If he will make a statement on the development of coronary heart disease services. [102260]

The White Paper "Saving Lives: Our Healthier Nation" set a target to reduce the death rate from heart disease, stroke and related illnesses by at least 40 per cent. by 2010. Modernising cardiac services is one of the Government's top health priorities.

Does my right hon. Friend accept that more investment is needed for coronary heart disease services, both locally and nationally and especially in the north-west, as there is a dire need to ensure that lives are not lost at the rate that they were in the previous 18 years? When will he provide details of authorities' allocations for 2000–01?

I agree with my hon. Friend that there is a need to modernise our cardiac services, in his part of the country and elsewhere, because they suffered years of neglect under the previous Government. That is precisely why we have made the modernisation of cardiac services one of our top priorities. Today, I have placed in the Vote Office details of health authority allocations for the year beginning April 2000, and the average cash increase is 6.8 per cent. compared with 6.6 per cent. for this year. That is sensible sustained investment, which will continue the Government' s 10-year programme of modernisation, and it includes extra money for cardiac services so that thousands more heart patients can get the early access to heart surgery that they need.

Does the Secretary of State recall promising the House that hospital consultants would

"help shape the local health service as they have been unable to do under the internal market"—[Official Report, 24 February 1998; Vol. 307, c. 165.]?

On the specific issue, I am aware of the correspondence and some of the cases that the hon. Gentleman and the right hon. Member for South-West Surrey (Mrs. Bottomley) have raised, but I understand that those allegations are not wholly substantiated. I shall be meeting the right hon. Lady this afternoon to talk about some of the issues, but the hon. Gentleman has to be very careful: it is not true that, somehow or other, the problems with cardiac surgery began on 1 May 1997. We acknowledge that there are problems, but the truth is that cardiac services in our country suffered years if not decades of neglect when his party was in office. We have the appalling coincidence of Britain having some of the highest rates of cardiac heart disease and some of the lowest rates of cardiac intervention in the developed world. We are putting that right by investing more money, which his party opposes.

Although there is a crying need for resources for coronary heart disease services throughout the country, may I, on behalf of my constituents, congratulate the Government on allowing a rate of increase to health authorities that is triple the rate of inflation? That is almost unprecedented in British history.

My hon. Friend is absolutely right—we are putting more money into the national health service and today we are paying the second instalment of the record cash injection that my right hon. Friend the Chancellor of the Exchequer announced a year ago. That is money for modernisation and it is opposed by the Conservative party, which described it as reckless, mad and irresponsible. Conservative Members cannot have their cake and eat it—even their Christmas cake, at this time of year—and, even though my remarks are not seasonal, they cannot get away with complaining about the state of cardiac services and opposing extra investment in our public services at the same time. They have to come off the fence. It is about time that we had honesty in the debate from the Conservative party: does it support or oppose extra investment in our key public services?

Can the Secretary of State confirm whether the promised extra money for cardiology is new money or part of the extra £21 billion that has already been allocated over the next three years? If it is part of that £21 billion, which other services will be cut to fund it?

The hon. Lady needs to understand that that is extra money on top of the extra money that is already going in this year. There is extra new money this year, extra new money on top of that next year and extra new money on top of that the year after. She should also understand that all that extra investment is opposed by the Conservative party under its tax and spending plans because its priority is tax cuts for the privileged few, which would be achieved at the expense of public services for the many.

In this "year of delivery", how does the Secretary of State square his announcement of an increase in the number of heart specialists by more than 400 with the fact that, according to the chairman of the British Medical Association, those specialists are already on the NHS training ladder? In the new Labour lexicon, does the word "extra" mean the same in relation to the number of doctors as it means in relation to the number of police on the beat?

That was a tricky one! As the hon. Lady knows fine well, there is a difference between doctors in training and doctors in post. I decided that there would be extra consultant posts.

What recent representations he has received about the availability of cancer treatment. [102261]

The Government receive many representations about the availability of cancer treatment from the public, and from professional organisations.

As prostate cancer is set to become the commonest male cancer in the next millennium, is there not a strong case for a prostate screening programme for men of the appropriate age? When can we expect such a programme?

