If he will make a statement about the grading of qualified midwives. [57349]

The great majority of midwives are graded E to G and will earn salaries up to £22,255 from 1 December 1998.

Will my right hon. Friend join me in applauding the excellent work of midwives, such as those whom I met at Nevill Hall hospital last Friday? Will he work with his Welsh Office colleagues to ensure that midwives working in trusts in Wales receive as a minimum the F grade recommended in England?

Yes, I join my hon. Friend in recognising the invaluable work performed by midwives in the NHS. The Government accepted last year's pay review body recommendations, which urged us to reflect any changes in midwives' roles and responsibilities in the appropriate grade and pay. That message has been communicated directly to all NHS trusts. We expect each and every trust to take that issue seriously but, equally, we expect them to ensure that grading reflects real responsibilities and clinical expertise.

Given that no Minister was willing to come over to Westminster Central hall three weeks ago to face the 1,000 midwives— [Interruption.] That is quite true. The midwives were clear that a few of them had a meeting in private at the Department, but Ministers were not willing to meet the rally in Westminster Central hall. Given that there is clearly a huge crisis in staffing and morale not just among midwives, but among nurses and other health workers, how much of the £21 billion announced in July will be used to improve the pay and conditions of midwives, nurses and health workers? It is no good modernising equipment and buildings in the NHS without modernising pay and conditions, and paying any salary increase in one go rather than in stages.

The hon. Gentleman has made two foolish points. First, my right hon. Friend the Minister for Public Health did meet midwives on the day that they lobbied Parliament and, in addition, my noble Friend Baroness Hayman met the leader of the Royal College of Midwives. Secondly, the hon. Gentleman will know as well as I do that the process for determining pay and conditions for midwives and nurses is governed by an independent pay review body, and its work is now under way. As I understand it, all parties in the House subscribe to that process, as do nurses and midwives. We have submitted our evidence, and the midwives and nursing trade unions have submitted theirs. Our evidence makes it clear that we want to see a fair pay rise for all nurses and midwives which is affordable to the NHS. In particular, we want to see progress on the starting rate of pay for nurses. If we are to do that and to end staging, as we want to, the review body must come up with recommendations that allow the NHS to live within its means.

If he will make a statement on the Government's plans for the ambulance service. [57350]

We are committed to modernising the NHS and improving services to patients, including ambulance services. Our plans include achieving faster and more appropriate response times for patients, including wider use of call prioritisation.

Is my hon. Friend aware of the grave concerns surrounding the performance of the East Anglian Ambulance NHS trust which serves my constituency and is currently under investigation by the regional health authority? Ambulance staff are frightened to speak out about what they know is wrong. Does my hon. Friend agree that the days of gagging clauses ended when the Labour Government were elected in 1997? Will my hon. Friend assure me that, under this Government, my constituents can rely on a top-quality ambulance service, and that all NHS staff will be respected as well as protected? [Interruption.] I do not find those desires funny.

I can certainly give my hon. Friend the assurances that she seeks. As she will be aware, the Minister of State, Department of Health, my right hon. Friend the Member for Darlington (Mr. Milburn), has already written to chairmen of NHS trusts and health authorities on that issue. Confidentiality clauses discriminate against staff's rights and responsibilities to bring unacceptable practices into the open and there is no place for them in the NHS. NHS employers are expected to allow their staff maximum freedom of speech, consistent with their obligation to maintain patient confidentiality. I am sure that my hon. Friend will also be aware that the Public Interest Disclosure Act 1998, which will come into effect in January 1999, will, for the first time, provide statutory protection for employees who are subject to a detriment as a result of blowing the whistle.

Can the Minister assure the House that the Government will ensure that 999 ambulance calls are always responded to by blue-light ambulances?

I am sure that the hon. Gentleman is aware of the Audit Commission's recent conclusions on that. It is sensible to answer life-threatening emergencies first. Matching resources to clinical needs will help us to improve emergency care. Call prioritisation is about when, not whether, to send an ambulance.

What steps he is taking to ensure that young people are consulted on the future development of the NHS. [57351]

The involvement of all who use the health service, young and old, is essential in rebuilding a public service that is open and accountable to the people whom it serves, shaped by their experience and responsive to their needs. That is why the voice of patients will be heard at every level, whether through primary care groups, the national institute for clinical excellence or the increased involvement of local people on trust boards. That involvement is part of building a national health service in which people have confidence— no longer one governed by a take-it-or-leave-it attitude, or where people are treated as numbers, but a partnership to build quality and responsiveness.

