If he will make resources available to ensure that children's hospices receive the same level of funding as other hospices. [127508]

Children's hospices are on the same footing as adult hospices. We are increasing the resources available to the national health service across the board, and we expect local areas to put in place palliative care strategies; that includes support for children, and families too.

I do not think that that is quite the case—far from it. In fact, Derian house, based in Chorley, does not get the same funding as an adult hospice would. All that we are asking for is equal funding. Quite rightly, my neighbour, Mr. Leo Duffy, who is the treasurer to Derian house, came to see me and asked me why children's hospices do not receive the same amount. I could not give him an answer, but I promised that I would raise that with my hon. Friend the Minister. I do hope that we can change the situation and that funding can be found, especially as children's hospices—particularly the one in Chorley— take children from all over the country, and therefore the burden should be spread and there should be direct funding from the Government.

It is a matter for local commissioners to develop palliative care in each area and to set up appropriate commissioning arrangements. We expect that to include support for children as well as for adults. We are aware that, where children have illnesses that are life-threatening, there are specific additional needs for support for such children and their families. That is exactly why we have introduced the Diana's children's community nursing teams, who often work with hospices to provide extra support directly for those children and families in need.

As chairman of the all-party parliamentary hospice group, I am aware that not just children's hospices but many other hospices are finding it extremely difficult to meet their revenue costs mainly from voluntary subscription, and that some are facing serious financial problems. Will the Minister undertake to review the resourcing from the Government for hospices, to ensure that they remain viable and continue to provide such a worthwhile service in our community?

We recognise the huge contribution that the hospice movement makes to palliative care. We have identified the need for more systematic support for palliative care, especially for cancer; that is why Professor Mike Richards is currently developing a supportive care strategy for palliative care that includes suggestions of how we can improve that across the board.

If he will make a statement on the role of the Commission for Health Improvement. [127509]

If he will make a statement on the role of the Commission for Health Improvement. [127511]

The commission's role is set out in section 20 of the Health Act 1999. The Commission for Health Improvement is the health service's first independent inspectorate. It began its programme of hospital reviews last week. The commission will help to raise standards in all parts of the NHS as part of the Government's drive to tackle unacceptable variations in performance across the NHS.

As a Member of Parliament representing an area where postcode medicine is at its worst, I welcome that statement by my right hon. Friend. Does he agree that users of the NHS attach much more importance to the raising of standards within the NHS than they do to the policy of the Conservative party, which is to promote private health insurance and the use of the private sector?

My hon. Friend is right. The country has a fundamental choice to make. The Conservatives seem to have made their choice. The hon. Member for Woodspring (Dr. Fox) confirmed in the House last week—and on television earlier last week—that their policy is now to contemplate spending about £468 million on subsidising people who already have private health insurance, in company-based schemes, out of the taxpayer's pocket. I believe that it is also the case that, earlier this year, the hon. Gentleman and, indeed, the Leader of the Opposition explored the possibility of the taxpayer subsidising individuals who had private health insurance policies. The deadweight cost of that alone would come to £1 billion. That is more than the costs of this year's nurses' pay rise and of the modernisation, in which we are investing, in casualty departments in every part of the country.

Will my right hon. Friend ensure that the commission raises standards in such a way that it will be impossible for the Conservative party to introduce a two-tier system in the national health service and, more important, for things such as hip replacements and so on; and that it will ensure that the private sector, as supported by the Conservative party, will not get a foot in the door?

The Commission for Health Improvement has a very important role to play in the NHS. Although regrettably the Opposition voted against the establishment of the commission in the Health Act 1999, many people agree that it is about time that we had some form of independent inspectorate for the national service. We all know from our constituents that the quality of care, standards of service and even the services on offer vary immensely according to the part of the country in which people live. That is unfair and it has to change. One of the ways that we can best do that is through an independent inspectorate such as the Commission for Health Improvement.

Does the Secretary of State accept that what drives up quality in most services is not just inspectorates—important though they are—but the choice of users within the service? Are we not fighting with one hand tied behind our back by depriving users of the national health service of choice between different hospitals? Should not that choice be restored?

I have heard the right hon. Gentleman make such comments before both in this place and in the articles that he has written for newspapers. We have made the point before that he is wrong. In fact, if he cared to examine the history of choice in the national health service, he would know that, prior to the introduction of the Conservatives' internal market in the early 1990s, there was freedom to refer for individual general practitioners. Unfortunately, the internal market mechanisms, and particularly the establishment of GP fundholding, meant that that choice was denied to 50 per cent. of GPs. We have restored the right to refer, because every primary care group now has the choice of where best its patients should receive the care that they need.

