that. They did not benefit in that way under the previous, Conservative-led Government.

According to figures that I have received from the Library, at the end of the financial year 1995–96, the debt owed to the national health service by non-NHS debtors was a staggering £543 million. Does my hon. Friend agree that many of the difficulties that the previous Administration bequeathed to the national health service could be dealt with if some of the debt that they left us were collected?

The previous Administration have a great deal to answer for, and that is a small part of it.

What research he has (a) commissioned and (b) evaluated into the causes of premature deaths each year which can be ascribed to (i) tobacco, (ii) alcohol and (iii) cannabis. [50983]

The harmful effects of tobacco are well researched and documented—most recently, by the Scientific Committee on Tobacco and Health. An estimated 120,000 people die every year from smoking or smoking-related causes.

It is interesting that the one illegal recreational drug of the three is the one that, apparently, caused the fewest deaths. However, will the Minister address a problem that many health professionals have identified? There appears to be a beneficial medicinal use for cannabis, yet at the moment it is improper—indeed, illegal—for health professionals to prescribe cannabis for any purpose. Will the Minister reconsider the matter, to discover whether those who would benefit from the medicinal use of cannabis might be enabled to do so without being criminalised?

There are perfectly clear procedures for applying to conduct research to establish the medicinal benefits of cannabis. The Government have absolutely no intention of making the use of cannabis legal, but this is an opportunity for Opposition Front Benchers to clarify their position on the issue, and perhaps for the hon. Member for Rutland and Melton (Mr. Duncan) to make clear his position in relation to his recent book, "Saturn's Children", in which he said:

"Nor are drugs a particularly threatening health problem."

Of the 120,000 people who die prematurely from smoking-related diseases each year, 53,000 are over the age of 75. Given that the Minister's Department has stated that life expectancy for men is 75 years, how can those people possibly be described as having died prematurely?

I made it clear that, every year, more than 120,000 people die from smoking or smoking-related causes. I did not identify those who died under the age of 75, but, with life expectancy increasing, it is absolutely clear that, for people who smoke, the chances of dying from tobacco or tobacco-related causes are increased by something like 100 per cent. Half of smokers die from causes related directly to smoking.

Does not my hon. Friend recall that tens of thousands of people in this country who suffer from multiple sclerosis, the effects of chemotherapy and glaucoma take cannabis illegally as it provides the best relief from the serious pain that they endure? Why does she continue to condemn those people to dealing in an illegal market where they cannot guarantee the quality or strength of the product—and can only smoke it, which is the most dangerous method of using cannabis?

I join my hon. Friend in assuming that the failure of the hon. Member for Rutland and Melton to respond to that point means that he has not changed his mind about the legalisation of hard drugs.

Order. The hon. Member for Rutland and Melton (Mr. Duncan) is not allowed to respond. He does not have an opportunity to do so; he has had his question. Let us have a little justice.

To my hon. Friend the Member for Newport, West (Mr. Flynn), who has long argued the case in relation to people who suffer from multiple sclerosis, I reiterate that those who wish to undertake research into the beneficial medicinal effects of cannabis use may apply to the Home Office for permission to conduct that work.

Does the Minister agree that, when examining the use of drugs—recreational or otherwise—we should consider not only premature deaths but ruined lives? Does the Minister agree that the Liberal Democrats' policy of legalising cannabis is both dangerous and irresponsible?

I agree.

What factors underlay the response rate times achieved by Staffordshire ambulance service in the last three years. [50984]

My hon. Friend will be aware that Staffordshire ambulance service has achieved the best response times in England for the third year running. I commend this achievement, which is attributable in part to an innovative system of positioning ambulances on standby close to areas where emergencies are most likely to occur. We need to spread that good practice, which I know other ambulance services are looking at. I congratulate both staff and management of Staffordshire ambulance service on their enterprise.

What plans does my hon. Friend have to ensure that all ambulance services take advantage of Staffordshire's valuable experience? It appears that nothing has been done in the past three years to ensure that other ambulance services—such as Cornwall, which is at the bottom of the league table—benefit from the Staffordshire experience. The results have been startling and have produced huge dividends for patients, particularly those suffering cardiac arrest.

The Staffordshire ambulance service has already led several seminars that we have organised in order to encourage the spread of good practice. We must make it absolutely clear that we expect all ambulance services to respond to 75 per cent. of life-threatening calls within eight minutes by 2000–01. Staffordshire is so far the only ambulance service to have met that target already, and it is showing the way for others. Clear, strategic business planning has managed to achieve improvements without additional costs. Ambulance services nationwide must learn that lesson, and we intend to ensure that they do.

What meetings his Department held with members or representatives of local authorities prior to the June 1997 trawl for nominations to NHS trust boards; and if he will make a statement. [50985]

So far as I know, the only meeting with local authority representatives at which nominations to NHS boards was discussed was an official meeting on 12 May involving myself and other Ministers and official representatives of the Local Government Association.

Will the Secretary of State take this opportunity to confirm that last year's scandal of Labour activists constituting 80 per cent. of board appointments to trusts—as confirmed by the Commissioner for Public Appointments—is a thing of the past? If political correctness is no longer an overriding concern when it comes to appointments in the national health service, can the Secretary of State explain how, although the chairman of the West Sussex health authority recently approved and offered 14 names to fill a vacant board appointment on the West Sussex health authority—all of them male—the Secretary of State managed to appoint a woman?

