What is his estimate of the percentages of costs of the nursing element in nursing homes paid by (a) the national health service, (b) local authority social services departments and (c) patients. [106238]

About 147,000 people are resident in nursing homes in England. About 9 per cent. are funded by the national health service, about 49 per cent. wholly or partly by local authorities, about 17 per cent. have their care funded from state benefits and about 25 per cent. pay for their own care.

I thank the Minister for his helpful reply. However, as we all know from our constituency casework, once it has been decided that a resident patient is entitled to state aid, the patient tends to become caught in crossfire between the NHS and local authority social services departments over who should pay how much of the nursing element. To avoid all that haggling, should we not lay down in statute what the breakdown should be? Will the Minister consider that?

My right hon. Friend the Secretary of State set out the Government's position in December, and explained that we intended to respond more fully to the royal commission's recommendations. In March, we will organise a seminar involving all the key organisations and individuals who have a view, so that they can discuss with the Department issues involving the definition of nursing care in this context.

What steps he is taking to reform the pay system in the NHS. [106239]

We are negotiating with the NHS trade unions on a new pay system for the health service. In the meantime, we have offered non-review body staff an innovative three-year pay package, and we are implementing the recommendations from the doctors' and dentists' review body and the nurses' review body in full.

Does my right hon. Friend agree that the joint statement published by the health departments, management, the unions and NHS staff-side organisations offers a way forward for the NHS after at least 18 years of attack from the last Government? Does he further agree, however, that the real tests of the proposals are whether they are an improvement on what we have now, whether they are easy to understand, whether they are easy to implement, whether they are fair to all staff groups and whether they deliver a genuinely improved service to patients?

I certainly agree with my hon. Friend's sentiments. He is right in saying that too many of the employment and, indeed, pay structures of the NHS date back to its inception in 1948. Today's world is very different: different requirements are placed on the health service, and on NHS staff. It is important for us to combine fairness with flexibility in the way in which we employ doctors, nurses and other health care professionals, and that is precisely what our negotiations for a new pay system are designed to achieve.

Given last week's report on NHS laboratories, which revealed that 60 per cent. were using unqualified staff, and given yesterday's news that two leukaemia patients in Wales had received each other's test results, what steps is the Secretary of State taking to address the problems and to reassure patients? Will he ensure that biomedical scientists are given a substantial pay increase, and bring them and all other professional and technical staff in the NHS under the remit of the review body? If he does that, will he address the fact that such staff have fallen 30 per cent.

As the hon. Gentleman knows, part of the negotiation on the new pay system is designed to reconfigure the coverage of review bodies. Some have argued, I think reasonably, that the groups covered by the two review bodies do not necessarily reflect the fact that team working is now crucial to a modern national health service. We are considering that, and are negotiating with the NHS trade unions to establish a common position. I think it far better to achieve results through partnership and agreement.

Is my right hon. Friend aware that, partly owing to the recent pay settlement in the NHS, the Northamptonshire health authority currently projects a deficit of £8.7 million for next year? I know that Northamptonshire has received a great deal more money, but the chair of the health authority is due to retire in April, and the chief executive will shortly move to another post. We face the prospect in Northamptonshire of having no chief executive, no chair and no money. Will my right hon. Friend look into that serious matter, which is of great concern to my constituents?

I do not know about the position as regards the chair of Northamptonshire health authority, or, indeed, the chief executive. Clearly, those are matters that we will have to address. On the question of there being no money, I am slightly surprised by my hon. Friend's view as Northamptonshire health authority and other health authorities have received a substantial growth in the amount of money that they will have for the next financial year, compared with the current financial year.

Does the Secretary of State accept that not only is the 3.6 per cent. increase in nurses' pay well below average wage increases of 4.6 per cent. in the economy as a whole, but that the Government's failure to fund it fully amounts to giving with one hand and taking with the other?

I do not agree with that view. That view will come as a great surprise to nurses and doctors in the NHS, who, year after year, suffered from their pay being staged, rather than being paid in full.

May I ask a question about the pay of dentists? Why is it that the review body that reported a couple of weeks ago found it impossible to compute the average earnings of dentists who are employed wholly or mainly on NHS work because, it said, the necessary information was not forthcoming from my right hon. Friend's Department, or from the British Dental Association? Will he give me an assurance that next year, when we get the next report from the pay review bodies, it will be possible for them to compute the average earnings of NHS dentists?

