If he will make a statement on the quality of service at the Royal Surrey hospital. [84996]

It is the responsibility of management and doctors to ensure the quality of services provided locally.

That contribution is welcome, but waiting lists at the Royal Surrey hospital are still higher than two years ago; the turnover of nursing staff has reached 28 per cent; and 20 per cent. of nursing staff places are currently unfilled. Since the abolition of the internal market, there has been a recurring deficit at the Royal Surrey of £1.4 million a year, which led to the closure last Saturday of one of the clinical wards. In the circumstances, when will the Government give the funding that the Royal Surrey needs to maintain the high standards that it has achieved in the past?

The truth is that the health authority has received 2.9 per cent. in real growth this year, and more than £800,000 extra will be available from the modernisation fund to tackle waiting lists. The Royal Surrey hospital has met and will meet its waiting list targets, and it will treat more patients than ever next year.

Is the hon. Gentleman aware that 58 per cent. of junior doctors at the Royal Surrey hospital are working more hours than are specified under the new deal?

The Government have made progress in implementing the new deal by improving the conditions for rest periods. We will continue to make progress, working with the junior doctors.

How does the hon. Gentleman match that statement with the national figures, which show that whereas only 16 per cent. of junior doctors were working beyond the 56-hour limit when we left office, some 28 per cent. are now working beyond that limit?

Because, as the right hon. Lady knows, the figures would show continued progress by the Government if they were seen on a comparable basis. We agreed with the junior doctors that there should be more stringent criteria for their rest periods, as that was in their interests and those of patients. Everyone accepted that bringing in the changes in December would produce a rise in the headline figures for non-compliance with the new deal. However, all the evidence suggests that the actual number of hours worked by junior doctors has not increased.

The figures for the Royal Surrey hospital fly in the face of what the hon. Gentleman has just said. At 31 March 1998, all 128 posts at the Royal Surrey hospital were declared to be compliant. By 30 September 1998—before the new monitoring criteria were imposed—12 per cent. of posts were not compliant with the hours in the new deal. That shows that the trend of increasing non-compliance started before the hon. Gentleman and the Secretary of State changed the criteria. When will we see the national figures which, mysteriously, are available, but have not been published?

The answer is the one that I have already given. The reason for the increase in the headline figure for non-compliance is the change in the definitions in the new deal. However, progress continues to be made, and there is no evidence that junior doctors are working longer hours. So far as any individual hospital is concerned, it is clearly the responsibility of the hospital management to work towards compliance with the new deal. One of the reasons why we are continuing to fund the regional task forces is to work with that minority of hospitals which have a minority of junior doctor places that are not compliant with the new deal.

In my 15 years as a local Member of Parliament, there has not been a more severe situation at the Royal Surrey hospital. I would like to help the hon. Gentleman to help the hospital to make difficult decisions, but the options that it is now considering are not fair to patients. The area has one of the highest costs of living, high expectations and massive demand. The combination of the hon. Gentleman's decisions on health funding—among the lowest in the country—and the vindictive social services settlement means that the hospital cannot maintain the quality of service that is necessary. Will he personally look at the health and social services figures together?

It is an inescapable fact that the health service in the area has to deal with the deficit of about £18 million built up over two years under the previous Administration. Viewed nationally, the hospital is not typical. There has been considerable progress since we came to office in reducing the number of NHS trusts in serious financial difficulties.

What action he is taking to improve the sexual health of young women in Britain. [84997]

My right hon. Friend the Minister for Public Health announced on 23 March that the Department of Health will, over the coming year, develop a comprehensive strategy on sexual health. We expect to be in a position to announce in the very near future the membership of an expert group to steer the work.

Does my hon. Friend share my concern about sexual ill-health among young women and the rate of chlamydia—a non-symptomatic sexually transmitted infection, most common among women between 16 and 19—with 630 cases per 100,000 women? Is he aware that research suggests that an integrated specialist service can ensure that young women are more likely to be tested for such infections, to be diagnosed and to avoid problems such as infertility and ectopic pregnancy in later life? Will he do more to ensure that specialist services not only focus on reproductive health but deal with sexually transmitted infections in an integrated way?

