What estimate he has made of the additional cost to the NHS of permitting prescription of beta interferon wherever clinically indicated. [115148]

No estimate has been made, since opinions vary about when beta interferon is clinically indicated. We have referred beta interferon to the National Institute for Clinical Excellence, and we expect to receive its draft report at the end of May.

I am sure that, in the next 60 minutes, we will hear several times about the large amounts of money going into the NHS. Will the Minister give an undertaking that when the decision on beta interferon is made, affordability will not be a barrier, and that treatment levels of the drug will rise to the European level of 12 per cent. against the current 3 per cent?

It is for NICE to give guidance on the clinical and cost-effectiveness of beta interferon to enable us to make the best use of resources. It remains, as it always has been, the responsibility of Ministers to determine the level of resources available in the NHS. I am particularly pleased that, in last week's Budget, a substantial increase in resources for the NHS was announced.

Has the Minister seen the league tables in The Mirror today which show the health authority provision of medicines and drugs, with a variety of provision for beta interferon? Some areas are not supplied, some are partially supplied and some are fully supplied. What lessons does my hon. Friend draw from that information?

I draw the lesson that the Conservative party is the mother and father of the postcode lottery in care. The following of the guidance on the prescription of beta interferon, which was introduced by the previous Government, remains, and has led to this situation. I am pleased that this Government have been able to set up NICE, which will tackle the postcode lottery of care, and that we have been able to announce a substantial increase in resources for the NHS to enable spending on the treatment of patients to increase.

The national health service is supposed to be precisely that—national. Multiple sclerosis patients have a right to expect that, where it is clinically approved, they should have the drug of their choice. When will the Minister take charge of the situation, and not use NICE as a cop-out?

The hon. Lady must know that the guidance currently being followed by the NHS was introduced several years ago by the previous Administration. It is precisely because the Government were not happy with that situation that we created NICE. We referred beta interferon to it as one of its first year's programmes of work. We look forward to receiving advice later this summer, as this is the only way in which we can tackle the postcode lottery of care from which so many people are suffering.

Does my hon. Friend agree that there is another drug, prostocyclin, with the same problems as beta interferon, in that health authorities cannot afford to pay for it? As a result, patients are dying. In the United States, the same British-made drug is four times cheaper than it is here. Is not the solution that those high-priced drugs with relatively small use are modulated, in that their prices drop to an affordable level while the general price of drugs provided by the same drug company is slightly increased? If so, the price to the NHS would remain the same; we would not have postcode prescribing; and, in the case of prostocyclin, patients would live.

I am aware of my hon. Friend's concerns about the use of prostocyclin for pulmonary hypertension. This drug has not been licensed to treat that condition, which means that it is prescribable only on a named-patient basis. That means that it is being prescribed in small numbers, and there are not the economies of scale that are seen in America, where the drug is more widely licensed. In general, US drug prices are some 70 per cent. higher than in the NHS. The pharmaceutical price regulation scheme will save some £200 million in the coming year from the drugs budget, which will become resources that are available for the NHS to treat patients. Treatment of the condition is being considered by the national specialist commissioning advisory group at present.

The fact that affordability was slipped into the criteria used by NICE by virtue of a statutory instrument amending the Health Act 1999 would mean that NICE, in deciding on treatments such as beta interferon, could be at odds with the Secretary of State, who said on 8 March:

"I take decisions about affordability."—[Official Report, 8 March 2000; Vol. 345, c. 1022.]

As I have already said, the ultimate determinant of affordability is the level of resources available to the national health service. I am very proud that, over the next four years, this Government are committed to putting a level of resources into the national health service that will be twice the rate of increase achieved by the previous Conservative Government, under whose stewardship so many of the problems arose. If a Conservative Government were returned to power, they would return to a policy of postcode lottery and underfunding. They would promote a policy of forcing patients to buy their own drugs.

What assessment he has made of the improvements brought about by health action zones. [115149]

Our own monitoring of health action zones and independent evaluations both show that the extra resources that we have committed to them are helping them to modernise health services and tackle health inequalities. Today, I am making further funds available for health authorities in health action zone areas, and for authorities in all parts of the country.

