How many dentists there are per head of population (a) in the UK and (b) in North Staffordshire health authority; and what impact Government policies are expected to have on these figures. [67159]

The number of general dental service dentists per 100,000 of the population at the end of September 1998 was 35 for England and the United Kingdom, and 24 for North Staffordshire, excluding salaried dentists. The Government are funding six Investing in Dentistry bids in North Staffordshire, which will increase the number of dentists by six and allow 16,000 people to receive national health service care.

I thank my hon. Friend for that answer. I was horrified, when I was elected in May 1997, to find that there were no NHS dentists in my constituency. Since then, the very good work of John Rose and Liam Stubbs in the local health authority has attracted two more dentists to my area, but we are very much running to stand still. What are the Government doing to encourage more dentists to move into areas outside those covered by the dental schools? More dentists are especially badly needed in health authorities such as North Staffordshire, where dental health is so poor.

A number of initiatives are under way to meet that need, and I congratulate my hon. Friend on her close involvement in this matter in her constituency. One of the most important initiatives is the Investing in Dentistry process, from which North Staffordshire has benefited already, and I know that two further bids are under consideration in my hon. Friend's constituency.

Is the Minister aware of the scandal that has developed over the past few months which means that people in Staffordshire have to wait 15 months or two years for dental and other operations at Good Hope hospital? In contrast, people in Birmingham have to wait only five or six months for the same operations.

Inequities in health care between different parts of the country were a feature of the development of the national health service under the previous Administration. I shall, of course, be more than happy to look into local cases brought to my attention by any hon. Member, but I assure the hon. Gentleman that, with the extra investment through modernisation to tackle the pressure of waiting lists, the national health service in his area will do far better than it did under the previous Conservative Government. That applies in all other parts of the country as well.

What proposals he has to reduce the use of neuroleptic drugs in care homes. [67160]

We are aware of concerns that have been expressed about the possible over-use of neuroleptics, and several current initiatives will help to address them, including the National Institute for Clinical Excellence and the national service framework for older people.

I thank my hon. Friend for that helpful reply and for the action that his Department has taken to deal with a distressing problem. The symptoms of senility displayed by many people in care homes are the result not of old age but of the misuse and over-use of neuroleptic drugs.

I am grateful to my hon. Friend for raising that very legitimate concern about the use of neuroleptic drugs. I shall certainly look into the work that has been done in Manchester.

The Minister referred to draft national standards. Will he confirm that there will be formal consultation on them.

Yes.

Is it not ironic that, while residents of care homes may be over-medicated with neuroleptic drugs, there is massive rationing of psychoactive drugs for people with mental illnesses? What does that imbalance say about the Government's priorities and values? Will the Minister at least admit that that imbalance exists.

I must tell the hon. Gentleman that the use of neuroleptics is very serious, and we are determined to address the issue. He has conveniently forgotten that, as part of our strategy to modernise mental health, we are releasing significant new resources to help purchase new anti-psychotic drugs.

How many primary care groups he expects to commence during 1999. [67161]

How many primary care groups he expects to commence during 1999. [67166]

Some 481 primary care groups will commence on 1 April 1999, and they will have the capacity to commission services from that date. The degree of responsibility for commissioning services will be agreed between the PGC and the health authority.

Last week, I met representatives of Barnet West primary care group, who stressed the importance of recognising local factors in the work of PCGs. Does my hon. Friend share that PCG's desire for flexibility both in the setting up of PCGs and in ensuring that our doctors, our nurses and our community are in the driving seat when it comes to planning health care for our local area.

I can certainly assure my hon. Friend that we have established PCGs covering all the general practitioners in a particular area in order to put GPs, nurses and other professionals in the driving seat in primary care. As the groups develop, enormous use will be made of the new powers of PCGs to develop much better services.

Can my hon. Friend reassure GPs who are working hard to set up the primary care groups, and to make them work, that clinics and out-patient services provided for their local communities will be adequately funded by each health authority.