We do have some figures available, as I think my hon. Friend is aware. He takes a great interest in dentists' salaries. We have some figures about the average earnings of dentists who have a reasonable commitment to the NHS. Those figures are widely available. As he is also aware, this year the Doctors and Dentists Remuneration Review Body recommended that we pay a further £20 million to dentists who have demonstrated a real commitment to the NHS. We will, of course, discuss with the profession how best to achieve that.

If he will make a statement on the implementation of the review of cleft lip and palate units. [106240]

Designated centres have so far been identified in three regions and discussions are continuing to identify the remaining centres.

Today, there has been a luncheon for charter mark winners, one of which is the Poole cleft lip and palate unit. As the Minister wrote to me just before Christmas:

"The charter mark is recognition for those public service organisations that listen and respond to their users and staff. It is the centre of the Government's programme to improve public services and modernise them for the 21st century."

Charter mark awards are made in recognition of public services. Discussions on the reconfiguration of Poole's provisions for cleft lip and palate are about clinical decisions. I have said that three areas have been identified for Poole and the whole of the south-east, including London. The four health authorities are still forming a stakeholder group. Reports are expected at the end of February, but it is important to recognise that although, nationally, some 865 newly born children need such surgery, in Dorset health authority alone, only 10 will need it. All the recommendations from CSAG say that, to deliver the best service, surgeons should deal with about 30 cases a year.

My hon. Friend will be pleased to know that, although we might not have a chief executive or chair of the health authority, we have an excellent consultant in our cleft lip and palate unit at Northampton general hospital, but will she expand her answer to include the future for those that carry out the Delaire technique, such as Bill Smith, who works at the hospital? Parents are concerned that, with the forthcoming changes, that pioneering technique—which concentrates on natural growth and surgery rather than plastic surgery—could be phased out. Will she give some hope to those parents that the Government will continue to allow the Delaire technique, and that, where it is being practised, it will continue to flourish?

Different orthodontic and cleft palate surgeons use different techniques. Once the overall national reconfiguration system has been implemented, the posts will be advertised, and it will then be a matter of which types of surgeon are able to provide continuity. No decisions have been made on which techniques will be continued, but the decisions will be based on clinical considerations and on what is best for the treatment of those children.

When he expects the National Institute for Clinical Excellence to issue further recommendations. [106241]

The National Institute for Clinical Excellence will be disseminating its guidance at various times throughout the year. In December, the Secretary of State set out the timetable for this year's work programme, and we expect the next guidance to be issued in the spring.

I am grateful to the Minister for that answer. Will she assure the House that, when NICE's recommendations on targeting the drug beta interferon for multiple sclerosis sufferers are considered, MS sufferers will not be placed in a catch-22 situation, in which everyone is denied access to the drug because it is not possible to identify its principal beneficiaries?

Obviously, I cannot pre-empt the guidance that NICE will provide on beta interferon. However, we have referred beta interferon to NICE because there is such wide variation across the country in prescribing the drug. We think that that type of postcode lottery is unfair.

Will my hon. Friend assure the House that any decisions that the national institute takes will be taken by clinicians, and that they will improve the clinical effectiveness of our health service?

Certainly the whole purpose of the National Institute for Clinical Excellence is to tackle the postcode lottery—in the biggest onslaught on the postcode lottery in the history of the NHS—and to ensure that decisions are taken on the basis of the latest clinical evidence about what works and what is best for patients.

Will NICE's evaluation of the cost-effectiveness of beta interferon take account of the cost of domiciliary care or of the required domestic adaptations in the absence of its supply?

Certainly NICE will be able to take account of all the data that are submitted, and that includes the costs of care and of social services. NICE will be able to take into account all those matters when it considers both the cost effectiveness and the clinical effectiveness of beta interferon.

May I tell my hon. Friend about the case of two of my constituents? They were advised by their consultant that beta interferon was the appropriate treatment; invited in for training in the use of beta interferon; but then, only at that point, were told that the budget would not allow them to be issued with the drug. Will she ensure that when NICE produces its guidelines, it will include some guidance to trusts on processes and the information that should be provided to patients well in advance, to avoid the type of disappointment that my constituents experienced?

