If he will make a statement on waiting times for surgery during the period from November 1999 to February 2000. [119054]

Average waiting times for operations are now lower than when we came to office. The waiting list figures for December and January reflect the fact that, as planned, the national health service gave priority to emergency cases. Waiting lists fell again in February and we remain on track to achieve our manifesto commitment to reduce waiting lists by 100,000 from the level that we inherited.

In February, the Secretary of State said that he would eat his hat if priorities in Shropshire were different from those in previous winters. Dr. Ian Rummens, secretary of the local medical committee, has written to me with numerous cases, some of which show that at times no beds at all were free in Shropshire this winter, even though there was less flu than usual. Even heart attack patients were turned away. Given this, will the Secretary of State please apologise, investigate these cases and go to a public place and eat his hat in penance?

As I said to the hon. Gentleman at the time, I do not normally wear a hat—probably just as well. As for his allegation, he is simply wrong. He knows fine well that this year, just as in previous years, the NHS did the right thing. It put emergency cases first, and if that meant cancelling elective work that was the right thing to do. It was not a distortion of clinical priorities, but the right clinical priorities. It is the hon. Gentleman who should withdraw his allegation, not the Government.

I was pleased to welcome the Secretary of State to Wexham Park hospital in my constituency this morning. Will my right hon. Friend use this opportunity publicly to congratulate the hospital on reducing by 1,700 the number of people waiting over the past two years, and on ensuring that three quarters of patients are treated within three months? Can he keep giving that hospital the resources that will enable it to modernise and to continue its good work?

I am very pleased to join my hon. Friend in welcoming the excellent work that is undertaken at Wexham Park hospital. I had the pleasure of visiting the hospital this morning with her and my right hon. Friend the Prime Minister. I pay tribute to the work that my hon. Friend does with the hospital and, indeed, with the local trust and the broader local health community. The hospital is achieving results on the basis of a clear foundation of partnership between clinicians and managers and on the basis of the extra resources that we are investing in the national health service. I give my hon. Friend this undertaking: we will continue to invest those resources year on year to give patients the sort of modern, dependable health care that they deserve.

What does the Secretary of State have to say to the widow of Bill Fox, who died, aged only 62, following a heart attack during the period referred to in this question? Sheffield health authority told him that there was no money to find the replacement for his outdated heart valve, but failed to warn him of the risk that such a delay might cause, or to give him the possibility of going privately, which might have saved his life.

I say to the hon. Lady and to the gentleman's family that it is precisely because of those sort of cases that we place such priority on tackling coronary heart disease and improving access to heart surgery for patients when they need it. That is why we have already invested extra money to provide more heart operations—an extra 3,000 operations over the next few years. It is why, incidentally, we have provided Sheffield health authority with cash increases of more than 8.7 per cent. in this financial year alone.

I am pleased to tell my right hon. Friend that the ophthalmology department at the Royal Bolton hospital has become a centre of excellence. It could get its waiting list down even further and take on extra cases if it could get the theatre time. Will my right hon. Friend therefore look favourably on the bid that the trust has made for a designated theatre for eye operations?

How could I resist? I shall look very closely at the bid that my hon. Friend's trust has submitted. It is very important to use all the capacity that is available to the NHS so that we can reduce waiting times for patients. We are getting the waiting lists down and, as we know, reducing waiting lists reduces waiting times too. In particular, we are prioritising operations that are regarded by patients as urgent. Cataract operations are precisely those sort of operations. They are largely the operations of old age, and we are shortening the waiting times for them. Incidentally, they are the sort of operations that would be taken out of the NHS altogether if the Conservative party had its way.

What estimate he has made of the number of patients who have left NHS waiting lists as a consequence of having paid for their treatment in the private health care sector since May 1997. [119055]

What proportion of the decline in NHS waiting lists he estimates is attributable to patients having secured treatment from the private health care sector since May 1997. [119068]

The decision to seek treatment as a private patient, for whatever reason, is a matter for the individual. We have no data on the number of patients who have left NHS waiting lists and chosen to seek private treatment as an alternative.