I acknowledge my hon. Friend's tribute to the active role that GPs are playing in ensuring that primary care groups will work. We have made it clear to health authorities that, where cost-effective and good services have been developed at practice level, we wish to see them continue. We also want to see plans drawn up to spread the benefits of those services to other patients in the PCG area.

Will the Minister acknowledge concerns about the extent of lay representation on PCGs? Will he undertake to reconsider lay representation if it is shown that it would be of immense benefit to the PCGs, particularly if it brought in wider expertise from outside the medical profession.

I have looked at proposals for membership of primary care groups, and my view is that the different factors involved have been appropriately balanced. It is understandable that people are examining the formalities of PCG constitutions at this stage, but, given existing flexibility, primary care groups will develop effective partnerships to provide primary care at the local level. I am sure that health professionals will draw on the expertise of others, including lay people who are not themselves members of the PCG, to develop effective services. As PCGs evolve in practice, effective working partnerships will be created, and that is most important.

Does the hon. Gentleman agree that, even by the standards of a Government who arrogantly sideline Parliament as much as they can, it is amazing, when the Secretary of State has published a Bill within the past few days to enable the abolition of fundholding, that fundholding has already been effectively abolished, and that arrangements are in place to dragoon GPs into collectives on 1 April, by which time the Bill will not have achieved even parliamentary consent, let alone Royal Assent.

The right hon. Lady has failed to notice the enthusiasm, commitment and dedication with which so many fundholding GPs have committed themselves to primary care groups. They see that this is the right way to develop the national health service. Professional GPs are working in co-operation with other health professionals to develop better primary care. They realise that we are moving in the right direction, and the right hon. Lady is out of touch with them.

I am wholly in touch with the timetable: primary care groups are to be set up on 1 April and the Bill has not even commenced its passage through the House. I am aware that the Minister has dodged my question—he is so ashamed of his arrogance that he will not address it. Will he now answer me?

The right hon. Lady does not understand either the legal or the parliamentary situation—although it has been set out very clearly and is evident from the Bill. Primary care groups can be, and are being, established under existing legislation. Fundholding will be abolished when the Health Bill achieves Royal Assent—assuming that that occurs. We shall make provision in the Bill—it should be perfectly clear to the right hon. Lady—for a residual fundholding scheme to operate from 1 April. I believe that the vast majority of fundholders will dedicate their energies to developing primary care groups and accept that fundholding will end on 1 April. It is there in the Bill. There will be a residual scheme for fundholders which will continue until the health legislation receives Royal Assent. I have answered the right hon. Lady's question, but she does not like my answer.

The majority of Labour Members warmly welcome the establishment of primary care groups. Will the Minister join me in welcoming the establishment of such a group in North Charnwood—which covers the Loughborough constituency—which builds on existing co-operation between general practitioners in the area? However, will the Minister look closely at the management responsibilities of the group? It does not wish to appoint a manager but wants to allocate existing resources among the general practices in the group. Does that send the wrong signal to others who are involved in the PCG, for example, non-GPs—that it is GP-led?

It would be wrong to comment on the particular local example to which my hon. Friend referred, although I shall be happy to look into the situation. We have published guidelines about the way in which we expect primary care groups to develop that strike the right balance between central encouragement and local flexibility. I shall look into the case that my hon. Friend has raised.

When the Government were elected, they claimed that they would save £100 million on administration in the national health service. The Government have already allocated a massive sum for the administration of primary care groups and they have stated that health authorities will also have to make money available to that end. The Government also expect GPs and other health professionals to give freely of their time to help with that administration. Have the Government assessed the total cost and effectiveness of primary care groups?

The hon. Gentleman fails to realise that, by introducing primary care groups, we will be able to cut out a huge amount of the bureaucracy and waste that were an integral part of the internal market. For example, whereas there were about 4,000 purchasing groups under the internal market, there will be about 600 commissioning groups under the new arrangements. That will enable a huge cut in bureaucracy to occur. I assure the hon. Gentleman that we are on target to meet our aim of saving £1 billion in management costs during this Parliament.

