If he will make a statement on the establishment of primary care groups. [77698]

Four hundred and eighty-one primary care groups, covering the whole of England, will become operational from 1 April. They will replace the divisive internal market introduced by the previous Government, which set doctor against doctor and hospital against hospital. In place of that, the primary care groups will represent all local family doctors, together with community and practice nurses, representatives of social services and lay people. They should ensure more modem and dependable services and less bureaucracy overall.

Now that PCGs are a reality, is the Secretary of State worried about their management capabilities and about the level of management cost allowance, which was said by John Chisholm of the British Medical Association to be inadequate at £3 a head? Is he concerned about the suggestions by other GPs that PCGs may form a perfect vehicle for rationing health care services?

Primary care groups were introduced with the consent and agreement of the BMA. The level of management costs is neither a floor nor a ceiling; it varies from place to place, and rightly so. I am confident that, as a result of the introduction of primary care groups, people will have more universal access to top-quality care. What we are proposing goes with the grain of what the professions wanted, and that is what we have delivered.

In developing the policy, will my right hon. Friend consider the future capital resourcing of primary care? Is he aware of the difficulties with the funding arrangements in respect of GPs' surgeries and health centres, whereby GPs occasionally have to charge exorbitant rents to social services and community health trusts for community psychiatric nurses who are in attendance, which obstructs the close working relationship of health and social services in a primary care setting?

We want to continue improving primary care premises. We have changed the rules to make it easier for people to develop or improve existing primary care premises in health action zones, and we will continue to try to help. As an indication of the progress that has been made, the Turnberg review of health care in London more than a year ago reported that about 50 per cent. of premises were inadequate. That figure is now down to 32 per cent.

Does the Secretary of State recall telling the House on 18 January that

"primary care groups provided incentives for all concerned to level up' to the standards of the best."—[Official Report, 18 January 1999; Vol. 323, c. 594.]?

First, let us get the facts straight. It is not the case that 60 per cent. of GPs were fundholders when we took over. It was about 50 per cent.—a large number of whom were unwilling fundholders, but had decided to go along with the scheme. We have tried to make it clear to health authorities and others that we do not expect people to withdraw services that are presently being provided.

It is happening already.

If it is happening, it should not be—but that is down to local decision making. The decisions will be made by the doctors, the community nurses, the practice nurses, people from social services and lay people who serve on the boards of primary care groups. Decisions will be taken by the people who are responsible for delivering the services in each locality; the first time that that has been the case in the history of the health service.

Is my right hon. Friend aware of the success of the primary care group in Northampton, which built on the work of the commissioning GPs—who existed under the previous Government—and did such important work in terms of commissioning emergency pelvic scanning for women, which has helped deal with the problems of the early stages of pregnancy? Does he agree that, if the doctors of Daventry are having problems setting up their primary care groups, they could come to Northampton where they would learn a great deal?

I take this opportunity to pay tribute to the medical profession. Until 1 April, it will have had monopoly control over decision making in primary care since primary care was invented. Voluntarily, the profession agreed to give representation to nurses, social services and lay people on the boards of the primary care groups because it thought that that was the best way of serving local people. In nearly every part of the country, the profession has made remarkable strides in developing primary care groups. I emphasise that this is an entirely voluntary arrangement; no law has been changed. However, in every part of the country, the primary care groups have been established with the consent of—and, in most cases, a great deal of enthusiasm from—the professionals on whom we depend.

How many beds are currently blocked in the district general hospitals in west Middlesex and Kingston. [77699]

On 19 March, out of 376 occupied beds at Kingston hospital there were 19 containing patients ready for discharge but still in acute care. In the 319 occupied beds at West Middlesex hospital there were 40 such patients.

Does the Minister accept that the considerable problems that those two hospitals have with admissions are being compounded by the fact that the surrounding local authorities, which happen to be respectively Labour, Liberal Democrat and Conservative controlled, are all having to cut their services for the elderly because of the local government settlement? At a national level, what is his reaction to last week's Age Concern report, written by a leading NHS geriatrician, which said that up to 70,000 additional admissions could be secured if the Government were willing to co-ordinate, with local authorities, effective rehabilitation programmes for elderly patients?