Let me give the Secretary of State some data. My constituent, Mr. Charles Scott, who lives in Hordle, suffered from atrial fibrillation for a number of years. In despair of the waiting list, and because his attacks were becoming more frequent and debilitating, Mr. Scott sank £12,000 of his savings into having a pacemaker fitted. Since then, he has received from Customs and Excise a demand for more than £1,000 in value added tax payable on his pacemaker. That cannot be right, or is it what is meant by Labour's double whammy?

I remind the hon. Gentleman that it is not my party's policy to force patients to leave the NHS and pay for private treatment. That is, in fact, his party's policy. If he has a concern, he should take it up with the hon. Member for Woodspring (Dr. Fox), who told his party conference last October:

What we are starting is perhaps a Trojan horse for private medical insurance.

I think what we are proposing could revolutionise private insurance in the way we revolutionised pensions in the 1980s.

Philosophically we have moved on. Insurance companies could cover conditions that are not high-tech or expensive, like hip and knee replacements, and hernia and cataract operations, which currently involve long waiting times.

Given that Austria, Finland, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain and Sweden all spend proportionately more on health than we do, and given that a larger share of their expenditure derives from the private sector—often, indeed almost ordinarily, voluntarily—why does the Secretary of State not understand that his refusal to contemplate a bigger private sector contribution is blinkered, irresponsible and a betrayal of the very patients whom he is paid to serve?

I welcome the hon. Gentleman back from his break, which has obviously done him a power of good. There is a world of difference between the NHS paying the private sector to provide patients with care for free and the policy suggested by his party, which is that patients should be forced out of the NHS and should pay for their own care. That is precisely what the Tories advocate. The hon. Member for Woodspring advocates it, and so does the hon. Member for Buckingham (Mr. Bercow). However, he and his constituents should be aware that the operations that the Conservative Front-Bench team would take out of the NHS altogether are precisely those that involve old age—hips, knees, cataracts. Conservative policy amounts to a new tax on old age, and pensioners will reject it.

Is the Secretary of State not astounded by the Conservative party's hypocrisy on the NHS? The Conservatives claim that they want the NHS to deal with serious, life-threatening illnesses, but they would force my constituents to have private operations. It may not mean much to Conservatives if they have to pay £5,500 for a hip operation, but that is far too much for my constituents to pay.

My hon. Friend is absolutely right. The elderly are the very people who most need health care and can least afford private health insurance, yet it is their operations that the Conservatives want to force out of the NHS. Judge the Conservatives not only on their record—cuts in bed numbers, cuts in nurse numbers, cuts in NHS funding—but on what they promise for the future. They want treatment not according to clinical need, but according to ability to pay. The Conservatives offer patients only one guarantee for the NHS—an NHS that is not modernising, but privatising.

Can my right hon. Friend say what the Government have done so far to hurry along surgery for knee and hip operations? Can ordinary people afford large sums for private surgery on their joints? What does he hope to do to help older people who cannot afford private surgery?

We are trying to get waiting times down for precisely that sort of operation. Indeed, as we get the lists down, so waiting times go down too. It is obviously important that people do not have to wait, sometimes in pain and discomfort, for a long period before they receive treatment.

Given that the Secretary of State's defence in this matter is that the service is giving priority to emergency cases, what does he have to say to my constituent, Miss Kerry Wort of Totton, who, last December—at the very time he claims that emergency cases were being given priority—was told that she would have to wait 10 months for an emergency kidney operation, and that that wait would mean that she would lose the whole kidney, whereas if she could have had the operation sooner, she would save the kidney? She was, of course, forced off the list and had to use £5,000 of her own money to get the same operation from the same surgeon privately, three days later. If that is the Government's idea of emergencies receiving priority, they are not even delivering on that.

It is precisely so that patients avoid the invidious choices that they are sometimes forced to make that we are trying to get down waiting times and waiting lists. We are doing that by investing more cash in the national health service and modernising the way that it works. I wish that the hon. Gentleman and his party would have the courage of their convictions. Before the Easter recess, the Opposition had the opportunity to back their apparent commitment to match our spending on the national health service by supporting our proposal to increase tobacco taxation and to earmark the proceeds for the NHS. At the very first test, they failed. They failed to put their money where their mouth is, because their commitment to the NHS is, I am afraid, not what it was in the past.