I thank my right hon. Friend for that answer, and I especially welcome the new resources that he is to make available to health action zones. The health action zone in South Yorkshire that covers the coalfield areas is running a number of progressive projects that are improving health and reducing health inequalities.

I am aware of the work of the health action zone in my hon. Friend's constituency—indeed, I think that I launched it a couple of years ago. I am glad that it is making progress, and that my hon. Friend is closely involved with it.

I was most interested in that reply from the Secretary of State, but I should be even more interested to hear his response to the findings contained in the report entitled "The Widening Gap". It found that the areas selected for health action zones are vague, and that they are not based on greatest health needs. What is the right hon. Gentleman's response to that?

If the hon. Lady had bothered to visit the constituency of my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham)—who I think would be very happy to extend an invitation and where I am sure that she would be extremely welcome—she would understand about health inequalities and the sort of problems that my hon. Friend's constituents face. The Government are determined to achieve two things. First, we aim to improve the health of the population overall, which of course is the right thing to do. Secondly, we aim to improve the health of the worst off at a faster rate—precisely in order to narrow the health inequalities that are a scar on our nation.

I thank my right hon. Friend for his reply to my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham). He is very welcome to visit the health action zone in Plymouth, as is the hon. Member for Broxbourne (Mrs. Roe), who seemed so sceptical about its ability to deliver.

I welcome the initiative with which my hon. Friend the Member for Plymouth, Sutton (Mrs. Gilroy)—and, indeed, my hon. Friend the Member for Plymouth, Devonport (Mr. Jamieson)—are closely involved. I have to keep on the side of the Whips, Madam Speaker, because otherwise I will get into dreadful trouble.

I am sure that the Secretary of State will accept that all the country is a health action zone of one type or another, and that much work has been done to create the health improvement programmes that are the basis of health delivery in a given locality. Can the right hon. Gentleman assure us that the criteria set for the money flowing down into localities, and the bonus payments, will be local criteria, accepted by the Secretary of State as part of his health improvement programme, but that the determination of the flow of money will be made locally rather than at Richmond house?

I should explain to the hon. Gentleman that today I am making available two sources of extra funding for the national health service from the money that the Chancellor announced last Tuesday. First, there is £600 million extra for the NHS to deal with the very real service pressures that the hon. Gentleman, and others, have been banging on about for some time. That money was called for by the NHS Confederation the weekend before the Budget statement. It is to deal with the issues of winter, waiting, and getting back into financial balance. On top of that, a further £60 million is available, but that is dependent on good performance. Frankly, once we provide these extra significant levels of resources—twice the level of real-terms growth that we have seen in the NHS over the past 25 to 30 years—there should no longer be any excuse for poor performance. Patients in every part of the country want excellence, not excuses, and the new fund is designed to incentivise good performance.

What steps the Government are taking to improve the quality of personal social services. [115150]

We are taking a range of measures to improve the quality of personal social services. Our quality protects programme is improving quality and consistency in children's services. The Care Standards Bill will establish a new independent regulatory system in residential care homes, so improving standards in care settings. Our new performance assessment system will, for the first time, provide a national benchmark by which we can measure change. We shall also be consulting in the very near future on a quality strategy to plan a range of further steps that we wish to take in improving the quality of personal social services.

I thank my hon. Friend for his answer. I also welcome the commitment to extra resources that we heard last week in the Chancellor's statement. Does my hon. Friend agree that vulnerable citizens, whether they are elderly, children, physically or mentally disabled, need the assistance of personal social services, and that they, in particular, need to be treated as individuals? That requires a professionalism about the provision, whether it is delivered by the public, private or voluntary sector. In areas where there is a mixture, how will my hon. Friend ensure that those standards of quality and professionalism are delivered across the board in personal social services?