My hon. Friend is certainly right to draw attention to the risks posed by chlamydia. The rate of infection rose significantly in the last year for which we have figures, with an increase of nearly 21 per cent. Nearly 22,500 young women were diagnosed with chlamydia infection. That is why the Department is trying to promote better awareness. We mounted two public awareness campaigns, targeted primarily at younger women. A booklet was issued through 19 magazine in March and distributed through further education colleges. We are expecting two pilot schemes—one in the Wirral and one in Portsmouth—to begin operating a chlamydia screening service for young women in the summer. The Government are taking action and I certainly recognise the strength of my hon. Friend's argument.

I accept that constructive sex education in schools can safeguard and even improve the sexual health of young women, but does the Minister agree that the recent suggestion from the hon. Member for Oxford, West and Abingdon (Dr. Harris) that sex education should be available in schools to children of seven is wrong and will rightly be viewed with alarm by millions of people throughout the country?

I appreciate the hon. Gentleman's constructive comments about the importance of good health and sex education in schools. It is compulsory in secondary schools, and has been since 1994; at present, it is at the discretion of school governors in primary schools. I do not want to get involved in that argument today. It is important to recognise what good sex education can contribute. Of course it has to be appropriate to make a good contribution to promoting the sexual health of our young people. The Government are committed to that and we are taking the action that I have already outlined.

Is my hon. Friend aware of recent research reported in the British Medical Journal, concluding that teenage sexual health in Britain is not only bad but getting worse, with increases in terminations among the under-19s and in birth rates? In the context of a fall in cases of sexually transmitted diseases generally, we have had an increase in cases not only of chlamydia but of gonorrhoea among the young. Does he agree that, although sex education and contraception are essential parts of the strategy, they are by no means sufficient by themselves and we must tackle issues of social exclusion, education, parental involvement and indeed poverty?

I agree strongly. My hon. Friend made several sensible and useful points. It is very much the Government's intention to approach these issues in a joined-up way, considering all the services that are available to young women. It is extremely important to improve the sexual health of our young people. We have the highest rate of teenage pregnancy in western Europe and very high rates of sexual infection among young people. That is not acceptable. The Government will address the issues and we are determined to improve the sexual health of our young people.

In view of that answer, does the Minister accept the need for urgency and does he understand the concerns of the British Medical Association, the Royal College of Nursing and the Sex Education Forum about the initiative that he announced a minute ago? We are halfway through this Parliament and we are still awaiting the joint report from the Department of Health and the Department for Education and Employment on personal health and sex education and the report of the social exclusion unit on teenage pregnancy. I urge the Minister to consider becoming involved in the debate on sex education so that we can have a system, such as those in Scandinavia and Holland, of early, clear sex education which has delivered the lowest rates of teenage abortion and under-16 conception in Europe, instead of the highest, which we have.

I welcome the hon. Gentleman's interest and concern, but I shall not take any lectures from him about the speed of the Government's response. We have responded quickly and are putting together a comprehensive strategy to address such issues in the near future. It is a clear priority for the Government to tackle them as quickly as we can, but that must be done in the right way. We have the elements of the strategy in place and that will make a significant contribution to improving the sexual health of young people in this country, which is what we want to do.

What plans he has to increase public confidence in cervical screening for women. [84998]

It is vital that women have confidence in the cervical cancer screening system to identify early signs of abnormalities or to provide reassurance that none are present. The only way to increase such confidence is to provide services that justify it. That is why I announced in December 1997 stringent new quality assurance arrangements to apply to all cancer screening services. This involves setting high standards, outside monitoring of those standards and external accreditation of the laboratories involved.

I thank my right hon. Friend for that answer. I welcome the new targets and innovative methods for getting women to accept that screening is the best way to ensure that they maintain their good health. Is he aware that some commentators seek to undermine screening and suggest that it is somehow an invasive and nasty procedure that the medical profession do to women? Does he agree that screening is a partnership between women and health workers and that better methods of increasing take-up of screening will increase the numbers of women who survive—some 1,300 a year currently—and who would not do so without screening?

