What studies his Department has commissioned, undertaken or reviewed concerning the use of private finance within the NHS. [131847]

It is a very real pleasure, Mr. Speaker, to be the first Minister able to welcome you to your new official responsibilities. I am sure that you will discharge your responsibilities with your customary fairness and good humour—qualities which, even during Health questions, I hope will not be too sorely tested.

May I also be among the first to congratulate you, Mr. Speaker? I hope that your choice of clothing is an indication of a more modern approach to come. It is strange to be here; this is my first question.

I welcome the hon. Lady to her first Health Question Time. I am sorry that I will have to disappoint her by saying no, that will not be possible. The truth is that the PFI is providing much needed new hospitals in many parts of the country, sometimes in communities that have long campaigned for them. It is an efficient means of procuring new hospitals. Indeed, owing to the time and cost overruns associated with the old method, which tended to procure through Exchequer capital, the taxpayer ended up footing the bill for six hospitals and receiving only five in return. I do not know about Liberal Democrat economics, but that does not seem to make sense to me.

I, too, congratulate you, Mr. Speaker.

I assure my hon. Friend that we already monitor the performance of individual ambulance service trusts; it is important that we do so. I can further assure her that, in future, we intend to move away from the PFI approach based purely on the procurement of an individual institution such as a new hospital. As she is aware, when we establish a new hospital in a community, it has implications for primary, community and social services, as well as for ambulance services. The NHS plan published in July sets out a new approach to procurement, whereby private finance will be extended into such areas and out of the purely acute sectors of the NHS.

May I add my congratulations to you, Mr. Speaker, and, at the risk of embarrassing you, say as a Catholic that it is remarkable that we have our first Catholic Speaker?

There are problems in Kent and we keep the situation under review, but, in all candour, I have to say that many of the problems of pressure on parts of the NHS and of backlogs in repair, maintenance and new developments have not arisen suddenly and recently, but are the consequence of decades of under-investment in the NHS.

I, too, congratulate you, Mr. Speaker.

We shall make announcements in due course on further capital and revenue allocations to health authorities. As my hon. Friend is aware, the extra investment we are now making provides the foundation for a real expansion of NHS services. Under the NHS plan, during the course of this decade, we expect to build 100 new hospitals and to modernise every accident and emergency department that needs it. In the next few years, there will be 250 new scanners and more beds, nurses and doctors in the system. We have achieved a lot, but we are the first to acknowledge that there is a lot more to do. We have a long way to go if we are to rectify the decades of under-investment over which Conservative Governments presided.

Mr. Speaker, as one whose first name is Martin, I congratulate you on your new office and assure you of my good wishes and those of my colleagues.

That is what we want and it is happening, not only in England, but throughout the United Kingdom. As the hon. Gentleman knows, there is more money than ever before going into the NHS. Of course, that will not solve every money problem and there will continue to be pressures in the NHS—there will be pressures this winter and it would be foolish to pretend otherwise. However, there is a good reason for that: the problem facing the NHS today is no longer purely one of a shortage of cash; it is a problem of capacity. When we have not enough trained doctors and nurses, it is self-evident that it will take time to put that right. The question is, who is best placed to deal with those capacity problems? Are they best dealt with by a party that is committed to growth in the national health service, or by a party that is committed to cutback and closure in the NHS?

What funding he is committing over the next three years to research into the cancers specific to men. [131848]

Congratulations, Mr. Speaker.

I welcome you to the Chair, Mr. Speaker. I also welcome the Minister's boost for prostate cancer funds. Will she join me in applauding the achievement of my constituent Colin Osborne, whose Orchid appeal in respect of male cancers has raised £6 million in three years? Will she also recognise the work of the men's health forum, which is also campaigning for increased resources for male cancers? Does she agree, however, that there is much more to be done to increase awareness of male cancers, and of men's health issues in general?

I certainly congratulate my hon. Friend's constituent on his work in raising awareness of male cancers, but I also congratulate her on her own work in raising awareness, and raising funds for future research as well.

May I be—possibly—the last to congratulate you on your post, Mr. Speaker, and, perhaps appropriately, wish you the health to enjoy your time in office?

he would never consider having a prostate cancer test himself because treatment was likely to do more harm than the disease itself.