Prostate cancer kills about 10,000 men each year, and we take it extremely seriously. Population screening is not currently recommended, on the advice of the national screening committee, but, as I have said, we take the issue seriously, and have asked the committee to re-examine it in the new year. It will be doing so.

We have the CalmanHine guidelines relating to cancer services, but we know that they have not been followed in all parts of the NHS. Will my hon. Friend take it on herself to ensure that best practice is observed throughout the health service, so that all cancer sufferers are given the best possible treatment regardless of where they live?

I entirely agree with my hon. Friend, and we are committed to ending the unacceptable lottery of care—the postcode lottery—throughout the country. Even more unacceptable is the fact that those who are least likely to survive cancer live in low-income areas. We have appointed Professor Mike Richards as national cancer director so that he can examine exactly those issues, and improve cancer care across the board.

The Government's new priority on cancer is welcome, but are they not putting the cart before the horse in establishing the policy of a two-week wait between referral and consultation? How many trusts are meeting that target? Is the World Health Organisation not correct in saying that the policy is flawed unless the necessary resources are provided to ensure that it can be delivered?

I can tell the hon. Gentleman for a start that, according to the most recent figures, 95 per cent. of women who are referred urgently in connection with breast cancer are seen within two weeks. That has been the first roll-out of the two-week wait; we will extend it in regard to other cancers over the next two years.

I congratulate the ministerial team on the launch of the cancer services collaborative. It includes nine national networks, one of which is in Leicestershire and involves the north-west Lancashire primary care group and Glenfield hospital. Is my hon. Friend aware of the cloud of uncertainty that hangs over that hospital, and especially over the breast care unit, which was opened by the last Secretary of State for Health? Will she give careful consideration to any proposals from the area health authority that would downgrade the hospital and jeopardise the excellent work done by the breast care unit and by the hospital in general?

I shall certainly look into those points. My hon. Friend is absolutely right that the introduction of cancer collaboratives is an example of superb and best practice in introducing and improving cancer care across the country. The collaboratives will smooth patients' experience, so that they no longer have to wait and are able to book admissions and receive care when they want it.

The director of the Cancer Research Campaign's education group says that the Government's cancer initiative has led to a waste of resources and a waste of specialist time. The professor of cancer medicine at Imperial college says that the whole approach is flawed. He also said that we have a shortage of more than 500 cancer specialists, a £1.2 billion backlog in radiotherapy equipment, and need £170 million a year more for chemotherapy. Which of those figures does the Minister think is wrong?

As the hon. Gentleman raises those points, I assume that he will welcome the 6.8 per cent. cash increase to health authorities across the country, which allows them not only to improve treatment for cancer care and treatment, but to address all health issues. Whereas the Government are committed to ending the unacceptable lottery of care, Conservative Members want to replace it with a new lottery which is based on patients' ability to pay.

That was an appalling evasion even for a Minister in this Government. Although the Minister has decided to give the soundbite of the day rather than answer any questions in the House, will she say why—when we are supposed to have a national health service, and the cancer initiative is under way—the proportion of patients seen within two weeks varies so hugely across the country? The fact is that 98 per cent. of patients in the south-west have been seen within two weeks, whereas the percentage is only 61 per cent. in the north-west. Why?

As I said, we are determined to end the unacceptable lottery of care. Who does the hon. Gentleman think introduced the lottery of care in the United Kingdom? It was introduced by the previous Government. They introduced the internal market, which has created unacceptable variations in care right across the country. This Government are determined to do something about the situation, and we are implementing policies to do exactly that.

We have a Health Minister who cannot answer the basic questions asked by the professor at Imperial College and who does not know why cancer outcomes in the north-west are so bad. We also have huge regional variations in access to care; poorer outcomes than comparable countries in cancer treatment; staff shortages; and, now, rationing of medicines and half a million people simply waiting to get on the waiting list. In other words, we have a national health service that is not national, and in which health targets are not being met and services are well below par. Is it not true that, in Labour's so-called year of delivery, the Government's health policies are a complete and unmitigated disaster?