Certainly I accept the points that my hon. Friend makes. The new arrangements will raise standards, although no screening system can be 100 per cent. accurate. Our present system saves the lives of more than 1,300 women every year, and mortality rates from cervical cancer have fallen year on year. We are drawing up plans for a national publicity campaign to increase public understanding and confidence in the NHS cervical screening programme.

I was interested in the Secretary of State's response to the last question, but many women still die every year from cervical cancer despite the undoubted success of the national screening programme. What interest is his Department showing in the potential of a new technology to assist in the treatment of the disease? A company called Digene has a new product that could screen with an almost 100 per cent. success record according to the trials that have taken place so far. Will the right hon. Gentleman set up a pilot scheme to discover whether the product is as effective as it appears and, therefore, potentially save the lives of the many women who still die from that entirely treatable disease?

My interest in cervical cancer screening did not commence when I became Secretary of State for Health. When I was the shadow health Minister more than a decade ago, I put together the first comprehensive report on screening call and recall schemes, which the then Government could not be bothered to do.

I am sure that the Secretary of State wants this country to have the best cancer screening processes and to succeed in bringing down our cancer death rate, which is far worse than in many parts of Europe. Does he agree that that will require the best processes, technology and education system, and that we have all the necessary staff—nurses, doctors, consultants, and other professionals?

Rather than joining in the vague theorising that Liberal Democrat Members go in for because they will never be within a sniff of being in power, I shall address the point that the hon. Gentleman raises in relation to the amount that is paid to people working in the cervical cancer screening system. We have offered pay increases of between 6 and 26 per cent. to those who train cytoscreeners. To qualified cytoscreeners, we have offered an increase of 11 per cent. That reflects the difficulty of recruitment, the poor levels of pay that they have received in recent years, and the importance of their work, which is very demanding and which, up to now, has been badly paid.

When he expects to publish the report of the social exclusion unit on teenage pregnancies. [84999]

The social exclusion unit will be publishing its report very shortly.

I thank the Minister for that welcome reply, although I wonder what the word "shortly" means. Does he share my shame that this country has the highest rate of teenage pregnancy in Europe? Does he connect that in any way with the reduction in the number of family planning clinics and the very poor quality of sex education over the past 18 years?

In my earlier response to my hon. Friend the Member for Stretford and Urmston (Ms Hughes), I described those areas in which the Government are already taking action to deal with some of the problems arising from sexual health and pregnancies among teenagers. The hon. Lady is usually right, but she was wrong to say that we have waited two years for the social exclusion unit report. My right hon. Friend the Prime Minister commissioned that report last July, and we expect it to be published very soon.

Before finalising his plans for reducing teenage pregnancies, would my hon. Friend encourage health authorities to consider the lessons learned in pioneering baby-doll projects run in Rawmarsh and Wath-upon-Dearne? Fourteen-year-olds are given life-like dolls to look after, and the dolls wake at night, scream, feed and much more. Half those who took part in the projects said that the age at which they would wish to have children was a lot higher than it had been beforehand. Will my hon. Friend congratulate the Rotherham youth workers, Karen Kirby, Ann Brown, Pat Hickling and Sue White, on pioneering the projects?

I am happy to endorse what my hon. Friend has said about that work. The experience of young children to which he has referred was certainly my own experience when I first became a father. My hon. Friend confirms that action is already being taken up and down the country. Many health action zones are doing pioneering work to develop new approaches to tackling teenage pregnancy. We support that work, and we want to spread best practice around the country.

If he will make a statement on (a) the level of take-up and (b) regional disparities in the take-up of Aricept in the NHS. [85000]

Donepezil hydrochloride— Aricept—was prescribed by general practitioners in the national health service in all health authorities in England over the 12-month period ending March 1999. At a regional level, the number of prescriptions per 100,000 population aged 60 years and over varied from 58 in west midlands to 339 in Trent, with an average of 170 for each region.