Last week, when I was canvassing, I met a constituent—an elderly woman—who had been forced into paying £7,000 for a hip replacement operation. However, my constituent was clear about who was most to blame for that—the Conservatives, for their previous underfunding of the NHS. Will my right hon. Friend confirm that the £800,000 allocated to Milton Keynes general hospital as its share of the extra money announced in the Budget to deal with waiting lists is a much more effective way of ensuring that no more of my constituents feel forced to go private than the Opposition's proposals?

My hon. Friend is right. The extra resources that we have already committed to the NHS are allowing services to be modernised. They are a once-in-a-lifetime opportunity to speed up treatment and care for all patients in the NHS—not just some patients, but every patient. Nobody pretends that that is easy or that it can happen overnight; of course, it cannot—not least because we have to recruit the extra staff and build the extra capacity that the NHS needs. However, we have the opportunity to do that because the Government have put their money where their mouth is: we have backed our commitment with real cash. We have done that because we believe in the NHS. We believe that the NHS can work—it can be sustainable; it can modernise and can offer patients the fast and convenient services that they want in the 21st century.

What data his Department receives from hospital trusts on the number of nurses each employs. [119056]

The Department receives information from national health service trusts on all nurses employed as part of the annual non-medical work force census. The census contains details of area of work, hours worked, age, gender and ethnicity. Data of that sort enable us to know that, in the year until last September, the number of nurses employed by the national health service increased by 5,580.

I thank the Minister for that information, but it is a great pity that some of the nurse numbers that he mentioned have not made their way to the Blackpool Victoria hospital, which has, since 1997, been struggling with a shortage of nurses. Thankfully, it appears that that problem is being solved, but in making its case for greater nurse numbers, the trust had difficulty in obtaining comparative benchmark nurse numbers from other local hospitals to help it to make its case to the North West Lancashire health authority to ensure that nurse numbers and activity moved upwards together. What assurances can the Minister give me that that problem will not occur again?

The right hon. Gentleman says, rightly, that the problem is being tackled. Indeed, as the House meets, a meeting is taking place between Blackpool Victoria hospital and the health authority to consider nursing numbers, and I understand that there are proposals for additional funds for additional nurses to meet that hospital's needs.

Understandably, the Government are claiming to have brought more nurses back into the profession, which is very welcome, but are they not concerned that there are still nearly 15,000 vacancies? As they look forward to the future, are they not concerned that things might get considerably worse before they get better, given the new emphasis that they have been placing on intermediate care and caring for people in the community? Are they not concerned that the age profile of community nurses, occupational therapists and health visitors—some of the very professions on whom the burden of caring for people outside hospitals will fall—is very top-heavy, and that there will be a real problem of recruitment in those areas in the next few years? What further steps will the Government take to increase dramatically the number of nurses entering the profession and to reform the pay and conditions to keep the people who are already there?

The work force needs of the new, modern national health service is one of the key issues to be addressed by the modernisation action teams set up by the Prime Minister following the Budget announcement. They will obviously address the numbers of staff that we need and the expanded roles that we want nurses and other health professionals to take on board.

The Secretary of State said earlier that it was essential to use national health service capacity to the full. Does he agree that one of the great bottlenecks is the shortage of nurses trained for intensive care, because that ties up an awful lot of people in bed blocking when they should be out and about?

The hon. Gentleman is absolutely right. We did increase the number of critical care beds last winter, but there was still significant pressure on the national health service. I believe that the national health service, and the trusts and hospitals within it, know that we need to do more to address that problem in the coming winter. Obviously, one of the issues that the health service is now looking at actively throughout the country is the need to ensure that we have more trained intensive care nurses.

What steps he is taking to strengthen the system for representation of patients' views in the NHS. [119057]

The patient care empowerment modernisation action team and the wider consultation exercise with patients and the public on the national plan will develop and strengthen the representation of patients' views in the national health service.

We have excellent hospitals in Portsmouth, but concerns have been expressed to me, mainly by elderly patients. They need more care, and extra effort must be made to ensure that they understand their rights. There is some confusion, so will the Minister make that extra effort to ensure that elderly patients and organisations that support them, such as Age Concern, understand their rights?

We are committed to developing a service that is sensitive to patients' needs. As part of the national plan development, we shall consult regionally and locally and ensure that all representative groups have an opportunity to comment and feed in their opinions. In addition, the action teams have considerable patient representation, which we hope will cover the whole spectrum of needs. We shall, of course, pay particular attention to the needs of the elderly within that framework.