I thank my right hon. Friend for that detailed and encouraging response. May I draw her attention to Manchester's healthy school initiative, under which 50 school children recently communicated their views about the national health service directly to managers and providers in south Manchester? Does she agree that such events are important in ensuring that young people have a say, and because they can lead to real improvements in the delivery of health care services?

I commend the initiative of my hon. Friend's health authority. It is part of the health action zone, and I hope that that example of the involvement of young people in developing the national health service is one which other health authorities will seek to copy.

Many young people would regard the Minister's response as totally at variance with their experience locally. There may be a consultation exercise for NHS development, but all too often it is a total charade. The wishes of thousands of people, including young people, appear to be ignored. What practical steps will the Minister take to ensure that their wishes are translated into action inasmuch as they pay for the health service and those in my constituency want to see their local hospital, Mount Vernon, built up rather than run down?

Perhaps one of the most important changes that has marked the past 18 months is that consultation in the NHS no longer means simply a period of time. The hon. Gentleman is absolutely right to say that, where a consultation is undertaken and the views expressed are completely disregarded, people's confidence in the process will begin to diminish. We regard consultation and the views of those who use the health service as essential to developing it, which is why, for the first time in the history of the NHS, we are now conducting a patient survey of about 100,000 people who are being asked about their views and experiences of the service. The feedback from that survey will be vital in assessing the performance of the health service against the national performance framework.

Has my right hon. Friend considered communicating with young people, especially young women, through the medium of their magazines? A visit to any newsagent would show how many such magazines are published. Is she not disturbed when she analyses their contents? There may be a lot about breast enhancement surgery, but there is very little about the dangers of smoking or the causes of breast cancer and other cancers. Given that young women do not read newspapers, will my right hon. Friend use those magazines to get through to them?

My hon. Friend is absolutely right. That is why I have recently had two meetings with the editors of teenage magazines, at which we discussed young people and smoking, and young people and teenage pregnancy. He is right that, if we want young people to listen and to hear what we have to say, it is much better if the information comes from the magazines that they read and the people to whom they relate rather than from middle-aged Ministers.

In projecting to young people the future developments of the national health service, will the Minister bear in mind the need to project the attractiveness of NHS careers for nurses, dentists and doctors? Unless that is done more positively and the attractions are underlined more effectively, there is a danger that there will not be enough people to train for that important work.

That is absolutely right. My right hon. Friend the Minister of State recently launched a competition for school children specifically to awaken their interest in a career in the national health service. We must inspire young people with the prospects that a career in the NHS can offer. If any young people in the right hon. Gentleman's constituency would like to enter the competition, it is still open.

What representations he has received concerning the funding of beta— interferon; and if he will make a statement. [57352]

In the past 18 months, the Department's records show that we received 177 written representations from Members of Parliament, patients' groups and the public about the prescribing and funding of beta-interferon. I also met representatives of the Multiple Sclerosis Society in May.

Is the Minister aware that many MS patients in North Derbyshire have been prescribed beta-interferon, but have been lucky enough to receive it only if they are in the top eight on the list for treatment; have successfully pursued a court case, as one of my constituents has; or have decided to go private until the money runs out, such as Lesley Coombes of Ashover? Reassessments have been made to take off the list between 40 and 50 people who had hoped to receive beta-interferon. Is there not a case for earmarked resources for such authorities as North Derbyshire so that it can handle that massive problem?

I would be very glad to look into the individual case that my hon. Friend has highlighted, and I hope that North Derbyshire health authority feels in a rather more comfortable financial position as a result of today's extra allocation of resources. The extra £ 13.9 million that my hon. Friend's health authority will receive next year represents a cash increase of 6.6 per cent.

Given the inconsistent availability of beta-interferon, does the right hon. Gentleman continue to believe that there is no such thing as rationing in the national health service?

Opposition Members are in terrible danger of fermenting a crisis on this issue in the national health service. It is important to remember that for the vast majority of patients, in the vast majority of places, for the vast majority of the time, the vast majority of treatments are available on the national health service. Under this Government they will continue to be available on the NHS.