I thank the Minister, but does he agree that those figures demonstrate the enormous regional disparity that is already clear to many patients and their carers? In some areas, prescriptions are freely available, but in others, patients can obtain them only at the considerable cost of around £150 a month. In view of the growing clinical evidence of the benefits of the drug and of the enormous help it gives victims and carers, does the Minister accept that the drug should be included in the first round of drugs appraised by the National Institute for Clinical Excellence?

Two important points must be made. First, Aricept, which is licensed for treatment of mild to moderate Alzheimer' s disease, is a symptomatic treatment, and there is no evidence that it affects the progression of the underlying disease. Secondly, I am advised that it has not been widely prescribed to date because of concern that the moderate improvements it brings in cognitive function tests may not necessarily translate into worthwhile clinical and social benefits. The variation in the figures that I have given probably reflects differing attitudes among specialists to use of the drug. Research projects are under way, and a large trial organised by the NHS in the west midlands is covering 3,000 patients. In addition, it is likely that NICE will at some point be asked to consider drugs for the treatment of Alzheimer's disease.

NICE may attempt to iron out regional disparities in the availability of drugs such as Aricept, but has not its chairman, Professor Rawlins, already admitted that he will rule out advocating the use of drugs that NICE considers to be too expensive, even if they are highly clinically effective? Can the Minister name just one respectable organisation prepared to support his absurd claim that there is no rationing in our national health service?

Clinicians in the NHS want NICE to offer consistent guidance on the clinical effectiveness and cost effectiveness of treatments. There has been wide support from a variety of professional bodies for the establishment of the National Institute for Clinical Excellence precisely because people know that such guidance will be made available.

What guidance has been issued to the NHS about developing smoking cessation services. [85001]

Guidance was issued on 16 April 1999 to the NHS on the development of new NHS smoking cessation services. Up to £60 million will be available over the next three years, initially in health action zones, to develop these new services.

I am grateful to my hon. Friend for that answer. Birmingham health authority leads the field in smoking reduction. Recently, about 110,000 free guides to a smoke-free Birmingham were delivered to C2, D and E households. In his reply, the Minister said that extra money is to go to health action zones. Will he say whether, in future, money will go to authorities such as Birmingham, which are not health action zones but which nevertheless lead the field in that area, to support their good work?

Again, I am happy to join my hon. Friend in supporting the excellent work that is done in Birmingham. The smoke-free Birmingham campaign is an excellent model for other partners to explore. The first year of the new three-year programme of promoting smoking cessation services will be focused on health action zones, but in years two and three we expect the benefits to be spread more widely throughout England. We expect £20 million to be spent in year two and £30 million the year after, throughout the country.

How he will ensure that health authorities use the HIV prevention special allocation in ways appropriate to the epidemiology of HIV. [85003]

The forthcoming guidance to health authorities on the use of HIV and AIDS special allocations will emphasise the need to match funding of prevention initiatives to the local situation and highlights the target groups identified in the current HIV health promotion strategy.

Can the Secretary of State confirm that HIV-AIDS strategy will strengthen targeting work with the three communities that the all-party hearings last summer regarded as most at risk—first, gay and bisexual men, secondly, African people and, thirdly, injecting drug users—if that analysis was correct?

I can confirm to the right hon. Gentleman that we want to target the effort and we want people in the national health service to target in particular those three groups that are most at risk. However, we do not want to concentrate all the effort exclusively on them because we need to ensure that groups that are near the boundary are also properly covered and protected. That is the way that we can stop AIDS spreading among groups of people who are not at present particularly susceptible.

Given that there are about 2,500 new infections of HIV a year and that the Public Health Laboratory Service Board still states that HIV is the most important communicable disease in the country, as well as advising health authorities, will my right hon. Friend consider what can be done to strengthen monitoring systems so that we regularly get meaningful and consistent data on how each health authority is spending and using money to target those people who are most at risk?

I do not know whether I am disclosing things that I should not disclose, but I have been spending considerable time with my officials to try to ensure that what my hon. Friend asks for is done.