What plans he has to increase the number of medical doctors in training. [67162]

The Government are currently implementing their recent decision to increase the number of undergraduate medical education places by about 20 per cent.—that is about 1,000 extra places—over the next few years. Numbers in postgraduate medical training are also growing to meet future requirements for general practitioners and consultants.

I thank my hon. Friend for that reply. In inviting bids for that work, will he welcome and encourage new and innovative practices that complement other measures for developing a national health service for the 21st century? I have in mind the bid from the Exeter, Plymouth and Open universities, which, in addition to having a strong community focus, will seek to develop training through telematics and information technologies which will be the stuff of communication for doctors in the next century.

I am aware of my hon. Friend's support for that proposal and sure that she will continue to champion it enthusiastically, but it would be wrong of me to comment on any individual proposals. Proposals for new medical schools will be considered alongside proposals from existing providers by the joint implementation group, which is now implementing the increase in medical school places in England. The group will judge those proposals against the objectives that are set, including value for money.

Will the Minister confirm that his plans for more doctors include the number of qualified medical students who were due to enter the system anyway.

The position is that there will be 1,000 medical school places in addition to the number that we inherited on entering office in 1997.

May I take the opportunity to bring to my hon. Friend's attention the existence of Wimbledon Civic Forum's health forum, which brings together local executives from the health sector and local residents to discuss the future shape of health services in our community? Will he acknowledge that such forums and community health councils have a valuable role to play in promoting transparency and accountability in the new national health service, and will he undertake to review the future role of such forums and CHCs as important partners in the new NHS.

I am very interested in what my hon. Friend tells me: I am not familiar with that forum, but perhaps I shall have an opportunity to become acquainted with it in the not-too-distant future. One of the hallmarks of the new NHS is the way in which we are encouraging wider public involvement and consultation, for example, in the development of health improvement programmes, and co-operation between different parts of the NHS. That helps to overcome the fragmentation and competition that were so characteristic of the health service as it was left by the previous Administration.

rose—

Order. I remind hon. Members that the question is on the training of doctors.

Yes, thank you, Madam Speaker.

Yesterday, we implemented in full the recommendations of the pay review body for doctors, which was the right thing for us to do. We are continuing to make progress on the matter of junior doctors' hours: we have increased the funding to the task forces that deal with that problem; and, although I accept that this is not the thrust of the hon. Gentleman's question, we have made it clear that some of the conditions in which junior doctors are required to work—for example, their access to rest and canteen facilities out of hours—should be improved.

Does my hon. Friend know how many of the new doctors will receive training in the specialised treatment of cancer? The reason I ask that question is the huge amount of unsolicited tobacco advertising that still pours through people's letterboxes. My constituents are delighted that, in the White Paper, the Government proposed to ban such advertising, but can my hon. Friend tell me when that ban will come into effect, as it may have some bearing on the number of cancer specialists who need to be trained?

My hon. Friend raises a number of important issues in his question. We set out our proposals for action to reduce smoking and dependence on tobacco in last year's White Paper, and we are moving ahead on the implementation of those measures. In addition to the need for basic undergraduate training, there is the need to continue postgraduate specialist medical training, for we have to ensure that we are able to meet the service standards and targets that we want to set in respect of the treatment of cancer.

What assessment he has made of the costs to nurses of on-going and re-entry training requirements. [67163]

This Government are committed to encouraging the training of nurses. In this year alone, £72 million will be invested in post-registration training of non-medical staff. As part of our effort to encourage former nurses to return to the NHS, we are investing £4 million this year in local return-to-practice initiatives and free return-to-practice courses. We are also making available £36 million over this year and the next three years to help enrolled nurses to upgrade their qualifications. Ward assistants and other NHS staff can now train to be qualified nurses while retaining their existing pay for the duration of the course.