The Government have announced plans for a proper watchdog for independent hospitals—a watchdog that will have teeth and the power to inspect the hospitals and to deregister them if they are not safe and satisfactory. By comparison, the Commission for Health Improvement is a toothless tiger with no sanctions available to it. Given the Government's policy of treating increasing numbers of NHS patients in the private sector, is it not time to establish a single, unified regulatory and inspection body that is responsible for monitoring standards across all hospitals, so that people can be confident of the quality of health care that is being delivered to them wherever it is delivered and however it is financed?

I hear what the hon. Gentleman says, and I know that he has been exploring some of these issues in Committee with my hon. Friends. The Commission for Health Improvement and the National Care Standards Commission have very different functions. The Commission for Health Improvement is intended to act as an independent inspectorate for the national health service as a managed care system, which is what it is. The National Care Standards Commission has a quite different function. However, the hon. Gentleman is aware, as my hon. Friends are aware, that we introduced an amendment during the passage of the Care Standards Bill through the House to ensure that there is much closer co-operation and flexibility between the two commissions. That is the right thing to do, and it will help to ensure that wherever people receive care—whether in the health and social care system or in the public or private sectors—the quality of care that they receive is always of the highest possible standard.

How many people he estimates are now receiving drugs who would not have received them in their area before recommendations by the National Institute for Clinical Excellence. [127510]

NICE has completed its appraisal of the taxane drugs. It estimates that an additional 4,000 women with advanced breast cancer and 1,000 with advanced ovarian cancer should now be offered treatment with taxane drugs who might have been denied access to those treatments before guidance was issued.

I thank my hon. Friend for that answer. It is particularly pleasing to know that 5,000 women suffering from breast cancer will receive a proven and effective treatment for that cancer, which they would not have previously received under the postcode prescription lottery that we inherited from the previous Government. The cost of that treatment, however, will be £7 million. How will health authorities be able to find that money?

The health authorities will be able to meet the costs of this decision from the record increases in funding that we have made available to the national health service and, in particular, the £660 million allocated to health authorities just after the recent Budget.

Is the Minister satisfied with the progress that NICE is making? Was its original objective to examine not only new and existing drugs, but other procedures and interventions throughout the health service? Given that its first work programme was to examine only 13 drugs, that the plan is to get that number to only 30 per annum and that more than 100 new drugs come on to the market each year, how on earth will it catch up with the task of examining even just the new drugs, let alone its original task of considering all existing procedures in the NHS?

I am very pleased with NICE's progress. It has given important guidance on relenza, stents, wisdom teeth and a variety of drugs and procedures. In the first year, it has been essential that NICE establish its credibility in its decision-making and appraisal systems. It will move on to assess more drugs. We are currently consulting on the referral of about a dozen extra cancer drugs to NICE and shall shortly announce decisions on that referral. At the same time, NICE is commissioning guidelines on the handling of several different conditions.

May I tell my hon. Friend how welcome was the recent announcement to add zyban, the anti-smoking drug, to the possibilities to help people give up that terrible habit? However, will he explain why a ban has been placed on the prescription of that drug in East Sussex, Brighton and Hove health authority? Is that simply a local decision, and can my hon. Friend do anything to assist in making the drug available?

I shall certainly examine the position in Sussex. The answer is that that would have been a local decision by the health authority. Clearly, we are giving consideration to the question of whether zyban should be referred to the National Institute for Clinical Excellence.

On that point, what criteria were used to make sure that beta interferon was referred to NICE, but that zyban was not, before the Secretary of State's decision was announced?

There is a set of well-publicised criteria, including the likely impact on the national health service and possible benefits for patients, all of which were set out in public form in documents that were published last summer. Those criteria have been used to make decisions on referral to NICE, and will continue to be used for the future consideration of existing drugs and new drugs that become available.

Will the Minister tell us what is the difference, in his view, between affordability and the effective use of clinical resources?

Quite clearly, NICE has been asked to assess the clinical effectiveness and cost-effectiveness of drugs and treatments. I believe that, in a speech last week, the hon. Gentleman supported the Government's position that NICE should examine clinical effectiveness and cost-effectiveness. The question of the total amount of resources available to the NHS is clearly a responsibility of Ministers and government.

What a muddle. Is it not true that there is no difference between the concept of affordability and the effective use of clinical resources? The Government changed the criteria for NICE because that was merely another spin trick for Ministers who wanted an arm's-length rationing mechanism as they were too cowardly to take decisions directly. Is not the real reason that zyban was rushed in that the Government were desperate to get another good news story on health, regardless of its consequences or even their own policy? Does that not show that Ken Follett was spot-on with his analysis of the Government, when he said that they were intellectually bankrupt, morally suspect, all spin and no substance, and were willing to let anyone suffer, as long as Ministers got good headlines?