I know that the Minister is aware of the work on beta-interferon by Professor Blumhardt in Nottingham. I understand that the prism trials have now been published in The Lancet. I support the argument for earmarking funds, but will my right hon. Friend's assessment take account of the study in The Lancet? Will he introduce consistency to the prescribing process in decisions about whether beta-interferon is appropriate for MS sufferers?

I can give my hon. Friend that assurance. The products currently on the market are for a particular form of MS— the relapsing, remitting form— whereas the article in The Lancet is about the more serious, progressive form. The product to which my hon. Friend referred has not yet been licensed through the European procedures, let alone in this country. It is our intention to examine all beta-interferon products to achieve the greater national consistency in prescribing that all right hon. and hon. Members want.

First, may I welcome the Under-Secretary of State for Health, the hon. Member for Barrow and Furness (Mr. Hutton) to the Dispatch Box for the first time? He has important responsibilities, and I assure him that we have every intention of keeping him as busy as possible.

I am not sure that grown-up debates and the hon. Gentleman are always as compatible as they should be. The real reason why the Opposition are seeking to foment a debate about rationing is not beta-interferon, but the Conservative party's failure to match our record levels of investment in the national health service. It is about time the Opposition came clean. If they are not prepared to match pound for pound the extra investment in the hon. Gentleman's health authority and others, they should list item by item, procedure by procedure and treatment by treatment, those patients who will lose out and will not now be treated on the NHS, and will be forced to go private. The difference between the hon. Gentleman's party and the Labour party is that we believe in treatment being available according to clinical need and not ability to pay.

If he will make a statement on the investment he is making to reduce NHS waiting lists over the next three years. [57353]

If he will estimate the total cost of his planned reduction in waiting lists; when he expects to achieve that reduction; and if he will make a statement. [57354]

If he will make a statement on his Department's funding for reductions in NHS waiting lists over the next three years. [57361]

Waiting lists have fallen by more than 98,000 since April. The Government are investing an extra £21 billion in the national health service over the next three years, and I announced today the main allocation of next year's funds to health authorities, amounting to a total of £31 billion. That includes £320 million specifically for reducing waiting lists, to help us to deliver our promise to reduce them to a total 100,000 lower than the total that we inherited.

I am sure that many people, not only in Coventry but throughout the country, will welcome my right hon. Friend's statement. Is he aware that the shadow Chancellor has said that our investment in the national health service is reckless, and that the shadow Secretary of State for Health has said that it is a waste of time spending money on waiting lists? What is more appropriate—the investment of money in reducing waiting lists or the recklessness of the Tories in not investing any money at all?

I fully expect all honest Tory Members to say now that, as the shadow Chancellor says that our health spending is reckless, they do not want the money to be spent in their constituencies.

I congratulate the Secretary of State on attempting to match the previous Government's record of real increases in health spending. May I point out, however, that the number of patients waiting for more than 12 months has risen by more than 30,000? Will the right hon. Gentleman now admit that the only reason for the general decline in waiting lists is that simple, quick operations are being performed before longer, more complex ones?

No—and the number of people waiting for more than 12 months for treatment has fallen by 9,000 since June this year.

I thank my right hon. Friend for his statement. It is very different from the statements that I heard under the last Administration: in those days we repeatedly sought meetings with Secretaries of State, only to be told, "No money is available for your area".

I have to agree with my hon. Friend. The two health authorities that serve his constituency will receive more than £62 million extra to serve the people next year, which will bring spending in those two areas—many parts of which are very deprived—to nearly £8 billion. That is hugely in excess of the funds that the previous Government made available in the past, or intended to make available in the future. I am glad that we are doing this; I am proud that we are keeping our promises; and I am confident that the excellent 1 million staff in the health service will be able to deliver the better, quicker, more efficient top-quality health service that we all want.

Will the right hon. Gentleman confirm that, when he said yesterday in the House that patients waiting for the removal of internal fixations have never been included in official waiting list statistics, he was utterly incorrect?

No.

Then can the right hon. Gentleman explain why a very clear memorandum issued by Bradford hospitals trust makes it clear that before June, when these convenient falls began to happen, such patients were included in its monthly statistics, whereas after that they were not?