Is not the best means of representing patients' views the right of their GP to refer them to the hospital of their choice? Why, therefore, have the Government effectively curtailed that right, and not even mentioned it in the circular on out-of-area treatments? What is the Minister's response to the president of the Royal College of Surgeons who, in last week's New Statesman, said:

It is terribly important that a GP can refer to the appropriate specialist centre. Yet the new system…makes that more difficult. That is very disappointing and not right for the highest standards of patient care…?

I do not agree that the right of GPs to make referrals has been restricted in a way that will adversely affect patients' treatment. It is absolutely important that we end up with a system in which patients see the right doctor at the right time in the right place, and many of the modernisation programmes are geared towards that. That means that there must be some reconfiguration of services, but I do not agree that the system of GP referral is in any way under threat.

Will my hon. Friend join me in congratulating community health councils on the work that they do to represent patients and inform them of their rights? Does she agree that with more resources they could do much more work and represent many more patients?

Community health councils have an important statutory function, but some groups of patients and parts of the community may not have a sufficiently well-structured input into service reconfiguration. We are keen to broaden that base and to involve the community health councils. We want to build on the model of CHCs in certain areas that have been very innovative, and we should recognise their role in involving the local community and build on that success.

Given that one of the roles of the House is to ensure that the rights of the weakest and most vulnerable are protected, what specific plans does the Minister have to improve representation for the mentally ill? In the light of yesterday's announcement, what specific ideas do Ministers have about advocacy for the elderly in the health care system?

It is, of course, extremely important that the most vulnerable have the greatest protection. The advocacy system is being examined as part of the national plan for development of patient empowerment, which can mean empowering individual patients themselves or their carers or those who speak for the patient. That remit also includes the mentally ill.

The Minister might like to write to me with a fuller answer, which can be put in the Library, as this issue is obviously important to hon. Members on both sides of the House. I welcome yesterday's announcement and the Government's conversion to a public-private partnership in rehabilitation of the elderly, but what representations can patients make in such a system of treatment, and what say will they have? What safeguards will be put in place to guarantee minimum standards of care? Given that NHS treatments are subject to the Commission for Health Improvement, what changes will be required to the Care Standards Bill as a result?

The hon. Gentleman's question rightly covers a range of issues, which I shall take one by one. Mental health patients will be taken much more into care. We have spent an extra £100,000 on NHS Direct for a special line for mental health service patients. The Care Standards Bill will strengthen services within the social care sector. As for evidence of greater involvement, I ask the hon. Gentleman to wait for the national plan, which will shortly be published. It will refer to real actions rather than aspirations.

A few moments ago, my hon. Friend referred to the important work of community health councils. Will the Government ensure that the councils can represent patients' views at local level? It is essential that they remain local and do not become remote, which is what the previous Government were threatening.

It is absolutely essential that representation and consultation always take place at local level. That is why we are strengthening the role of health authorities and considering closely ways of broadening the base of that representation, which may not always be through the community health councils. The councils play a vital statutory role and we are committed to widening their base, but always with a focus on local delivery and local input to serve local patients.

What steps he is taking to ensure that IVF treatment is available throughout the country. [119058]

The decision to provide specialised infertility treatment is one for individual health authorities. This decision should be taken in the light of local needs, available resources and clinical effectiveness.

With that answer the Minister confirms that postcoding exists when it comes to this form of treatment. Does she agree that that is unfair on a couple in my constituency—hence my question—who are being deprived of the service, whereas if they lived in another part of the country, it would be available to them? Surely the Government should insist on fairness throughout the country. We must end postcoding.

We are very concerned about the postcode lottery in care, which is a legacy from the previous Government. The internal market perpetuated a postcode lottery and a money lottery. We are taking action to tackle the postcode lottery, including setting up the National Institute for Clinical Excellence and the Commission for Health Improvement and referring important cancer drugs to NICE. We shall build on this in future. We shall publish shortly a survey of IVF provision throughout the country to inform local decision making.

