What progress has been made since May 1997 in extending team midwifery. [110853]

The last Department of Health survey of the extent of team midwifery was published in 1993. At present, there is no accurate information on the extent of team midwifery nationwide. That is why we have recently commissioned a comprehensive review of midwifery organisation locally. It will also examine the impact of different models of midwife care and report by the end of the year.

Does the Minister accept that the changing child birth project resulted from a Select Committee on Health report and was introduced under the previous Government, but instead of extending women's choice and providing the best possible service for expectant mothers, are not the Government reducing child care, particularly by the midwifery service? I draw her attention in particular to the Iceni midwifery team in Colchester, which is threatened with disbandment.

I disagree with the hon. Gentleman. The Government are strongly committed to the values behind the changing child birth project, focusing on the women involved and keeping them at the centre of maternity services.

Is my hon. Friend aware that in St. George's hospital, which is in my constituency, there is an excellent midwifery unit? On a recent visit there I saw the work that was being done, but it was pointed out to me that, sadly, local general practitioners are not always fully aware of the services that are on offer. Will she look at that matter?

My hon. Friend is right to say that the Tooting service is a great model of best practice from which people throughout the country can learn. The Government are strongly committed to having GPs, primary care groups and acute trusts working closely together to ensure that the best quality maternity care is provided for all women, wherever they should want it.

Does the Minister accept that there is serious concern among pregnant women, particularly those who will become first-time mothers, that there is a possibility that they will be left alone during labour because of a shortage of midwives? Will she outline the Government's strategy for recruiting more midwives, thus ensuring that maternity services are good, reliable and give confidence to those who are about to face motherhood?

I can certainly reassure all first-time mothers and all mothers to be that the Department expects any woman who is in established labour who needs or who wants support to have it. We expect maternity care to be organised accordingly. However, the hon. Lady is right that decisions by the previous Government left us with a shortage of midwives, as well as a shortage of nurses and doctors. Given how long it takes to train midwives, nurses and doctors, we would be in a better situation if the previous Government had got their act together and increased recruitment several years ago.

Is my hon. Friend aware that, in most normal births, any midwife is worth a dozen doctors? If she is genuinely concerned, will she not just recruit new midwives, but look at the terms and conditions of existing midwives and ensure that those excellent and essential ladies are still knocking around, irrespective of what the doctors want?

My hon. Friend is right that we need to ensure that midwives' terms and conditions are such that we sustain their recruitment—we do not simply recruit them, but keep them in the profession. That is why, for example, the NHS is increasing family friendly employment policies to promote things such as part-time working and to encourage midwives to stay in the profession.

What plans he has to review the level of ancillary staff pay in the national health service; and if he will make a statement. [110854]

For the first time, we have offered a guarantee of real-terms pay increases for national health service staff who are outside the pay review bodies, not only for one year, but for a three-year period.

That longer period is certainly welcome. However, is the Minister aware that, this Monday, I met a support staff worker who is a married man, works a 39-hour week, but has only £139 in take-home pay—which is clearly below benefit levels? Is the Minister also aware that it is not only a matter of pay? Full-time support staff in the NHS are systematically being replaced by part-timers and by temporary workers, with the consequence that support staff consider themselves to be doing ever more work for ever less pay.

Of course I would be prepared to meet the hon. Gentleman and the hon. Member for Tweeddale, Ettrick and Lauderdale (Mr. Moore) to discuss those matters. It is worth bearing in mind that when we were elected, the starting point for an adult ancillary worker was £3.60 per hour, but from the coming year, because of the offer that we have made, the minimum will be £4. Furthermore, the structure of the deal that is on offer has been weighted towards those who are on the lowest income—with a flat-rate increase for the lowest paid, from which 75,000 workers benefited last year and 85,000 will benefit in the coming year.

Does my hon. Friend agree that it is a shame that during 18 years of Tory Government the ancillary workers were often ignored? Is it not to be commended that, under the current Government—with their working families tax credit, child care tax credit, reduction in national insurance and the 10p starting rate—we are really able to help to make work pay for those who are at the poorest end of the scale?

My hon. Friend is absolutely right. Last week, I was very pleased to meet a health worker in a south London trust who, as a result of the working families tax credit and the child care tax credit, was fully £80 per week better off than she had been before the introduction of those changes.