The hon. Gentleman refers to international comparisons, but the most extensive international comparisons date from the mid-1990s. I am therefore still wondering who he thinks is responsible for the condition of cancer care in the United Kingdom. The Government have made delivering on cancer our top priority, and that is exactly what we shall do. That is why we have spent an extra £70 million on improving cancer care since the general election, and why we shall spend an additional £80 million on it in the next two years. How would Conservative Members afford any of those improvements, given that they believe that our increased health spending is reckless and irresponsible?

What representations he has received regarding the possible loss of accreditation by the royal colleges of Barnsley district general hospital. [102263]

None; any such representations are made to the Specialist Training Authority, which is responsible for the supervision of specialist training in hospital practice in the United Kingdom. No such representations have been received by the Specialist Training Authority on Barnsley district general hospital.

Is my hon. Friend aware that the health problems that we already have in Barnsley are likely to be exacerbated if the royal colleges withdraw accreditation for consultant posts at hospitals serving fewer than 500,000 people? Does he agree that the people of Barnsley should not be required to travel long distances, to other towns and cities, simply to see a consultant? Is there any action that he could take to intervene in the matter, to ensure that a full national health service is still available to the people of Barnsley?

I can reassure my hon. Friend on all of those points. The Under-Secretary of State for Health, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), has just made it clear that we are committed to a comprehensive national health service that is available to all constituents in all parts of the country and provides a first-class service. That is unlike the Conservative party, which sees the future of the NHS as a second-line service for those who cannot afford to take out private health insurance.

If he will make a statement on future hospital provision on the Gosport peninsula. [102264]

The Portsmouth and South East Hampshire health authority is currently preparing detailed proposals on future hospital provision in the area and these proposals will be subject to full statutory public consultation in the new year.

Is the Minister aware that my constituents will not regard that answer as satisfactory, any more than they will regard as satisfactory the fact that she could write to me last week almost in the role of a casually interested observer of the problems of hospital care in the Gosport peninsula? Ministers are responsible. The Government have created the problem with the closure of the Royal Hospital Haslar. It is for the Government, through the NHS, to resolve the problem. Will the Minister give active support to the NHS taking over Haslar facilities?

I take great issue with the assumption that I am just a casual observer of events in the Gosport peninsula. It is important that efficient services are delivered to the local population. There has already been a £72 million private finance initiative investment in the Queen Alexandra hospital to improve facilities. Similarly, the hon. Gentleman is more than aware that extensive discussions are going on at the moment. I have written to my hon. Friend the Minister for the Armed Forces to facilitate negotiations about the continued use of the Haslar site. Negotiations are going on with the ambulance service to ensure that patients who need urgent care are stabilised during transport. We have made a firm commitment, and an extensive consultation process will go on over the next three months to ensure that the people of the Gosport peninsula receive appropriate services.

Which health authorities authorise the prescribing of Aricept on the NHS. [102265]

I understand that there is some prescribing of Aricept in all health authority areas.

May I take this opportunity to tell the Secretary of State how disgusted people in Dorset are at the fact that, for the second year running, they will have the lowest per capita increase in health funding? Is that not discrimination by the Government against a county with a lot of Conservative Members of Parliament?

I thought that the hon. Gentleman was going to stand up to thank the Government for the extra £28 million that we are investing in his health authority area from April next year. That is on top of the extra millions that we are already investing. If the hon. Gentleman has a complaint about a lack of investment in his area, he ought to take it up with his Front-Bench colleagues. They oppose our spending plans. The Conservative party cannot get away with saying simultaneously that the Government are spending too much money on our public services, that our spending plans are reckless, madness and irresponsible, and that we are spending too little.

Answer the question.

It is time for Opposition Members—including the hon. Member for Woodspring (Dr. Fox), who is chuntering from the Front Bench—to come clean on this matter. Which is it? Do they want more spending, or less?

I thank my right hon. Friend for the extra 7.46 per cent. that Nottingham health authority will have next year.

I agree with what my hon. Friend says. Aricept and other potential anti-Alzheimer's drugs are precisely the sort of drugs that we have referred to the National Institute for Clinical Excellence for its first work programme, which includes an assessment of drugs and treatments not only for dementia but for other serious and chronic conditions such as cancer, heart disease, multiple sclerosis, hepatitis C and motor neurone disease.