What plans he has to review the formula for distribution of funding between health regions and individual health authorities to take account of the impact of poverty on health. [119059]

On 24 March 1999, my right hon. Friend asked the Advisory Committee on Resource Allocation to undertake a wide-ranging review of national health service resource allocation.

I think that it is common knowledge that people in constituencies and cities such as mine are among the poorest in the country. As a result, they live shorter lives, which are punctuated by more frequent episodes of ill health. Does my hon. Friend agree that the last thing that my constituents need is another Conservative Government, who would widen the gap between the poor and the better off, and would ask my poor constituents to pay for health care? Does he agree also that the time for redistribution to ensure that health funding matches health need is now, when the Government are putting record sums of money into the health service? That process would make things much easier for everybody else.

I strongly agree with my hon. Friend. There is little doubt that it would be a disaster for the people of Manchester if the Conservatives were ever returned to office to implement the policies that they are proposing for the national health service. We should not forget that the Tories found it impossible to use the two words "health inequalities". We recognise that there are serious health inequalities in our society, which continue to scar communities throughout the country, including those in Manchester. My hon. Friend will be aware that, thanks to the measures that we have taken this year, an additional £30 million is going into the NHS in Manchester. In addition, Manchester is a health action zone, which is being supported by nearly £12 million of additional resources. His constituents face serious challenges. We are determined to rise to them, but the Conservative party would not.

Does the Minister appreciate that some of the longest waiting lists are in Surrey, where the length of the waiting lists has led to the effective dismissal of the chief executive of the East Surrey hospital for her political failure to meet, within the resources made available to her, the political targets imposed on her? When reconsidering the formula, should the Minister not bear in mind that the effective increase in Surrey will be less than 2 per cent. in real terms? Therefore, there is no confidence in Surrey that the money made available to Isobel Gowan's successor as chief executive will be sufficient for him to be able to carry out the task that the Government have set him.

The hon. Gentleman usually does his homework meticulously, but I am afraid that he has not done so on this occasion, if he wants to check allocations to the East Surrey health authority for this year, he will find that it will have a cash increase of 8.26 per cent., which is a real-terms increase of 5.62 per cent. Uncharacteristically, he is quite wrong about these matters. This Government, unlike the one whom he supported, are determined to ensure that we have a genuine national health service that provides high-quality care right across the country. That, I am afraid, was not the legacy that we inherited from the previous Administration.

Will my hon. Friend bear in mind that there are inequalities in health care not only in inner cities, but in constituencies such as mine where people in wards such as Bewsey, Poplars and Hulme suffer much higher rates of debilitating long-term illnesses than the areas that surround them? Will he also bear in mind that people in such wards have never been able to buy private health care because they simply could not afford to? That is why the private wing in the grounds of Warrington hospital went bust. When he considers future allocations, will he ensure that the areas that I have mentioned receive their fair share of resources, which they were denied during 18 years of Tory Government? Will he look favourably on the application of Warrington hospital to use the Daresbury wing to provide orthopaedic facilities for all the people of Warrington and not just for those who can afford to pay for them?

We shall certainly consider that, and I agree with my hon. Friend about many of the points that she made. I tried to emphasise that we want a system that guarantees fairer funding right across the national health service, which was not the case with the arrangements left in place by the previous Administration. She is right to draw attention to deprivation and health inequalities in her constituency and such problems are found all over the country. Unlike our predecessors, we are determined to ensure that the NHS provides high-quality care and improves at a faster rate the health of those who live in the poorest and most deprived parts of the country.

How much of the £150 million committed from the new opportunities fund to combat cancer has been distributed. [119060]

Some £116.25 million from the new opportunities fund has been made available for cancer services in England and £93 million of that has already been allocated across the country for new cancer equipment. A further £23.25 million will be spent on palliative care and support and information services. Successful applicants for this money will be announced in September 2000.

Does not the Minister, in her heart, agree that state health care should be funded by Government money and not by lottery money? However, is she aware that, if we are to have such funding, although that £150 million was trumpeted with fanfares and welcomed by the Prime Minister and the previous Secretary of State for Health, Leicestershire health authority is having to make a bid for a health care initiative for disadvantaged communities? Would it not be better to provide a CT scanner that would benefit all the people of Leicestershire than to have such gimmicks?