I do not agree with what the hon. Gentleman says. We have made it perfectly clear, from the time that NICE was first proposed, that it would need to consider clinical effectiveness and cost-effectiveness. That is in all the documents that the Government published. We have made it clear many times that we amended the establishment order for NICE last summer because we had received legal advice that, as the order was drafted, NICE would not have been able to consider cost-effectiveness at all. Given that the hon. Gentleman believes that NICE needs to consider cost-effectiveness as well as clinical effectiveness, he would have been required to make that amendment, had he been in that position—[Interruption.] I must tell Conservative Members that that advice was received by the Government.

What advice his Department gives to health authorities regarding mergers of NHS trusts. [127512]

We have said that mergers should proceed only where they bring clear benefits for health and health care. Every merger must save at least £500,000 in management costs in the first two years. The savings released are retained locally for investment in front-line NHS services.

I thank my hon. Friend for that answer. Does she recognise that in trust mergers, services do not always dovetail perfectly? Where they do not, will she give guidance and ensure that services are levelled up, rather than down, that there is no fragmentation of services and that services to patients are the principal factor guiding the process?

Of course, I agree with my hon. Friend, and the proposals for Northamptonshire make it clear that we want to create a new organisation that delivers community-based services throughout the county. It is intended that the new organisation will capitalise on best practice, and the main outcome will be that local people and staff will have access to high-quality, modern community services. My hon. Friend will be aware that consultation on the proposals is well under way, and the outcome will be accepted by Ministers only when it is clear that the proposals represent the best possible options for patients locally.

Can the Minister give a categorical assurance that when two NHS trusts merge, each with its own hospital with an accident and emergency department, it will not lead to one of those departments closing? I am thinking in particular of the merger between Chase Farm and Barnet.

It may be helpful if I remind the hon. Gentleman that mergers of trusts should not be confused with hospital services reconfigurations. Merger proposals concern the merging of organisations and management, and the services that are to be provided form part of the reorganisation structure. Trust mergers do not always lead to the closure of associated hospitals—that is always a matter for local consultation.

When considering trust mergers, will my hon. Friend have regard to the fact that we now have community health trusts, whose functions are changing? Are there are any proposals to make trust mergers more efficient by merging community health trusts with hospital trusts, or is there a general policy in the Department to review the workings of community health trusts?

As it stands, it is unlikely that community and acute trusts will he merging. It is important to stress that mergers and reconfigurations are being considered because we have ended the competition of the internal market in which one hospital competed with another, and our policy has a wider scope and focuses on the provision of decent services for local areas. I take on board what my hon. Friend said about the provision of community services, but any mergers have to be in the interests of the patients and must provide significant savings for the local community.

When contemplating trust mergers, will the hon. Lady always bear it in mind that a clear line of responsibility and chain of command are crucial for the effective provision of services within the hospitals that are grouped together? Is it not the case that, all too often, the loyalty and morale of individuals are undermined and, as a consequence, the standard of patient care diminishes?

I agree with the hon. Gentleman that the whole purpose of the process must be to improve patient care, and that sometimes requires sensitive handling of discussions and negotiations, because some of us fear change more than others. That is why we are always sensitive about the need to consult locally with all key stakeholders and to come up with service configurations that serve local communities. Sometimes that is difficult: when we inherit health economies that have run up huge deficits, hard choices have to be made. However, I reassure the hon. Gentleman that the bottom line for any decision is patient care.

If he will make a statement on the steps he is taking to protect NHS staff from violence. [127514]

Violence to staff in the national health service is unacceptable. A cross-Government campaign, the NHS zero tolerance zone, was launched last October with targets to reduce violence against staff by 20 per cent. by April 2001 and 30 per cent. by April 2003. Changes have also been made to the choice of medical practitioner regulations to combat violence against GPs.

I thank my hon. Friend for that answer. How many verbal and physical attacks on NHS staff have been recorded recently? More specifically, can he assure my constituents in Bury, South that he and other Health Ministers liaise with the Home Office to ensure that those brought to the courts and convicted of such attacks on NHS staff feel the full force of the law?

My hon. Friend raises some important issues. Our surveys show that about 65,000 staff suffered physical and verbal assaults last year. One of the aims of the new strategy is to ensure that all such incidents are recorded, so the figure will probably increase in the short term as people are encouraged to report them. He is right that cross-Government co-operation is important. We work closely with the Home Office and the Lord Chancellor's Department on that strategy. For example, the Lord Chancellor, who is president of the Magistrates Association, has said that it is entirely legitimate for magistrates to respond decisively to a particular form of criminal behaviour, such as assaults on NHS staff, and to impose a sentence that has a deterrent component. In the Bury area, where the police, the health authority and the magistracy co-operate closely, there has been a reduction in violent incidents against staff of some 24 per cent.

I congratulate the Government on the work that they have done in improving casualty departments and, therefore, reducing, I hope, threats of violence in them. Employing more porters has helped in that respect. Can the Minister give an assurance that community staff will not be forgotten?