That is exactly the direction of our current work within the Government. We want to reduce delayed discharges, and we are working to that end. Last winter, we spent £209 million in additional money on trying to find better ways of managing discharge from acute hospitals into the community. Many of those schemes operated in the hon. Gentleman's constituency. Nearly £1.5 million was spent in Kingston and Richmond health authority area, and one such scheme benefited 40 patients. We are pursuing the right policies and additional resources are being spent. The new national service framework for older people, which we launched last week, will include an expert task group working specifically to improve discharge arrangements from acute hospitals into the community.

What analysis he has made of the impact on employment in the NHS of his accident and emergency modernisation schemes. [77700]

Altogether, £100 million extra will be invested over the coming year in modernising accident and emergency departments. That will be better for patients and staff; it will also help to retain and create jobs. The recent investment of more than £1 million in modernising the accident and emergency department at the Queen Alexandra hospital in Portsmouth provided orders for more than 20 firms from all parts of the country. Rule of thumb suggests that the £100 million investment will provide 100 times as many orders, and that 100 times as many jobs will flow from them.

May I congratulate my right hon. Friend on one of the biggest hospital development programmes in history, with 31 new hospital developments worth more than £2 billion? Will he publish a list of the companies involved, and the jobs created as a result of that new development?

Yes, I will. As I have pointed out, more than 20 firms received orders for £1 million worth of improvements in Portsmouth. The developments in some parts of the country—at the Norfolk and Norwich, for example, where the total cost of the hospital is £160 million—will result in huge orders being placed all over the country. That is part of our policy not only to benefit the patients and hard-working staff of the health service, but to create jobs all over the country.

The Secretary of State will know that some people being treated in accident and emergency units have to go into an intensive care unit because of the severity of their injuries. He will also know that the director of the ICU at Bedford hospital wrote to him six months ago complaining about the fact that he had had to turn away 58 patients because he did not have enough beds. Why has the Secretary of State not yet replied?

Because I went there and spoke to him.

From among the many advisers and specialists that my right hon. Friend talks to in the Department of Health, has he yet received any clinical explanation for the fact that, whenever he gives us good news about the national health service, Opposition Members look depressed?

They look depressed today because we can announce that waiting lists in February fell by 39,000, taking the figure 38,000 below the one that we inherited. Over the past year, more than 450,000 extra operations have been carried out. [Interruption.] It is no good idiots opposite talking about fiddling—

Order. I am sure that such language is not necessary. The Secretary of State knows what "Erskine May" says about good parliamentary language.

I withdraw the word "idiots", and replace it with "Tories", Madam Speaker.

If he will make a statement on the provision of beta interferon in the NHS. [77701]

All health authorities were issued in 1995 with guidance that covered the use of beta interferon for the treatment of multiple sclerosis. It recommended that prescribing should be initiated by hospital specialists where clinically appropriate. The costs of prescribing are expected to be met within health authority allocations, taking account of local priorities.

I am grateful for that reply. May I draw the Minister's attention to two cases in my constituency? Josephine Timms, a mother with a young family, and Adrian Donno, a young man with a promising career ahead of him, were each diagnosed with multiple sclerosis last July. Both were recommended by consultant neurologists for beta interferon prescription, but both are still waiting.

Obviously, I shall take an interest in any individual case raised by an hon. Member. However, we should be clear that there are continuing questions about the clinical effectiveness and cost effectiveness of beta interferon, the level of benefits achieved, which patients will benefit and for how long, and how the benefits compare with those of supporting MS patients through, for example, specialist nursing care. Health authorities and clinicians rightly take those and other factors into account when they set local priorities.