I strongly agree with the way in which the new opportunities fund is being spent, and I think that the people of Britain also agree. They would certainly far rather have the money spent on important cancer equipment than on the Churchill papers. I am proud that the money for palliative care is being spent on disadvantaged communities, because this Government, unlike the previous one, are committed to tackling health inequalities and the unfair lottery of care across the country.

Is the Minister aware that the director general of the Cancer Research Campaign will give evidence to the Select Committee on Science and Technology tomorrow that the use of Temodal, the revolutionary brain cancer drug developed by Cancer Research Campaign's own scientists here in Britain, is eight times higher in Germany than in Britain, five times higher in Italy, three times higher in France and twice as high in Spain and Greece? Against the backdrop of the Government's rhetoric of priority to cancer services, does the Minister consider it acceptable that a world-class cancer drug developed in Britain with voluntary contributions made by the British people should be freely available in other EU countries, but available to only one in four of British patients who could benefit from it?

We take seriously the lottery of care across the country with regard to cancer drugs, which is why we referred the taxanes to NICE as a matter of early priority. We will shortly make an announcement about the next wave of cancer drugs to be referred to NICE, and Temodal will be one of those drugs.

If he will make a statement on the pay of medical laboratory staff working in hospitals. [119061]

For the first time, we have offered all medical laboratory scientific officers—MLSOs—a guarantee of rises above projected underlying inflation, not just for one year, but for three years. In addition, trainees have been offered increases of up to 26 per cent. for last year, all MLSOls have been offered 7.1 per cent., and we have offered to increase the minimum national starting pay for MLSO2s by 7.1 per cent. If accepted, all that would be backdated to 1 April 1999. We are also discussing positively with the NHS trade unions proposals to reform and modernise NHS pay, as we outlined last year in "Agenda for Change".

When I recently visited the pathology laboratories at St. James's hospital in my constituency, I met staff there who are committed to the work that they are doing, but concerned about the reward that they receive for that job, and about the difficulties that they face in recruiting adequate staff. I welcome the step that the Government have taken to recognise that problem through "Agenda for Change". Can my hon. Friend tell the House how soon he expects proposals to be forthcoming so that those staff, a vital group of backroom staff in the NHS, receive the reward that they feel is long overdue?

We are making good progress with the NHS trade unions, and I hope that we continue to do so. We hope to reach broad agreement about how the proposals would be implemented this summer or later this year. They would then have to be implemented effectively and properly by NHS employers throughout the country. On our side, we are determined to make good progress with the trade unions and, with good will on their side, I am sure that we can do that.

I welcome the Minister's announcement today. Does he accept that there is still a pretty wide disparity in pay between medical laboratory staff and other professionals in the NHS, particularly after four years' service, when the disparity is about £4,000? Does he agree that there is an overwhelming case for medical laboratory staff to be included in pay review body reports?

As I should have said earlier, I pay tribute to the work done by all our medical laboratory staff, to whom hon. Members on both sides have referred. They do a tremendous job and are a key part of the health team. With regard to the disparity in salaries between those jobs and other professions, any existing disparities certainly did not begin to emerge over the past three years, but are a much more long-standing part of the pay system. It is possible, and it is envisaged in "Agenda for Change", that some professional staff groups might become members of the pay review body system. It is too early in the process to have reached agreement on which groups those might be. That is part of the overall package of measures that we are negotiating under "Agenda for Change" and on which we are keen to make progress in the next few months.

The Minister knows that there is a crisis of confidence in the laboratory service and a major problem with recruitment and retention. Why will he not give the simple undertaking, which the Conservative party is happy to provide, that in future all medical laboratory staff will be included in the full pay review structure?

The hon. Gentleman is unbelievable. His party was in power for 18 years and had the opportunity to implement his proposal. That the hon. Gentleman makes such a suggestion without prior notice or discussion shows that nothing that he says can be taken seriously. We have made it clear that some professional groups can join the review bodies. However, that needs to be part of a negotiated package of changes to the national health service pay system, which will benefit not only staff but patients. The hon. Gentleman's proposal to announce one part of the negotiation as Opposition policy is not credible. He shows no understanding of what is necessary to provide a modern pay system for the national health service.