The hon. Gentleman raises an important issue. We shall produce further material as part of the campaign, either at the end of this month or at the beginning of August, which will provide guidance to staff, health authorities and employers in mental health and community health settings and the ambulance services because those staff are at particular risk. On mobile phones and other forms of communication, I agree that employers should make proper assessments locally. [Interruption.] The hon. Gentleman sighs, but the work done by individual members of staff varies, so it is important that the working position of each of them is considered. In circumstances where such measures would add to their safety, I certainly think that employers should put them in place.

What Government financial support is given to the provision of air ambulance services. [127515]

Air ambulance services in England are financed largely through public subscription. We support existing services by providing qualified paramedic crew through the national health service.

Given that there is evidence that air ambulance services can result in a significant reduction in deaths in transit and from head injuries and in the amount of time spent in intensive care, is not it extraordinary that they are entirely dependent on public subscription and charitable fund raising? Even more extraordinarily, I am told that some ambulance trusts charge air ambulance services for providing paramedics to go out and save people. Would it not be better if this country were to follow the example of Germany, where there is properly co-ordinated, comprehensive air ambulance cover, which is at least partly publicly funded?

I fear that I have to disagree with the hon. Gentleman because the evidence on the clinical outcome is by no means as persuasive as his question would suggest. Professor Jon Nicholls made it clear in his report, "The costs and effectiveness of helicopter emergency ambulance services", that the evidence is not convincing. All the local studies on the outcomes, including those in London, have not made the case for air ambulances. However, it is important that we support them. In some areas they are most appropriate, not least in the hon. Gentleman's area, where the NHS provides 14 trained paramedics to support the service. According to all our evidence, the optimal solution for the 11 air ambulances in the current structure would be to work with the ambulance services, the police and the military when necessary.

When my hon. Friend considers the financing of air ambulance services, will she also consider the position of those independent air ambulance services that are sometimes used by the national health service? Will she also consider the need to introduce guidelines for both the staffing and the equipping of air ambulances? Although many air ambulances do an exceptionally good job, there is no guarantee to patients being transferred that standards will be the same as in a road ambulance.

That is an important consideration and my hon. Friend may be aware that in the north-west consultation is taking place in the working group on developing proper proposals and protocols for transfer. We agree with her basic sentiment and will certainly take that forward.

Will the Minister consider carefully the evidence that has come forward, particularly in rural areas, on air ambulances and the way in which they are funded? I understand that the lottery is not willing to provide funds to help the NHS with air ambulances, although a lot of money has been taken from the lottery to replace old NHS equipment. There is not the additionality that people are looking for, but surely additionality is important. I should be grateful if she considered that carefully.

It is easy to assume that air ambulances would always provide solutions, certainly in rural areas, and Cornwall was one of the first to have an air ambulance. However, it should be remembered that civilian staffed air ambulances operate only during daytime hours and that the task has its own hazards. For example, there have been a number of civilian deaths in the past few years during such operations so we need to look much more closely at how we get to patients more quickly, whether in rural or urban areas. Our work to improve the ambulance service and support the air ambulance service, rather than thinking that extending air ambulance services would solve the problems experienced in some rural areas, is the right way forward.

What plans he has to reduce the numbers of infant deaths in inner-city areas. [127516]

Infant mortality rates have fallen for very many years, but there remains a gap between those born into affluent families and those born into more deprived families. We are currently developing a national plan for the NHS, which will set out a programme of change and improvement to address some of those problems. It will confirm that the Government's ambition is not only to improve the health of the population overall, but to narrow the gap between the worst off and the better off.

I thank my right hon. Friend for that reply. I have no doubt that he is aware of the research from Sussex university that shows that more babies die in Britain than anywhere else in northern Europe, that babies born into the poorest families are twice as likely to die as those born into professional families and that in inner-city areas such as mine—Salford—30 per cent. more babies are likely to die than the average for England and Wales.

This is a very serious issue that deserves to be considered seriously. From visits to my hon. Friend's constituency, I am aware of the good work that is being done by the local authority, the NHS and other players. On health outcomes, she is absolutely right that the gap between the richer and poorer parts of Britain remains stubbornly wide. On infant mortality rates, there was a three and a half to fourfold difference between different health authority areas in the last year for which we have figures. Although progress has been made over many decades to reduce infant mortality rates in England and across the United Kingdom, none the less it is also correct that our infant mortality rates remain above the European Union average. We must address that. To do so, we must not only achieve the proper focus on prevention and treatment, but take action across the Government to tackle some of the root causes of ill health. My hon. Friend is absolutely right that there is a clear correlation between poverty, ill health and, sometimes, infant mortality rates.

Will the Secretary of State explain how his decision to cut the budgets of 11 health action zones in the poorest part of the country, including Salford, will help those plans to cut infant deaths?

