If he will make a statement on ambulance response times in Cornwall. [62442]

Ambulance response times in Cornwall improved in 1997–98. The percentage of 999 calls reached within 19 minutes rose by more than 1 per cent. despite a 1.5 per cent. rise in the number of ambulance callouts.

The Minister did not say, however, that the response times were very much below those in the citizens charter for health standards. Anyone calling an ambulance in Cornwall stands a very high chance of it taking well over the response time in the citizens charter. Is that not because there is no proper funding for ambulance services in rural areas to take account of the obvious extra difficulties in reaching patients quickly? Does that not result in patients' lives being put at risk?

I am sorry that the hon. Gentleman did not feel able to join me in congratulating NHS staff in Cornwall on achieving the improvements in response times to which I have referred. We are aware of the difficulties and officials in the NHS regional office are working closely with the health authority and the ambulance service in Cornwall to see what further action can be taken to improve response times. The hon. Gentleman mentioned resources. The changes introduced to the weighted capitation formula for 1998–99 include a geographical cost adjustment for emergency ambulance services which benefited Cornwall health authority by more than £1 million.

When he will publish his strategy for NHS dentistry. [62443]

We will publish our new strategy before too long, when we have considered all the points raised by those who have contributed their views on the future of NHS dentistry.

I thank the Minister for that reply and for the additional funding promised by the Government to increase people's right and accessibility to NHS dentistry. I note that it is 20 times more than that provided by the previous Administration, but I would like to ask the Minister for his proposals and his strategy for sorting out the current bureaucratic muddle that seems to be delaying the allocation of funds to dental practices.

As my hon. Friend rightly says, we have made available extra money to improve access to NHS dentistry and to try to clear up the mess left by our predecessors, who ran down NHS dentistry in too many parts of the country. The Government are committed to building it up rather than running it down, and to date we have approved some 250 bids under the investing in dentistry initiative. As a result, an extra 600,000 patients now have access to NHS dental care. An additional 90 proposals are in the pipeline, including some from my hon. Friend's area, and we are assessing them carefully.

On the issue of free dental checks for all, the Deputy Prime Minister said on the BBC:

"We've got to find the money to finance it".

As the hon. Gentleman is aware, his party was in power for 18 years. If he is so committed to free dental checks, perhaps he should have done something about it.

Does my right hon. Friend agree that, if a dentist mistreats patients in order fraudulently to create work for himself, those patients should be properly compensated? Does he agree that it is not acceptable for any insurance company to reject any such claim without giving proper reason? Does he plan to do something about that in future?

I am not aware of the issue that my hon. Friend raises, although I am happy to look at any individual case. The overwhelming majority of NHS dentists—and NHS staff—are trustworthy, honest and reliable. However, we intend to take tough measures against the minority who are not. As my hon. Friend is aware, we have recently appointed a new director of counter-fraud work who will spearhead the assault on fraud wherever it occurs—in dentistry, medicine or anywhere else within the NHS.

If he will make a statement on the refusal by some health authorities to fund recently approved drugs for cancer patients. [62444]

We want to ensure that cost-effective clinical services, including treatments for cancer, are provided on a consistent national basis. There is unacceptable fragmentation and variation which we are tackling, first by establishing next April the national institute for clinical excellence, which will set standards for clinical excellence and secondly, through the commission for health improvement, which will ensure that those standards are applied in practice.

On 30 June at Health questions, the Minister of State, the right hon. Member for Darlington (Mr. Milburn) told the House:

"no one will be denied the drugs they need. That is a guarantee."—[Official Report, 30 June 1998; Vol. 315, c. 143.]

Frankly, that is pretty thin. My right hon. Friend was referring to the approach to consultation and the local priorities that would be adopted by primary care groups. The hon. Gentleman's question was about cancer. For the benefit of his constituents, who may feel cheated if he does not receive the answer, I shall set out precisely what is happening in cancer treatments involving Taxol, about which there is some concern.

Many cancer patients will have cancer because of smoking. Although no doubt many people will continue to choose to kill themselves through smoking, does my hon. Friend agree—bearing in mind last week's White Paper, particularly its title—that it is unacceptable that those of us who do not smoke should continue to be put at risk of being killed by those who do smoke? What steps will she take to protect non-smokers from the dangers of passive smoking?