What steps he is taking to improve facilities for identifying and treating those suffering from osteoporosis. [119063]

The Government take osteoporosis very seriously. Significant progress has been made in highlighting the importance of preventing osteoporosis and resulting fractures since the launch of the national strategy in June 1998. That provides a solid foundation for health authorities to develop local strategies. The Government expect to publish the national service framework for older people in the autumn. That will focus on areas of greatest concern to older people including falls and fractures partly in the context of osteoporosis.

I thank the Minister for that hopeful answer. The cost of osteoporosis amounts to £4 million a day because of fractures. Will the Government provide specific funding for primary care groups to manage osteoporosis, especially for elderly people?

The causes and treatments of osteoporosis are complex. Medical conditions that result from osteoporosis, such as fractures, are fully funded and treated by the national health service. Several health authorities have adopted a strategy for prevention. Primary care trusts will continue to receive basic guidelines, which will be taken up with more enthusiasm in some areas than in others. To be frank, the response in some areas has not been as encouraging as we would wish.

The Minister has been candid. Why do differences exist in the response to the serious matter of osteoporosis in various parts of country?

When local health authorities decide priorities, prevention of osteoporosis may be higher on the agenda in some areas than in others. However, the national health service framework for the elderly and the Care Standards Bill will highlight osteoporosis and prevention. Prevention is a long-term issue, and our strategy includes work on better nutrition because vitamin D deficiencies and an unhealthy life style can cause osteoporosis. Health action zones have taken up those matters, and we are dealing with the differences in several ways.

The Minister rightly referred to the importance of prevention of osteoporosis. Has she had time during the recess to assess the evidence that shows that light gardening by the over-50s can prevent the onset of osteoporosis?

If the hon. Lady wants me to support gardening and exercise in the open air as measures to prevent osteoporosis, I am more than happy to do so.

What discussions he has had with Trent regional health authority about the building of a new breast cancer unit at Nottingham City hospital. [119064]

The national health service executive's Trent regional office is working with Nottingham City Hospital NHS trust to take forward its proposal for a new breast care centre. The case is considered to be of high priority by both the regional office and the Nottingham health community. The project will be considered by Ministers, along with other priorities, when the capital allocations for the next year are announced shortly.

Is the Minister aware that the development of a new breast cancer unit at Nottingham City hospital is a huge local priority? I have visited the breast cancer unit and the work of Professor Blamey, Dr. Robin Wilson and the staff is well appreciated by the local community, but for too long they have had to work in substandard accommodation. With the extra money that we have made available, there are high hopes that they will soon have the first-class accommodation and facilities that they should expect for the first-class service and professionalism that they provide at the hospital.

I shall certainly take on board the points that my hon. Friend makes. He has been a strong advocate for the new breast care centre and I can tell him that the regional office and Ministers will note his argument that it is considered to be a regional priority. We shall bear what he says in mind when we make a decision.

If he will make a statement on his plans to regulate and inspect domiciliary care agencies. [119065]

The Care Standards Bill will introduce a new regulatory framework for home care services. We have amended it to ensure that all domiciliary care agencies—not only those contracting with local authorities—will be required to register and be inspected annually by the National Care Standards Commission. A consultation version of the proposed regulations and standards will be published later this year.

I welcome what my hon. Friend says about including all domiciliary care agencies in the proposed regulations, but can he provide an assurance on domiciliary care workers in particular, many of whom do an excellent job, provide a high standard of care and enable people to remain in their homes, which is usually their choice? Sadly, there have been cases of care workers abusing or taking advantage of the people for whom they care. Will the regulations take into account not only quality of service, but the recruitment and training of staff employed by the agency?

I can give my hon. Friend that assurance and she is right to say that enabling more people to stay longer at home is one of the principal objectives that we have set for social services. If we are to succeed, we need higher-quality domiciliary care services. A key part of that is making sure that the right people with the right training and the right supervision are employed in domiciliary care agencies. I give her an absolute assurance that, as we develop those new national standards, we will put a premium on ensuring that domiciliary care workers are properly vetted, trained and supervised in future.

During the drafting of the domiciliary care regulations, will the Minister consider the difficulties that many private sector providers of such services face with the contracts and spot contracts that they are being given by local authorities? They are set at such unrealistically low prices that even now they find it difficult to provide a quality service: we know that many are leaving the residential sector and are beginning to abandon the provision of services at home. Insufficient resources are being allocated to guarantee the quality that he and I both want to be provided.