I was not aware that the hon. Lady was a signed-up member of the health action zone fan club; obviously I was wrong. I know from her views about the national health service that she likes to visit NHS hospitals to see what it is like for those who do not have private health insurance. I think that that is what she had to say on the record in The Health Service Journal.

Is my right hon. Friend aware that inequalities within some health authorities are even greater than those between health authorities? My constituency comes within the Berkshire health authority. For 20 years, the health authority's view of ending health inequality has been to ensure that it does not spend a penny more in Slough than is spent in the rest of the county. Indeed, over the years it has spent much less in Slough, with the result that infant mortality and deaths from heart attacks and strokes are comparable with those in the inner-city area represented by my hon. Friend the Member for Salford (Ms Blears).

My hon. Friend is right to say that there are inequalities between areas and within health authority areas. We have made it clear that over time we expect health authority areas will be able to move their allocations to primary care groups and trusts so that they begin to address inner health authority problems and inequalities so that there is a fairer distribution of cash between health authority areas and within them.

What the proposed timetable is for taking forward the proposals in the Green Paper "Reform of the Mental Health Act 1983". [127518]

Consultation on our Green Paper "Reform of the Mental Health Act 1983" ended on 31 March. We have received more than 1,000 responses to this Green Paper, and we are considering all of them carefully. We will be making an announcement on the next stage of this reform process in the near future.

Does the Minister's reply mean that he is ruling out legislation in the next Session? If compulsory powers are to be more widely used, does he agree that they should be balanced with better rights to assessment and effective early treatment?

On the second part of the hon. Gentleman's question, we have always made it clear that we believe the answer is yes. That is precisely why the proposals on which we consulted set out the establishment of a new independent tribunal. In future that body would take decisions about whether compulsory treatment should be authorised. That would be a significant change from the present procedure whereby such decisions are essentially made by the clinical teams. That would be a substantial contribution to improving patients' civil liberties.

My hon. Friend will be aware that many of the people who responded to the Green Paper expressed concern that the Government had not wholeheartedly accepted recommendations made by the expert scoping group on the use of compulsion. Does he agree that compulsion should not be used as a substitute for good quality care? When legislation is introduced, will he consider using the capacity-based approach to safeguard against the inappropriate use of compulsory treatment?

I must correct my hon. Friend: we did not reject the Richardson committee proposals in that regard. We simply posed an alternative procedure as a different gateway into compulsion. The consultation response revealed a marked divergence of opinion about the benefits or otherwise of a capacity-based system, and we must take that seriously. Of course, compulsion is not a short cut into second-quality treatment. We want patients who have mental health problems to have access to exactly the same high-quality standards of treatment and care as any other group of patients in the NHS.

Does the Minister accept that notwithstanding any legislation that may be needed to reform the Mental Health Act 1983, it is equally important that the Government do not lose sight of the massive amount of work that must be done—led by the Government, one hopes—to seek to reduce the ignorance, the discrimination and the stigma attached to mental health problems in this country? If the Government can lead on that and help to educate people and to minimise the fears and the stigma, they would be doing a great favour to the whole of society.

I strongly agree with what the hon. Gentleman says. He has held the same position as I in the Department of Health and he will know the situation. We accept our responsibilities to make sure that people who suffer from mental health problems are not routinely discriminated against in our society, because they certainly are; we know that. There is new legislation about disability discrimination rights on the statute book.

If he will make a statement on the number of cataract operations carried out on the NHS in the last year. [127519]

In the last year for which figures are available, there were just over 200,000 finished consultant episodes relating to cataract treatments. The £20 million that we are investing in our action on cataracts programme will ensure more efficient services and will increase the number of operations performed to 250,000 over the next few years. The programme will also ensure that we get waiting times down for cataract treatment.

I thank my right hon. Friend for his helpful announcement. What impact will those plans have on the situation of my Ilkley constituent, who will have her first out-patient appointment on 25 October, by which time she will have been waiting 16 months; and then, of course, she will have to go on the waiting list for her operation for cataracts? In the early 1990s, I had four elderly relatives suffering from cataracts. All of them had to withdraw their savings in order to pay for an initial appointment. Will my right hon. Friend comment on that?

My hon. Friend is right—waiting times are too long at present. That is why we want to get them down. With regard to action in her area, I understand that Bradford health authority is to introduce a new programme of work over the next few months precisely in order to get the waiting times down for cataract operations. It is partly a matter of investing more cash, and that is what we are doing, and hopefully also employing more staff. It is also a matter of redesigning the way in which the system works.

I congratulate the Secretary of State on his announcement on 30 June that an extra £20 million is being made available for cataract services. The only slight problem was that that announcement was first made in February; it was a re-announcement. Is the fact that the Government are prepared to acknowledge that it was a re-announcement proof that at last they are waking up to what was said in the leaked report yesterday by the Minister's colleagues that enormous damage is being done to confidence in the health service by the constant announcement and then re-announcement of money available to the service?