As the Minister tells us, beta interferon can be prescribed only by a hospital consultant. The problem is, however, that, after initial diagnosis, many people with multiple sclerosis do not see a hospital consultant for years. They therefore do not know whether beta interferon would be the drug to help them. Would it not be sensible to put in place some recall system so that people with MS have the option to see a consultant if they feel that beta interferon or some other drug might help them, or if they are not coping as well as they should with MS?

I shall consider my hon. Friend's suggestion carefully. We must ensure that clinical and cost-effective treatments are spread throughout the national health service as quickly as possible, and that is one of the roles of the National Institute for Clinical Excellence, which will provide clear and authoritative advice on key treatments and procedures. Subject to the outcome of consultation on the discussion document and appraisal by NICE, we are minded to refer beta interferon to the institute.

Is the hon. Gentleman aware of an exchange about rationing in the health service that took place last year between me and the Minister for Public Health, in which I asked a very simple question:

"Is there rationing or is there not?"

"No".—[Official Report, 15 December 1998; Vol. 322, c. 746.]

No.

Is there or is there not rationing of beta interferon? Is there or is there not rationing of Aricept? Is there or is there not rationing of Ironotecan? Is there or is there not rationing of Taxol? If not, why cannot those patients who are prescribed those drugs obtain them?

The reality is that priority setting is a feature of every health care system in the world. It happens to be the case that the national health service is fairer, more equitable and more efficient than the privatised alternative that the hon. Member for Rutland and Melton (Mr. Duncan) advocated earlier this week. While the Conservatives are giving up on the national health service, new Labour is building a new national health service.

Will the hon. Gentleman answer a simple question? If he is denying rationing in the health service, will he explain to the House, and to those concerned people who would like to obtain drugs and operations that are not available, his definition of the difference between rationing and a priority?

Under the health system advocated by the right hon. Lady and her hon. Friends, any access to health care would be rationed by the ability to pay.

What estimate he has made of the total amount to be spent in the current financial year on improving NHS children's services. [77702]

Forecast total gross expenditure on the national health service in the United Kingdom for 1998–99 is £48.1 billion. Overall funding does not distinguish between age groups, although there are specific initiatives in our expenditure plans that will be of direct benefit to children's health services. Planned gross expenditure for 1999–2000 is £50.8 billion—an increase of 3.1 per cent. in real terms.

I thank my hon. Friend for that reply. Northumbria health care trust plans to build phase 2 of Wansbeck general hospital. When will that building commence and will it include the much-needed children's centre?

I acknowledge the support that my hon. Friend has shown for the new hospital development in his constituency. The child health centre is an integrated part of the Wansbeck phase 2 scheme, which is now under private finance initiative negotiation. It is expected that a full business case will be submitted to the regional office in May 1999. The trust hopes to be in a position to complete negotiations with a PFI partner within the next few weeks and officials from the regional office and the PFI unit are working with the trust on various aspects of the deal.

Is the Minister aware that funding of additional paediatric intensive care beds at Addenbrooke's hospital in my constituency is a priority task for the management in the financial year ahead? Is he further aware that Addenbrooke's hospital is forecasting for the first time ever a revenue deficit of £2.5 million in the year ahead? For a well-managed hospital, that is an exceptional situation. Can the Minister explain why the Government have contributed to that difficulty by imposing costs of £622,000 next year to pay for the implementation of the working time directive?

The hon. Gentleman takes a regrettably negative tone. He has failed to acknowledge the fact—and it is a fact—that additional money is being made available to provide additional paediatric intensive care beds in the national health service.

indicated dissent.

It is no good the hon. Gentleman shaking his head, because that is a fact. Some £15 million is being made available to provide additional paediatric intensive care beds. He let that fact slip through his hands.

Does my hon. Friend agree that one of the most unpleasant experiences for parents and children in the NHS is being rushed to accident and emergency departments with no separate facilities for children? My right hon. Friend the Secretary of State had the pleasure of visiting the separate, specialist facilities in my constituency at the Queen Elizabeth II hospital, which provides an excellent service for children admitted to A and E. Can my hon. Friend comment on monitoring the expenditure of the welcome new money going into A and E provision and how it will improve services for children where there is no separate provision for them?