As for the practices in Bradford, I have no control over what that trust has been doing directly, but, as I explained to the right hon. Lady yesterday, the rules that were introduced by her Government, whether they are being complied with in Bradford or not, stated that, if someone with a broken arm had a metal plate inserted and was told by his doctor, "You need it in for 18 months, so you do not come back to have it removed for a further 18 months," that person did not count as someone who was waiting for an operation for 18 months. The previous Government were daft in a lot of respects, but they were perfectly sensible when they said that such people should not be included on the waiting lists.

We may have been perfectly sensible in suggesting that such operations should not be included in the monthly returns, but the fact is that they continued to be so in some authorities, including Bradford. They have now been taken out of the monthly returns, so part of the fall in waiting lists announced by the right hon. Gentleman can be accounted for by patients who have not actually received their treatment.

Up and down the country, in the first six months of this year, 250,000 more people were treated by the national health service than were being treated in the equivalent half of last year, and the year before that. The right hon. Lady apparently wants us to include in waiting lists people whose doctors have said that they should not have an operation for six, 12 or 18 months. To repeat what I said yesterday, to advocate that is just as daft as suggesting that a woman who discovers she is pregnant today should count on the waiting list for the next nine months.

I warmly welcome the 3.92 per cent. increase in real expenditure that my right hon. Friend has made available to Shropshire health authority. I ask him to remember, as the House will remember, that each month that the waiting lists increased was met by vociferous criticism from the Opposition. I ask him therefore to place in the Library all the letters of congratulation that he will receive from Opposition Members now that waiting lists are falling.

I can assure my hon. Friend that the Commons Librarian will not need to set aside much shelf space for that purpose, but I am sure that, in common with their elected representative, people in Shropshire will be glad to know that they will benefit from an extra £15 million towards their health care next year. That, of course, is merely the first round of the available extra money.

Does the Secretary of State recognise that, however hard the NHS works, it has to have a throughput on beds? How on earth could the NHS in Cambridgeshire expect to fulfil its obligations when the right hon. Gentleman granted the local social services £1 million less in cash terms in their standard spending assessment? We now have serious problems, particularly with elderly people who remain in hospital beds long after they should simply because social services have no money to fund their care outside?

I hope that the hon. Gentleman will therefore welcome the extra £250 million that the Chancellor announced next week—

Next week?

I meant last week. I must not give the game away. I hope that the hon. Member for South-East Cambridgeshire (Mr. Paice) will therefore welcome that £250 million extra, which will help local social service departments, hospitals and the rest of the national health service. That money will ensure that people, particularly frail, elderly people who should not be in hospital if they could be properly looked after at home will receive such care at home, and that those in hospital who could be discharged if there was someone to look after them at home will also be properly cared for in their own home. That is what that £250 million is for.

If he will make a statement on progress in establishing a system of medically auditing the effectiveness of various therapies employed in the NHS. [57355]

In July we published "A First Class Service" which set our plans to establish the new national institute for clinical excellence early next year.

I welcome my right hon. Friend's answer and the long overdue steps that are now being taken to disseminate best practice throughout the national health service with the national institute for clinical excellence and the Commission for Health Improvement. Does my hon. Friend agree that the rapid development of medically relevant biotechnology is now likely to provide new therapies that mimic the body's own biochemical processes, allowing the early diagnosis of disease and providing indications of predisposition to disease in certain circumstances, all of which are likely to revolutionise medical practice? Can my right hon. Friend assure the House that new arrangements for medical audit will promote the early introduction of those innovations into the NHS and that there will be the fullest collaboration between the NHS and British companies and research organisations to progress those new developments towards medical use?

I can give my hon. Friend that assurance. As he rightly said, we could be on the verge of some extremely exciting medical breakthroughs that will revolutionise patient care and the life chances of thousands, if not millions, of patients. It is important, therefore, that we achieve our aim, which is to ensure the introduction of more effective treatments into the national health service more quickly than has been possible before. We will do that through the national institute for clinical excellence and our new national service frameworks. We will also do it by abolishing the old internal market which inhibited collaboration and so fragmented decision making that we ended up with thousands of competing health units instead of a single national health service. We want to see a single national health service, providing care according to clinical need rather than depending on where a patient lives or who happens to be their GP.

Is the Minister aware that one direct casualty of the abolition of GP fundholding and a move to commissioning groups has been the provision of physiotherapy services? In West Sussex, many of my constituents who need physiotherapy because they are elderly or have suffered severe accidents are now faced with either not having those essential services or having to pay for them privately, which many of them cannot afford to do.