What research he has (a) commissioned and (b) evaluated on the feasibility of midwifery—led maternity units. [85004]

The NHS research and development programme is funding two relevant studies, "Re-designing postnatal care: a randomised controlled trial of protocol based midwifery-led care", and the "Extension of an established clinical data set to address the effect of structural variables on the process and outcomes of United Kingdom maternity units". In addition, evaluation of the midwifery-led unit at the Royal Bournemouth hospital has been funded by Dorset health authority and evaluation of the Edgware birth centre has been commissioned by Barnet health authority.

I thank my hon. Friend for that reply. I am sure that he would wish to join me in congratulating Warwickshire health authority on the positive work that it is undertaking to re-evaluate the way in which maternity services are delivered throughout the county. I hope that my hon. Friend will also join me in supporting the authority's continued research into bringing about a pilot midwifery-led unit at the Hospital of St. Cross in Rugby.

I certainly pay tribute to my hon. Friend on his campaign to promote and defend maternity services in his constituency. He may be aware that Warwickshire health authority has been carrying out a survey of women's views of maternity services throughout the county. As a result, the authority will be reconsidering the future configuration of maternity services in Rugby taking into account the views of local women and health professionals.

Midwives do a wonderful job, in which we all want to encourage and support them, but does the hon. Gentleman acknowledge that there is a need for a consultant presence to deal with problem cases? Does he share the concerns of the confidential inquiry into stillbirths and deaths in infancy about the lack of consultant input in such cases? Will he confirm that by 2001, each year, 500 specialists in obstetrics and gynaecology will be chasing only 50 consultant posts, and that as a result, many of them will leave the national health service? Is it not a scandal that those expensively trained, badly needed doctors are being thrown on the scrap heap because the Government will not fund the necessary NHS consultant posts?

I can accept very little of that. The hon. Gentleman usually has something sensible to say, but I am afraid that today he did not. Research evaluating midwifery-led maternity services has been generally positive about their contribution. My right hon. Friend the Secretary of State recently asked a multi-disciplinary working party, including the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and others, to develop criteria for ensuring that small maternity units, including those that provide a midwife-led service, can avoid closure while maintaining patient safety. I reject fundamentally the hon. Gentleman's attack on midwifery. The Government are committed to developing good-quality midwifery and maternity services, and that is what we will do.

Will my hon. Friend bear in mind how important midwife-led services are in rural areas, where they add greatly to choice? Will he note the importance of general practitioners, who can make or break such units? Will he encourage the health service to talk to GPs to ensure that they are aware of their benefits?

I agree with my hon. Friend. The Government remain fully committed to the principles of woman-centred maternity services that offer women greater choice, continuity of care and control. We will bear my hon. Friend's comments in mind.

What assessment he has made of the influence of diet and environmental factors on the incidence of breast cancer. [85005]

The causation of most breast cancers is complex and has not been established but may involve several dietary, hormonal, environmental and hereditary factors. The influence of diet and nutrition on the incidence of breast cancer was considered by the Committee on Medical Aspects of Food and Nutrition Policy in the 1998 report "Nutritional Aspects of the Development of Cancer", a copy of which is in the Library.

I thank the Minister for that helpful reply. While it is of course necessary to co-ordinate proper screening, detection and treatment of breast cancer, does he agree that understanding the causes is as important—possibly more so—in the long run? Some companies produce arguably carcinogenic agrochemicals while making vast profits out of breast cancer treatments such as Tamoxifen. Does the hon. Gentleman agree that it is important to give proper priority to research and its dissemination, so that perhaps this country will follow others in banning lindane?

I agree with much of what the hon. Gentleman said. He knows that the Government support a wide variety of research programmes examining this area and others. The Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment recently considered the potential association between organochloride insecticides, which I think are the hon. Gentleman's concern, and breast cancer. I expect that it will prepare a draft statement at its June meeting, which should be available for publication early in July.

Does my hon. Friend share my concern about the importance of improving and modernising the equipment available for the detection of breast cancer? I believe that £100 million of lottery money will be made available for that. When, and on what projects will it be spent?

I strongly agree with what my hon. Friend says; it is important that new investment goes into improving cancer services. The sum of more than £100 million from the new opportunities fund will make a most significant contribution to doing that. We expect the first resources to be available during the winter.