I am grateful to my hon. Friend for raising that point. She is dealing with the reality, which is that the Government are spending significant extra money modernising accident and emergency departments across the country. She, like my hon. Friends, but unlike Opposition Members, will be interested to know that some of the money in the modernisation programme will be spent on providing A and E facilities for children. That is good news and it is a pity Opposition Members are not prepared to acknowledge it.

What assessment he has made of the level of nursing shortages; and if he will make a statement. [77704]

From the various figures and sources available, I estimate that there are around 9,000 nursing vacancies in the national health service that have existed for three months or more. As the hon. Gentleman knows, on 1 February we launched a major recruitment campaign. Since then, more than 52,000 people have contacted the national response line. Around 5,000 of them were qualified nurses asking about returning to nursing. Nurses who have to go on refresher courses and return to the NHS will have their fees paid by the NHS; those who have already done so will have their fees reimbursed, including his constituents.

I am grateful to the Secretary of State for that clarification. The Royal College of Nursing estimates that there are between 12,000 and 13,000 nurse vacancies and believes that nurse shortages rather than flu epidemics created the winter crisis. What steps will he take to encourage experienced nurses—the backbone of the NHS—to remain in nursing and not leave the NHS at the present rate?

The RCN certainly produced estimates different from those of officials of the NHS and my Department. When I last appeared before the Health Committee, I said that I would authorise my officials to get together with people with other estimates so that we can agree how many vacancies there are and not have futile discussion about numbers rather than doing something about it. We are trying to recruit extra nurses. It looks as though the campaign is successful. We are also trying to introduce family friendly policies so that services are available for nurses who want to be able to take their children to school in the morning, take them home in the evening or need a creche so that they can take younger children to the hospital or community service with them. We are determined to bring that about. That applies not only to nurses, but to everyone who works in the NHS because it must provide a top-class service for patients while allowing its hard-working staff to reconcile their jobs with their family responsibilities.

Will my right hon. Friend join me in congratulating the Surrey and Sussex Healthcare NHS trust, which held open evenings at the Crawley and East Surrey hospital sites attended by 165 people? Ten at Crawley signed up for the back-to-nursing course. They are delighted. There is clearly a new view about nursing and people feel invigorated that they are getting back into the profession that they love.

My hon. Friend, speaking from her experience as a qualified nurse, offers me some reassurance. In other parts of the country, besides the national initiatives that we have taken, local nursing managements are conducting a variety of initiatives to attract people back. It looks as though they are working. I have recently visited several hospitals with nurse returners. When I asked one why she had come back, she said that her children had reached the stage where it was quieter at work. She was working in the intensive care unit.

The NHS cannot afford to lose any competent and qualified nurses. I certainly applaud the steps that have been taken to follow up the Opportunity 2000 initiatives. The NHS was the first public sector body to join Opportunity 2000. We had a debate yesterday on the Macpherson report. In 1993, the NHS set a target for the number of black and ethnic minority G grade nurses. What further steps are being taken to ensure that we do not lose the skills of public sector workers in the NHS from the black and ethnic minority communities?

I agree with the right hon. Lady that it is bad if we lose trained nurses from the health service. When we got in there were 140,000 qualified ex-nurses no longer working in the NHS, the odd one or two of whom, I have reason to believe, left when the right hon. Lady was Secretary of State for Health.

Is my right hon. Friend aware that anyone with an ounce of common sense is highly delighted not only with the recruitment campaign that he has mounted, but with his serious acknowledgement that there is a problem with nurses and nurse retention? Will my right hon. Friend assure me that he will abandon any idea of introducing schemes for discretionary payments for nurses? We know that within the NHS such a scheme for doctors is unfair, inequitable and expensive.

I am not entirely clear what my hon. Friend is referring to. We have certainly set our faces against the idea of performance-related pay in the NHS. We want to relate pay mainly to responsibility. With—I think—the likely agreement of the profession, we intend to get rid of the rigid grading system that is holding back the professional development of nurses and holding down their pay.