May I draw to the Minister's attention the plight of medical laboratory scientific officers? On Friday, my hon. Friend the Member for Surrey Heath (Mr. Hawkins) and I went to see the MLSOs at Frimley Park hospital. MLSO-1 grade staff are on a maximum of £17,200 annually, which is only about £2,000 per year more than the starting pay for nurses. Does the Minister agree that MLSOs are extremely important people, who do all the blood tests and other tests performed in hospitals, but that the Government have neglected them?

Has the hon. Gentleman ever wondered how on earth that state was reached? I am very pleased to say that the offer that we have made, which I mentioned earlier, puts on the table quite significant increases for some of the lowest-paid MLSOs. More than 1,000 staff have on offer more than the basic 3 per cent. increase, and, for some staff, the offer proposes an increase as high as 26 per cent. Only yesterday, my right hon. Friend the Secretary of State said that, in time, the recruitment campaign that is being directed at nurses would be rolled out to encompass other members of the health team.

If he will make a statement on the development of intermediate care services. [110855]

If he will make a statement on the development of intermediate care services. [110858]

The national beds inquiry, which I published earlier this month, outlines the case for development of new services, especially for older people. Intermediate care services can prevent unnecessary hospital admissions and enable people to regain independence in their own homes after a period of active rehabilitation. That is why the Government will develop those services.

How does my right hon. Friend intend to expand the number of intermediate care beds, not only to take patients out of hospital acute beds, but, more importantly, to ensure that elderly people receive the proper treatment that they deserve?

My hon. Friend is right. The results of the national beds inquiry show that there are a lot of older people in hospital beds who need not be there. They have gone into hospital for an operation and then found themselves trapped in a hospital bed because there is nowhere else for them to go. They face a bizarre choice between staying in a hospital bed or going home without adequate support. That is why it is important to build a bridge between the hospital and the home by developing new care services. That means that we have to invest in more active rehabilitation and recovery services than we have in the past. We can do that partly in NHS hospitals, partly by giving new life to cottage hospitals, and partly, when necessary, by entering into new arrangements with the private sector to develop intermediate care services.

I draw my right hon. Friend's attention to the excellent work being done at the Bevan intermediate care unit in Thamesmead, which provides high-intensity nurse and therapist-led treatment, care, recuperation and rehabilitation, with medical input from general practitioners, thereby providing greater job satisfaction for the staff involved and giving a more appropriate form of care at approximately a third of the cost of an acute bed in a district general hospital. Will he make a special allocation of money or ring-fence money following the beds survey for the development of intermediate care?

As I understand it, the Bevan centre in my hon. Friend's constituency has ring-fenced some of the funding available to it. Such active rehabilitation and recovery services are popular among staff and could give a new role to nursing and physiotherapist staff, getting them working at a level appropriate to their skills. The services are also very popular with patients. That, and how effective they are, counts more than cost. I am slightly more doubtful about ring-fenced funding. It is important to try to overcome some of the fragmentation in funding that there has been in the past. That certainly characterised the old internal market. We must recognise that hospitals, community services, intermediate care services, primary care services and social services are part of one system, rather than being separate systems. The funding structures must support that rather than inhibiting such developments.

I welcome the announcement of new intermediate beds, but I should like more detail on what they will comprise. Will the Secretary of State reassure us that there will not be a return to geriatric wards, which tended to be dumping grounds for the elderly? Is there an opportunity for a reprieve for some of the community hospitals under threat of closure? Some of them have been closed even while the inquiry was going on. Will there be a rehabilitative role for the new beds? Will there be an expansion in occupational therapy and physiotherapy to ensure that there is genuine progress and that we do not just move along the bed blocking problem?

The hon. Gentleman is right on two counts. The new intermediate care services have the potential to give a new lease of life to cottage hospitals, but it is pointless retaining cottage hospitals unless they perform a useful function in the care system. Some do and some do not. We want to move away from passive systems of care that assume that older people in particular are going to deteriorate. We should assume that the care system can rehabilitate them and literally get them back on their feet so that they can have what we all want—an independent life in our own home. Intermediate care services can do that. We shall put in investment to make that happen.

I welcome the Secretary of State's ideas for the development of intermediate care. They follow on from work that was going on before the general election, including the development of some community hospitals in Devon, to which he might have drawn attention. I hope that he will not lose sight of the opposite pressures in the health service—for example, overcentralisation in acute services such as maternity care and sometimes accident and emergency care. In developing his welcome ideas for intermediate care, will he explain some of the disciplines that he intends to introduce to ensure that we have some check against the natural tendency to overcentralise care in large acute hospitals?