The hon. Gentleman is wrong about that. Before too long—hopefully within the next three weeks— we will be issuing new guidance to health authorities and to primary care groups in their shadow form, urging them to ensure the retention of proven and effective services provided by GP fundholding, and that their benefits are spread to all patients. We want to see a levelling up, not a levelling down. In particular, we want to see the end of the two-tier system that GP fundholding introduced into the NHS.

What action he is taking to promote booked admission pilots in the NHS. [57356]

On 24 September I announced 24 pilot schemes to develop systems of booked admissions so that patients can arrange to go into hospital at times that suit them. A total of £5 million pounds has been made available this year and £20 million will be provided for further schemes next year. We hope that, eventually, the entire system will go nationwide.

I thank my right hon. Friend for that reply. Does he agree that, as my constituents can book their holidays and various appointments by telephone, it is about time that they were also able to book by telephone their hospital appointments, rather than waiting anxiously for that brown paper envelope through the letter box?

I certainly agree with that. It is a strange irony that it is difficult for people to make bookings and other arrangements in the national health service—which, for more than 50 years, has served the United Kingdom 24 hours a day, every day of the year—because of its communications system.

We welcome development of a booked admissions system. However, booked admissions will help only those who are fortunate enough to have secured a specialist out-patient appointment to get on to the waiting list initially. The Secretary of State has been asked repeatedly to publish figures on the number of people waiting for out-patient appointments. The figures are already collected and reported to the NHS executive by hospital trusts; all he has to do is to add up the figures. Is not the reason why he refuses to publish the figures that they will show that, taken as a whole—elective surgery and specialist out-patient waiting lists together—NHS waiting lists are going up, not down as he would have us believe?

I have heard of people trying to change the goalposts once the match has started, but the hon. Gentleman seems to want to change the stadium. In the first six months of this year, the national health service dealt with 67,000 more out-patients than previously.

What about out-patients?

If the right hon. Lady would just keep quiet and let those who are supposed to answer the questions do so, and stick to her appointed job of asking questions, we might get somewhere.

May I, on behalf of my GP colleagues across the country, welcome my right hon. Friend's initiative in ensuring that patients will be able to book out-patients appointments directly from GPs' surgeries? May I also ask him to ensure that, once the initiative has been implemented, out-patient appointments will be booked on the basis of clinical need, to ensure that patients who need to be seen as soon as possible are fast-tracked through the system—thereby eliminating a very significant cause of waiting?

Ever since we were elected, we have tried to make it clear that clinical need should be the major determinant of how quickly people are treated. I hope that, as the information technology system becomes more sophisticated, doctors' and other clinicians' capacity to express their views, and to have their views heeded, will be improved, as that will be to the benefit of everyone. Both patients and those who treat patients like to know that everyone is being treated fairly. People are comfortable doing something that they believe to be fair, and very uncomfortable if asked to do something that they do not think is fair.

When the White Paper on tobacco will be published. [57357]

Soon.

Given that there are now hundreds of deaths every day from tobacco-related diseases, does the Minister agree that it is vital to discourage children from ever taking up smoking in the first place and that school nurses have an important part to play in that? What steps does she intend to take to ensure that there are no further cuts in the community school nursing service such as, sadly, are now threatened in Berkshire?

I entirely agree with the hon. Gentleman about the importance of protecting children from the impact of tobacco advertising and of taking every effective step to make it very hard for them to get hold of cigarettes. However, there is more to it than that—we have to change young people's attitude towards cigarettes and, in turn, change their behaviour, making them not want to buy cigarettes. I entirely agree that school nurses have a very important role to play in this, as do parents and teachers and the whole range of professionals with whom children come into contact. Measures to prevent children from smoking are already an important part of the healthy schools programme and will feature very specifically in the tobacco White Paper.

Is my right hon. Friend aware that the answer that she gave to the initial question simply means that the frustration felt for many months now by the health lobby will continue? However, more important than the publication of the White Paper is that it should be comprehensive and should address the issues around smoking, which has for decades been the biggest killer in this country. I am pleased that we now have a Government who are prepared to take on these issues on behalf of the public.