I am grateful to the Secretary of State for that helpful reply. What advice can he offer my constituent, Rachel Blight, who broke her nursing career after 14 years for the sake of her family and now wants to return to nursing? She has recently paid £350 for her re-entry training, which involves going 35 miles to the local training centre for three weeks of study and two weeks of practical work. If we want to—

Order. This is perfect material for an Adjournment debate. Will the hon. Gentleman get to his question now?

Thank you, Madam Speaker. We want to encourage nurses to return to their careers, but do not such conditions represent an obstacle to them.

Certainly, charging people for such courses is an obstacle, which I why I announced last year that the courses would be free. I shall look into why they are not free in the hon. Gentleman's constituency.

On regional television a few days ago, a nurse from the Royal Bolton hospital made the comment—with which I agree—that there is a pool of young people and others who want to enter nursing but are put off by what they see as the high academic qualifications required to enter the profession. Has my right hon. Friend taken that into consideration?

Many people perceive the present courses as too academic for their liking. We are trying to change the situation to make it easier for people to enter nurse training in various ways. The changes in the past few years certainly put off a substantial number of young people who might well have gone into nursing.

I welcome any and every means to increase the number of nurses in the national health service, but will the Secretary of State guarantee that those steps will prevent a repetition of the case about which I had cause to write to him a fortnight ago? That case concerns a constituent who was told that he needed a quadruple heart bypass operation and that it would be 24 months before the NHS could perform it. His GP told him that if he waited 24 months he would die, so he had to spend £10,000 on a private operation. Surely a case where someone has to pay to save his life represents the ultimate privatisation of the NHS.

All I can say to the hon. Gentleman is that his Government promised that no one would ever have to wait for more than 18 months for in-patient treatment; they did not keep that promise for a single month, but we have kept their promise since April.

What steps he is taking to increase the number of nursing trainees. [67164]

Between 1992 and 1994, the Tory Government reduced the number of nurse student training places from 15,000 to 11,000. The figure never rose much above 13,000 in subsequent Tory years. In January 1997, they announced their plans for an additional 1,300 nurse training places in 1997–98. We managed to add 1,400 nurse training places in that year, despite taking over after the start of the financial year.

I thank my right hon. Friend for that answer. Is he aware of the centre for health care education at University college, Northampton in my constituency, which has had a share of the increase, successfully filling 60 extra nursing places over the past year and planning an extra 100 over the next three years? It filled all those places by careful local recruitment and close partnership. Will he join me in paying tribute to University college, Northampton for successfully attracting more people to fill the extra places that the Government have created?

I would certainly like to congratulate everybody involved in the increase. We have increased the number not only of training places but of applicants per 100 places—from 106 to 120 since we took office.

Why did the Government almost entirely undermine yesterday's welcome announcement, on increasing nursing recruitment by awarding some trainee nurses a pay increase of 11.8 per cent. and junior nurses a decent pay rise, and by not staging the awards, by announcing a pay increase of 4.7 per cent. for two out of three nurses—200,000, or all the rest? When they receive their rise in April, they will be less well off in real terms than four years ago. The Chancellor has £5 billion in the contingency fund. Could that not have been used to pay all nurses a decent increase?

I do not know whether that would be another charge on the famous Liberal penny. The hon. Gentleman should remember that the Royal College of Nursing was very keen that an independent pay review body be established, and that the Government carry out the body's recommendations. We have done exactly that. I do not think that the Royal College of Nursing would want me to substitute my judgment for that of the independent review body, and I have no intention of doing so. We have implemented its recommendations in full.

My right hon. Friend probably agrees with me that we will never satisfy the Liberals, who said in their manifesto that they wanted an extra £700 million for the health service in this financial year and the next one. In reality, £7 billion is going in as a result of the statement the other month. Does my right hon. Friend agree that, in order to ensure that we get enough nurses and other hospital staff, the pay rise needs not only to be adequate but repeated next year? Perhaps he will consider the point that, 20-odd years ago, we found a way of putting the pay of firefighters into the upper quartile. With rare exceptions, the problem was solved.