I have been informed of the case that my hon. Friend mentions, and I have asked the regional office to provide me with a detailed report on the circumstances of the provision of beta interferon for those patients. I can also tell him that we shall be ensuring that NICE's guidance is available to be followed across the country, to tackle some of the problems that he mentions.

How many patients are waiting more than 13 weeks for their first referral to see a consultant. [106242]

At 30 September 1999, 512,000 patients were waiting for more than 13 weeks for a first out-patient appointment following general practitioner referral.

Now that we know that there is a growing waiting list for the waiting list, will the Minister abandon the pledge to cut the waiting list by 100,000 and measure success instead in terms of waiting times? Would it not be better to break a pledge than to force the sickest patients to continue to wait the longest for their treatment?

I am afraid that the hon. Lady is wrong on all of those points. We are not going to abandon our target of reducing in-patient waiting lists because as we have brought down in-patient waiting lists, we have brought down in-patient waiting times. Also, we will tackle the problem of out-patient waiting times—which were rising under the previous Government—into which we are investing an extra £30 million this year and an extra £90 million next year.

Does my hon. Friend recall a report by the Select Committee on Health in 1990-91 which commented on the time spent by NHS consultants in private practice? Will he conduct a review of the impact on waiting lists of private practice work by NHS consultants? Does he agree that if NHS consultants spent more time working in the NHS, waiting lists would be reduced considerably?

Recently, we have reached a heads of agreement with the BMA on a new consultants' contract—the most significant change in that contract since 1948. My view is that we should concentrate on what consultants do in the time that they are paid to work in the NHS. The new contract offers the possibility of ensuring not just that NHS consultants' time is spent effectively in the NHS, but that consultants get professional and proper appraisals, in which their development needs can be met. We will concentrate on investing in consultants to make sure that we get the best deal for the NHS in the time that consultants are paid to work in it.

The Minister will know that an inquiry has been set up at Derriford hospital in Plymouth to look into the way in which waiting lists there have been collated. A number of individuals at the hospital have complained to me of incidents of bullying, racism and failures properly to follow disciplinary procedures. Will the Minister extend the remit of the inquiry to cover those matters, and the culture of the trust generally?

Allegations of that sort are serious and must be looked at carefully. If the hon. Gentleman writes to me, setting out the allegations made to him, I will look into them and make sure that they are dealt with appropriately. The Government have introduced legislation to protect whistle-blowers to ensure that, for the first time, people are able to bring such matters of concern to the attention of the proper authorities, or to the attention of the public if necessary.

What can be done to overcome the problem of GPs referring patients constantly to one particular consultant, even though that consultant may have a longer waiting time than others within the same department? How can we ensure that patients have proper access to all the information about the waiting times and waiting lists of every consultant within a department, so that they can make an informed choice about which consultant they wish to be referred to?

My hon. Friend makes an important point and we are tackling several issues that will help to address those problems. Clinicians have a responsibility to make the appropriate referrals to the right doctor, but there are examples of GPs referring out of habit or past practice, even though another consultant may be more specialised in an area of treatment and it would be more appropriate to refer the patient to them.

If he will make a statement on treatment waiting times. [106243]

If he will make a statement on the role of clinical need within his waiting list initiative. [106244]

As waiting lists fall, waiting times are falling, too. The in-patient waiting list is now 87,000 below the level we inherited. We have made it clear throughout that patients should always be treated according to their clinical priority. Emergencies are always treated immediately and patients who need urgent treatment are given priority.

If so, why was cold surgery cancelled for weeks on end this winter in Shropshire?

The NHS did this winter what it does in normal winters.

indicated dissent.

I would be astonished if the hon. Gentleman could produce a dossier of evidence that showed that in previous winters, when his party was in power, the NHS in Shropshire did not do what it always does, which is to prioritise emergency cases. I would eat my hat even though I am not wearing one.

As I was the Chairman of the Health Committee when it produced the report that the hon. Member for Erith and Thamesmead (Mr. Austin) mentioned in his question, I hope that the Secretary of State will take my question seriously. Does he accept that grave concern is felt that, in seeking to reduce the in-patient waiting list, clinical priority is—sadly—being ignored in many cases? He gave a forthright response to the question from my hon. Friend the Member for North Shropshire (Mr. Paterson), but will he assure me and the House that clinical priority will take precedence in all situations, even if that means that, for a time, the in-patient waiting list increases?