I certainly agree with my hon. Friend about the importance of additional resources. She will be aware that we are increasing the total resources available to local authorities in England for personal social services spending at twice the rate of inflation. That is important. However, my hon. Friend is also right that it is not just a question of resources, which is why the Government have developed a new approach to raising the standards of care provided in social services departments. It is totally unacceptable that similar authorities have a completely different range of outcomes in relation to the services that they provide.

I welcome the Minister's comments on protecting the vulnerable against abuse, but is he aware of the concern among nursing homes in East Kent caused by his "Fit for the Future?" document, especially some of its more bureaucratic provisions, which have been cited as the reason for the closure of one nursing home already? Is he further aware of the impact that the programme is likely to have on bed blocking in the acute hospital sector? Two of our three hospitals have this very week been closed for a while to new admissions.

Yes, I am aware of the concerns that he and other hon. Members from Kent have made about "Fit for the Future?" It is inappropriate to say that "Fit for the Future" is the reason why homes are closing, because it is not in operation yet and is unlikely to be so for several years to come. We are making it clear to care home providers that, whatever decisions we eventually make about the national minimum required standards, those standards will be fair, affordable and realistic. We have no intention of driving good care home providers out of the sector. Far from it, good care home providers have absolutely nothing to fear from "Fit for the Future?"

What steps he has taken to increase the number of student nurses. [115152]

We have increased the number of nurse training places and we have increased pay for nurses and midwives. As a result, we have also increased the number of applicants for training. Last year, over 70 per cent. more people applied for nurse training courses.

I thank my right hon. Friend for that reply. Is he aware of a problem that a number of student nurses have brought to my attention? When they come back to training, they have an interaction with the benefits systems that cause them problems. One constituent was promised that she could continue to receive the working families tax credit, but when she became a student nurse, she found that she could not.

I am aware of some of those problems. As my hon. Friend is aware, a review of the NHS bursary schemes through which student nurses are paid is under way. I can reassure my hon. Friend that the review is taking place not only inside the Department of Health, but in conjunction with our colleagues in the Department for Education and Employment and the Department of Social Security.

Can the Secretary of State tell us how much money the Government will save as a result of the decision to cut travel allowances for student nurses on clinical placement?

I am not aware of the amount of money that we will save, but the investment that we are making in nurse training and in expanding the number of nurses in the NHS is good news for patients and good news for nurses, and stands in marked contrast to the cuts in nurse training places and in the number of nurses that we saw under the Conservative Government.

It is clear that the Secretary of State does not understand that his Department is cutting travel allowances for some of the poorest nurses currently on clinical placement. That is proving a great hardship. If the right hon. Gentleman had contacted the Royal College of Nursing, he would have been more aware of it.

I have in front of me what the Chancellor told the House last Tuesday. He said two things. He said that, with the extra resources and the reforms that were still to come, we would be able to recruit at least 10,000 more nurses next year and the year after and that, as a consequence of the historic levels of funding that we had put into the NHS, there would be even more nurses to come. That stands in marked contrast to what happened under the previous Government. The number of nurse training places was cut. The number of qualified nurses fell. We are now beginning to turn the corner on nurse shortages. There are now 4,500 more nurses working in the NHS today than just a year ago. If the hon. Gentleman had any sense whatever, he would welcome the extra resources and nurses that the Government are putting into the NHS.

Two questions; no answers. The Secretary of State does not know that he is cutting nurses' allowances, and he is unable to answer—for a second time—detailed questions that the RCN has put to him in writing. He betrays the fact that the Government are making it up as they go along. What a bunch of waffle.

Hear, hear.

The hon. Gentleman and his hon. Friends are becoming excited, so I shall leave some basic facts with them. From 1 April, an extra £600 million will go into the NHS—delivered by Labour, opposed by the Tories. The NHS will receive an extra £2 billion for the next financial year—delivered by Labour, opposed by the Tories. The NHS will receive an extra 6.3 per cent. in real terms over the next four years—delivered by Labour, opposed by the Tories. The NHS will receive an extra 50 per cent. in real terms over five years—delivered by Labour, opposed by the Tories. The truth is that the Tories are desperate to talk of spinning because they cannot match our spending. They have made their choice about the NHS, public spending and taxation policy—tax perks for the privileged, not a health service for the people.