We believe that it is up to individual men to make their own choices about whether to have a prostate-specific antigen test. That is why we are developing an informed-choice programme, to provide men with all the information that they need to make their own decisions about whether to have the test.

How many nurses previously employed at Kidderminster district general hospital have accepted alternative employment within the NHS in the last two years. [131849]

I add my congratulations, Mr. Speaker.

I must say that I am rather disappointed by that reply. I am sure that the Minister will be as concerned as I was to learn that the chairman of Worcester Acute Hospitals NHS trust has said, "We must attract more nurses and retain them."

Order. The hon. Gentleman is making a speech.

rose—

Order. The hon. Gentleman will not get away with making a speech. He had an opportunity to put a question, and that is the end of it. Does the Minister wish to reply?

Thank you, Mr. Speaker. The hon. Member for Ludlow (Mr. Gill) will be delighted to learn that Kidderminster hospital has a full complement of nursing staff. In addition, unlike the previous Government, who cut nursing training places consistently—between 1992 and 1994, the number went down to some 13,000—we have not just increased nursing training places but we have brought back some 5,000 nurses. Furthermore, unlike the Tory Front-Bench health team, we regard women, who form a large part of the nurses who return, as being 100 per cent. members of the work force, not as being worth only 80 per cent.

What administrative impact the national changeover plan has had on NHS trusts. [131850]

As set out in the second outline national changeover plan published in March, the NHS has carried out a measure of pre-planning for the possibility of UK entry into the single currency. This was carried out by existing staff from within current running cost budgets. Resources have not been diverted from patient care.

Is not that an extraordinary answer, when it has been estimated that the cost to the NHS of the national changeover plan will total between £75 million and £95 million? That is four times the cost of the new community hospital that is being built to service New Forest. How does the Minister feel about sacrificing four community hospitals to the Government's obsession with the single European currency?

Those Opposition Members who are so fanatically opposed to anything European that they are even further to the right than those on the Opposition Front Bench are in the habit of quoting wild figures, exaggerations and unfounded claims about this matter, like many others.

The amount of time and money taken up by this exercise so far is a few days in each trust and would equate to a cost of several hundred pounds, rather than the hundreds of thousands of pounds previously quoted in the press.

I wish you all the best, Mr. Speaker, in your new role.

It is outrageous for the Opposition to suggest that such figures have been diverted from patient care, when, as I made clear by quoting from the statement issued by Buckinghamshire health authority, that is not the case. That health authority refers to costs of several hundreds of pounds, not the £433,000 previously quoted in the press. The Opposition should not peddle figures that are simply not true. I am one of those who, unlike the Opposition, believe that at the right time the British people should have the choice as to whether we join the euro, and it is obviously right that a modest amount of sensible planning to anticipate what a change would involve should be undertaken.

What steps are being taken to recruit more occupational therapists for the NHS; and if he will make a statement. [131851]

Qualified occupational therapists increased by 1,000 between September 1997 and September 1999. The NHS plan will see a further 6,500 more therapists and other health professionals by 2004. The Department's recruitment and retention strategy includes introducing more flexible and family-friendly employment conditions, increasing training commissions, attracting former staff back to the NHS, and encouraging flexible retirement.

I add my congratulations to those that you have already received, Mr. Speaker.

I agree strongly with my hon. Friend. She and the House will know that my right hon. Friend the Secretary of State recently announced a major new investment to ensure that, in future, the NHS provides effective child-care facilities for NHS staff. That would be a major contribution to ensuring that we attract large numbers of extra therapists into the NHS. My hon. Friend will know from discussions with her health authority and her trust the strong and important role that occupational therapists will play in ensuring that the new £900 million investment in intermediate care services, especially for older people, constitutes effective intervention and effective investment.

While I welcome the Government's commitment to recruiting more occupational therapists, especially in view of the current 20 per cent. shortfall, what steps will they take to ensure that they do not lose occupational therapists? There is a particular problem with pay, which lags behind even that for other NHS professionals. Will the Government take steps on that, on in-service training, which is underfunded in comparison with other NHS profession, and on career development? Occupational therapists do not have the same opportunities as doctors, nurses and other health professionals to move into management in the health service or in social services.