I suppose that it was predictable that the right hon. Gentleman would claim credit for the development of intermediate care services. However, in too many parts of the country such services are absent altogether. Indeed, this morning, when I visited St. Thomas's hospital with my right hon. Friend the Prime Minister, staff from the accident and emergency department to the acute sector were telling us that, in addition to real pressures in the system—

Was it a media opportunity?

It was not a media opportunity; it was an opportunity to speak to the staff. If Liberal Democrat Members took that opportunity more often, they would have a rather more sensible health policy.

The Secretary of State referred to the national beds inquiry report. The numbers of beds have continued to fall under the present Government. Will he demonstrate the commitment of which he has spoken by giving an undertaking today that he will not approve any further proposals by health authorities that result in a net loss of beds in that health authority area?

No, I will not do that. Sometimes there are good reasons for changes in the beds system. Let me give the hon. Gentleman an example. At the moment in Norwich, there is a hospital that dates back to the 18th century. It operates on two sites. It is inappropriate in the 21st century, so we are going to replace it with a brand new hospital. We are doing that for a simple reason: it is not possible to deliver 21st century health care in some hospitals that were built in the 20th century or, indeed, the 18th century.

I do not know whether my right hon. Friend has had the opportunity to look at reviews in the press today of a book called "A Tourist Guide to the British", which was published yesterday and includes the following disgraceful slur:

A rare smile on the face of a Yorkshireman will be a sign only of impending breaking wind.

I am glad that my hon. Friend went off in that direction rather than the one that I anticipated. As he knows, I announced to the House last December that we were looking seriously at a proposal by the royal commission on long-term care on free nursing care. We are looking at that proposal in the round because it is important that we consider it in the context of what we should do about elderly care services generally. Of course, we have to sort out some of the funding anomalies, but it is equally important that we make sure that the quality of care that elderly people receive, whether it is in the social care sector or the health care sector, is always provided at the highest possible standard. That is precisely what we shall do. As I said to the House last year, following the spending review announced in the summer we shall announce our final conclusions on the royal commission and publish a White Paper.

If he will make a statement about the work of the trolley task force. [110856]

Last year we set up an accident and emergency modernisation programme team, backed by an investment of £115 million, to spearhead improvements in accident and emergency departments. The programme has a much wider remit than looking at trolley waits. The team produced an interim report last November, which is available in the Library. Its final report will be presented to Ministers within the next three months.

That answer shows, in effect, that this is another new Labour broken promise. The Prime Minister addressed a big conference of health administrators on 20 June 1996 and said:

Today I want to announce that in Government we will set up a task force to report urgently on how we can end trolley waits in the NHS for good.

I hate to suggest that Opposition Members could be mistaken, but on this occasion I am afraid that I have to do so. As my right hon. Friend the Prime Minister said on his visit to St. Thomas's A and E department, we are witnessing a revolution in critical care and in casualty care. One element of that is the process of how we deal with patients between the ambulance and the A and E department, and then subsequently.

I thank my hon. Friend for the £700,000 spent on accident and emergency at the Royal Liverpool hospital, which virtually eliminated long trolley waits over the Christmas period. I also look forward to the completion of the new medical assessment unit at the hospital. That is being built, at a cost of £1.4 million, to support the work of the A and E services.

My hon. Friend is right: the problems in A and E departments cannot be dealt with in isolation. That is why we are reviewing ambulance services and making extra investment available. It is also why, as part of the national beds inquiry, we are reviewing the way that beds are used. That review includes observation units, acute beds and step-down facilities.

What was interesting about the Prime Minister's casualty stunt this morning was that there was no mention of how new Labour would abolish trolley waits in accident and emergency departments, nor of the fact that in 1999 patients waited for up to 49 hours on trolleys, nor of the fact that the average wait in casualty has risen to between four and five hours. To be fair to the Prime Minister, however, he did mention that there would be more nurse prescribing in casualty. If that is a real change, and not a stunt, will the Minister say what changes to the Medicines Act 1986 will be required?

To assume that an accident and emergency department will never use trolleys is to misunderstand how admissions to such departments work. Patients will always have to wait on trolleys for a certain time while assessments and tests are carried out before a permanent bed can be made available.