As my hon. Friend knows, I am very careful about making individual promises on behalf of the Government. The pay settlement and the changes that we want to make in the career structure of nurses over this coming year are intended to start solving the problems of nurse shortages and the way in which the previous Government ran the health service, which resulted in most nurses feeling as if they had been run off their feet and unable to give patients the attention worthy of their professional standards. We cannot put it all right in one go; this is a start.

May I draw the right hon. Gentleman's attention to one effect of yesterday's announcement and ask him how he intends to ease it? The pay rise granted to nurses, especially new nurses, will have to be met not only by the NHS but by the hospice movement and the voluntary sector, which depend on grants. Is it his intention that those grants should be enhanced, to ensure that the hospice movement and similar concerns are able to afford to pay for good and adequate nursing care?

One way or another, the hospice movement gets substantial grants from the Government. We want to encourage the hospice movement, and when it submits its applications, they will be carefully considered. The right hon. Lady would not expect me to be able to go any further today on that individual item.

Will my right hon. Friend confirm that paying 12 per cent. to newly qualified nurses will be one way of attracting new trainees into the profession? Will he outline to the House some of the other initiatives that the Government are taking to attract more people to the nursing profession—in particular, action on family-friendly policies and measures to tackle violence in the workplace?

Since we came into office we have been encouraging NHS management to introduce family-friendly policies, not just for nursing, but for the entire staff of the NHS, so that they can do their jobs as well as discharging their responsibilities to their families—for example, by offering staff shifts that enable them to take children to school in the morning and bring them back in the evening.

What progress he has made in implementing the proposal to create supernurses. [67165]

Many talented nurses and midwives want to keep on treating patients and training their less experienced colleagues. Up to now, highly skilled nurses who reached the top of their professional grades could better themselves in the national health service only by going into management, so their hands-on skills are lost to patients and colleagues. In future, they will be able to apply to become consultant nurses, instead. We have been discussing the details of that with representatives of the professions, and our plans will be set out as part of our new strategy for nursing.

The fact is that, since the plan for supernurses was announced with a great fanfare last September, not a single one has been appointed. Indeed, the right hon. Gentleman's Department has instructed trusts not to appoint them. Yesterday, the Government announced a pay rise of 4.7 per cent. for the most senior nurses. I shall not ask the right hon. Gentleman whether that is fair or affordable, but will he tell the House whether he believes that it is sufficient to stem the haemorrhage of skilled and experienced senior nurses from the NHS?

I sincerely hope that it is. As the hon. Gentleman would know if he had read the details—and if he has not read the details, let me tell him for the first time—a number of discretionary increments are added for people who are at the top of the more senior scales, which make it possible for their pay to go up by more than 4.7 per cent.

I congratulate my right hon. Friend on his forthright recognition that one of the ways to keep senior and experienced nurses in the health service is to recognise that most of them have family responsibilities for young children or elderly relatives and that, as well as invaluable work in the NHS, they also do invaluable work at home. I draw to his attention the industrial tribunal case of Hale v. Wiltshire Health Care NHS trust in which the trust was found guilty of discriminating by changing nurses' work patterns in such a way that they were prevented from taking their children to school. Will he ensure that all NHS managers implement his family-friendly policies?

Yes.

Although I welcome the attempts to improve the standard of pay and other matters, such as training for nurses, does the Secretary of State agree that the average patient speaks of a supernurse as one who gives tender nursing care? Is he aware that there is some concern that, with the professionalisation of the nursing profession, some nurses are so busy that they cannot spend the time with patients that patients require.

I have already said that many nurses find that they are run off their feet and feel that they cannot give individual patients the attention that they deserve. We want to deal with that, in part by increasing the number of nurses available so that there is a bit more time for patients. We must recognise that everyone still expects nurses to provide tender loving care for the individual patient, while, at the same time, nursing is becoming infinitely more demanding and complex, as new and incredibly complicated pieces of equipment come on to the wards and pharmaceutical products become more complex. It is very difficult for an individual nurse to reconcile those needs and it is vital that we have more nurses to enable them to do so.