If he will make a statement on the proposed merger of health trusts in Lincolnshire. [85006]

Ministers are currently considering a proposal from NHS Executive Trent to carry out a public consultation on a possible merger of the three Lincolnshire acute trusts: Grantham and District Hospital NHS trust, Lincoln and Louth NHS trust and Pilgrim Health NHS trust.

As he sits in London, does the Minister understand the real fear and concern of rural people that, as these mergers continue, it is the rural hinterlands that will suffer? People from those areas may lose their places on the boards, and small hospitals, such as Gainsborough, will not receive the same level of commitment and energy that they enjoyed when they had their own health trusts.

We would never proceed with a merger of trusts unless we were convinced that patient care would benefit as a result. In addition to that overall criterion, we have set down some important tests, one of which is that mergers between NHS trusts would be expected to realise a minimum of £500,000 in bureaucracy savings within the first two years of going ahead. That money would be available for investment in front-line services. Trusts will not be forced to merge; the test is whether they would improve patient care. Clearly. that test must apply for all the patients whom they serve—not merely for some of them.

How many private finance initiative community hospital schemes are awaiting decision by his Department. [85009]

The private finance initiative scheme for a new community hospital in Sheppey, being taken forward by the Thameslink Gateway NHS trust, is one of a package of PFI schemes being negotiated with one consortium. Difficulties in resolving some of the outstanding issues on the most advanced of those schemes—that for Chichester—has held up progress on all the schemes. I expect the Chichester scheme to reach financial close shortly. I am sure that my hon. Friend will be pleased with that, because it should mean that, within the next two months, the trust in his area will know whether it has a viable scheme to build the much-needed community hospital in Sheppey.

I thank my right hon. Friend for that reply—although he has stolen some of my thunder. That particular PH scheme on the Isle of Sheppey has been going for three and a half years and £1 million has been spent so far on legal fees for a scheme costing only —10 million. What my constituents are most concerned about is that, if the scheme does not go ahead, we will not have a hospital. Will my right hon. Friend comment on that matter?

That was one of the innumerable shambles that we inherited from the Conservatives. [HON. MEMBERS: "Come on."] It is no good moaning£it was. It is as simple as that. We have gone a long way towards sorting things out; that is why 12 major PF1 hospitals are being built already and there are dozens of smaller schemes. Provided that the Chichester scheme is okay, I expect the Sheppey scheme to go ahead. What is crucial is that, if the scheme cannot be undertaken through the PFI, we shall have to use other methods. The people of Sheppey are entitled to a decent community hospital, and that is what we are determined to provide—one way or another.

I am pleased to welcome the fact that the Government are continuing to develop the private finance initiative for hospital building. May we be precisely clear about the Government's position? Would it be accurate to say that, in relation to the ancillary services of the national health service, the present Government are more effective privatisers of those services than their predecessors? Is that the Secretary of State's position?

No, it is not. Given that, for countless decades, the average cost overrun for major hospital developments was 20 per cent.—so that the NHS got five hospitals for the price of six—the main thing that we are privatising is the cost overruns. Under the PH, if there are any cost overruns, the private sector will have to meet them-not the taxpayer.

Is my right hon. Friend aware that the delay in the PFI decision on Oldchurch hospital in Romford is causing great anxiety within the community and having an impact on the modernisation of other health service facilities—for example, the overdue reprovision of Warley hospital, which should have been closed years ago? The delay is even having an impact on the local authority's review of leisure facilities in Havering. Are we likely to have a decision soon?

I certainly hope that we shall have a decision soon. However, it has to be said that, until the Labour Government entered office, no decision was taken, even in principle, to go ahead with the new hospital at Oldchurch, so it is no good any of the local Tories moaning—their Government did nothing about the matter for 18 years.

If he will make it his policy to publish the annual Audit Commission NHS management letter. [85010]

The Audit Commission does not produce an NHS management letter. However, it does prepare a summary of the findings of its appointed auditors, and the decision on whether to publish that summary is for the Audit Commission. The view of the Department is that publication would duplicate the statutory work of the National Audit Office, which covers similar ground in its annual report to Parliament on the NHS accounts. The NAO report is, of course, published.