I am grateful for the qualified support that the hon. Gentleman expressed for what we are trying to do. He is right to say that we need to provide a more attractive career structure for occupational therapists and other NHS professionals. That is why, for example, consultant therapists will work in the NHS in future. That constitutes an extra career grade and is an important development.

Congratulations, Mr. Speaker.

That is a tricky one. I support my hon. Friend's comments and her actions in her constituency to support the expansion in the NHS. I would tell young people in her constituency and everywhere else that the future of the NHS is optimistic and positive as long as Labour is in government. I could not say the same if there was a change of Government, given the Conservative party's record and the legacy that we inherited from it. Under us, the NHS has a positive future; under the Conservatives, it does not.

May I also congratulate you, Mr. Speaker, on your elevation?

I shall look into the matter. Perhaps the hon. Gentleman might like to stand on this side of the House when he asks questions about complementary therapy to see the expressions that they attract from the Conservative Front Bench. I know that the hon. Gentleman has a long-standing interest in the issue and I shall look into the anxieties that he raised.

What support and assistance he makes available to Chorley hospital. [1318521

The total projected income of Chorley and South Ribble NHS Trust for 2000–01 is £62 million. The trust is currently forecasting that at the end of the financial year it will be in a balanced position. I am sure that my hon. Friend will welcome the regional office's recent approval for an additional 30-bed medical ward at Chorley and South Ribble district community hospital, which amounts to a £1.6 million capital investment.

I thank my hon. Friend for that answer. We welcome the new medical ward at Chorley, which is more success for the hospital. We could have even more success at Chorley hospital if we could end postcode medicine. Is my hon. Friend aware of the silly anomaly concerning the two health authorities of south and north Lancashire? If someone comes from north Lancashire and is to go to Chorley hospital, there may be an eight-week waiting list. If someone comes from south Lancashire, there is a 33-week waiting list. If we were to merge the health authorities, there would be more money for Chorley hospital. We would also end a bureaucratic anomaly within the hospital.

I am aware that in the short term the regional office is promising to support south Lancashire. The long-term solution is a strategic review of the health authority configuration. I know that Members are actively engaged in that. The health authority will have to approve the arrangements. We are proceeding to consultation, and probably towards the end of next year we might be able to reach a conclusion on the best way forward.

A number of my constituents use Chorley hospital and its neighbour, Royal Preston hospital. I have written to the Minister several times about the case of Mr. Salthouse, who has had three heart attacks. If he is not in hospital, he spends most of his time on a sofa with an oxygen mask. He is receiving continuous morphine. His doctor has said that he is at the severe end stage of heart disease. The only procedure that will help him is percutaneous myocardial revascularisation, and the North-West Lancashire health authority says that it will not pay for it. Talk about the postcode lottery. The authority will not pay because it does not recognise the procedure. However, the procedure is carried out at St. Thomas's.

I shall certainly examine the individual case which the hon. Gentleman has raised. I say to the hon. Gentleman and his constituents that with this Government the way forward is to expand the facilities of the NHS through tax revenue. There should not be an expansion of the private medical health care sector, where treatment would depend on the ability to pay for it.

How many patients are currently receiving beta interferon on the NHS. [131854]

What recent representations he has received on the provision of beta interferon on the NHS for certain multiple sclerosis sufferers. [131862]

We estimate that between 1,700 and 1,800 people in England are currently receiving beta interferon on the national health service.

I thank the Minister for that answer. He is fond of statistics, but that does no good for the many people in my constituency who plead with me to help them get beta interferon, which they need to try to alleviate their suffering. The Minister has not told the House that the NHS is prescribing beta interferon to less than 3 per cent. of multiple sclerosis sufferers. That is the lowest percentage prescribed by any European Union country. What recommendation has the Minister given to the National Institute for Clinical Excellence to ensure that MS sufferers are not deprived of drugs that their counterparts in the EU are receiving?

rose—

Order. Before I call the Minister, I appeal to hon. Members to be brief. We shall get through more questions if the questions—and possibly the answers—are more crisp.

I apologise for citing statistics, Mr. Speaker, but I was asked how many patients were receiving the drug and that seemed the best way of answering the question.

I call Mr. Healey.

Thank you, Mr. Speaker, and congratulations.