The Minister could not answer my question. Her answer means that Downing street has not yet told the Department of Health what the Department's policy on A and E departments is to be. It is No. 10 that determines health policy, not the Secretary of State and his Ministers.

The hon. Gentleman might find it useful to spend some time looking at what happens in the accident and emergency departments in our hospitals around the country. Some of the announcements that were made today are about things that are happening in some parts of the country. The legacy of the previous Government is the huge difference in the services that are being provided across the country. That is why we invested £115 million to ensure that every major hospital that needs improvement will get it. There are some 244 projects for improvement, and about 80 per cent. were finished this summer. It is clear that the previous Government would not have spent £115 million on improving the health service.

When the National Institute for Clinical Excellence will conclude its assessment of beta interferon. [110857]

The timetabling of the work programme is a matter for the National Institute for Clinical Excellence, although I understand that it should have finalised its deliberations on beta interferon by 30 May, leaving time for appeals and dissemination of the results. The results of NICE' s appraisals should be available in late summer this year.

I am grateful to the Minister for that reply, but how does he reconcile the addition of affordability to the remit of NICE with the Government's policy statement in June 1998 that NICE would not become a national council for rationing? Does he not agree that all patients in the national health service should expect the best possible drug for the treatment of their condition?

It is certainly the case that NICE will provide authoritative guidance on the clinical effectiveness and cost-effectiveness of treatments. That will enable us to ensure that clinically effective and cost-effective treatments are spread as quickly as possible throughout the national health service, and that the best use is made of NHS resources. I think, to be fair, that the hon. Gentleman has misunderstood the nature of the amendment to the establishment order of NICE earlier this year, which was to ensure that it could examine questions of cost-effectiveness.

Will my hon. Friend reaffirm that one of the principal purposes of NICE is to overcome the long-standing problems of postcode prescribing of drugs such as beta interferon? What assurances can he give multiple sclerosis sufferers that the current NICE study will lead to greater consistency, transparency and equity in prescribing this drug?

My hon. Friend is absolutely right. One of the features of the national health service that, regrettably, we inherited from the previous Government was the unacceptable variations in access to care and treatment in different parts of the country. The guidance that is being followed on beta interferon was introduced by the previous Government. One of the great strengths, we hope, of NICE is that by providing consistent guidance to health authorities and to clinicians, those unacceptable variations in treatment and care for a whole range of conditions will be tackled effectively.

Is the hon. Gentleman aware that I have been in correspondence with his Department about the problems in the Lincolnshire health authority area? Is he further aware that over the past four and a half years, of those for whom beta interferon has been recommended as treatment 81 per cent. remain untreated? Is he also aware that the Lincolnshire health authority contends that those numbers are because there are insufficient funds available within the Lincolnshire health authority area to treat more people? Given that, what advice does he have that will ensure that more people can be treated with beta interferon in the Lincolnshire health authority area?

I am grateful to the right hon. and learned Gentleman for recognising in his question that the variations in access to care stemmed from the previous Administration. My advice is that the reason for referring beta interferon—and a range of other important, controversial, questioned drugs such as the taxanes—to NICE is to ensure that authoritative guidance is available to the right hon. and learned Gentleman's authority, and to others, which they should take full account of when making decisions.

One of my constituents moved from Burnley to Cheshire to obtain beta interferon under the present arrangements, which, as my hon. Friend rightly pointed out, came from the previous Conservative Government. Will he give an assurance that everything possible is being done to ensure that when the current assessment has been completed, provision will be clinically based—on medical need and not on cost?

My hon. Friend raises the sort of example of which all hon. Members will be aware. NICE will give guidance both on the clinical effectiveness and the cost-effectiveness of the drugs—that is the basis on which the institute was set up. It will ensure that the most clinically and cost-effective treatments are spread rapidly throughout the NHS and that we make the best use of NHS resources—both factors will be taken into account.

One understands the role of NICE, but can we have an assurance that cost-effectiveness will not rule out modern, more expensive drugs that could be cheaper for the health service in the long run and more effective in the care of patients? What about those patients who have already benefited from beta interferon, but have been taken off the drug because they were taking part in a random test? The patients and the clinicians discovered the benefits; cannot the patients continue their treatment?