That is extraordinary. Is the Minister aware that, year after year, members of the Audit Commission asked the previous Secretary of State to allow publication, but that their request was always refused? The current Secretary of State has continued the practice of refusing to allow publication. Is the Minister aware that, at the end of next month, the Audit Commission will produce a package containing the annual report and the management letter—as it is usually described—for local authorities in England, for local authorities in Wales and for the police authorities, but that the one package it cannot publish is the one for the health service, because the Secretary of State will not allow it? Is that freedom of information?

I repeat: the decision on whether to publish is for the Audit Commission. However, I do not want to mislead the hon. Gentleman: the Department's view is that the summary is valuable, and one of the reasons for that is that the informal status of the document allows for a degree of subjectivity which is quite helpful. To be frank, if the document were to be published, we would expect to agree the text, and the process of doing that would result in the document losing much of its value and many of the messages being lost.

Before either the Audit Commission or the NAO produces its next letter or report, will the Secretary of State ask them to investigate the matter of young doctors' hours, and to take special note of the most serious aspect of the problem, which is young doctors who are on call but working continuously, with the result that they work continuously from 9 am one day to up to 5 pm the next? That is contrary to the Secretary of State's own health circular, so will he ask for a report to ensure that the practice is stopped?

As I said earlier, last December we agreed and introduced more stringent criteria for rest periods as part of the new deal. That is evidence of our commitment to work to improve the working conditions of junior doctors, not only because it is in the interest of junior doctors, but because it is in the interest of patients. I shall meet junior doctors to discuss that and other matters later this week.

What plans he has to review the grading of midwives. [85011]

In February, we published proposals on modernising the national health service pay system to provide midwives and nurses with a modern career structure to replace the current rigid grading system. The proposals have been generally welcomed and are now the subject of talks with representatives of the staff involved.

Is the Secretary of State able to give comfort to those in the profession who are seriously worried that continued recruitment at grade D will only bring further problems with recruitment?

I can try to reassure members of the profession. As I said, our proposals for modernising health service pay are intended to give midwives and nurses a new, modern career structure, with three tiers to replace the current clinical grades, including grade D, and to enable progression within each tier for any individual midwife who takes on particular responsibilities or undertakes courses in professional development.

If he will make a statement on the future of hospital services in East Kent. [85012]

The future for hospital services in East Kent is bright. On 22 December I ended the years of uncertainty about the future of acute services in Canterbury, Ashford and Thanet. On 1 April a new single NHS trust was established to deliver the necessary changes and improvements, and a new chief executive has been appointed. In this financial year the trust will receive £221 million. It will also receive £2.2 million to be invested in accident and emergency services in East Kent. As the hon. Gentleman represents Ashford, he will be interested to know that a new MRI scanner will come into operation at the William Harvey hospital in Ashford.

The Secretary of State is aware that the East Kent health authority had a budget deficit of £1.7 million this year and had to consider the option of closing one of the community hospitals in East Kent. As members of the local community health council are sure that the deficits will recur, can the Secretary of State give a guarantee that none of the community hospitals will close over the next few years as a result of such deficits?

When we came to power, the national health service was running a deficit of more than £400 million a year. Last year it was down to about £20 million.

When we in East Kent were debating the rationalisation of hospital services, I promised my constituents that, as a result of the change, they would get the best possible standard of care for everyone in East Kent, everywhere in East Kent. The investment announced by my right hon. Friend the Secretary of State shows that he, too, is committed to that. Does he accept, however, that because of the delays in appointing a chief executive to the new combined trust, some of the clinicians in that new trust have started to believe that people are dragging their feet and are not fully committed to implementing his recommendations? Will he ensure that they know that he expects them to get on with the job of implementing those recommendations and improving standards for everyone as quickly as possible?