When he will announce his decision about the construction of the new Newbury hospital. [77705]

Officials at the south-east regional office of the NHS executive are currently in discussion with West Berkshire Priority Care Service NHS trust on the funding mechanism for the construction of the new Newbury hospital. Ministers will consider the project once those discussions are complete.

Is the Minister aware that there is a nurse now serving at Newbury hospital who was promised when she did her training as a young person that the new Newbury hospital would be built shortly? As it is still not being built and she is coming up to her retirement, is it not time that the Government stopped saying, "Shortly" and said, "Now"?

The hon. Gentleman will be aware that the scheme is unusual and complex. For example, it is the first time that a charity has been proposed to act as a private finance initiative partner. It was also important to examine whether the plans fitted the strategic direction of Berkshire health authority. As the hon. Gentleman is aware, Berkshire is benefiting from a £73 million publicly funded scheme for the Royal Berkshire and Battle Hospitals NHS trust to resite its services at the Royal Berkshire hospital. That is one of the 31 major hospital developments worth almost £2.4 billion that make up the largest hospital building programme in the history of the NHS.

How many patients have been removed from central returns health service waiting list statistics since 2 May 1997, without having received the treatment intended. [77706]

National health service waiting lists are falling because thousands of extra patients are being treated; more than 4 million elective patients have been treated in the first nine months of 1998–99—a third of a million more than a year ago.

Why has the number of patients waiting to get on to waiting lists apparently doubled since May 1997?

It would be better for the hon. Gentleman to acknowledge what has been achieved in Dorset, where he comes from and where the allocation of an additional £4.2 million means that 8,000 more people were seen in hospitals in the Dorset health authority area during the first half of this year than in the first half of 1997–98. That additional work is a tribute to the staff of the national health service, whom he should not try to undermine.

Will my hon. Friend ensure that all people with Down's syndrome have equality of access to all waiting lists? According to the Down's Syndrome Association, that is not the case at present; contrary to Government policy, some practitioners are treating those patients as second-class citizens. My hon. Friend will be aware of a recent television documentary that highlighted some cases, and some hon. Members will be aware of other cases.

I shall certainly look into any cases that my hon. Friend draws to my attention. It is the case that clinical need is the principle that governs the national health service.

I hope that the Minister will answer my actual question and not the one he hoped I would ask.

First, the number of people waiting more than a year has fallen. Secondly, the number of people referred to out-patients includes those—perhaps 150,000—who attend for post-surgery visits. We intend to pay attention to out-patients; we are considering our planning for this year and anticipate that about a third of a million more out-patients will be treated in the coming year. That will take the number to be treated to more than 11 million for the first time.

Does my hon. Friend agree that the past 24 hours have been a significant demonstration of the contrast between the Labour Government's approach to the NHS and that of the Conservatives? The falling waiting lists contrast with the statement made by the hon. Member for Rutland and Melton (Mr. Duncan) articulating the Tory philosophy of the massive expansion of the private health care sector as a solution to the country's health care difficulties.

My hon. Friend is right. While the Labour Government are building a new national health service—modern, dependable and there when people need it—the Opposition have given up on the national health service.

Does the Minister recall that, before the election, the objective of the NHS was that 90 per cent. of patients should be seen in out-patients within 13 weeks of their first referral by a GP, and that the remaining 10 per cent. should be seen, at the latest, within 26 weeks of referral? Is it true— I cannot believe that it is—that the Government have junked that objective? If it is true, what alternative, tighter target have the Government set in its place?

No, we have not junked the objective, but we are delivering on our manifesto commitment to cut waiting lists, and we have now brought them down to below the level that we inherited.

What advice does my hon. Friend have for a constituent of mine who has been waiting for a heart bypass for many months? In the past few months, he has three times been sent to the hospital, gowned up, given pre-meds and then sent home. I understand that he is to go tomorrow to try again. I also understand that the Freeman hospital, Newcastle upon Tyne, has only five emergency beds.