How many women in the Trent health region have received cervical smear tests in the last year. [67167]

In the year ending 31 March 1998, 350,617 women in the Trent region were tested, up from 328,014 women in the year to 31 March 1997—an increase of nearly 7 per cent.

I thank my hon. Friend for that response. I congratulate the Government on their recent action in ensuring that quality standards on cervical screening are consistent across the whole country.

I am grateful to my hon. Friend for drawing attention to the success of the cervical screening programme. About 4 million women are screened each year in England and it has been estimated that the programme prevents up to 3,900 cases of cervical cancer each year. He might also want to know that coverage in Nottinghamshire is among the highest in the country—slightly over 90 per cent., compared with a target of 80 per cent.

I am pleased that the Minister recognises that the cervical smear testing programme constitutes a huge advance in women's health in this country—in the Trent region and elsewhere. Will he also recognise that the programme was introduced—and was given huge stimulation—as a result of the NHS reforms introduced in 1990 by my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke)? Will the Minister take this opportunity to congratulate the previous Conservative Government on an important public health programme launched by my right hon. and learned Friend.

I am sorry to have to disappoint the right hon. Gentleman, but I shall not be able to do that. We inherited a situation that was not satisfactory and I should point out to him that one of the consequences of the reforms that he oversaw, and for which he was responsible, was the compromising of the effective monitoring arrangements for the cervical screening tests. He should be ashamed of that.

My hon. Friend will be aware that the assessment of the cervical tests varies from area to area, and that causes some concern. What mechanism is he considering to drive best practice through the service?

I can assure my hon. Friend that the whole thrust of our reforms, right across the board, is to improve the quality of services available to everyone who uses the national health service, including those women who use the cervical test screening programme.

If he will make a statement on how he intends to meet his target for nurse recruitment. [67168]

Our target is to have enough nurses and midwives to provide the treatment and care that patients need. We therefore need more nurses, and we need them now. That is why we have agreed the biggest real-terms pay rise for nurses for 10 years, and why we are paying it in full.

I thank the Secretary of State for his answer. He will know, however, that only 15,000 of the 300,000 nurses in the national health service will welcome yesterday's announcement. In that context, is the right hon. Gentleman not concerned about the NHS Direct service, about which he will shortly make a statement? The service was piloted in Wiltshire hospitals—so well run by the Wiltshire NHS trust over the past three years, incidentally, and set up by the Conservative Government. Does the right hon. Gentleman not fear that a nurse-based service such as the NHS trust—thought up by the Conservatives—will be hard to man if experienced nurses leave the service?

The hon. Gentleman ought to learn to count, or else brief himself before coming into the Chamber. While between 13,000 and 15,000 nurses will receive a 12 per cent. pay increase, another 70,000 will receive an increase of 8.2 per cent. or more, and the remainder will receive 4.7 per cent.

Can my right hon. Friend reassure us that the superb nurses' award—about which many of my colleagues will be thrilled—will affect neither recruitment nor the modernisation of our health service? Those who work in the health service are our best-ever asset, and we must ensure that we modernise their pay. Will my right hon. Friend confirm that the money that has been set aside for modernisation will not be affected by the award?

I can confirm precisely that to my hon. Friend, who is one of two former nurses in the House. We are financing the nurses' pay increase with money that we put into the NHS budget for next year. We made the decisions in July last year, and, not unreasonably, we anticipated that the review bodies would make a recommendation well in excess of the rate of inflation, which they have. We therefore set aside, within the modernisation fund, certain sums to help to pay the increase if it reached the level that it has reached. That is a proper use of money to modernise the health service. I think that many people, especially nurses, detest the suggestion that there is a conflict between paying nurses a decent wage and looking after patients. After all, it is the nurses who do the looking after.

I am sure that the Secretary of State will agree that nurse recruitment needs good schools of nursing. Will he use his good offices to sort out the unseemly dispute between the universities of Portsmouth and Southampton following the transfer of the contract for nurse training? A number of nurse tutors have been left in limbo, because those two public bodies will not agree on which is responsible for redundancy payments.