I will make a start. Following the precedent set by the House of Commons some five or six years ago when we appointed 100 per cent. of the Speaker as a woman, I tried my best to ensure that at least half the appointments to NHS trust boards and health authority boards were women. We have achieved that target and I am proud to have done so. If the chair of the health authority—I forget which one—to which the hon. Gentleman referred could not come up with one woman out of 14 names, he should have his head seen to.

Does my right hon. Friend agree that it is extremely important that local authorities and health authorities work closely together if we are to achieve a seamless system of health and community care? I particularly commend to him the experience in my constituency, where the unitary council worked closely with the health authority with regard to the winter crisis money and, between them, effectively reduced the problems in the area and helped a number of elderly people to obtain more appropriate treatment with support in the community. Is it not reasonable that such co-operation between local authorities and health authorities should be reflected in appointments to health authority boards?

It is true that one reason for appointing at least a number of members of local authorities to health boards is to improve the liaison between the two, but elected members and appointed non-executives should not be the main channel for such liaison. Liaison at an official level must be improved, and that is one reason why we propose that, in future, the chief executive of a local authority should be expected to attend and participate in, but not vote at, the board meetings of the health authority. Such co-operation is necessary.

When the right hon. Gentleman addressed the annual meeting of the Association of Community Health Councils for England and Wales on 9 July last year he said:

"At the General Election we promised that we would make sure that the boards of health authorities and trusts would be more representative of the local communities they serve."

When I set about making the appointments about which the hon. Gentleman complains, I was addressing the problem of significantly unrepresentative boards appointed by our predecessors. In case anyone says that I am justifying myself, the Commissioner for Public Appointments, who was appointed by the previous Government and served in a senior position in the NHS as an appointee of the previous Government, has endorsed, in his Official Report, all that we have been doing, and has recognised that we have carried out the obligation that we entered into at the general election to make the boards more representative of local people. That is what we said we would do and that is what we are doing.

What proposals he has to reduce the incidence of over-medication of the elderly. [50986]

The Department and the national prescribing centre will publish a report on GP prescribing support in September. The document will give many examples of good practice where pharmacists have assessed prescribing for patients in a number of areas, including nursing home settings.

Is the Minister in a position to respond to my letters and the reports that I have sent him from Gloucester, Glasgow and Manchester, which reveal that up to one in five hospital admissions for elderly people is the result of the misuse and overuse of medicinal drugs; and that, of those patients in care homes who show symptoms of dementia, more than half have drug-induced dementia? Will he replicate the splendid review carried out by the department of psychiatry at the university of Manchester, which shows that reducing drug intakes for elderly people makes them more alive, relieves them from the confusion and misery in which they live, saves the health service a small fortune and makes available extra money to spend on care?

I will reply in detail shortly to the points that my hon. Friend raised in correspondence, but I was glad to have the opportunity, on 26 June this year, to give a prize to that self-same department—the department of old-age psychiatry at the university of Manchester—as part of the pharmaceutical care awards. We have learnt from the experience of that Manchester project that where pharmacists go out and about in the community, particularly where they are concentrated around nursing homes, the number of drugs prescribed per resident can be significantly reduced, stays in hospital can be reduced, and, significantly, the number of deaths is reduced. We want that good news and good practice replicated throughout the national health service.

Does the Minister agree that one reason for over-medication, especially of mentally ill and frail elderly people, is the NHS's withdrawal from respite care, day care and long-term care for elderly people? Does he recognise that the only way in which those people are being contained in the community is by doping them up? Does he agree that, to avoid that problem, we need more resources to support people in the community?

We certainly need to ensure that resources, including any new resources, are applied in ways that complement health and social care being delivered together. By making a wider range of therapies and assistance available to old people we can reduce their dependence on drugs, particularly where we work in contact with the voluntary sector, which has introduced some important and innovative ways of proceeding. We are working on that now.

What plans he has for extending NHS Direct. [50987]

The new -hour, nurse-led telephone helpline, NHS Direct, will be nationwide in 2000. It is currently being piloted in three areas, and, by the end of this financial year, it will be extended to cover at least 20 per cent. of the population. Three of the new areas to be covered will be Manchester, Birmingham and Cornwall, and the others will be announced in early August.

I welcome my right hon. Friend's announcement that NHS Direct will be extended to the country's second city, Birmingham. That is very much welcomed by all my constituents. Has my right hon. Friend analysed the success of the first wave of areas in which NHS Direct was used so that I may give my constituents a clear idea of what benefits they may receive from it?

I am glad that my hon. Friend welcomes the proposed extension of the scheme to cover the great city of Birmingham. It may interest her constituents to know that some 80 per cent. of those who called said that they were following a course of action different from the one that they had intended to follow before making their call. Thus 80 per cent. of people were influenced by the nurse on the end of the helpline. Some 30 per cent. of callers were directed by the nurse to less resource-intensive care and some 25 per cent. were guided towards more resource-intensive care. In other words, when people were told, "Little Johnny has a bit of a fever, but will probably be all right in the morning," no care was provided, whereas arrangements were immediately made for an ambulance to be sent to take people in desperate need of care off to hospital.

Will the Secretary of State confirm that NHS Direct will not be funded at the expense of other nursing-led activities?

Special funding has been made available this year for the pilot schemes, and will also be made available for the additional schemes that are coming on stream. The scheme has an advantage, which we hope will be put to good use. A substantial number of nurses give up nursing because they have suffered back or other injuries which make it impossible to continue normal nursing. We hope that the idea of using their nursing skills on the end of a telephone will appeal to some of them, and that we will be able to bring their expertise and experience back into the national health service—to their benefit, and the benefit of patients.