The title of the White Paper—"Smoking Kills"—is a statement of fact. My hon. Friend is right to suggest that we will not make progress in tackling cancer or heart disease unless we reduce the number of deaths from smoking. He will know that the measures set out in the White Paper include an agreement with the Health and Safety Commission for consultation on the establishment of an approved code to guide practice on smoking at work, which will have legal status if approved. Moreover, the five leading organisations in the hospitality trade have given a commitment to work together to improve ventilation in pubs, wine bars and restaurants where people smoke, and to increase the number of smoke-free public places.

The hon. Lady said that she had a system for the evidence-based prescribing of Taxol, but will she accept that there will be new drugs, which will not be as widely available as they should be? Does she recognise the fact—I seem to invite her every three weeks to do so—that rationing is taking place in the NHS? That is nothing to be ashamed of—there will always be such tension. Will she at least start a debate with Liberal Democrats and the public and find out how much people are prepared to pay to ensure that rationing—I invite her to use that word—is not as extreme as it is at the moment?

I make it clear once again that the NHS will not apply blanket bans to clinically effective treatments. We have also made it clear that the NHS must be able to keep pace with what are, as the hon. Gentleman rightly said, rapid advances and developments, particularly in new drug treatments, so that those treatments are properly assessed for their clinical and cost effectiveness. We must ensure that the status and benefits of the new drugs are established through the work of the national institute for clinical excellence and the commission for health improvement.

Is there rationing or is there not?

No.

In view of the Minister's unequivocal statement that there is no rationing—which I think will be greeted with disbelief by the medical profession—can she now comment, for the benefit of the House, on the availability not only of the cancer drugs, but of beta-interferon, which is rationed; recombinant, which is rationed; Aricept, which is rationed; and the new anti-psychotics, which are rationed?

There are two ways of dealing with precisely the kinds of prescribed drugs to which the right hon. Member has referred. We had 18 years of the Conservatives' way, which produced fragmentation and 3,000 GP fundholders, who all had different systems of prescribing. The alternative—which would be just as unacceptable to the people of this country—would be to define clinical protocols, which would mean that everybody's treatment was preordained in Richmond house.

I am tempted to observe that the pantomime season must have come early. May I ask the Minister a straightforward question? Under her Government, are any drugs not being prescribed by practitioners or others on the ground of cost—yes or no?

I would be very happy to volunteer to be either the front or the back of the right hon. Lady's pantomime horse. I have already made it clear that the basis on which drugs are prescribed and treatment administered is clinical need and proven clinical effectiveness.

What assessment he has made of the preparedness of ambulance services in respect of year 2000 compliance. [62445]

Ambulance services are making good progress towards ensuring year 2000 compliance. Progress is monitored quarterly by the national health service executive.

May I point out to my hon. Friend that Derbyshire ambulance trust has not yet reached year 2000 compliance? However, the recently announced merger between Derbyshire, Nottinghamshire and Leicestershire ambulance services may allow it to use the more advanced technology available in those services. I very much hope that the merger will not distract Derbyshire ambulance trust from improving response times in the area, which, sadly, are the worst in the country, in spite of the tremendous efforts of the trust's hard-working staff, who have put in a great deal of time and effort to try to remedy the situation.

I can assure my hon. Friend that the new trust that will operate in the east midlands will improve the delivery of service to his constituents and others in the east midlands. That is clear, and we approved the merger for those reasons. We are monitoring closely issues concerning improving response times for the Derbyshire ambulance service. As he will know, additional expenditure has been authorised to ensure year 2000 compliance, and we expect to see an improvement in response times.

Can the Minister confirm his current estimate of the total cost to the NHS of millennium compliance? What progress has his Department made in seeking to recover any part of that anticipated cost from suppliers of equipment to the NHS?

I am afraid that I am unable to respond in detail to the hon. Gentleman's questions. I am happy to look into the matter and respond to him in writing, if that would be helpful. However, Government Members will take with a pinch of salt the lectures from Conservative Members, who had plenty of opportunity to address these issues in government, and conspicuously failed to do so.

As Derbyshire does not have millennium compliance and Nottinghamshire does, will my hon. Friend take steps to ensure that the new ambulance trust of Nottinghamshire, Leicestershire and Derbyshire rises to the level of the best rather than sinking to that of the worst.