If the members of the new board can read, they should be perfectly clear that they are expected to implement the changes that were approved, because they were told that by me. I assume, therefore, that the new chief executive, whom they appointed, also understands that that must be the priority. We are determined to ensure that the health services in East Kent are first-rate for everyone in East Kent, not just at individual hospitals. After widespread public consultation and a proper decision, we cannot allow people to think that they can go back on that decision. The uncertainty is over. Progress must now be made.

What action he takes to encourage the retention of high-calibre non-executive directors of NHS trusts. [85013]

If eligible for re-appointment, the best non-executive directors will always be encouraged to re-apply when their term of office is due to end. All appointments are made in accordance with the guidelines of the Commissioner for Public Appointments and the Department's own published procedures for NHS appointments.

If it is the policy to retain high-calibre non-executive directors, why did the Secretary of State sack three high-calibre non-executive directors of the Guild Community Health Care NHS trust in Preston? Why is not the Secretary of State answering the question, as he sacked them? What message does that send to non-executive directors throughout the country?

We will be discussing this matter at greater length during tonight's Adjournment debate, but I shall briefly give the background. After a series of events—critical reports on the trust, the suspension of the chief executive and the resignation of the chair—my right hon. Friend the Secretary of State concluded that, although he did not apportion any individual blame to non-executive board members for the serious problems that occurred, it was not in the interests of the Guild trust or the NHS for the previous non-executive board members to stay in post. A new chair and a full team of new non-executive board members have now been appointed.

Will my hon. Friend also consider the value of high-calibre chief executive officers such as the chief executive officer in the Guild community trust, whose excellent work included winning the confidence of ethnic minorities and patients' families as well as the creation of unique, award-winning provision for suffers from late-stage Huntington's disease? Less than a year ago, my right hon. Friend the Secretary of State himself put an award into the hands of the chief executive, who has been victimised on the basis of unsubstantiated assertions which are not backed up by evidence.

In my view, the proper procedures have been followed and, in respect of the way in which the Guild trust has handled those matters, there has been proper consultation with the regional office. If anything, my hon. Friend's comments reinforce my view that my right hon. Friend the Secretary of State was absolutely right to get a fresh start for the trust so that it can build on its record and provide good patient care in the future.

Does the Minister agree that non-executive directors of NHS trusts ought to be remunerated? If so, does he believe that there is a case for looking at that question, particularly as it is some years since the remuneration was fixed?

As the hon. Gentleman suggests, non-executive directors are remunerated, but I am not aware of any immediate plans to review that remuneration. Across the country, we are able to attract candidates of excellent background and qualities who are willing to serve the NHS in that capacity, and we are grateful to them for that.

What action he is taking to amend the regulation of private health care for the elderly. [85014]

The Government set out their plans for regulating nursing and residential homes, domiciliary care and other social services in the White Paper "Modernising Social Services". We also made a commitment to consider further the regulation of health care and, in fulfilling it, we will shortly be consulting widely on the future regulatory arrangements for private and voluntary health care. Our aim is to establish a modern regulatory structure that will meet the need to protect the public and patients, particularly those who are vulnerable or elderly.

I thank my hon. Friend for his answer, but he will be aware that, in Sheffield as elsewhere, there has been a fairly rapid reduction in the number of acute medical care beds in hospitals. There was consternation recently when the Royal Hallamshire hospital proposed the closure of a further 22 acute medical beds for the elderly. Most of those patients will almost certainly go into or under private health care in the future. How will my hon. Friend reassure the public, through regulation, that moving from health service beds to private care beds will lead to absolutely no diminution in the medical and nursing care that they receive?

I can certainly confirm to my hon. Friend that the closure of the 22-bed rehabilitation ward for elderly people in her constituency, about which she is concerned, will not now go ahead, and I am sure that she will be relieved to hear that. She, like me, would agree that it is important that we regulate the private health care sector properly to ensure maximum protection for the public. There is a general consensus that the current regulatory system is out of date; it is unsatisfactory and not particularly independent. For example, it treats private hospitals as nursing homes and does not reflect the increased range and complexity of private sector work.

Will the Minister reintroduce tax relief on private health insurance for the elderly?

No.