I hope that my hon. Friend's constituent will benefit from the measures that the Government are taking to invest in the NHS: from 1 April begins the investment of an extra £21 billion in the NHS, and we have announced a further £320 million to tackle waiting lists in 1999–2000. The measures announced by my right hon. Friend the Secretary of State on nurse retention and recruitment are the key to ensuring that hospitals are properly staffed and able to meet their commitments to patients.

Today is not the triumph for the Minister that he would like people to believe it is. Instead of a serious improvement in what is really happening to patients who need treatment, there has been a published fall in the number of people on waiting lists together with a parallel rise in the number of people waiting to get on waiting lists in the first place. The real figure is far higher—[Interruption.]—as the Secretary of State, who is barracking from the Front Bench, well knows. People on the lists are waiting longer—[Interruption.]—in the case of the Alexandra hospital, Redditch, they are waiting more than 1,000 per cent. longer. Will the Minister, perhaps to a quiet House, now confirm that he has not yet met his pre-election pledge? In the interests of doing what is good for patients rather than for politicians, will he now drop his ill-conceived waiting list policy altogether and concentrate on what is good for the treatment of people who need it?

All the 450,000 extra operations carried out last year were performed on people who needed them. Which of them would the hon. Gentleman prefer we had not treated?

Will my hon. Friend commend the approach to waiting lists adopted by the new Morecambe Bay Hospitals NHS trust? In its first year of operation, which ends tomorrow, the trust has achieved not only its waiting list targets, but management savings of a recurrent £400,000 per annum. It has targets of a further recurrent £400,000 per annum next year, and all that money will be diverted into patient care. Will my hon. Friend commend every single person who works in that hospital trust on their excellent work?

I certainly commend all the staff in that hospital trust, and all the staff in the NHS, without whose work we could not have achieved the fall in waiting lists that has been announced today. My hon. Friend is right to refer to the efficiency with which his local trust and many others now operate. Supported by the waiting list task force, the NHS is not only treating more patients, but treating them better, and organising services in more effective and more efficient ways. I am sure that my hon. Friend's local hospital is an example to the rest of the country.

Which health authorities have discussed with general practitioners measures to reduce the number of patients which they refer to hospitals for surgery for which there is a waiting list. [77709]

I would expect all health authorities and primary care groups regularly to discuss with GPs arrangements to ensure that patients receive the treatment they need, as quickly as possible. That is the key to improving health, reducing inequalities and modernising NHS services. Reductions in waiting lists are being achieved on the back of record growth in activity, with an extra 460,000 patients expected to be treated in 1998–99 than a year earlier.

In view of the exchanges that we have heard this afternoon, will the Minister confirm to the House that the number of patients who have waited more than 13 weeks to see a specialist has increased by more than 200,000 since Labour came to power?

I repeat what I said earlier: in planning for next year, we anticipate treating at least a third of a million more out-patients. That will take the number of out-patients to be treated in the national health service above 11 million for the first time.

Does the Minister think it is ethical for GPs to be told that their patients cannot be referred for major operations because hospitals are trying to reduce waiting lists by performing only small operations and spending insufficient money? Does the Minister accept that that practice is prevalent, and will he condemn it?

I assure the hon. Gentleman absolutely that, if he can give me chapter and verse on those allegations, I shall look into them. We have made it perfectly clear that we do not expect and will not tolerate any manipulation of waiting list figures. I shall certainly examine any cases that the hon. Gentleman uncovers.

What measures he proposes for improving the regulation of health professions. [77710]

The Government are committed to improving quality in the national health service through the introduction of clinical governance. Strong, open and accountable systems of professional self-regulation play an integral part in that, and we want to work with the professions to build on and strengthen existing systems. The Health Bill includes measures to allow for the regulation of new professions and the strengthening of existing regulatory schemes by order.