The hon. Gentleman raises a couple of important points. When any drug is under consideration by the national institute, it is expected that manufacturers and others—such as patients' groups—will submit evidence on the best use of both NHS and personal social services resources, so that the full economic impact can be taken into account. Indeed, it will be open to people to submit evidence over a wider range of costs. I hope that that reassures him.

If he will make a statement on the number of knee replacement operations carried out in the NHS in 1998–99. [110859]

According to provisional data for 1998–99, 28,876 primary knee replacement operations were carried out in national health service hospitals in England.

I have had a letter from my constituent, Mr. Bracewell, which describes as "great news" and "a miracle" his successful knee operation. He said:

as a Godfearing man, you will be rewarded for helping in due course.

It was going so well until then. I am sure that my hon. Friend will receive his due reward.

You must be getting desperate.

Indeed I must be if I am reading that. The briefing states:

Knee replacements are important to enable patients to retain mobility and, therefore, independence. They should be available according to clinical need.

conditions…like hip and knee replacements, hernia and cataract operations

when they had serious, life-threatening conditions and would look to their private insurance to help them with the rest.

My constituent, Mr. James Hickson, agrees with the Secretary of State that such treatments should be provided according to clinical need. Yet six months ago, after an interminable wait under this Government to have a seriously diseased hip replaced, he was forced to go the private sector for an operation. He is without private health insurance and I have at least one other constituent who has been forced, under the Labour Government, to resort to private treatment without having insurance to pay for it.

The hon. Gentleman rails against private treatment for hip and knee replacements. People talk about joined-up government, but what about a bit of joined-up opposition between Conservative Back Benchers and Front Benchers? Once again, Front Benchers say one thing and Back Benchers say another, and the Conservatives' health policy is in tatters.

Will my right hon. Friend assure the House not only that the Government will eschew any suggestion that we go down the route of postcode health care provision, but that they will eschew what Conservative Members would suggest—bank sort code health care provision?

My hon. Friend is right. It is about time those on the Conservative Front Bench came clean. They give interviews to newspapers and to television companies, and it is the Conservatives' policy in which people are interested. Overwhelmingly, cataract, hip and knee operations are operations of old age. Older people will therefore literally pay the price of Conservative health policy. They will pay the price in a new tax on old age if the Conservatives have their way.

What assessment he has made of the role the independent hospitals can play in easing demands on national health service hospitals. [110860]

We have considered at length the role that independent hospitals can play in easing demands on NHS hospitals. Our existing policy on commissioning health care services from the private sector allows the NHS to negotiate with the private sector where no local NHS beds are available, and where it is cost-effective. It has also been a long-standing practice in the NHS to use the independents sector where historically there has been little or no provision in the NHS—for example, for mental health secure units and termination of pregnancy.

That contradicts everything that I have heard takes place not many miles from my home and in a wide area of the south-east. The complaint is—it follows very much the statement attributed to the Secretary of State, who came down like a ton of bricks on anyone who had anything to do with the private sector—that in point of fact—

Ask a question.

I am coming to the question. Why does the prevailing evidence suggest that the national health service is prevented from sending its patients to charitably and independently financed hospitals that would help to relieve pressure on the national health service? Someone must have got the truth wrong in the information provided to the Minister.

Circumstances on the ground may not be precisely those rumoured to exist. Some hospitals—such as in Bristol, which had a shortage—negotiate with and use the private sector. This winter, local hospitals negotiated with social services and private providers. It is not true that there is a surplus of private beds that the NHS does not use. It is true that we need to build capacity across NHS. Beds in the private sector that are registered but not supported by staff would not be available for use.

Madam Speaker, in view of the conflicting evidence that I have—

Order. I thought that the right hon. Gentleman was seeking to withdraw and to have an Adjournment debate.

Yes, Madam Speaker.

In that case, I cannot proceed. That is reasonable.

What progress is being made in reducing the waiting times for cataract operations. [110861]

The Government have launched action on cataracts—a major programme to ensure that all local NHS eye services can match the best in providing a modern and convenient service. It will enable us to build on the substantial progress that we have already made, which has seen the number of cataract operations rise from 157,000 in 1996–97 to more than 200,000 last year. We have also allocated £20 million over two years to modernise and to cut waiting times for cataract surgery. That cash will enable about 50 local centres to streamline cataract treatment, so that patients can make fewer visits to the optician, General Practitioner, and hospital.