I have the greatest respect for the hon. Gentleman's views on health. He will know that from the outset we made it clear—by issuing guidance to trusts and to other parts of the NHS—that in tackling the waiting list problems that we inherited, priority should be given to conditions associated with the most severe clinical need. That must be right.

Is not the reality that, with an increasing elderly population and the ability of the NHS to do ever more complex surgery, the demands on health service provision will continue to rise rapidly? The simple fact is that this Government are doing much better at meeting the public's demands than their predecessor did over 18 years.

I am grateful for my hon. Friend's views. He is right to say that demands on the NHS, from changes in the demography and the advent of new treatments and technologies, place additional stresses and pressures on the system. The debate in this country is about what form of health care can best deal with those pressures. The Conservatives' answer is that the future for our health care system should rely on more people being made to go private: we say that that is not the answer because it will not work and it is not fair. We say that the best means to secure health improvement for the majority of our citizens is through a modernised and expanded NHS.

Given that Opposition Front-Bench Members repeatedly describe our spending plans as reckless, can my right hon. Friend give me an idea of how many Tory Members have asked him to reduce expenditure on health?

None. [Laughter.]

Order. Dr. Brand.

The Secretary of State will know that many patients languish in a sort of statistical purgatory while investigations are carried out and decisions to begin treatment are made. Is the right hon. Gentleman collecting information on the number of people who, having been seen by a consultant, are still waiting for a decision about treatment? Does not he consider it unacceptable that the number of patients who seem to be parked in a queue awaiting a decision is not measured at present?

The hon. Gentleman will know, from his political and clinical experience, that the Government are taking steps to tackle that problem. We are investing in one-stop diagnosis and testing, precisely to avoid the difficulty that he describes. In the modern age, at the beginning of a new century, it seems to me that it is not beyond the wit of the national health service to provide faster and more convenient care for patients, so that people going into hospital are not passed from pillar to post. We are striving to ensure that diagnosis, results and, where possible, treatment are dealt with in one day. It will take time to reach that objective, not least because we have to reorganise how services are delivered. We also need to expand the number of staff available to deliver the new services.

What plans he has to increase the proportion of gross domestic product spent on health to the average EU level. [106245]

What plans he has to raise NHS spending as a percentage of gross domestic product to the level of the United Kingdom's European partners. [106254]

As my right hon. Friend the Prime Minister made clear to the House on 19 January, we are entirely confident that we will be able to sustain increases in funding for the health service to reach the European Union average.

Do the Government accept that they have disappointed the public because they have promised too much and achieved too little? Did not the Prime Minister make another promise on "Breakfast with Frost", when he said that he would bring UK health spending up to the European Union average? Does the Secretary of State agree that we are now spending less than 6 per cent. of national income on the health service, and that the European average is 8.8 per cent? Will the right hon. Gentleman be specific about which average the Government are aiming for, and over what period of time they will achieve it?

Welcome to Health questions. If my memory serves me right, the right hon. Gentleman was Chief Secretary to the Treasury for a substantial period during the previous Government's time in office. If anyone is responsible for our funding lagging behind the European Union average, it is he and his cronies.

It would have been nice if the right hon. Member for Kensington and Chelsea (Mr. Portillo) had prefaced his question with an apology to the House. However, in the absence of that apology, will my right hon. Friend confirm that the £11 billion spending shortfall between the UK and our European partners is the real legacy of Tory tax transfers, from public health services to private wealth holders, which took place throughout the Tory Administration? Will he also confirm that the Department of Health has evidence to show that, irrespective of other reasons for admittance to hospital, about 40 per cent. of adults and 15 per cent. of children are admitted because they are classed as malnourished? Is not that a scandalous way to start the 21st century? Does not that fact alone justify my right hon. Friend the Prime Minister's commitment to restore UK health spending to the European average?

My hon. Friend is right. It is clear that we must do two things: we must expand the national health service to ensure that it is there when patients need it and, equally significantly, we must tackle the root causes of ill health. The Government have pledged to do what no previous Government, Labour or Conservative, have ever pledged to do—to improve the overall health of the population, and to improve the health of the worst off at a faster rate.