I thank my hon. Friend for that answer and welcome any action that is designed to improve the regulation of health professions. I draw his attention in particular to the situation regarding psychologists. It would seem that people can call themselves counsellors, therapists or psychologists without receiving any training whatever. Will my hon. Friend support the current moves by that profession to establish a register of chartered psychologists in order to protect the public from possible exploitation, abuse or harm? If necessary, can such registration be made a statutory requirement?

I share my hon. Friend's concern about bogus psychologists or anyone else who makes false claims concerning health care and treatment. The Government are well aware of the issues involved.

While we may accept that some regulation of the medical profession may be necessary, does the Minister agree that the medical profession across the spectrum requires a boost in morale? Will he follow the example set by the East Cheshire NHS trust and its chairman Peter Hayes and ensure that morale across the hospital service is of the highest order? In doing that, he would ensure the best service provision to the people of this country and treatment of a maximum number of people.

I am very keen, as are my right hon. and hon. Friends, to ensure that best practice is spread throughout the national health service. The system of NHS beacons is designed, among other things, to identify good practice in leadership and management. I hope that the hon. Gentleman's local trust will be able to contribute to that process. However, the hon. Gentleman should not underestimate the significant determination of the medical profession to modernise its system of self-regulation, which I think will benefit patients throughout the country.

I welcome the Minister's attempts to improve the quality of service in our hospitals. However, is he aware that last week two patients in Nottingham City hospital contracted malaria? Even more worrying, it has been discovered since then that another patient who was discharged from the hospital has died from malaria. Will the Minister assure us that there will be a thorough investigation into the causes and that whatever measures are necessary to protect the public in future will be taken?

That is a very unusual occurrence.

It had nothing to do with the question, either.

For the reason given by my hon. Friend, the authorities will certainly establish what happened in that case and whether there are any lessons to be learned from that.

When he expects to announce the conclusion of his Department's reviews affecting regional specialist units at hospital in the borough of Hillingdon. [77711]

The Turnberg report on the future of London's health services recommended a thorough review of specialist health services in west London. We accepted all the Turnberg recommendations, including that one. A group covering all the specialist services involved is now considering how best to provide top-quality patient services, teaching and research in that area, which includes Harefield hospital in Hillingdon. The hon. Gentleman will, I hope, be reassured to know that I have discussed the review with Sir Magdi Yacoub on two occasions, that he is content with the proposals and that I have given him my personal undertaking that NHS funding will be available to help to fund the heart sciences centre and the patient services centre at Harefield.

I am most grateful to the Secretary of State for that reply, particularly with regard to Harefield. However, I turn his attention to the future of the regional specialty for burns and plastic surgery at Mount Vernon hospital. There is a grave discrepancy between the right hon. Gentleman's boasts that he will take into account local opinions on the siting of services, and the blithe disregard for the wishes of local people as expressed in a petition with more than 80,000 signatures, as well as an early-day motion in my name and a deputation to the former Minister of State, the right hon. Member for Darlington (Mr. Milburn).

The future of the burns and plastic surgery unit at Mount Vernon hospital is being considered by an expert advisory group. The group has not yet reported back even to Hillingdon health authority. If local people and the community health council are opposed to the proposals, the decision will eventually rest with me. No decisions have been made. I shall, in line with the Turnberg recommendations, make sure that the best health services for treatment, training and research are available in west London. That may or may not mean that there will be changes at Mount Vernon. I do not know at the moment because I have not received the advisory group's report.

Does my right hon. Friend agree that the future of specialist treatment centres such as the burns and plastics unit at Mount Vernon would have been better assured if, in 1996, before the election, the Tories had not closed the hospital's accident and emergency department?

Yes.

What action he is taking to promote high standards in social work; and if he will make a statement. [77712]

We shall promote high and improved standards for all social care staff. We have already announced our proposals to create a general social care council. Before that, we aim to reshape the social work training system and launch a new post-qualifying award in child care later this year. This summer, our new training strategy will allow us to start raising qualification levels in the whole social care work force.

Does my hon. Friend agree that a key to high standards in social work is a trained work force? Is he aware that some 80 per cent. of the social care work force do not have any qualifications? Is that a priority for him, and what action is he taking to improve the situation?