Yes, I can give my hon. Friend the assurance that he seeks. Let me make it absolutely clear that, following approval for the merger, the Derbyshire ambulance service will use the same accident and emergency control systems that are currently in use by Leicestershire and Nottinghamshire, and that those two systems are completely year 2000 compliant.

What plans he has to review the workings of independent review panels in the NHS. [62446]

An independent evaluation of all aspects of national health service complaints procedures is due to begin in the new year. It will include consideration of the independent review procedures.

Does the Minister agree that there is a great danger that the review panels' independence—which is so vital for patients—could be undermined by the intervention of health service officials? Will he agree to take a fresh look at a case about which I have written to him, concerning a constituent of mine, the Hertfordshire health authority and the Queen Elizabeth hospital? The authority arbitrarily ruled that a maximum of two members of a family could be present at an inquiry into their mother's death, and as the family is larger than that and is unwilling to be divided, the inquiry cannot proceed.

I am certainly extremely happy to refer that case to the people who will carry out the review of the NHS complaints procedure. That procedure was introduced by the previous Government in 1996; as it has now operated for a couple of years, we think that it is right to review it, and in particular to consider it from the point of view of complainants, patients and indeed the NHS staff who have to operate the system. I am happy to take on board the hon. Gentleman's comments and to ensure that they are fed into the review.

When he expects to publish his White Paper on tobacco. [62448]

When he expects to publish his White Paper on tobacco. [62451]

The White Paper, "Smoking Kills" was published on 10 December 1998.

I thank my hon. Friend for her reply. Is she aware that the pressure group ASH—Action on Smoking and Health—recently described the White Paper as the first serious and sustained assault on the enormous burden of illness and death caused by smoking since scientists first brought its dangers to our attention 40 years ago? Is she also aware that, each and every day, about 450 children take up smoking, and that half of all smokers will die from the habit? In the light of the White Paper, what further action will the Government take in their war against smoking?

I thank my hon. Friend very much indeed for that question. I am glad that ASH, and almost every other organisation except the Tobacco Manufacturers Association, welcomed the White Paper's sensible approach and the fact that we have set very clear targets and recognised that achievement will come through the combined efforts of Government and other organisations that can deliver solutions to the many problems that arise.

Smoking causes one in seven deaths from heart disease, and my constituency has the highest incidence of heart disease in the country. In my local authority of Salford, the British Heart Foundation runs the Heartstart scheme, which trains young people to give emergency life support to those suffering from heart attacks and teaches them about the causes of heart attacks, including smoking. Does my hon. Friend agree that such schemes help local communities and educate young people about the dire consequences of smoking, and will she commend the scheme to other areas?

I am happy to commend the Heartstart scheme that my hon. Friend mentions. We want to ensure that we do everything we can to spread the benefits of best practice more widely. Next year, we will publish the public health White Paper, which will set clear targets for tackling heart disease, especially in areas where the rate is high, such as my hon. Friend's constituency. I reiterate the point I made earlier: that the White Paper "Smoking Kills" is a critical part of our battle against cancer and our battle to reduce unnecessary deaths from heart disease.

I declare an interest as a smoker. Although I welcome the Government's proposals, I am sceptical about their likely success. If the Government are serious about curbing smoking, why do not they adopt a fiscal approach and massively increase the price of cigarettes, so that people cannot afford to buy them? The Government could also levy a windfall tax on the tobacco companies, so that they are no longer so profitable.

My hon. Friend will see from the White Paper that fiscal measures are part of the battle against smoking, because keeping the price up means that children are less likely to be able to afford them and to take up smoking in the first place.

If he will make a statement on the advice given to Goodmayes hospital by the NHS executive concerning the possible continuance of mixed-sex wards in psychiatric units. [62449]

The advice given to the Goodmayes hospital about the elimination of mixed-sex wards in psychiatric units is exactly the same as the advice that has been given ever since the new Government started to issue advice on the matter. We are determined to eliminate mixed-sex wards in all hospitals, including psychiatric ones.

Does the Secretary of State understand that a contradiction is apparent? Does he recall that on two previous occasions when I have raised the issue of the continuation of mixed-sex wards—and even the construction of new mixed-sex wards in psychiatric units—he said, in forthright and welcome terms, "If this is going on, I am going to put a stop to it." In the light of what he said when stopping the mixed-sex ward at Charing Cross hospital, how does he explain the letter from the NHS executive to Goodmayes hospital which stated:

"completely segregating services would not be acceptable, as there are good clinical reasons to provide an environment in hospitals which, as closely as it can, prepares people for their return to their own accommodation"?