I thank my hon. Friend and pay tribute to the very great efforts that he made while in opposition to try to protect children from the impact of tobacco advertising. It is in no small part due to his efforts that we now have, for the first time, a comprehensive Europe-wide ban on the advertising and promotion of tobacco. The way in which that will be implemented in the United Kingdom will be set out in detail in the forthcoming White Paper. There is impatience about the publication of the White Paper and getting the policy implemented. We have worked with impatience and a sense of urgency over the past 18 months because absolutely nothing was done in the previous 18 years.

If the Minister believes that school nurses have an important role to play in this and other respects, will she explain why Cambridge and Huntingdon health authority has effectively abolished the role of school nurses? Will she undertake to evaluate what the adverse implications of that have been before other health authorities, such as that mentioned by the hon. Member for Newbury (Mr. Rendel), go down the same path?

No doubt the hon. Gentleman will be pleased that his constituents will be receiving £14.7 million more for their health care, which will go some way to dealing with precisely the problems that he identifies. Yes, I do think that the contribution of health visitors and school nurses should be effectively evaluated so that we can ensure that what they do is based on the best possible evidence that it will work in practice.

If he will estimate the number of people to be covered by NHS Direct by April 1999. [57359]

If he will estimate the number of people to be covered by NHS Direct by April 1999. [57364]

The second wave of NHS Direct, which will be operational by April next year, will cover 20 million people, or more than 40 per cent. of the population of England.

I thank my right hon. Friend for that answer. My constituents and I are green with envy that coverage is being achieved elsewhere in the country. As the millennium is approaching, and given the potential of NHS Direct in changing the way in which the ambulance service works and the demands upon it, may 1 have an assurance that my constituents will have NHS Direct by 2000? May I have a pledge from my hon. Friend?

Yes. Like all our pledges, it will be kept. We are a Government who keep our promises. By the end of 2000, NHS Direct will be available in my hon. Friend's community and in every community in the land. The Government have made available an extra £44 million to spread the availability of NHS Direct, not just to second-wave areas but beyond, to ensure that all communities have the benefit of instant access to 24-hour, 365-day-a-year care from expert nurses at the end of a telephone. That is already proving its worth in many communities and we are determined to spread its benefits everywhere.

Will the Minister confirm whether the general public will be able to use the telephone line to ask why the research and development budget has been cut by £10 million, which has been switched to the hospital waiting lists initiative? Will my constituents be able to use the telephone line to ask why, as a result of Government pressure, a local orthopaedic consultant has cancelled an out-patient clinic in order to carry out operations and that, as a result, the waiting time for outpatients has risen from 26 weeks to 40 weeks? Are my constituents right to believe that the figures are being fiddled?

No. The hon. Gentleman's constituents are wrong. That is not the appropriate use for NHS Direct. However, I can tell the hon. Gentleman that his health authority will receive an extra £28 million as a consequence of my right hon. Friend's decisions today. I hope that he and his constituents will welcome that.

What action he is taking to identify the number and use of acute beds in the NHS. [57360]

My right hon. Friend the Secretary of State announced on 30 September the establishment of a national inquiry into hospital beds. This work is already well under way within the Department and the findings will be published next spring.

I thank my right hon. Friend for that reply and for the £367 million plus to Sheffield health authority. The money will certainly help and it is very welcome. May I raise the issue of mental illness, which to a large extent is still considered to be the Cinderella service within the national health service? It needs special attention at present and I am asking whether that would be possible.

Obviously, my hon. Friend raises an important point. Certainly it is absolutely crucial to have an adequate number of psychiatric beds to ensure that mental health services can meet and respond to the range of needs in psychiatric patients—for example, by providing day care services locally. My hon. Friend will be aware that an expert group is drawing up a national service framework in order to develop a proper national framework for the delivery of psychiatric services. His point about ensuring an adequate number of beds in relation to those provided for other services will be part of that consideration.

Will the figures for acute beds in the NHS specify how many of them will be in mixed-sex wards in acute psychiatric units? Does the Minister recall the Secretary of State's categorical pledge to me earlier this year that he would put a stop to the building of any new mixed-sex wards in psychiatric units? How does she square that pledge with advice given by the NHS executive to Goodmayes hospital which restates all the old discredited arguments in favour of mixed-sex wards in such units?

My right hon. Friend the Secretary of State stopped the development of a mixed-sex ward last time the subject was raised in the House. He will do the same again, if the hon. Gentleman would like to supply details.