What studies he has undertaken of the incidence of racism in mental health services. [115153]

Last year, the Department of Health and the Royal College of Psychiatrists jointly produced a detailed study into ethnicity and mental health. It recognised the problems of racism and set out practical solutions to problems identified in clinical practice. These have been reflected in the national service framework for mental health as we have sought to address specific needs of black and ethnic minority mental health service users.

I congratulate my hon. Friend. At last, a Government are taking mental health services seriously after years of neglect, and are resourcing those services. Is my hon. Friend aware of the MIND charity report that contains evidence that mental health services discriminate against black and minority ethnic communities? Is he aware that a constituent of my hon. Friend the Member for Peterborough (Mrs. Brinton) died under restraint procedures in a hospital in my constituency, and that an inquest is still awaited a year and a half later?

My hon. Friend makes two points. First, we recognise the need to improve mental health services. That is why they are one of my Department's major priorities. We are introducing significant new reforms to mental health services, backed by significant new resources. Many people from black minority populations feel that they do not receive a fair deal from mental health services. Many parts of the national service framework try to address their concerns, including those on primary and non-institutional care, and that will benefit patients from black minority ethnic backgrounds.

Has the Minister discussed his concern about racism in the provision of mental health services with the Home Secretary in the context of the recent Second Reading of the Race Relations (Amendment) Bill?

Yes, these matters are discussed across government. We must address that serious issue. There is a temptation among some Opposition Members—the hon. Gentleman may not have fallen into the trap—to pretend that there is no issue relating to black people's access to mental health services. We are determined to address problems, and we are doing so seriously. I hope the hon. Gentleman will be able to support us.

What plans he has to review the financial allocation formula for health authorities. [115154]

A review of the formula is already under way. We want a fairer formula that contributes to our goal of reducing health inequalities. All parts of the NHS will benefit from the cash boost announced last week. Redbridge and Waltham Forest health authority's share of the first £660 million is more than £6 million. That will give the health authority an 8.23 per cent. cash increase for the coming year.

My hon. Friend's announcement of extra money will be most welcome in Redbridge and Waltham Forest. However, does he agree that the existing allocations formula, with its staff market forces factor, causes difficulties for several London health authorities for whom there is a distinct cliff edge between one authority and its neighbour? Will he look closely at the impact of higher wages in the City of London? Those high wages mean that, because of the formula, people in outer-London boroughs lose out financially.

The advisory committee that is considering the formula is examining many issues; for example, market forces; rurality; and the number of the older population. They must all be taken into account; it will be some time before there is any prospect of a change to the formula.

Is the hon. Gentleman aware of the serious difficulty that has arisen in West Sussex as a result of the extremely bad funding arrangement for West Sussex county council? That has left many geriatric beds in hospitals blocked with people who should rightfully be cared for in old people's homes. Will the hon. Gentleman liaise with his colleagues in other Departments to see what help can be given to West Sussex county council to overcome that problem? It has led to the council being unable to cope with its obligations.

I hear what the hon. Gentleman has to say. I am not familiar with the details of the situation in West Sussex, although I know that social services departments throughout England received a good increase in their standing spending assessments last year. I shall look into his particular concerns.

Do the allocation arrangements mentioned by the Secretary of State today, which bypass health authorities, indicate some thinking about the possible future role of those authorities?

We simply wanted to achieve one important effect: we want the money to be spent on real services and not on red tape. We want to put it into the hands of front-line doctors and nurses in primary care groups, who, in any case, would have been responsible for commissioning at least 60 per cent. of services from this April. By making it clear that the money must go into front-line services for patients, we can ensure that the extra investment will have the fastest possible impact on real patients and their treatment in the health service.