I very much welcome the referral of Aricept and what we hope will be more effective anti-dementia drugs to the National Institute for Clinical Excellence, but will the new criterion that NICE must take into account—affordability—prove a handicap to making a proper assessment? We all hope that we will eventually have an effective drug for dementia but the main saving will be not necessarily for the NHS budget but for other Government budgets and, especially, for carers. Who will make the assessment? Will NICE determine whether the drug is affordable, or will Ministers take their proper responsibility?

It is Ministers' job to take responsibility. I and my fellow Ministers will have the final call on all these issues, but it is right and proper for the National Institute for Clinical Excellence to take into account both clinical and cost-effectiveness, as we made clear from the outset, when we first proposed its establishment.

Given the continued denial of drugs such as Aricept and, for example, beta interferon to patients whose doctors say that they need them but whose health authorities say that they cannot afford them, can the Secretary of State explain what he meant when he told the House that

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

That is precisely what we are doing. [Interruption.] If the hon. Gentleman wants to ask another question, he may get up and do so, but I wish to answer his first question before he asks a subsequent one. No one denies that the national health service, just like every other health care system in the world whether public or private, has to set priorities and make hard choices. The issue is not about whether choices have to be made but about how those choices are made.

When he will make an announcement about a further increase in the number of doctors in training. [102266]

In July 1998, the Government announced that intake of medical students in the UK would be increased by about 1,000 places per annum, or 20 per cent. The responsibility for the allocation of places to individual medical schools in England lies with the Higher Education Funding Council for England—HEFCE. Last summer, the HEFCE announced the allocation of approximately 840 new medical school places in England and plans to announce a further allocation in spring next year.

I thank my hon. Friend for that reply. He will be aware that the team submitting the peninsula medical school bid is working hard to ensure that its bid is of the highest quality so that it can be among the successful next round of bids. Is he also aware that in the south-west peninsula young people are only half as likely as their counterparts elsewhere to enter medical training? Is he further aware that people in the south-west peninsula are 15 per cent. less likely to have access to some of the more complex tertiary medical treatments? Does he agree that Plymouth Derriford's becoming a teaching hospital will help us to address some regional equity issues?

I acknowledge the strong representations that my hon. Friend has made on behalf of the peninsula medical school and I had the opportunity to meet her recently to discuss the proposals. Of course I acknowledge the case that has been made to improve health provision and access to care in the south-west, but it is important to say for the record that the responsibility for the decision on the allocation of places lies with the Higher Education Funding Council for England.

I welcome the fact that the Government are continuing the policy of their predecessor of increasing the investment in medical training. However, does the Minister recognise that it does not make much sense to increase the number of recruits coming into the medical profession if that number is offset by increasing numbers of people leaving the profession because they are dissatisfied by the terms and the way in which their skills are used in the NHS?

The rate of retention of trained doctors in the health system in this country is extremely good, and we are pleased about that. The right hon. Gentleman has a bit of a nerve to raise that question but I shall answer it head on. What will maintain the high motivation that we have seen since this Government were elected, and will ensure high morale among medical staff, is continued investment in the NHS at the record rates that the Government have achieved. The best news for everyone working in the NHS is the average of 6.8 per cent. cash increase in funding that we have announced today, because that means that the professional staff working in our health service know that we are keeping our promise year on year to make the resources available to them to deliver the high-quality health services that they want to deliver.

May I say how pleased I am that the long-awaited undergraduate medical school has been established at Keele university in north Staffordshire? However, will my hon. Friend look carefully at the projected numbers of GPs who are set to retire? Will he consider linking training with incentives, so that the parts of the country most in need of additional GPs will get trained and qualified doctors?

I, too, am pleased that the HEFCE took the decision to make the allocation of medical student places to Keele university. One of the factors taken into account in the decisions over Keele and Birmingham concerned the proposed links with the development of general practice.