I strongly agree with my hon. Friend. It is unacceptable to us—and, I am sure, to everyone in the House—that such an important group of key workers remain largely unqualified. Some of the measures that I have already announced will help to raise the qualification levels in the social care work force, but my hon. Friend may be particularly interested in the steps that we are taking to introduce a new national vocational qualification level 3 award for people working in residential child care settings. It is our priority to improve the qualification levels of all the social care work force, and the programmes that we have set in train will achieve that.

Does the Minister recall the recent letter that he sent to Worcestershire county council congratulating it on the high priority that it attaches to a high standard of social work and social services? Does he understand that that demands an inflation-busting increase in council tax of 9.9 per cent? To avoid any possible charge of hypocrisy, will he make representations to his right hon. Friend the Deputy Prime Minister in order that the county council is not penalised for protecting social services and social work, to which the Minister says he attaches such importance?

The local government settlement was a fair one for all authorities. I have recently been to Worcester to see at first hand some of the outstanding and excellent social care schemes that the county council is organising. I pay tribute to the staff there for that. I am sure that the hon. Gentleman would join me in welcoming the recent announcement by my right hon. Friend the Secretary of State that a new hospital costing more than £100 million will be constructed in Worcester, which is good news. It is something, I am afraid, that his Administration never quite got round to doing.

If he will introduce a system of health care charges for smokers before they receive NHS treatment. [77713]

The Government have no plans to introduce such a system. I am quite sure that my hon. Friend needs no reminding that to do so would be in breach of the founding principles of the NHS: it is open to all regardless of income; it treats sick people when they need treatment because they need treatment, not because of why they need treatment.

I know that, like me, my right hon. Friend wants not to penalise smokers but to help them liberate themselves from a disgusting habit that damages their health and future. Does she agree that it is worrying that, after many years of decline in smoking, the use of tobacco is increasing again, especially among young people, and particularly women? Will she stand up to all the pressures on her, unlike the previous Secretary of State for Health, the right hon. Member for South-West Surrey (Mrs. Bottomley), who, even in the face of a recommendation from three Cabinet Ministers, including the Deputy Prime Minister, would not ban tobacco advertising?

I have seen the reports, to which my hon. Friend refers, of the right hon. Member for South-West Surrey (Mrs. Bottomley) not supporting a ban on tobacco advertising. We know that our strategy against smoking, particularly to reduce smoking among young people, will not work unless we ban tobacco advertising, which is why we will ban tobacco advertising. We know that smoking is the single greatest cause of health inequality. We know that the right hon. Lady, when she was Secretary of State, banned the term "inequality" in the Department of Health. It is therefore not surprising that she refused to take measures to reduce inequality in health. We will tackle smoking and we will reduce health inequality.

I warmly congratulate the Minister on her reply to the original question. Does she agree that there is no reason on earth why smokers, of whom I ceased to be one on 25 June 1986, should pay an extra tax for NHS treatment, given that they contribute approximately six times more to the Exchequer than they cost the NHS in treatment for smoking-related illnesses? Does she agree furthermore, that if she were so foolish—which she is not—to pursue the pernicious nostrum recommended by the hon. Member for Huddersfield (Mr. Sheerman), she would in all logic have to extend it to people suffering from alcohol-related illnesses or, indeed, avoidable obesity?

I have from time to time wondered how the hon. Gentleman might be an example to the young people of this nation: this afternoon, he has revealed to the House that young people can admire him for the fact that he gave up smoking.

I congratulate my right hon. Friend on her commitment to reduce smoking among young people, particularly women. Will she congratulate Birmingham health authority on its tremendous work and commitment to make Birmingham a smoke-free city by 2005?

I am delighted to join my hon. Friend in congratulating the leadership shown in Birmingham in declaring itself a smoke-free city. We hope that, as we implement the agreement to extend smoke-free public places, other cities will enjoy the benefits that the people of Birmingham are enjoying.