Has the Secretary of State seen the report published last week by the National Institute of Economic and Social Research, which looked at the Prime Minister's pledge to raise health spending to the EU average? It predicted that such a rise would cause a 2 per cent. fall in manufacturing output, a permanent 1 per cent. increase in the inflation rate, and expose the economy to sudden and massive increases in taxation.

I was going to say that I am slightly confused, but it is the hon. Gentleman and his party who are confused. Just a few weeks ago, Conservative spokesmen were professing support for what my right hon. Friend the Prime Minister was saying. Our position on this matter is clear: we know that we need to expand resources for the national health service, and that is precisely what we are doing. The question is where the Conservatives stand on the issue. They stand for more private health insurance—more subsidies for the few rather than public services for the many.

Does my right hon. Friend agree that the biggest increase in costs in the health budget has been the 35 per cent. increase in the cost of drugs over the past 10 years? Does he further agree that the Government, by setting up the National Institute for Clinical Excellence, have already established a great improvement because they have exposed the fact that the vastly overpriced drug Relenza not only has very little effect on the symptoms of influenza, but has a serious side effect on vulnerable patients? Is it not right that the Government look with new rigour at the greedy propaganda of the drug companies?

I do not want to comment on Relenza, because the drug company itself has done so and has issued what is, in my view, appropriate guidance to the national health service. Just a few weeks ago, Conservative Members were urging us to reverse the NICE decision on Relenza. Well, thank heavens we did not listen to them.

As the Secretary of State was unable to give any firm commitments to my right hon. Friend the Member for Kensington and Chelsea (Mr. Portillo) on European Union averages of gross domestic product spending, perhaps we can look closer to home.

If the hon. Gentleman is so concerned about these apparent differentials between spending in England, Wales and Scotland, why did his Government not do something about them for 18 years?

If he will make a statement on the progress of the meningitis vaccination programme. [106246]

The introduction of the new meningitis C vaccine is progressing very well—immunisation for 15 to 17-years-olds is largely completed, and babies have been receiving the vaccine since November. We are on target to offer the vaccine to everyone under 18 by the end of the year. We are the first country in the world to have introduced a national programme for the new meningitis C vaccine, and we are implementing it a year ahead of schedule.

I warmly thank the Department of Health and the former Secretary of State, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), for providing the new strain C vaccine, in advance of the full immunisation programme, to the village of Ironville in my constituency. It has, tragically, suffered a uniquely high incidence of meningitis, with a so far unexplained series of outbreaks over the past three years.

I welcome my hon. Friend's concern about this issue. She has worked extremely hard on the problems it has caused in her constituency. I am aware of the point she makes about the PCR test; we want to ensure that people working in the field have access to that important test. I shall raise the issue with the PHLS. Officials have already held meetings with the service and I shall do so in March.

Will the Minister assist in the cases of older young people—especially those in their late 20s? We heard of the tragic case of the young rugby player who went to hospital and was, regrettably, misdiagnosed, with fatal consequences. If there was sufficient evidence that those people would also benefit from the vaccine, would the Government consider extending the vaccination programme to that older group?

Certainly, we will take advice about other groups from the Joint Committee on Vaccination and Immunisation. At present, we are on target to immunise everyone aged under 18. The situation is unusual because we are rolling out a new vaccination programme as quickly as possible. In those circumstances, we are obviously prioritising those groups that are at the highest risk.

What plans he has to provide resources for drugs recommended by the National Institute for Clinical Excellence. [106247]

New drugs and treatments are constantly being introduced to the NHS. The cost of those treatments—whether or not they have been referred to the National Institute for Clinical Excellence—is met from the rising resources allocated to health authorities. Those resources increased by 6.6 per cent. this year and will increase by 6.8 per cent. next year. NICE guidance will tackle the different local interpretations of evidence that have led to unacceptable variations in access to treatment and care.

Does my hon. Friend agree that drugs, such as Taxotere, which is extremely effective in advanced breast cancer, and Taxol for ovarian cancer, are not being spread throughout our population? Many women are not being given the right to be prescribed them. Does he agree that we need to allocate more resources to that matter? If NICE finally comes to its senses and realises that those drugs are effective, will my hon. Friend supplement the budgets of health authorities which want to use those drugs to treat everyone who would benefit from them?