What was the average annual real-terms percentage increase in funding for NHS hospitals between 1979 and 1997; and what is the equivalent figure planned for the next three years. [57362]

What was the average annual real-terms percentage increase in funding for hospitals in the NHS between 1979 and 1997; and what is the equivalent figure for the next three years. [57363]

During the years 1979–80 to 1997–98, the annual average real-terms increase in NHS total net expenditure in England was 3.1 per cent. On 14 July, I announced the Government's investment of an extra £21 billion in the NHS—an average of 4.7 per cent. above inflation over the next three years. Next year's allocation, which was announced today, will mean an extra £9.7 million for the health service in South Lancashire and £12.5 million in Northumberland.

I thank my right hon. Friend for that reply, which demonstrates the Labour Government's commitment to the NHS. I am concerned that residents of South Ribble have to wait 18 months for drug rehabilitation treatment. The Government have announced an extra £12 million for drug advisory services next year. Will my right hon. Friend join me in urging South Lancashire health authority to give a higher priority to drug services? Reducing the waiting lists would have beneficial effects for the health service and important implications for crime.

We have included some earmarked funds to deal with drug treatment over-subscription and drug misuse. I hope that that will benefit my hon. Friend's area.

Is my right hon. Friend aware that Stephen Thornton, the chief executive of the NHS Confederation, has described the level of investment in the health service as beyond his wildest dreams? How many more wonderful dreams does my right hon. Friend have up his sleeve for the health service?

I have been called all sorts of things, but I have never been called a conjurer—so far. I am not sure that I have much left up my sleeve, or even up my right hon. Friend the Chancellor's sleeve—he has a rather more important sleeve than I do. When various pointy-headed academics, those on the Opposition Front Bench and the Liberal party were demanding an average increase over the next three years of 3 per cent., we came up with 4.7 per cent., but standards of courtesy have fallen so low that they never thanked us for it.

The Secretary of State's announcement of more money for the health service is welcome to every hon. Member, but in Oxfordshire there is real concern about how much of the money will find its way into the local health service. At the Radcliffe infirmary, waiting lists for day in-patient treatment have risen by 119 per cent. in the past 18 months. At the Nuffield Orthopaedic hospital, only four people waited more than 12 months 18 months ago; today that figure has risen to 137 people. I have written four times to the Secretary of State on behalf of my constituents about the impending closure of Burford hospital, without receiving any replies. Will the Secretary of State take the opportunity to reassure my constituents that he will not close a single bed in Witney and that he will save Burford from closure until he does something to reduce the calamitous rise of waiting lists in Oxfordshire?

The hon. Gentleman knows well that I shall eventually have to adjudicate on the propositions being put forward by Oxfordshire health authority. I am prohibited from announcing my decisions until I have reached them, because I have to be fair to everyone. Today I met a delegation with the right hon. Member for Henley (Mr. Heseltine) about one of the community hospitals in Oxfordshire. Other delegations are coming to see me. I shall listen carefully to them. My officials will confirm that, sometimes to their chagrin, I do not always agree with the proposals that are put to me. It will help that Oxfordshire will be receiving £22.5 million extra next year in order to provide services. Not every delay in Oxfordshire is to do with funding; some of it is to do with the way in which things are run.

May I anticipate the right hon. Gentleman's response to my question by welcoming any new money that his Government are proposing to spend on Worcestershire health authority? Whatever that new amount may be, will it be enough to stop cuts that his Government are imposing on Worcestershire? Will it be enough to keep open the accident and emergency department at the Alexandra Healthcare NHS trust hospital in the constituency of his hon. Friend the Member for Redditch (Jacqui Smith)? Will it be enough to keep open the Kidderminster general hospital in the constituency of his hon. Friend the Member for Wyre Forest (Mr. Lock)? If there is not enough money to keep hospitals and A and E departments open, then it simply is not enough.

I am glad to discover that at least one Conservative Member wants to be even more reckless than we are with public funds. She knows that proposals for changes in services in Worcestershire must come to me for decision. I shall announce my decision when I have taken it. The £18.2 million extra that Worcestershire will receive as a result of today's announcement ought to improve services and the performance of everybody in the county. That should benefit the people whom the hon. Lady represents. During debates on the next Finance Bill, I trust that she will be putting her feet where her mouth is and voting with us in the Lobby for the money that we are providing.