Can the Minister give the House an assurance that he will use the allocation of £600 million to address the grotesque distortions in funding between NHS areas? That distortion means that, for example, in my constituency, where NHS spending is just £615 per head, the percentage of patients waiting for 12 months or more for surgery is 10 times higher than in the Secretary of State's constituency, where NHS spending is £730 per head—nearly 20 per cent. higher than in mine.

In answer to an earlier question, I said that a review of the allocation formula was under way. It will consider a wide range of factors. If the hon. Gentleman is seriously suggesting that a Conservative Government would wish to adopt a purely per capita system of funding that took no account of, for example, providing services in rural areas, inequalities in health needs or the size of health populations, that is astonishing. Such an approach would amount to a huge shift of resources away from those people who suffer most from ill health and who die earlier towards those areas where health provision is best. Some changes may be necessary to the allocation formula in relation to a range of issues. However, the hon. Gentleman should think again about going in the direction that he suggested.

If he will make a statement on progress with the new immunisation programme against meningitis C-type in Yorkshire. [115155]

The first phase of the new meningococcal group C vaccine programme in Yorkshire and across the country is progressing well. We are on target to offer the vaccine to all under-18s by the end of this year. I welcome the hard work of those across the national health service and that of the manufacturers who have done so much to put the programme in place so quickly.

I thank my hon. Friend for that reply. She will remember the three local teenage deaths in nine days last winter from the C-type killer. Is she, therefore, aware of the strong support in Rotherham for the Government's determination to make the United Kingdom the first country in the world to use this new vaccine in a national immunisation programme? Will she pay tribute to the health authority, the schools and other local agencies in Rotherham which together have achieved 91 per cent. coverage among the vulnerable 15 to 17-year-olds in schools? In particular, Rawmarsh comprehensive has achieved a 99 per cent. immunisation rate. Will she confirm that we have not seen such figures for any vaccination programme for that age group in the past?

I certainly pay tribute to the work done in Rotherham and to the high take-up rates that have been achieved. I am pleased to tell the House of the impact of the meningitis C vaccination programme so far. The data we have suggest that the new vaccine has already cut winter cases in the groups who were immunised first by 75 per cent. and that the number of tragic deaths from meningitis C in those age groups has fallen already. That proves how right my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) was, as the former Secretary of State for Health, to take the decision to bring in the vaccine as rapidly as possible and far more quickly than many people thought possible.

Will the Minister ensure that there is proper publicity, so that everyone who is eligible for the vaccine will be assured of it within a year? Will she join me in encouraging hospital staff and medical care workers generally to have the vaccinations to which they are also entitled?

I welcome the hon. Lady's support for the meningitis C vaccination programme. We have already begun television advertising to make people aware of the programme. Vaccinations for children of school age are being carried out in schools, and awareness in schools is also important.

Despite the excellent targets that are being met in the schools in Rotherham, some people are excluded from the programme. Will my hon. Friend ensure that there are means of contacting people who are not in schools, so that as many people as possible receive the vaccinations? Through my hon. Friend the Minister, may I thank my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), who spent a lot of time and energy when he was at the Department of Health making sure that we had the type of protection that our country and our children deserve?

I certainly support my hon. Friend's remarks. It is worth reinforcing the point that we are the first country in the world to have this vaccination programme in place. It is a tribute to the work of the NHS that we have managed to do that. My hon. Friend is right to say that there are groups of people—particularly 15 to 17-year-olds who are not in school—that we want to find other ways to reach. The under-fives and the 15 to 17-year-olds who are not at school will be reached through their general practitioners, but we are keen to make further progress on that in future.

What priority he will give to areas with high levels of heart disease in allocating new resources for improving cardiac care and surgery. [115156]

The national service framework, which I published earlier this month, is a 10-year programme of action, which will mean that everyone can get top-quality coronary heart disease services wherever they live. As a first step, the extra £50 million to increase heart operations is being distributed using a formula that takes account of deaths from heart disease.