I am delighted that the Government are planning for the best quality NHS cataract surgery nationally. That is also a feature of the strategic review of South Staffordshire health authority, which last year paid for 1,762 NHS cataract operations. Does my hon. Friend agree that it is right to reassure patients of improving free NHS cataract surgery, not threaten them—as the Conservative party would—with having to take out medical insurance to pay for operations privately?

I strongly agree. It is clearly the Government's ambition to improve the quality of NHS services for people who need cataract operations—unlike the Conservative party's, whose intention is to privatise that aspect of the NHS, and whose policy is not popular with the country. I am sure that ours is popular with my hon. Friend's constituents, who have benefited from free operations on the NHS.

A constituent recently wrote to me about his wife, who went blind in both eyes while waiting for a cataract operation, owing to the much longer waiting lists under the present Government. Does the Minister think it preferable to any other alternative that under the Labour Government, old people who are going blind are forced to go private and spend their savings, never having thought that they would need private health insurance? Does the Minister think that is the best system for this country's health care?

The hon. Gentleman ought to check his facts. If he will write to me with the details of the particular case he mentioned, I will look into it. This Government reintroduced free eye tests for pensioners—something that the last Conservative Government withdrew. If he is complaining that his constituents have to go private, he might like to take up his concerns with his own Front Benchers. The Conservative party wants to make sure in future that patients who need such operations go private rather than use the NHS.

Does the Minister accept that the problem with all waiting lists—including those for cataract operations—is that the Government's waiting list initiative is distorting clinical priorities? Dr. Peter Wilde, consultant cardiologist at the Bristol Royal infirmary, said this morning that heart patients are dying unnecessarily because they were waiting too long for surgery. Tragically, that is not due to a lack of resources.

I do not accept any of the hon. Gentleman's points. If he studies the December waiting list figures, he will see conclusive proof that the opposite is the case. We have always made it clear that clinical need alone should determine patient access to the NHS. If he is complaining about the Government's record on cataract operations, he ought to reconcile that with the concerns expressed by his hon. Friends about Conservative policy—which is to take the procedure out of the NHS and force people to go private. That is a completely unacceptable state of affairs.

I am clear about the need for the initiative to improve the rate at which cataract operations take place, as there are 22,000 pensioners in my constituency and I hear of sad cases of some disabled pensioners having to wait month after month after month. Deteriorating vision must make their lives much more miserable, not least because of the risk of falling. Can the Minister give us any idea of how long a wait he would think reasonable once the Government have achieved their objectives—and how quickly will we reach that day?

The average waiting time for cataract operations is falling. Currently, it is about seven months. Everyone in the House, including my hon. Friend, would want us to make further progress in reducing the waiting times—that is precisely what the initiatives that I have outlined to the House will do—but he, like me, would agree that the best way to ensure equitable access to health care for older people, particularly those who need cataract operations, is to ensure that a first-class national health service is available to meet their needs. That is what the Government are committed to doing, but sadly it is not the policy of the Opposition.

If he will make a statement on the number of NHS acute hospital beds and staff to support them. [110862]

The latest figures show that there are 108,000 acute beds in the NHS. We are currently consulting, through the national beds inquiry, on how we can best secure an increase in the number and the type of beds. Crucial to that are increases in nurse and doctor numbers. Both are rising under this Government.

I am grateful to the Minister for that reply, but does he not accept that under successive Governments, Secretary of State hospital bed numbers have declined by 2 per cent. a year since 1980, even though patient numbers have increased by 3.5 per cent. a year? The problem is not of the Government's making; but does he accept that, rather than the Government going ahead with the 1p in the pound tax cut, the British public would rather see that money spent on the national health service?

We are spending more money on the NHS—a damn sight more than the Liberal Democrats promised in their manifesto at the previous general election—but we need to reverse a 30 or 40-year decline in the number of beds in the whole system. Given the demographic pressures and our ageing population—we have seen this winter some of the pressures that they cause in hospitals—the Government want to expand services in the NHS. That is what we are about and my strong view is that the decline in hospital bed numbers cannot continue. That is not only a question of getting the number of hospital beds right, however. We have to make sure that there are enough beds in the whole care system and we are committed to achieving precisely that.

Will my right hon. Friend consider the serious problems and pressures in north-east London? In particular, I draw his attention to the recent letter from the chief executives of the Redbridge trust and the Redbridge and Waltham Forest health authority to the NHS London regional office, urging additional beds for the King George hospital site in my constituency.