"Within a mental health unit, medical opinion favours an environment which is as normal as possible."

Our promise was to eliminate mixed-sex wards. I am confident that about 95 per cent. of health authorities will have done so by 2002. When the hon. Gentleman raised with me the matter of the building of some mixed-sex psychiatric wards at the Charing Cross hospital, I put a stop to it. They have been redesigned, and they are no longer mixed-sex wards. The proposal for Goodmayes hospital is not for mixed-sex wards, but will mean that some of the day rooms and other facilities will be available to both male and female patients. That is reasonable, if the clinicians responsible for those patients consider it appropriate.

The Government are to be commended for ending what has undoubtedly been a very unpopular practice, which was introduced by the previous Government to save money. Does my right hon. Friend agree that elderly people who are sick and need to go into hospital will especially welcome the measure?

In fairness to the previous Government, I must say—it grieves me to do so—that the practice was not entirely their fault. For a brief period during that Government's time in office, the conventional wisdom among some of the practitioners in this sector was that mixed-sex wards were all right and were akin to mixed hairdressers and mixed saunas. However, it is not like that for people in hospital, and we are putting a stop to that mistaken fashion. The previous Government did nothing about it, but we are going to eliminate mixed-sex wards. We are going about doing so, and have found £70 million to do it with.

I have constantly welcomed the Secretary of State's stance on mixed-sex wards, which I know were introduced by the practitioners. Is the right hon. Gentleman aware that, in a recent answer to the hon. Member for New Forest, East (Dr. Lewis), the Secretary of State for Northern Ireland stated that about six or seven of the units in Northern Ireland still run mixed-sex wards? Will it be possible for the right hon. Gentleman to speak to his right hon. Friend to ensure that Government policy is consistent throughout the nation?

It is foolish in this House for people who are not experts to tread on Northern Ireland territory, as the history of the area shows. However, I will make sure that my right hon. Friend the Secretary of State for Northern Ireland is aware of what the hon. Gentleman has said.

If he will make a statement on his policy on emergency treatment fees in the NHS for road accident victims. [62452]

The Government intend to end collection of the emergency treatment fee by national health service trusts. An amendment to section 158 of the Road Traffic Act 1988, removing the right of NHS trusts to the fee, is contained in the Road Traffic (NHS Charges) Bill which was introduced in the House of Commons on 27 November 1998 and which was given a Second Reading on 8 December.

I thank the Minister for that reply. Is he aware, that on 12 March 1991, the right hon. Member for Charnwood (Mr. Dorrell), who was then a junior Health Minister, stated in a written answer that the Conservative Government intended to abolish the emergency treatment fee

"as soon as a suitable legislative vehicle becomes available"?—[Official Report, 12 March 1991; Vol. 187, c. 493.]

I am grateful for that question. It is probably another example of hot air as regards the Opposition's promises when they were in government—promises on which they conspicuously failed to deliver. On this occasion, as on many others, it has taken a Labour Government to clear up the mess that they left behind.

If he will make a statement on his plans for the future management of children's homes. [62453]

On 5 November, I spelled out to the House our plans for the future management of children's homes to ensure that children are better looked after and to protect them from abuse, exploitation and neglect. Further details were given in our White Paper, "Modernising Social Services", which I announced to the House on 30 November.

I thank the Minister for his reply. I sympathise with the view he takes, and admire the fact that he intends to do something about that serious matter. Given the risk that is posed by men running some care homes, which is obvious from the number of cases of abuse, he might consider recycling grannies—women who have raised families and who are good at spotting when something is going on. If such people were in charge of homes, the children in them would have a naturally sympathetic character to whom to turn. Will he consider that as a practical and serious proposition?

The short answer is yes, I will consider it, as it seems to be a perfectly sensible proposition. My only point on the hon. Lady's introductory remarks is that for boys in homes, as in schools, it is a good idea to have safe men around to provide role models of how grown-up males should behave. However, we need to ensure that they are not among the abusers and exploiters of children. The hon. Lady's point is practical and sensible, and I will look into it.