I thank my right hon. Friend for that reply. Under the Conservative Government, the town that I represent, despite being in the prosperous south-east, became unhealthier. It is one of the top 10 towns in the country for deaths from coronary heart disease among people aged over 65. Unlike the rest of the country, in Slough the rate of increase for deaths from CHD is continuing. I am glad that the targeted £50 million will be connected to deaths from heart disease. May I take this opportunity to thank my right hon. Friend for that money? That sum, together with the £600 million that he announced earlier, will mean that Slough, where people have been allowed to die for 20 years because of the ignorance of those who were not focusing on the health needs of the community, will no longer have the only district general hospital in the country without a dedicated coronary care unit.

My hon. Friend raises an important point. I think that all right hon. and hon. Members are aware that, by international standards, we have a high incidence of coronary heart disease in the United Kingdom compared with other developed nations. There is also an unfortunate coincidence in that the very parts of the country that often have the highest levels of coronary heart disease often have the lowest levels of cardiac surgery interventions. That is something that we must put right. We must get resources into the right places. That is the right and fair thing to do.

Will the Secretary of State join me in congratulating the cardiac thoracic unit at the Blackpool Victoria hospital on its excellent work in increasing patient throughput and on the quality of the surgery that it has performed? Will he take this opportunity to remove the cloud of doubt that hangs over the future of the unit? It is much needed in Blackpool and Fylde, and the doubt must be removed. Will the right hon. Gentleman ensure that, in his distribution of moneys, the North West Lancashire health authority has sufficient funds to ensure that patient throughput can again rise at Blackpool?

As I understand it, the issue about the unit to which the right hon. Gentleman refers is out for consultation. It is a matter that will need to go through the appropriate mechanisms, and it will be determined locally. If it is referred to me, I shall examine it carefully.

I understand that my right hon. Friend is currently considering demand projections for a fourth cardiac unit in the west midlands. In Wolverhampton, we have not only the highest number of deaths from cardiac disease in the west midlands but the lowest level of access to surgery in the west midlands. Will my right hon. Friend give sympathetic consideration to a new cardiac unit being sited in Wolverhampton?

I am not aware of the particular local circumstances. If my hon. Friend cares to write to me, I shall examine carefully the issues that he has raised. It is important that all right hon. and hon. Members understand that we have severe capacity problems with our cardiac services and units. As a result of decades of neglect of cardiac services, we have only 170 cardiac surgeons in the NHS in England. We are expanding the numbers pretty rapidly by more than 100 during the next five or six years. That will be an increase of about 60 per cent.

Can the Secretary of State reassure the House that he is aware that it takes more than surgeons, welcome though they will be, to perform cardiac surgery? Will he guarantee funding for intensive-care and high-dependency beds and the anaesthetists who will be needed to increase the number of operations being done?

It is not only those members of staff who are necessary, important though they are. We also need cardiac nurses and other back-up staff, who will be extremely important. The hon. Gentleman is aware that if we are to expand the capacity of major services to deal with our country's biggest killers—coronary heart disease and cancer—we require an expansion in the number of staff, including doctors, nurses and therapists. That of course requires an increase in the number of available beds, but as I have said to the hon. Gentleman before, it is pretty easy to get beds; it is harder to get trained staff, and I am afraid that it takes time.

When the National Institute for Clinical Excellence will examine the drug infliximab. [115157]

rose—

What about Gisela? Give her a go.

Order. That is disgraceful, juvenile behaviour. I call the Minister.

We are considering a number of possible topics for appraisal by NICE during the year 2000–01, and an announcement will be made as soon as possible.

Crohn's disease is an extremely unpleasant condition, which is not terribly common but common enough for those who suffer from it. Infliximab, which was licensed last August, appears to be a very effective treatment for many cases. Does the Minister remember the remarks of his right hon. Friend the Secretary of State—then a Minister of State—on 30 June 1998? He said:

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

In preparation for this question, I have endeavoured to establish whether any parts of the country are experiencing problems in the prescribing of that drug for Crohn's disease, and I am assured that in the great majority of health authorities, including Leicestershire, treatment with infliximab is now being funded in appropriate cases. If doubt about that remains, the hon. Gentleman may want to contact me. He will of course welcome the additional £11.3 million of resources that my right hon. Friend the Secretary of State has allocated to Leicestershire today—at least I hope that he will welcome it—because that will undoubtedly enable the health authority to meet a variety of patient needs, including increased drug costs.