As a matter of fact, the hon. Gentleman, who is nearly right, is actually wrong on this issue, as so often. What I announced on 30 June were the areas where the £20 million would be invested. They included the area represented by my hon. Friend the Member for Keighley (Mrs. Cryer). There will be 60 local schemes. Many parts of the country will benefit. People will draw the clearest of contrasts between the policy of the current Government, designed to get waiting times down for all conditions, and the Conservatives' policy, which is to force people to take out private health insurance for treatment such as cataract operations, hip and knee replacements and so on.

Philosophically we have moved on. Insurance companies could cover conditions that are not hi-tech or expensive, like hip and knee replacements and hernia and cataract operations.

What recent research he has commissioned into the (a) causes of and (b) treatment for prostate cancer. [127520]

The Government recently announced an extra £1 million for prostate cancer research this year. Research has now been commissioned on the identification, diagnosis and treatment of prostate cancer. Further work will be considered in the light of the report from an expert review group.

I thank my hon. Friend for that reply. Many people will be very pleased that an extra £1 million has been announced for prostate cancer research and treatment. Will she make sure that as many resources as possible go into research and treatment, because it is of growing concern that we seem to have an ever-increasing number of men suffering from prostate cancer? There has been very little research into prostate cancer so far, and there is very little clarity about the treatment that should be available. We have a long way to go. It is one of the greatest public health issues confronting this country now, and it will continue to confront us over the next few years.

I agree with my hon. Friend. Historically, the level of funding for research into prostate cancer has been too low, given how little we know about the disease and how many men die from it each year. That is exactly why we have put the extra £1 million into new research this year. It is also why we are working with other funders, with the major charities, the Medical Research Council and the Cancer Research Funders Forum, and have asked them as their first project to look into prostate cancer research.

The announcement is extremely welcome. Prostate cancer is a very large killer of men in our society. Will the Minister also bear in mind the fact that in the treatment of prostate cancer, about which so little is known, a large number of different specialists are frequently required to treat one patient? At present the level of understanding among general practitioners is not very high. Will she carefully examine the idea of having one named specialist in charge of each patient when he is diagnosed as having prostate cancer?

We are commissioning guidance on improving outcomes for prostate cancer as part of the work commissioned by the National Institute for Clinical Excellence. It is the first of the extra four cancer sites being worked on now. That is exactly the issue that we need to look at, building on the work of Calman Hine.

What estimate he has made of the long-term cost of private finance initiative funding of the Whittington hospital. [127521]

The current project at the Whittington should have a full-life net present cost of around £100 million. This is for the new building, its maintenance and operation over 30 years at today's prices, regardless of how the project is funded. Before the go-ahead is given to a PFI option, it will need to demonstrate that it delivers better value for money than a publicly funded alternative.

Will the Minister look very carefully at that and any other case of PFI funding of new buildings and consider, first, the long-term cost to local health services incurred by using private finance rather than public finance for new buildings; secondly, the likely increase in the number of private patients in the hospital to increase the income stream to pay the debts resulting from the PFI; and, thirdly, the implications for outlying health facilities in the district, given that experience of previous PFI initiatives tells us that outlying facilities are often closed and fewer beds are available in PFI-constructed hospitals than in publicly funded hospitals? There is great demand for new buildings in the NHS, but does the Minister accept that we must ensure that they are publicly owned and publicly funded?

There is certainly a great demand for new hospitals and hospital buildings, which is why I am pleased that the past three years have seen the biggest hospital building programme in the history of the NHS get under way. However, with respect, my hon. Friend is wrong on all counts. There is no evidence that the PFI funding route leads to reduced bed numbers; the whole point of the procedure is that the number of beds required in the local health economy is determined before the decision is made on whether a hospital will be publicly or privately financed. We shall ensure that hospitals planned in future, whether PFI or public sector financed, take full account of the conclusions of the national beds inquiry, which showed that, under the previous Administration, the number of hospital beds was cut far too far.

Can the Minister tell us what will be the annual rate of return to private investors who put money into the Whittington hospital?

That is a matter for the private investors. What matters to the NHS is to make sure that good value for money is obtained. Under a PFI scheme, the cost of the PFI route is compared with the cost of the public sector route. Experience so far tells us not only that every single PFI scheme that has gone ahead offers better value for money than the public sector alternative, but that PFI schemes are delivered ahead of schedule, instead of overrunning. On hearing Conservative Members, one might gain the impression that they are opposed to PFI. In reality, the Conservative Government spent tens of millions of pounds on consultants but did not get a single PFI hospital built, whereas the Labour Government have used PFI to start the biggest hospital-building programme in the history of the NHS—hospitals like the one in Carlisle are already open and accepting patients.