May I commend my right hon. Friend's commitment to the radical reform of the care system and the ending of abuse in it, to improve a situation that has brought great shame on this country? Perhaps he will reconsider his recent remarks. Surely men can play a tremendous role in the care system, in children's homes, in foster care and in social work with children. We have to get the protection of children in the system right, and we have to ensure that we have the right people in it, rather than making facile judgments based on gender.

My hon. Friend may have misheard me. I said that, provided that the men are safe, it is as well to have men around, because they set a proper example to young people of the way in which decent adult males should behave. That certainly applies to boys, and to some extent it may also apply to girls, some of whom may have come from homes in which the adult male has knocked about and battered the women of the household. It is probably a good idea for children who come from such households to discover that there are men who do not behave like that.

How many health trusts have become technically insolvent. [62455]

None.

Do I thank my hon. Friend for that answer? He is aware that there are some health trusts, such as the Mid-Staffordshire General Hospitals NHS trust in my constituency, whose finances are sufficiently precarious to need special monitoring by his officials. Does he agree that national health service staff in such trusts work in a dedicated and committed way and yet sometimes feel that the financial position is such that they are working with one hand tied behind their backs? Can he assure us that the monitoring is sufficiently robust to ensure that the full range and quality of services that the local populace, including trust employees, require will be available in those trusts?

Of course staff in organizations that have been landed in debt as a consequence of the policies carried out by the previous Government are at the sharp end of dilemmas. When we came to power, two thirds of health authorities were in debt and the national health service as a whole was in debt to the tune of £450 million, thanks to the lacklustre and reckless performance of the Conservatives. We have halved that debt and are well on target to get the NHS back into financial balance. That is largely a consequence of the record levels of investment that we are now making in the NHS, including the extra £38 million that has gone into the South Staffordshire area.

I am sure that the Minister is aware that the way he is tackling the funding problem in Worcestershire is to close Kidderminster general hospital and to downgrade the accident and emergency departments at Kidderminster hospital and at the Alexandra hospital, Redditch, to the status of glorified minor injuries units. That is the policy of the Labour Government, whereas, for 18 years under the previous Conservative Administration, those facilities remained open.

The hon. Lady must be the only person in Worcestershire who thinks that Kidderminster general hospital is closing. It is not closing; it is staying open. Instead of condemning my hon. Friend the Member for Wyre Forest, she would do better to praise him for the conscientious campaign that he has led to ensure that there is a high-quality, modern and dependable emergency centre at the hospital. Its existence is thanks to the decisions that we have taken, which are getting Worcestershire health authority and the good people of Kidderminster out of the mess in which the Conservative Government landed them.

What roles and responsibilities he proposes for regional commissions for care standards. [62457]

What roles and responsibilities he plans to give the regional commissions for care standards. [62458]

The current system for checking on children's homes and residential and nursing homes for adults is simply not up to the task. Some places are not regulated at all and there is no check on the standard of care delivered to people in their own homes. The commissions for care standards in each region will change all that. Their job will be to check on every aspect of social care, and to ensure that top-quality services are delivered and that no one is abused, exploited or neglected by the people who are supposed to be looking after them.

I thank my right hon. Friend for that answer. I warmly welcome the commissions on care standards and many of the other measures contained in the White Paper, not least the general social care council and the new national performance framework. Does my right hon. Friend agree that those measures to increase openness and accountability are vital if we are to deliver better services to carers and their families and to the staff who work in those vital services?

I certainly agree with my hon. Friend's point. The system we inherited is a shambles—it does not work. It leaves small children's homes and local authority homes uninspected; and in some cases, it leaves people of extremely dubious background delivering services into the homes of people who are often elderly or disabled. We believe that those arrangements need to be better regulated than they have been in the past, and I am confident that our proposals will do the job.

I, too, thank my right hon. Friend for his comments. Will the regulatory arrangements go beyond residential centres, such as nursing homes and children's homes, and extend into the community to cover those services that are carried out in the community?

Yes. As I have already said, we want to make sure that the standard of care delivered in the homes of individuals who are living in their own home is checked on and raised. Organisations such as fostering agencies also need to be checked on. The fact is that nearly everyone who provides social care to people in residential settings, in their own homes or through agencies does an absolutely first-class job. However, there are some rotten apples in the barrel and we need to sort them out.