I will consider the point that the hon. Gentleman raises, but I remind him that social services are being resourced at a record level. There is a significant increase year on year—more than twice the rate of inflation is going in—but how local authorities decide to use those additional resources and the rates at which they contract are matters for them. We have made it clear that we do not want rates to be set mechanistically, but we will look into those issues. I am sure he agrees that we need high-quality domiciliary care and residential care services and we expect local authorities to make sure that those services are available locally.

What assessment he has made of the nature of the relationship between poverty and heart disease. [119066]

Poverty is a major cause of heart disease. The poorest working-age men are 50 per cent. more likely to die of coronary heart disease than men in the overall population. That is why one of the key objectives of our new national service framework for heart disease is to tackle inequalities in the incidence of the disease, and access to services dealing with it.

I thank my right hon. Friend for his reply. We are now more hopeful that we will get to the bottom of illnesses caused by poverty, particularly heart disease. Does my right hon. Friend think that health action zones will give information on the relationship between heart disease and poverty? By the way, the Sheffield hospital for women is on song, on target and on price.

As always, my hon. Friend brings good news.

The Secretary of State has identified a disturbing connection between poverty and the high incidence of heart disease. How can he justify the proposed closure of Harefield hospital in my constituency, which caused a petition with 100,000 signatures to be lodged at Downing street last Wednesday, and gave rise to a procession led by an eight-year-old former patient who had been given a double transplant? Does not a hospital such as Harefield—unlike one in central London such as the Paddington hospital that is proposed for the future—offer an ideal location for poorer people? Their families— and they, as out-patients—can stay, at a reasonable price, in an accessible area. Harefield is the ideal locational hospital. Will the Secretary of State think again?

I think the hon. Gentleman knows that consultation is still taking place on the future configuration of acute hospital services in that part of London. Let me place on record my tribute to the part played by the hon. Gentleman's right hon. and noble Friend Lord Newton in leading some of the discussions about the best make-up of hospital services in the area. I can go no further than that today, but I will consider carefully the concern expressed by the hon. Gentleman and others.

What additional funding is being made available to health authorities in the south-east of England to facilitate the ending of mixed-sex wards. [119067]

Nationally, we are aiming to invest a total of £2.6 billion in NHS buildings and equipment for this year, part of which will be used to address on-going work to eliminate mixed-sex accommodation. The south-east received about £191 million of the £1.9 billion allocated so far. Of that, about £4 million will be specifically invested this year to help to eliminate mixed-sex wards.

In August 1997, Lady Jay threatened:

Any health authority which tells me it is unable to get rid of mixed sex accommodation within the next two years will have to have a very good reason.

Unlike the previous Government, who expressed the intention of phasing out mixed-sex wards, but never set any targets or introduced any monitoring to establish what was happening on the ground, we have set the target of eliminating the number of such wards by 95 per cent. by 2002. There is no reason to assume that we will not meet those targets. We could not set a target of 100 per cent., because, as the hon. Gentleman will know, major capital projects involving huge investment and rebuilding in five hospitals in his area mean that that target must be met slightly later, which is right and appropriate. However, the 95 per cent. target—progress on which we are monitoring, and can prove—still stands, and we will meet it.

What action he is taking to improve the delivery of drug rehabilitation programmes. [119070]

Action to tackle drug abuse is one of the key issues set out in the national priorities guidance for health authorities, which was issued last year. Drug rehabilitation forms part of our cross-government strategy on drug abuse. Better performance management and guidance on optimum models of care will ensure that more people get into treatment that really works, including residential rehabilitation. We are backing that with extra resources.

I thank my hon. Friend for that answer. Does she agree that one of the principal barriers to the effective working of drug rehabilitation units is the acute shortage of trained and experienced drug rehabilitation workers? What action are the Government taking to deal with the shortage of staff throughout the country, but particularly in some of our inner-city communities?

My hon. Friend is right. We are giving £70 million of additional resources to health authorities and local authorities over the coming three years, in addition to developing the national guidance to improve capacity, but one of the key issues is the work force, which is why we have launched a national recruitment campaign aimed at those who are not involved in drug treatment work. So far, we have received an extremely strong response.