Will today's medical students be expected to work excessive hours when they become doctors in training? The Minister will be aware that recent figures from the British Medical Association show that the number of doctors in training working in excess of the new deal has risen sharply. I hope that he will accept from me that that is due to the proper validation of previous figures—doctors are not working longer hours but the old figures were flawed. Has the Minister noticed that figures for the Oxford region, which were done properly, show very little rise? Will he examine that region to work out what has been done well there? I can tell him that if he does, he will find that the reasons for the good figures are planned consultant expansion, proper funding and the effective use of sanctions against trusts and consultants reluctant to change working practices.

The hon. Gentleman is absolutely right. The system has to be made tougher in certain parts of the country if we are to reduce the excessive hours worked by some junior doctors. That is why we have made it clear in the past seven days that we will invest an extra £p5 million both this year and next to tackle the problem. That money will be made available through the regional task forces.

What plans he has to increase the number and range of NHS walk-in centres. [102268]

Walk-in centres are a key part of our plans to modernise and to improve the access to, and the convenience of, NHS services. The first 36 walk-in centre pilots were approved earlier this year. They will begin to open from January 2000, and in the following months.

I welcome the announcement about the walk-in centre for Coventry. I also welcome the additional, above—average cash allocation for Coventry, which contrasts with the record of the previous Conservative Government's treatment of Coventry's health service. Is not this a major step in the right direction—the modernisation of Coventry's health services?

My hon. Friend is absolutely right. The walk-in centre at the Coventry hospital site in the centre of the city is just one example of the Government's commitment to modernising the national health service in my hon. Friend's area.

Will the Minister accept a welcome for the development of walk-in centres? With regard to the normal walk-in centres—GPs' surgeries—will he consider whether special attention should be given to the needs of practices with significant numbers of people over the age of 85 rather than 75? In some areas where the numbers in that age group are at levels which the rest of the country will match in 20 years there are significant delays.

The cash increase is running at nearly twice the rate that it did in the last two years of the previous Government's term in office. The scale of the increase is as important as its provision.

What was each monthly total for calls to NHS Direct since its establishment. [102269]

In October 1999, NHS Direct handled 109,000 calls. This is the first time that more than 100,000 calls have been handled in one month. By the end of October, NHS Direct had handled more than 700,000 calls. A list of the monthly total of calls since its establishment will be placed in the Library.

That is an impressive number by anybody's calculation. I understand that 65,000 callers called NHS Direct in west Yorkshire. However, numbers alone are not the most important issue—the appropriateness of advice is extremely important. One of my constituents—a very close friend—rang NHS Direct when she was feeling queasy and did not want to trouble her GP. She was advised to go to hospital immediately, where she was found to be having a heart attack. I am pleased to say that she is now very well. Is it not the case that NHS Direct is an additional service that allows for the range of NHS services to be used appropriately and effectively?

I am grateful to my hon. Friend for that example of how NHS Direct is an additional service that improves health care delivery. In September alone, some 2,000 callers to NHS Direct were directed to call 999 for an ambulance.

I am sure that the Minister will acknowledge the trials for NHS Direct that were set up by the previous Government. We certainly welcome its success. Is the Minister willing to tackle a difficult question? Will putting more money into walk-in centres and NHS Direct, and correctly reducing the load on GPs and casualty departments, mean a change in the funding of GPs in particular when that load is taken off them?

I am delighted that the Conservative party is beginning to see the light. Not too long ago, a Conservative Secretary of State called NHS Direct peripheral and irrelevant. It is neither. As for funding, it is a prime example that shows that modernising the NHS means producing facilities that allow patients access to an appropriate level of medical care, whether that is offered by the GP, the hospital or through self-care. The funding formula will respond to the service needs, and NHS Direct is additional to that.

What plans he has to ensure all women over 65 years old are informed of their right to self-refer for breast screening. [102271]

The availability of screening for older women is widely publicised. In particular, the NHS breast screening programme is working with Age Concern to encourage older women to request screening. It has produced a leaflet, "65 or over: You are still entitled to breast screening", which is widely available from general practitioners' surgeries, clinics, some post offices and some shops.

I am grateful for that answer, and I welcome the Government's co-operation with Age Concern to publicise the right to self-referral for women aged over 65, who form the group at highest risk. If take-up by older women increases—my local unit in Epping has reported 500 more women from that age group referring themselves over the past four years—will my hon. Friend address the problem of resources available for breast screening services? Of course, I welcome the extra funding that the Government have put into those services.