What flash of inspiration led to both the previous questions being identical? Were they planted?

I think they reflect the degree of concern on this side of the House about the appalling state of regulation, which we inherited from the previous Government, governing children's homes, old people's homes and other domiciliary services. I think they also indicate the extent to which my hon. Friends are determined to put the matter right and stick up and speak up for the people whom they were elected to represent. If one or two Opposition Members had been interested, they might have put down similar questions.

Will we have to wait until the regional commissions are in place before we are told how mental hostels in places such as Weymouth are to be funded? The Secretary of State will know that, before he moved to the Home Office, his hon. Friend the Member for Brent, South (Mr. Boateng) was working to ensure that people with mental illness who did not need medical care could be looked after in the community in the types of hostels that we pioneered in Weymouth decades ago.

If the hon. Gentleman will provide details of the particular circumstances in Weymouth, I shall do my best to sort them out.

rose—

It is no good the hon. Gentleman jumping up in the Chamber and expecting me to know the details of what is going on in Weymouth. I am very sympathetic to the problem as he has outlined it. I shall look into the matter and try to sort out the problem, if there is one.

What plans he has to facilitate the employment of refugee doctors. [62459]

We are aware of the difficulties faced by refugee doctors and the problems that they can encounter when trying to secure appointments in the NHS. Overseas-trained doctors provide an invaluable contribution to the effective operation of the health service. I shall ask the advisory group on medical and dental education, training and staffing to consider the needs of this particular group of overseas doctors and make recommendations as soon as possible.

I am very grateful for that reply. My right hon. Friend is probably aware of the important initiative taken by Redbridge and Waltham Forest health authority in setting up a group for refugee doctors, which includes people from Afghanistan and Somalia. The group comprises top medical specialists who, because of difficulties with regulations and the English language, cannot use their skills at present.

As my hon. Friend is aware, there are immigration and asylum rules, and it is important that doctors who are refugees to this country abide by them. However, the advisory group will consider a range of factors in making recommendations to me. It is also important to understand not only that concerted national action is needed in this area but that we should seek to build on the very good work that has been undertaken in my hon. Friend's area by the North Thames Deanery, the General Medical Council and local health authorities. They are seeking to provide better training for refugee doctors in order to facilitate their entry into the national health service where that is appropriate.

How does the Minister intend to meet his targets for the recruitment of qualified doctors for our national health service without being obliged simply to import them, a policy that he will know is vigorously opposed by the British Medical Association?

In a number of ways. First, as was recommended by Sir Colin Campbell's committee, established by the previous Government, we shall increase the number of doctors in training. I can tell the hon. Gentleman—[Interruption.] If the right hon. Member for Maidstone and The Weald (Miss Widdecombe) will stop chuntering and start listening, we will make some progress. We are already ahead on the first recommendations of the Medical Workforce Standing Advisory Committee.

Is the Minister aware that doctors in oppressive countries very often end up as refugees because they protect the victims of torture and maiming, or that the refugee experience often destroys people's self-esteem? I have in my constituency an Iraqi doctor who was completely convinced that she could not pass the test, although her English was excellent, because her self-esteem had been destroyed by the torture that she had experienced.

I am sure that my hon. Friend is absolutely right to say that refugee doctors who come to this country often face a host of problems. If they are admissible as refugees and if we want them to work in the national health service, it is obviously vital that we provide them with support and training to allow them to provide high-quality services to patients. There is a lot of very good local experience, such as that in the constituency of my hon. Friend the Member for Ilford, South, and we seek to build on that.

What progress is being made on plans for the new hospital in Swindon; and when it will open. [62460]

My right hon. Friend the Secretary of State for Environment, Transport and the Regions is currently considering whether the proposals for the hospital should be subject to a public inquiry on planning grounds, and will announce his decision shortly.

My constituents in North Wiltshire are very happy that the hospital is moving fast towards opening on its new site at Commonhead, which is so easily accessible from the M4, but are concerned that the considerations by the Secretary of State for Environment, Transport and the Regions will delay that. I hope that the Minister will have a word with him to encourage him to make progress as fast as he can. More importantly, will the Minister advise the House as to how many hospitals which are due to open in the near future under the private finance initiative, which her party so strenuously opposed before 1997, were planned under the Conservative Government?