My hon. Friend will understand that it would be wrong for me to comment on topics that are under proper consideration by NICE. However, in general the problem is often one of different local priorities—different views of the evidence. The whole point of referring key drugs to NICE is to provide consistent guidance through the NHS to identify those drugs that are both clinically effective and cost effective, and which represent a good use of NHS resources. When NICE produces such approved guidelines, we expect NHS organisations systematically and consistently to take account of them. Clinical governance and the Commission for Health Improvement will help to ensure that.

The hon. Gentleman will be aware that I have raised in the House and in correspondence the relative unavailability in Lincolnshire of beta interferon. He will understand that we all welcome the reference of beta interferon to NICE. However, does he realise that the problem is the lack of resources in Lincolnshire? Unless he is willing—in the event of a positive recommendation from NICE—to put more resources into the authority's budget, it will not be possible to give expression to the institute's recommendation.

Again, it would be wrong for me to comment on a particular drug that is being considered by NICE, but I have two things to say to the right hon. and learned Gentleman. The system that has led to very uneven availability of this drug and others was introduced by the previous Government. The existing guidance on the use of beta interferon was introduced by the previous Government, and that is where the problem originated. It is precisely because we do not find such a situation acceptable that we have set up NICE, and we have referred several drugs to it.

In welcoming NICE, which will put an end to the Tory racket of postcode prescribing, is my hon. Friend aware that there are a great many rising expectations of NICE, and that if NICE strikes a drug that many believe is of use off the list that is available on the NHS, that will greatly disappoint many people? Is he, in his discussions with NICE, drawing its attention to the need to make more drugs available, not fewer?

NICE is aware of the resources that are available to the national health service. It is aware that those resources are rising and that spending on drugs has increased faster than the resources available to the national health service.

I understand the problem to which the Minister refers, but what answer would he give to the lady who wrote to me to say that she had taken part in randomised testing, at the end of which, after she had found benefit from the treatment, she was told by the doctor that she had been taking not a placebo but beta interferon, but that, because of the restrictions, it was unlikely that she would be able to get it in future? Surely the hon. Member for Norwich, North (Dr. Gibson) was emphasising an issue that needs to be addressed, namely, to provide effective treatment throughout the country.

One of our problems is that the results of proper drug trials are sometimes interpreted differently by different clinicians and different health authorities, which can lead to a difference in the pattern of provision. The great advantage of NICE is that it brings together leading clinicians within an organisation that draws heavily on the expertise not just of clinicians, but of managers and of patients' groups, in order to make an authoritative assessment of the evidence emerging from those trials.

If he will make a statement on the number of acute beds in NHS hospitals. [106248]

Acute beds have remained broadly stable under this Government at around 108,000. Even so, there is a view that in some places hospital bed reductions may have gone too far or alternative services may not have been put in place. That is why the national beds inquiry was set up. It is now nearing completion and its findings will be published shortly.

Is the Minister aware that local NHS chiefs have said that more beds are needed in my health area, Redbridge and Waltham Forest, and that the Association of Community Health Councils has said that more beds are needed nationally? Under the previous Government, 40,000 NHS beds were cut. In September 1998, the present Government set up the national beds inquiry. Is it not time that it reported, and that the Government responded to it? Is it not the case that we need more beds—not only acute beds, but mental health and intensive care beds? I hope that the Government will not go to sleep on this issue.

I can assure my hon. Friend that we have no intention of going to sleep on anything, unlike previous Conservative Governments who, over 30 years, never conducted any systematic research into the use of beds. [Interruption.] We have done so, but the last systematic inquiry into the use of hospitals and beds happened under Enoch Powell.

Acute beds need nursing staff to care for the people in them. How does the Minister intend to tackle the problem of nurse recruitment, given that the Labour Government's campaign has been less than successful? The United Kingdom Central Council nursing register continues to fall. It shows that 12 per cent. of those on the register are over the age of 55 and that fewer than 20 per cent. are under the age of 30, thus creating an age timebomb. How does the Minister intend to tackle that problem?