I congratulate my hon. Friend on her work on raising awareness of breast cancer screening and the rights of older women to self-refer. She is right that the number of older women requesting screening is increasing—from 39,000 in 1994–95 to nearly 75,000 in 1997–98. It is precisely to deal with such issues that the Government have set up working groups to examine work force issues and ensure that we maintain the quality of the screening programme for older women and for those covered by the automated recall programme.

Does the Minister accept that those who are screened and who are unfortunate enough to be found positive may often find relief through changes in diet or complementary techniques, such as traditional Chinese medicine or homeopathy? Will she assure me that those treatments will not be forgotten when she addresses the issue?

The hon. Gentleman is quite right to say that many people, particularly those with severe cancer, seek and can find relief from alternative therapies. The Government certainly take complementary therapies seriously.

If he will make a statement about the standards of NHS care available to elderly patients. [102272]

The Government are committed to ensuring high standards of care in the national health service for all patients. Our forthcoming national health service framework for older people will set out for the first time new national standards for the treatment and care of older patients. It will be published next year. In the meantime, we have taken action across a number of areas to improve the care of older people. For example, we have extended the annual immunisation programme for influenza to ensure that everyone aged over 75 can have the flu vaccine free of charge. From 1 April, everyone over 60 has been eligible again for free eye tests, regardless of their income or health status.

Does the Minister accept that Age Concern has concluded that, contrary to existing guidelines, one in 20 older people are denied treatment because of their age? The Daily Telegraph has also found that significant numbers of elderly patients are literally being starved to death. Does the Minister accept those findings, and what is he doing about them?

We do not accept the accusation that nurses and doctors are routinely killing patients in the national health service. That ludicrous and absurd allegation strikes directly at the integrity and professionalism of nurses and doctors, and we reject it absolutely. We take criticisms about discrimination on the basis of age in the NHS very seriously. As part of our work on the national health service framework, we are developing new standards on fair access to NHS treatment and care for older patients.

I welcome my hon. Friend's statement on future provision for the care of the elderly. However, I have received a significant number of complaints from my constituents and from people throughout the Wakefield area on the problems being encountered at the Pinderfields and Pontefract hospitals NHS trust. Will the Minister say something about guidelines to the trust? May I welcome the 6.9 per cent. increase in resources for Wakefield health authority, which will help to address the problems of many constituents who have respiratory diseases? A great number of elderly asthma sufferers live in my area, and the increase will help them considerably. Will the Minister issue instructions to hospital trusts on the future care of the elderly?

I certainly want to reassure my hon. Friend about his concerns. We have taken the step of developing new national standards, which will be introduced next year, on the treatment and care of older people in the NHS to allay such anxieties. I also remind him, although I am sure that he needs no reminding of it, that, as part of our work on health action zones in his part of Yorkshire, a particular strand of work is devoted to improving the treatment and care of older people.

Is the Minister aware of the concern among my constituents at the way in which East Kent health authority's new blueprint for our hospital service has marginalised care for the elderly? Is he further aware that the excellent Nunnery Fields hospital, which cares for elderly stroke patients, is mentioned directly only once in the document—when an estimate is given of how much money could be realised by selling it?

I am not aware of the particular concerns that the hon. Gentleman has raised. I will look into them on his behalf, but, again, I point out that, as part of our work this year on developing the new national service framework for older people, a specific group is looking particularly at stroke care and treatment. We are doing that important work in consultation with the Stroke Association. We are looking seriously and actively at improving stroke care throughout the country, but I will look into the specific matters that he raised about East Kent health authority.

If he will make a statement about the average waiting time for heart bypass surgery. [102274]

The average waiting time for heart bypass surgery in the NHS in England in 1997–98, the latest year for which figures are available, was 188 days. We have made it clear that tackling coronary heart diseases is one of the Government's top priorities.

I am grateful to the Minister for that reply. Will he perhaps explain, or look into, why one of my constituents was told nine months ago that he would have to wait between seven and nine months for such an operation, only to be told a couple of weeks ago that he would have to wait a further 12 months? Is that typical, or is it an unusual case?