If he will set minimum cleanliness and hygiene standards in NHS trust hospitals and ensure that these are policed. [127522]

Chief executives are responsible for high standards of cleanliness and hygiene in hospitals. Standards for hospital cleanliness and infection control will be subject to independent inspections by the Commission for Health Improvement and the Audit Commission. NHS Estates has recently distributed guidance on cleanliness to all NHS trusts. The national plan will detail how we can take that forward.

Does the Minister accept that, even in hospitals with a high degree of clinical competence, narrowly defined, there are potential problems of poor hygiene leading to cross-infection? Does he also accept that that can be caused by a combination of private contractors cutting corners, trust managers trying to save money, and the lack of a proper supervisory system involving nurses, as there used to be under the matron system of old? Would not the principles he describes be strengthened by a system of spot checks, carried out by a national inspectorate and backed up by sanctions against offending contractors and hospitals?

The hon. Gentleman is obviously right to say that the causes of those problems can be numerous and that a variety of individuals and agencies may be responsible. We regard it as a priority that hygiene standards should be maintained and hospitals should be clean and free from the ever-present risk of infection. It is interesting to note that, whereas the Government are prepared to act on these matters, the hon. Member for Woodspring (Dr. Fox), at a recent conference in Glasgow, criticised Ministers for taking action to improve hospital cleanliness—and, as usual, got himself into something of a mess. I have no doubt that the public want us to ensure that their hospitals are clean and hygienic.

Does the Minister agree that the Government should be as responsible for high standards of cleanliness and hygiene as they are for other services that the national health service must provide? For that reason alone, does he agree that the Commission for Health Improvement should be responsible for delivering cleanliness and hygiene in the private and the public sectors to ensure that the same standards apply in both?

I am not entirely sure that that is the position the Conservative party adopted during the passage of the Care Standards Bill. Perhaps the hon. Lady needs to have a conversation with her Front-Bench colleagues about that. It is important to take effective action to improve standards of cleanliness and hygiene. We are taking that action.

I believe that there is a real problem. My hon. Friend knows that I have spent time in many hospitals over the past 15 years. It has often struck me that the standard of cleanliness in the toilets of many hospitals worries patients and their visitors. Should there not be a major effort to ensure that the necessary standards are achieved?

I strongly agree with my hon. Friend. He has much experience of such issues, and I am glad that he looks as well as he does today. We are going to take action to make sure that the issues that he raised are properly addressed. As I said earlier, the national plan, which we shall publish later this summer, will explain the way in which we can take that work forward.

What action he is taking to ensure that patients are represented during the deliberations of the National Institute for Clinical Excellence. [127523]

The National Institute for Clinical Excellence is responsible for determining its own processes. However, NICE invites submissions from relevant patient groups and offers them the opportunity to comment on draft conclusions of its guidance. There is also patient or lay representation on all of NICE's key committees, including the appraisal committee, the guidelines committee and the appeals panel.

I am grateful to the Minister for that reply. However, given that, on his own admission, patients are not directly represented on NICE, will he confirm that NICE's assessment of the cost-effectiveness of beta interferon has taken full account of the costs of home care, domestic adaptations, welfare payments and tax revenues forgone when individuals who are clinically suitable for the drug are denied it? Will the Minister also confirm that the institute will publish in full its findings on those important considerations?

I think the House and the hon. Gentleman will understand that the Government will not comment on a leak of a draft appraisal—there is some way to go before the full appraisal is published. Publication will occur possibly in August, depending on whether there is an appeal. In general terms, I can say that NICE will receive whatever evidence manufacturers, patient groups or others wish to give about the wider social costs that should be taken into account, and the way in which that should be done.

Will my hon. Friend confirm that when NICE makes its assessment of drugs and treatments, it takes into account patients' views on the way in which those treatments or drugs have improved their quality of life as well as abated their symptoms, but that that evidence must be subject to the same rigorous scientific assessment? That would avoid the clouding that the placebo effect provides.

My hon. Friend makes an important point. It is obviously essential that NICE's decisions and conclusions command confidence, not only among clinicians but among patients. That is why NICE invites patients' organisations to give evidence. I am sure that those organisations put forward the views of individual patients as well as their assessment of the scientific evidence. However, it is for NICE to determine the methodology that it wants to use, and to reach a conclusion about the evidence, its form and the weight it wishes to give it. I am sure that it gives great weight to properly validated scientific evidence.

I shall speak briefly.

One advantage of having three children and 10 grandchildren is that I am used to people not listening to what I say. Indeed, some would claim that I have made an entire career of talking when no one listens to what I say, which is why I have been so long in the House of Commons. However, I want to make a serious protest about the growing practice—on the part of not just the Government, but Opposition Front Benchers—of reaching an agreement on timetabling.