What assessment he has made of the effectiveness of private finance for health capital projects. [115158]

The private finance initiative option for every national health service capital investment project must demonstrate that, overall, it is better value for money when compared to the publicly funded alternative, the public sector comparator. Under this Government, 18 major hospital PFI schemes worth nearly £1.4 billion have been approved and are currently under construction. That is the biggest capital investment in the history of the national health service.

My hon. Friend will be aware that approval in principle has been given for a new hospital to replace the Selly Oak and Queen Elizabeth hospitals in south Birmingham. Although there is considerable public support for the new hospital, there is anxiety that the additional cost of private finance could lead to the provision of fewer beds and a reduced service.

We have not yet received the outline business case on the investment in Birmingham to which my hon. Friend referred. However, I hope that I can allay some of her fears about the issues that she has raised. In total, the first wave of major PFI schemes will provide slightly more beds than would have been the case if they had been built under the conventional public capital method.

the promotion of PFI projects has clearly led to a considerable and welcome increase in investment in our hospitals.

The Minister may know that it was private finance alone that built the breast cancer unit at the Glenfield hospital in Leicestershire, and that it was the Secretary of State for Health's predecessor who opened the unit last November. It is now threatened with closure. When will the Minister, on behalf of the entire ministerial team, be able to make a pronouncement about the future of the unit? I appreciate that the magic word "consultation" is being bandied about, but the people of Leicestershire and of the Trent region need to know the Government's attitude towards the future of that hospital.

If changes in services are proposed in the hon. and learned Gentleman's constituency or anywhere else, there must be proper public consultation. If issues are raised in the course of that consultation—for example, if a community health council opposed the service reconfigurations that were being proposed—it would be for Ministers eventually to decide the outcome of that process. We are not there yet, but there will be plenty of opportunity for the hon. and learned Gentleman to raise those concerns with me and my right hon. Friend the Secretary of State in future months.

Does my hon. Friend accept that the public sector route has a vital role to play in rebuilding our national health service, and that we should not rely on private finance initiatives alone? On that basis, may I thank him and the rest of the team for financing the £9.5 million Loughborough hospital, which will start work this summer and is financed solely by the public sector? Will my hon. Friend visit that site, along with the Opposition spokesperson, the hon. Member for Woodspring (Dr. Fox), who visited it recently, to see Labour delivering its health promises?

That is probably an invitation that I shall not be able to turn down, so I look forward to visiting my hon. Friend's constituency. Ultimately, what is important is what works, and what delivers the new investments and the new capital projects for the NHS on time and on budget. The PFI has an outstandingly good record on delivering those projects on time and on budget, but of course my hon. Friend is right to say that a significant amount of investment is still taking place through the traditional public sector capital route, and that will continue to be the case.

I am glad to hear the Minister speak of the 17 per cent. advantage that an average PFI project has. As he has just commented, such projects are also significantly faster than the public sector route. Given that one of his problems with the extra money that he has will be capacity increase, can we look forward to a dramatic increase in the use of PFI to accelerate the increase in capacity in the health service?

We want an expanded role for the private finance initiative. However, what matters not just for the right hon. Gentleman's constituents who are patients of the national health service, but for his constituents who are taxpayers as well, is that whatever route we take and whichever way we deliver new capital investment projects for the NHS, the system provides value for money. The PFI has shown its worth, and we are making sure that it will continue to play that role in future.

I, too, welcome my hon. Friend's comments on the effective use of PFI. What counts is what works. Does he suspect, as I do, that civil servants are sometimes reluctant to consider other uses of private finance initiatives, not just for capital projects but for the shared use of facilities and other imaginative proposals that could allow us to retain vital health services in smaller hospitals, which have sometimes been under-utilised? I am sure that there are plenty of good ideas out there, but I sometimes sense a reluctance to push ahead with them.