As the hon. Gentleman knows, I want to improve the arrangements for nurse training, not overthrow them because there have been some good developments. I want to change them, so that there is considerably greater national health service influence over who goes into nurse training and what sort of training there is. The aim is to redevelop the links between the NHS and nurses in training. As the NHS has had so little to do with nurse training in recent years, many of those in management have lost interest in nurse training and not given it enough attention.

What new legal duties on partnership and quality of care he expects to introduce during 1999. [67169]

What new legal duties on partnership and quality of care he expects to introduce during 1999. [67173]

We have set out new duties of quality and partnership in the Health Bill that was introduced in another place on 28 January 1999.

I thank my hon. Friend for his answer. I welcome the new initiative, which I believe to be the first on policing legal duties of partnership. Does it include social care?

Yes. If we are to improve services across the board—that is our primary objective—it is important that we find a way of getting the national health service and social services to work much more effectively together. We know from the result of the consultation on "Partnership in Action", which we published last year, that that is overwhelmingly what people want us to do. The Health Bill will, for the first time, remove the legal obstacles that currently prevent the NHS and social services from working effectively together.

Can my hon. Friend confirm that, through the Bill, for the first time, a legal duty will be placed on the quality of care, unlike before, when the only duty placed on trust chairs was to balance the books.

Yes, I can confirm that. Together, the changes that we have published in the Health Bill mark a decisive break from the NHS internal market and its preoccupation with competition, which was the inheritance of the previous Administration. We intend to put quality and partnership back at the heart of the NHS.

The Minister will accept that new legal duties will suggest new litigation. By how much will the NHS budget have to increase to take into account the litigation that will flow from the Access to Justice Bill.

I think that that is a typical lawyer's perspective. [Interruption.] I will answer the hon. and learned Gentleman's question because it is a serious one. The whole purpose and thrust of our new clinical governance and duty-of-care arrangements will be to improve the quality of care. That, I hope, will make it less likely that people will litigate.

Will the Minister clarify the Government's policy with regard to primary care centres and, in addition, beacon of excellence awards—proposed targets for practices? In my constituency, the leading general practitioner practice was well lined up to develop such a centre and has qualified for a beacon of excellence award, but, for the past few months, the NHS executive has been completely silent on how the scheme is going forward. Yesterday, the Secretary of State for Health was quoted in a leading paper as saying that he supported such centres, pulling together a wider package of optician services, prescriptions and other health care services, but it seems that the Government policy in that area is somewhat in limbo at present.

With great respect to the hon. Gentleman, the Government's policy is not in limbo. The Health Bill, which I invite him to study, will clearly apply to primary care, but the quality duty that we intend to legislate on is not about individuals; it is about institutions. The principle of clinical governance needs to apply obviously and clearly in the area of primary care, as well as secondary care, and it will.

Given that elderly patients represent around 50 per cent. of those in hospital, and consistent with the Griffiths report, "Agenda for Action", and Lady Walner's report, "Residential care: options for choice", may I invite my hon. Friend to agree that it is extremely important, as it was when those documents were published about a decade ago, that organisations of elderly people, individual elderly people and elderly people locally should be consulted on services that are vital to their particular needs.

The answer to my right hon. Friend's question is yes. I also draw his attention specifically to two of our current initiatives. The first is the establishment of the new national service framework for older people, which will make a very positive contribution in defining new service models and in setting national standards across the national health service for the care of older people. Secondly, as I said earlier, we are currently embarked on a new regulatory framework and standard-setting exercise for treatment in registered nursing homes and care homes. Together, the two initiatives offer the prospect of developing policy in that very important sphere.

What recent representations he has received on the unavailability of particular (a) drugs and (b) treatments to patients in certain health authorities. [67170]

I have received representations about availability on the national health service of certain drugs in certain parts of the country. The current situation is quite unsatisfactory, which is why we are establishing the National Institute for Clinical Excellence—NICE—chaired by Professor Sir Michael Rawlins, to assess new drugs and new treatments and to issue authoritative guidance. NICE will ensure faster access to modern treatment right across the health service—which is why it has the support of doctors, nurses, midwives and other NHS staff.