Unlike the previous Government, we responded to the need for nurses not by cutting nurse training places, but by increasing them. Since the Government came to power, 2,500 extra places for training have been created, 2,500 nurses have returned to the profession and we have also trained extra doctors. That is forward looking. We have not cut services and then tried to blame someone else for that.

Does my hon. Friend agree that nobody with any credibility will listen to the criticisms made by Conservatives Members about acute bed numbers or the number of nurses in the system? Does she agree that the problem of acute beds is the result not only of the 40,000 beds that were cut under the previous Government, but of developing a belief in the health service that increased efficiency would always reduce the number of beds? Therefore, if the inquiry suggests that we have too few acute beds in the system, will the Government act on its findings as a matter of urgency?

Of course, techniques change and the use of beds has to be assessed. That is why the national beds inquiry will consider the matter. There has been an increase in elective surgery and something like half of all elective surgery now takes place in day-care units. The important point is that we shall examine the system, modernise the NHS and respond to strategic needs. We will not say that the answer to long-term problems is the private sector and privatising the national health service.

During the past year, how many intensive care beds have been created?

I am aware that on a previous occasion I told the House that some 100 critical care beds have been created. I am delighted to say that that figure is not correct.

That was an interesting answer, but to a different question. I did not ask about critical care beds; I asked about intensive care beds. In the last health debate, the Secretary of State said that he had managed to identify eight; in his letter to me of 6 January he said that there were 100; on "Breakfast with Frost" the Prime Minister said that there were 60; and when my hon. Friend the Member for Daventry (Mr. Boswell) asked about the number of additional intensive care beds that had been created in each NHS trust in 1999 he was told:

"Information is not available in the form requested."—[Official Report, 24 January 2000; Vol. 343, c. 103W.]

My right hon. Friend the Secretary of State has written to the hon. Gentleman to clarify the position. However, if he is really interested in patient care, he will look at the figures published in the latest research, which was verified on 17 January. If he is interested in the truth, he will look at that rather than scoring cheap points that do not benefit any patients at all.

Imagine the audacity of the House of Commons in wanting information from a Minister! These Ministers could not ask for water if they were thirsty. Is not the truth that information that the Government do not like is denied, distorted or withheld? Like the Home Secretary's numbers, the Health Secretary's intensive care beds are complete fantasy. Will the Minister guarantee that by this time next year there will be an increase in the number of intensive care beds as well as critical care beds, and that those figures will be published monthly by trusts throughout the country? We could all then know the truth—we certainly cannot take the Government's word for it.

The hon. Gentleman has to make up his mind about what kind of backseat driver he wants to be. Does he want to keep saying, "Give us information faster and faster", or does he want reliable information that is analysed properly? Information, such as that produced by the national beds inquiry, is being analysed properly and will then be made available, and other information will be made available more quickly. Surely we should give out appropriate information at the right time and in the right place when it is most useful for management decisions.

What progress he is making with the development of primary care trusts. [106249]

Excellent progress has been made towards primary care trust development, with 68 primary care groups proposing to make applications to become 63 primary care trusts this year. Of the 19 applying for an April 2000 start, 17 will become operational in April and the other two will start in October 2000.

Does my hon. Friend agree that the introduction of primary care trusts and groups has led to increased effectiveness and efficiency in the use of NHS resources? However, in Gloucestershire several primary care groups that want to develop into trusts face funding problems due to Gloucestershire health authority's funding difficulties last year. What reassurances can my hon. Friend give to the primary care group in the Forest of Dean that it will receive sufficient funding in future to be effective, efficient and successful and to consider being developed into a primary care trust?

My hon. Friend is right about the advantages of primary care groups and trusts. From April, we shall devolve about £20 billion to those organisations, which is three times the amount devolved to front-line clinicians by the previous Government's fundholding plans. That will enable services to be developed more efficiently and effectively.

Will the Minister confirm that the introduction of primary care groups has resulted in patients now having to go to the hospital selected for them by their primary care group? The last vestiges of patient choice have been abolished, and patients, with the agreement of their GP, are no longer allowed to be referred to another hospital with a shorter waiting time or with a better success rate for the operation concerned.

No. The right hon. Gentleman needs to pay a little more attention to what is happening in the national health service. Nothing that we have done removes clinicians' right to make the appropriate referral for a patient. Indeed, a legal change in their position would be required to remove that right.