I reassure my hon. Friend that we are in the market for new ideas. We are examining all sorts of ways of encouraging the closer partnerships to which he has drawn attention. I am particularly interested in making sure that, in relation to social services, for example, we encourage greater use of the PFI as a route to getting some of the important reinvestment that we need. There is a clear difference, is there not, between the Government, who have delivered that capital investment through the PFI route, and the Opposition, who spent almost 20 years talking about it, but never built a single hospital?

What plans he has to improve access to NHS dentistry. [115159]

rose—

Hear, hear.

I hope that Opposition Members will cheer equally loudly when they see the extra allocation for health authorities.

Is the Minister aware that in large parts of the country it is almost impossible to gain access to an NHS dentist? How much of last week's new money will be spent on trying to reverse that trend?

We now have a record number of extra dentists. In the last 12 months, the number has increased by 480 to 17,746. The real issue, however, is not just the total number of dentists, but their commitment to the NHS. We have accepted all the recommendations of the doctors and dentists review body, which means a 3.3 per cent. increase in dentists' remuneration, along with the package rewarding extra commitment to the NHS. That amounts to some £17 million. In the current year, a total of some £50 million extra will be spent on NHS dentistry.

As my hon. Friend will know, following guidelines issued by the General Dental Council in 1998, the use of general anaesthesia in dental practices has virtually ceased. That, however, leaves the problem of patients who suffer from anxiety which must be controlled. The best method is through sedation techniques, but the British Dental Association has pointed out that not enough dentists are trained in such techniques, and that there are not enough facilities for them to be trained. Is my hon. Friend aware of that, and, if so, can she say what the Government are going to do about it?

I thank my hon. Friend for raising the issue. Because there is some anxiety in the profession, we have set up a review body which will shortly recommend guidelines on the best way in which to proceed.

I want to be kind to the hon. Lady. Will she join me in congratulating South Cheshire health authority on its proposal for a dental access scheme, which is currently out for consultation and which, if implemented—providing a new centre in Macclesfield, and others elsewhere—will dramatically increase the number of people who can gain access to NHS dentistry? Does she agree that healthy teeth can lead to a healthy nation?

I am delighted that, in being kind, the hon. Gentleman did not feel that he had to be cruel first. I hope that he will welcome the extra allocation of more than 8 per cent. to his health authority.

How many accident and emergency departments are being improved as part of the modernisation programme; and if he will make a statement. [115160]

How many accident and emergency departments are being modernised; and if he will make a statement. [115164]

The £115 million capital investment in accident and emergency services is enabling 244 improvement schemes to be carried out in 182 hospital trusts in England.

When considering the modernisation of accident and emergency units throughout the country, will my hon. Friend also consider the role of the ambulance service?

My hon. Friend is right: the modernisation review, examining the way in which patients are treated in accident and emergency departments, must go much further, and ambulances play a vital role. As well as giving extra money to the ambulance service and implementing the modernisation programme, we are piloting schemes in parts of the country to separate category C calls, which are less urgent, from those involving the patients in greatest need. We want to ensure through NHS Direct that the ambulances that are needed most urgently to take such patients to accident and emergency units are used as effectively as possible.

Labour Members welcome the improvements to accident and emergency units. However, we are not simply considering facilities. Anyone who has recently visited an accident and emergency unit must be aware of the tremendous pressures on staff. What is the Minister doing to help the people whom we employ in accident and emergency units?

My hon. Friend is right to say that as well as modernising the processes in accident and emergency units, we must recognise that our most valuable asset is the staff. Last October, we published a joint initiative with other Departments to support all hospitals in preventing violence, including attacks on staff. I recently visited Sandwell health authority, which has launched a successful anti-violence initiative. One of the most pleasing aspects was the announcement by the chair of the local bench that an assault on national health service staff would be considered an aggravating factor by magistrates sentencing in that area.

rose—

Order. Time is up. I hope that the hon. Member for North Shropshire (Mr. Paterson) is happy, as he has heard a great deal from the Minister now.