Many people hope that the new National Institute for Clinical Excellence will indeed encourage innovation and change. However, people are not prepared for the institute to act as a straitjacket, dampening down innovation and making it more difficult to develop and make available new drugs. Recently, the Secretary of State was condemned by the British Medical Association for an inequitable and irrational approach in reaching his rationing decisions. Health authorities are in despair about how on earth they are to meet the new pay awards. Will the Secretary of State now accept the offer of my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and lead a mature debate on the establishment of rationing and on how decisions are made in the national health service.

All I can say in response to that is that the professions welcome the establishment of the National Institute for Clinical Excellence. The BMA chairman was chairing the meeting at which I announced the appointment of Sir Michael Rawlins, and said that I had been as good as my word in appointing to chair the institute someone who commanded the professions' respect. The professions welcome the establishment of the organisation, which I am sure will do a good job. I am sure also that, if anyone is in despair running parts of the national health service, I should not want them to be working in despair—they can go work somewhere else.

Did not my right hon. Friend inherit a situation that included restraints—which varied across the country—on the availability of some drugs, such as beta-interferon, and huge disparities in the availability of some treatments because of huge waiting lists? Will he ensure that NICE maintains need as its primary criterion when it considers some of the alternative treatments that may become available because of genetic and other treatments.

Certainly, NICE will examine all new treatments and new pharmaceutical products, and it will issue authoritative advice. In some cases, it will be saying, "Get on with it, quickly. This is a good development, and you should introduce it right across the country." Currently, no one performs such a function. In other cases, NICE may say, "We are not too sure about this. The results of its effectiveness testing may not be as good as we should have liked." If so, NICE may recommend that the treatment or product should be made available systematically in only one part of the country, so that further proper tests and assessments can be performed.

Is the Secretary of State aware that 22,000 of my constituents made active representations about the closure of the Royal Haslar hospital in my constituency which would be a disaster for the defence medical services and a catastrophe for local residents? Will Ministers take a personal interest in the disaster that would result from the closure, particularly as the hospital in question is close to the constituency of the Minister of State, Department of Health, the hon. Member for Southampton, Itchen (Mr. Denham), and the closure would have reverberations there too?

It is clear that the closure of the Royal Haslar hospital will have an impact on health care in Portsmouth and in Hampshire generally and we are looking into that. I intend to meet the admiral who chairs the Portsmouth acute trust to discuss the matter. He is a most admirable admiral and probably carries a little more weight at the MOD than an ex-civilian.

What assessment he has made of the role primary health care plays in improving health service provision in Liverpool. [67171]

More than 90 per cent. of patient contact in the national health service takes place in primary care. In Liverpool, general practitioners and primary health care teams have a major role to play in improving the health of local people and in further developing services. That includes participation in the primary care groups where a key priority will be improving access to local services closer to where people live, rather than in a hospital setting.

Does the Minister agree that in areas such as Liverpool, where many people suffer chronic ill health, it is absolutely essential that all parts of the health service work together effectively and co-operate with social services? How will his Department encourage the health authority in Liverpool to ensure that primary health care is used to its maximum, working together with community hospitals so that the pressures of chronic ill health do not concentrate solely on the acute hospitals such as the Royal Liverpool and Broadgreen University Hospitals NHS trust.

A series of measures is already in hand, or will be introduced in the Health Bill, and will produce precisely the result that my hon. Friend would like. Already, in addition to the development of primary care groups, which we encourage to enable the health authority to grow and develop, there is a health action zone, and the health authority, in co-operation with others, will develop a health improvement programme identifying how primary health care should be improved. The Health Bill will place a duty of partnership on all parts of the NHS. I believe that in Liverpool and elsewhere we are getting the structures right, putting in place the legal responsibilities and providing the resources to enable local people to lead the way in developing better primary care services.