We all regret it when any patient waiting for a serious operation has that procedure cancelled. I understand that the hon. Gentleman's constituents—I do not know about the individual case that he mentioned—are often treated in Bristol and particular issues there are being addressed by an additional £100,000 of funding for the health authority and the United Bristol Healthcare NHS trust.

We welcome the decline in waiting lists in certain areas, although other parts of the country are not as well catered for. With all the new money going in, are there particular areas that are ahead of themselves in operations and are they able to provide the back-up for those areas where there seems to be scarcity of provision?

What is clear is that we inherited wide variations in access to treatment and care in different parts of the country. Indeed, in some parts of the country, there is an inverse relationship between the likelihood of serious coronary heart disease in the community and the likelihood of someone getting a bypass operation. One of the central purposes of the national service framework for coronary heart disease that we intend to publish next year is to set standards of care, from prevention right through to the most serious surgery. We shall expect the national health service to meet those standards, wherever in the country a patient may be. That will need to be backed up with the investment in equipment and in staff announced by my right hon. Friend a couple of months ago.

Will the Minister confirm that, as a result of the reforms introduced in April, any patient who needs a coronary bypass, or any other operation, and who chooses to attend a hospital with a shorter waiting time than the one contracted to his local primary care group, can no longer exercise that choice? Does the Minister agree with the director of the College of Health that, as a result of the Government's reforms, NHS patients now have less choice of hospitals within the NHS than at any time since the health service existed?

No. No such choice ever existed for individual patients under the previous Administration. We have swept aside the incredibly bureaucratic system of extra-contractual referrals that required approval before someone could be sent to a particular consultant. We expect that the vast majority of treatments for the vast majority of patients will be provided according to agreements reached locally between the primary care group and the main trust serving that area.

What plans he has to review waiting times for NHS abortions.[102275]

The Government are funding the Royal College of Obstetricians and Gynaecologists to undertake an audit of NHS and independent sector abortion services, including information on waiting times.

I thank my hon. Friend for that reply. Is she aware that a recent survey conducted by the Abortion Law Reform Association revealed that the most common reason for women to seek private terminations was unacceptable delays in the NHS? The survey showed that about half the health authorities set or monitor targets for waiting times for terminations. Will she consider the establishment, within the evidence-based framework produced by the Royal College of Obstetricians and Gynaecologists, of a target waiting time of 14 to 21 days? Will she ensure that that target is monitored so that women can have access to abortion on the NHS?

I am aware of the survey to which my hon. Friend refers. I assure her that the Government take the matter extremely seriously. I further assure her that the sexual health strategy will consider those issues; it will consider access to all services and how to ensure equity. The report will be produced during the next year.

Has my hon. Friend noticed the existence of an organisation called Precious Life? Thus far, the organisation has confined its activities to Northern Ireland and Scotland. It has attempted to intimidate workers in clinics and now threatens to picket the homes of Ministers of the Scottish Parliament. Does my hon. Friend agree with the Minister for Health and Community Care in the Scottish Parliament that any activities that attempt to prevent people from carrying out lawful functions will be met with the full force of the law?

I can certainly confirm that the Government condemn any form of intimidation that prevents the full operation of the law.

If he will make a statement on the availability of erythropoetin for patients suffering from anaemia and chronic renal failure.[102278]

Decisions about the provision of erythropoetin should be based on the clinical needs of individual patients. There are, however, no national guidelines or protocols issued by the Department of Health specifically on prescribing erythropoetin.

I thank the Minister for his reply. If my constituents reside in the Salford and Trafford health authority area and are told by the Manchester royal infirmary that they have a clinical need for erythropoetin, they are denied it as a matter of course. However, if they live across the border in the Manchester health authority area, they will receive it. The Secretary of State says that he wants to end the lottery of care, so will the Minister now undertake to do that?

I am aware of the particular concerns that the hon. Gentleman has raised and to which the Minister of State, my hon. Friend the Member for Southampton, Itchen (Mr. Denham), replied in February. My understanding is that the local health authority and the trust are working to establish a proper mechanism for prescribing erythropoetin, and I very much hope that an understanding will be reached soon. I think that there was a meeting yesterday to discuss the matter.