As the hon. Gentleman will be aware, none of the eight hospitals that are under way were planned under the Conservative Government. They promised a private finance initiative for hospital development, but delivered not one hospital.

Will my right hon. Friend confirm that the Ministry of Health has recognised the inadequacies of the Princess Margaret hospital in my constituency and the need to update its buildings for the Swindon population as we look towards the next century? Will she do everything in her power to ensure that we get the much improved buildings we need as soon as possible?

Yes.

Will the new hospital in Swindon provide much-needed neurological beds for the south-west region, especially in light of the experiences of my constituent, Mr. James Payne, who, having suffered a double fracture of the skull, was refused admission to a neurological unit in Taunton or in any of the other regional hospitals purely on the grounds that he was 65 years old, not on the basis of clinical assessment? Can that be right?

I am very happy to write to the hon. Gentleman about the distribution of services to the people of Wiltshire.

If he will further review the application for infertility treatment by Mrs. X whose name has been provided to him. [62461]

I have every sympathy with my hon. Friend's constituent. However, Mrs. X's situation has been fully considered and reviewed by the health authority, and it would not be appropriate for me to comment on or become involved in an individual case.

The health authority is simply wrong. This is one of the most distressing cases that I have had to handle in the 20 years I have been a Member of the House. It involves a jeopardised marriage and an attempt at suicide by Mrs. X some two months ago, all because North Cumbria health authority refused to show any flexibility about the rules. Is it not about time that we introduced new rules to require health authorities to provide this treatment, given that the only justification for not providing it is that a woman's husband had a child by a previous marriage? Surely it is a matter of civil rights.

First, I pay a very warm tribute to my hon. Friend for the energy and commitment with which he has represented his constituent in very difficult circumstances. However, I am sure he is aware that, as we have made clear today and on other occasions, the Government are absolutely committed to ensuring greater national consistency of access to services. He will also be aware that we have commissioned advice from the Royal College of Obstetricians and Gynaecologists, and are studying that advice carefully.

What the current trend rate is in NHS waiting lists; and what it was in the period up to May 1997. [62462]

We have reversed the rising trend in national health service waiting lists which we inherited from the previous Government. In the six months to March 1997, waiting lists rose by an average of 16,000 a month. In the latest six months for which figures are available, waiting lists have fallen by an average of 20,000 a month.

I thank the Secretary of State for that answer. It speaks volumes about the difference between this Government and our predecessors, and my right hon. Friend deserves to be congratulated by the House. Will he in turn join me in congratulating Nottingham health authority not only on continuing to meet the guidelines of no one remaining on the waiting list for more than 18 months, but on having in the past six months secured a 16 per cent. reduction in the number of people waiting between 12 and 18 months? Will he put a cherry on that particular cake by saying whether we have any Christmas suggestions as to how health authorities that meet those targets can be helped to maintain them in the year ahead?

I certainly join in congratulating the staff of Nottingham health authority, and everyone else in the NHS, on all their hard work. Certainly, the biggest proportionate fall in waiting lists has been in the Trent region, which includes Nottingham. We will shortly be releasing an additional £32 million to tackle waiting list problems in the winter, and that money is intended to go to those health authorities that have had the greatest success. That, of course, will be followed by 10 times that sum—a further £320 million—to be invested in reducing waiting lists next year.

Given that the Prime Minister answered a question from my right hon. Friend the Member for Yeovil (Mr. Ashdown) two weeks ago about waiting times for out-patient treatment by saying that the explanation was that referrals were increasing, when in fact they were going down; and given that the number of people waiting was going up, while there was a reduction of 37,000 in the number of people being treated, will the Secretary of State confirm that, although the Government have this year presided over a reduction in waiting times for those who have seen their consultants but not yet been treated, there has also been an increase of nearly 200,000 in the number of people who have seen their doctor but are still waiting to see their consultant?

No is the answer to that. Since the Labour Government got in, an additional 300,000 waiting-list cases have been treated compared with the preceding 18 months under the Tories. An additional 300,000 emergency cases have also been treated during that time. The number of out-patients who have been treated has also risen: in the previous quarter, the number was 100,000 more than the number of out-patients treated in the last quarter under the Tories. So work on waiting lists is up by 300,000, work on emergency cases is up by 300,000 and work on out-patients is up by 100,000. How that can be a reduction, God only knows—except he may be a Liberal.