I acknowledge the considerable efforts that my hon. Friend has made on this topic. I know that he has close links with the MS Society and others. Of course we will consider properly and carefully the recommendations from NICE when we receive them, but, as my hon. Friend pointed out, an appeals procedure is under way. Many organisations will have contributed to that appeals process. It is essential for the integrity of NICE that that is allowed to take its course without Ministers' commenting or speculating on what the final outcome might be.

I know that the Minister is aware of the concern on both sides of the House about the beta interferon issue, but does he agree that any decision by NICE to deny beta interferon to patients for whom it is demonstrably clinically effective would bluntly undermine the guarantee that was given by the Secretary of State, who said:

no one will be denied the drugs that they need.—[Official Report, 30 June 1998; Vol. 315, c. 143.]?

On that point—it is important—I have always worked on the assumption that such submissions would be placed in the public domain, so I am happy to give a positive response. For reassurance, however, may I say that such responses as have been made to provisional determinations have invariably been of a technical nature, or have suggested that the wording may need to be clarified in the interests of wider understanding. However, the hon. Gentleman has made a fair point and I will respond positively to it in that way.

I call Miss Anne Begg.

Thank you, Mr. Speaker. I add my congratulations.

My hon. Friend makes an important point. Even the most enthusiastic proponents of beta interferon have not suggested that it works in all cases and circumstances. Beta interferon has never been suggested as a cure for that very distressing condition, so there is a wider set of issues surrounding the appropriate care and support for MS sufferers. Discussions have been taking place between the Department, the MS Society and NICE on the possible preparation of clinical guidelines on wider MS treatment and support.

If he will make a statement about the Government's policy on clinical priorities in relation to the reduction of NHS waiting lists. [131855]

The very clear guidance that we have issued states that

clinical priority must be the main determinant of when patients are seen as out-patients or admitted as in-patients.

I am grateful to the Secretary of State for that information. Will he confirm that, in 80 per cent. of health authority areas, the number of patients waiting more than 12 months for operations has increased since his party took office, and that for the first time in 25 years, the number of heart bypass operations has decreased? Does not that underline the fact that the right hon. Gentleman has managed to get his in-patient waiting lists down only by postponing complex surgical procedures and pushing through the simpler operations as well as keeping people off the waiting lists for longer?

No, that is not true. The hon. Gentleman has heard me say before that the allegation from Tory Back-Bench Members that the number of coronary artery bypass grafts and of heart operations in general has fallen is not true. The number of operations is rising. Of course, we need to do more. That is why I have already made the extra earmarked cash available to ensure that we can carry out an extra 3,000 more heart operations this year and next year. I expect to be able to exceed that, largely because of the hard work done by NHS trusts, hospitals, cardiothoracic surgeons, theatre nurses and others up and down the country who have used the money to good effect.

My right hon. Friend will be aware that increased demand can put pressure on waiting lists during the winter, particularly as a result of people suffering from flu. I congratulate my right hon. Friend on the success of his advertising campaign in increasing the number of people taking advantage of the flu vaccine. [Interruption.] There is some evidence in my area that demand is outstripping supply.

As my hon. Friend is aware, there is a TV advertising campaign and other types of advertisement precisely to inform the public about what they can do. It is most important to ensure that those at the highest risk of serious illness if they contract the flu take advantage of the facilities that the Government have made available to them, which is to get a free flu jab. [Interruption.] I hear Tory Members alleging that the flu vaccine is not available. That is not true. This year we have ordered 11 million doses of flu vaccine, compared with under 8 million last year. We have also extended the range of people who are able to get access to the free flu jab. It is important that, in every part of the country, the free flu jab is offered to pensioners and others, and that people who want to take advantage of it do so as soon as possible by visiting their GP's surgery for their free jab on the national health service.

On the issue of clinical priorities, is the Secretary of State aware that Addenbrooke's hospital has now had to cancel the prostate operation on one of my elderly constituents for the fourth time? That is not because of a shortage of surgeons or nurses but because two and a half wards are blocked with elderly patients who cannot be discharged home and because there is a shortage of some 300 private sector nursing home beds in the Cambridgeshire area. Will the right hon. Gentleman liaise with the Secretary of State for social services to get the Government to help solve that problem?