I am aware of the pressures in my hon. Friend's area and in other parts of London, too. The answer, as Christine Hancock of the Royal College of Nursing rightly said recently, is not only an increase in the number of beds. We can get beds on any high street, but we cannot get trained nurses. It takes time to train the nurses, but I can tell my hon. Friend that we are beginning to turn the corner as regards nurse shortages. There are 4,500 more nurses in the NHS now than there were a year ago. That is good progress. There is still some way to go, but the signs are positive.

I am glad to hear that the Secretary of State acknowledges that the 15,000 nursing vacancies have such a disastrous impact on acute bed capacity. Given that the Royal College of Nursing estimated that there were 12,000 departures from nursing last year, is not the Secretary of State's claim to have turned the corner, with the equivalent of 3,000 full-time new recruits, a bit like the Home Secretary's over-optimism about the number of extra police officers?

No, the hon. Lady obviously has not been listening. There are not 3,000 full-time equivalent returners; there are an extra 3,000 nurses working in the national health service—that is the full-time equivalence. There are 4,500 extra nurses. Many of them are taking advantage of precisely the sort of flexible employment that we are opening up to nurses, so the total full-time equivalence is fewer than 4,500: it is 3,000— [Interruption]—as I have just told the hon. Member for Runnymede and Weybridge (Mr. Hammond), if he would care to listen.

When he expects to report on Government proposals for the reform of the Mental Health Act 1983. [110863]

Our proposals, which are set out in the Green Paper, are subject to consultation until 31 March. We will report on the outcome later this year.

I was pleased to hear the Secretary of State earlier reinforce the point that the NHS exists to serve patients. Will my hon. Friend ensure that the main purpose of the review of the Mental Health Act is seen to be to give patients the right to first-class care and treatment, rather than to reinforce the negative stereotypes of mentally ill people as being a danger to the public?

I can certainly reassure my hon. Friend that it is precisely the purpose of our proposals to improve mental health services. Those proposals do not consist only of the Green Paper; I am sure that she will be aware of the national service framework that we published in September and the additional £700 million that we are making available to modernise mental health services over the next three years. The entire thrust of our proposals is to ensure that people with mental health problems have access to a first-class national health service, and I am sure that she will be supporting them.

Can the Minister assure the House that those who are detained compulsorily under the Mental Health Act will always have a voice? There is a concern that people get lost and forgotten. Will the Minister give consideration in the consultation paper to ensuring that those people have an advocate so that they are not simply lost in the system?

Yes, I can assure the hon. Gentleman about those points. I hope that if he has had a chance to study the Green Paper, he will agree that in addition to improving the protection of staff, patients and the public, we have struck a better balance between resolving those issues and ensuring that patients who may in future be subject to compulsory treatment have access to a better process of decision making about their treatment. That has certainly been our intention in proposing detailed reforms in the Green Paper, and it makes a significant change in the way we deal with such issues in legislation. I hope that he will, in his own way, be able to support them.

Last year, the Secretary of State announced that there would be 231 new secure places in mental hospitals, 31 of which would be in the south-east. Where have the Government got to with those plans? Is the Minister aware of the case of my constituent, a patient who was attacked in a unit in St. James's hospital when a cup of boiling water was thrown over him? That resulted in his being taken to the special burns unit and the offending patient being held in a ward that should take five patients; so four patients had to be moved to accommodate one patient with seriously disturbed behaviour.

I can tell the hon. Gentleman that the 221 beds to which he is referring have already been provided in the national health service. My right hon. Friend the Secretary of State announced in November that we were increasing the total number of additional secure beds that we wanted to provide in the NHS from 300—a target that we set in the national service framework—to 500, and that we were bringing forward the meeting of that target by a year, so those additional 500 beds will be available in the NHS by April 2001.

I welcome reform of the Mental Health Act 1983, but will my hon. Friend pay attention to the anxiety expressed by members of the general public in the past few weeks about the protection of the mental health of children, especially regarding the over-use of mood-modifying drugs such as Ritalin?

I am well aware of the concerns that have been expressed about the use of Ritalin. That is why its use has been referred to the National Institute for Clinical Excellence. I hope that the institute will be able to provide authoritative guidance on the use of Ritalin in the future.