I say hurrah and—to quote a famous 18th-century speech in its entirety—"ditto" to the hon. Member for Crewe and Nantwich (Mrs. Dunwoody). However, I shall not follow that 18th-century speech in like measure because, as the hon. Lady said, this is the 35th Bill in this Parliament on which debate has been truncated. The purpose of all guillotine motions, whether agreed between those on the Front Benches or not, is to prevent continuation of debate, and, therefore, in many instances, as the hon. Lady said, to deny hon. Members the opportunity to speak perhaps to their own amendments and to vote on amendments.

For the purpose of concluding any proceedings which are brought to a conclusion at the time appointed by this Order, the Speaker shall forthwith put the following Questions (but no others).

the Question on any amendment moved or Motion made by a Minister of the Crown.

If two or more Questions would fall to be put under sub-paragraph (1)(c) on amendments moved or Motions made by a Minister of the Crown, the Speaker shall instead put a single Question in relation to those amendments or Motions.

My hon. Friend speaks with immense knowledge of the way the House operates, and with a fervour that can be picked up in all parts of the House. Is he not saying, in essence, that this guillotine motion—and it is typical of what might happen in the future—is making the role of Back Benchers in the House totally irrelevant and handing over control to the usual channels? Am I not right in saying that the House is a place in which Members of Parliament, whatever their role, should be heard, and that they are being denied?

I agree with my hon. Friend. He has only to refer to paragraphs 3(1)(c) and (4) to see that the motion gives enormous power to the Government. In addition, there is another device, to which my Front-Bench colleagues agree. What is so startling is that debate on guillotining Bills should be included in the time allotted to the first group of amendments. The objective is quite clear, and we have had enough of it—it is to stop people discussing the fact that they are being denied the right to speak to their own amendments, and even to vote on them. It has happened time after time.

Everything I say shall be law.

It is always a pleasure to follow my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd) and, if I may say so, the hon. Member for Crewe and Nantwich (Mrs. Dunwoody).

I would suggest to my right hon. and learned Friend that 35 Bills have been guillotined, with well over 50 motions to secure the objective.

I am very grateful to my hon. Friend for that clarification. The number is even greater than I anticipated. The contrast, therefore, with previous practice is even more marked. I understand that under the Government headed by my right hon. Friend the Member for Huntingdon (Mr. Major), there were some 17 timetable motions, while under the Government led by Lady Thatcher there were some 34 timetabled Bills in the 11 years that she was Prime Minister. We are seeing an extraordinary increase in the practice and it is wrong.

I welcome this debate on timetabling, believe it or not; although I do not welcome its direction or logic. I shall speak only briefly, particularly as I do not want to do the House a discourtesy, because I cannot remain for the whole debate.

In my time, I have been known to oppose my own Government—impossible though that may seem. Does my hon. Friend accept that there is a difference between carefully reading what is written in legislation and automatically opposing it? She assumes that only those who oppose the content will want to read what is in the legislation. I assure her that that is not the case.

I assure my hon. Friend that that was not my assumption at all. I should like another assumption to be undermined—that there can be parliamentary scrutiny only if debates are allowed to proceed in an untimetabled fashion.

The House is now in distinct danger of demeaning itself and denying its essential role in the legislative process. My right hon. and hon. Friends on the Front Bench who have apparently signed up to the timetable motion have not explained to me why they have done so. They may or may not do so subsequently, but it is beyond me to understand why they have connived in this grubby little parliamentary manoeuvre. That is a matter for them, but they cannot expect me to support it, and nor do I.

I will be very brief. I believe that in the very near future, if not during this debate, the House will have to decide whether there is any meaningful constitutional role and responsibility for the genuine Back Bencher in the House.

I just want to present to my hon. Friend evidence in support of his argument that the problem is not the fact that the Opposition's main weapon is time, but the progressive tendency of all Governments over time to compress Report stages. In the 1970s, multi-day Report stages were the norm; today, they are the exception. That is why half of all the guillotines and timetable motions in the past 15 years have occurred in the past three years, under the present Government.

My right hon. Friend is absolutely right, and he, too, has much experience of the way that the House operates. He has been a Minister. He currently chairs perhaps the most important Select Committee of the House and, I believe, is well regarded from all parts of the House for the contribution that he has made to the deliberations in the House. The point that he makes is absolutely right.

rose—

They are raping the House of Commons. They are castrating the House of Commons.

The hon. Gentleman suggested that timetabling is not necessary and that I want it because I need time to prepare for a speech. But earlier, I spoke after 30-seconds notice. He said that the timetabling motion is outrageous and that the Government are castrating the House.

I have to tell the hon. Lady that, of all the people in the House, I most value the fact that the House is accessible to women Members of Parliament. I should know; I am married to one. She came into the House on her own merit and she speaks for the Conservative party on an important matter.

It is very difficult to follow my hon. Friend the Member for Macclesfield (Mr. Winterton) but, as ever, it is a great privilege. I endorse everything that he said.