I am the Secretary of State for social services, so I shall do my best, depending on what sort of day I am having, of course—so far, so good. The right hon. and learned Gentleman raises an extremely important point, which is that, as we now know, what happens in a hospital is directly affected by and directly affects what happens in social services, primary care, community care and, as we heard earlier, ambulance services. That is why we have to encourage much greater co-operation in the local health service. That is also the precise reason why the Government got rid of the internal market, which the right hon. and learned Gentleman supported.

If he will give additional incentives to GPs to locate in East Lancashire. [131856]

East Lancashire health authority is aware of the problem with GP recruitment in its area and is developing a recruitment package that covers all four contractor professions. As part of that process, the health authority is proposing three new applications for personal medical service schemes; exploring the opportunities offered by salaried GPs and nurse practitioners; and reviewing its primary care investment plan to determine what other incentives can be made available through additional investments in GP premises.

That is a good answer, but is the Minister aware that 5.5 per cent. of all the GPs in my area are due to retire in the next five years? That is the highest such percentage of any area in England outside Greater London. Perhaps the way to get younger GPs into areas where there is an acute shortage of qualified GPs is to pay them more. Will the Government apply themselves to that point?

I am very glad that I have said something with which my hon. Friend is happy. As I am sure he is aware, however, we are paying general practitioners more. I am also absolutely sure that, if my hon. Friend wants to develop his concerns about the issue and express them to the health authority, it would be very willing to discuss them with him, as would I. My hon. Friend's area has a particular historical problem with which we have to deal. I am aware of the concerns that he and others have expressed about it, and we look forward to working with him to find a sensible way forward.

What action he is taking to increase the number of nurses working in the NHS. [131857]

The NHS plan sets out proposals to increase the number of nurses, midwives and health visitors in the NHS by 20,000 in the next four years. That is why we are expanding training commissions; improving pay; supporting international recruitment; encouraging family-friendly working practices; and encouraging more staff to return to the NHS.

I welcome that response, which will be welcomed also in The Wrekin and in constituencies across the country. However, can the Minister explain what action she and her colleagues are taking to recruit—and, crucially, to retain—other professional and technical staff? Would not such action help, and is it not time that such staff were included in the pay review body arrangements?

My hon. Friend will be aware that discussions on the future of the pay system are under way. We believe that, across the board, the pay system needs to be modernised to provide fair and affordable settlement across the NHS and to support expansion of the NHS. There were already 10,000 more nurses in place in September 1999 than there were in September 1997, and there have been other increases in the work force, too.

I should be pleased if the Minister could tell us what conversations on recruitment and retention she has had with the Royal College of Nursing since July, and what tangible progress has been made. Although some of us were interested to hear the Secretary of State say—rightly—that under-capacity is holding back development of the NHS, the president of the Royal College of Surgeons recently said that it would take 10 years before those problems were properly and adequately dealt with. Will it take 10 years before we get the recruitment and retention of nurses right?

Christine Hancock of the Royal College of Nursing is on the NHS modernisation board, and continuing conversations are being held on recruitment and retention. There has also been much progress on nurses, such as the fact that, in the first two years of this Parliament, we have put in place 10,000 additional nurses. Considerable progress still needs to be made, but it will take time. One of the reasons why it will take time is that the previous Government cut the number of nurse training places: that is what has made it so difficult to get in place the additional nurses that we need.

May I, too, offer my congratulations on your election, Mr. Speaker?

I can certainly reassure my hon. Friend that we are very keen to increase family-friendly working practices across the NHS. That is why we have a £30 million child care initiative to support staff across the NHS. The Government strongly value the important contribution that people, especially women, can make when combining careers in the NHS with family responsibilities—unlike the hon. Member for Runnymede and Weybridge (Mr. Hammond), who recently said:

It is a fact that you will get less work out of females

When Christine Hancock, the general secretary of the Royal College of Nursing, said that

We now have the evidence that the key nursing posts are being downgraded to save money,

Given that the previous Government cut the number of acute beds in the NHS by 43,000 between 1979 and 1997, it would hardly be surprising if the number of specialist nurses had fallen during that period. We are committed to increasing the number of nurses in the NHS, not just by 20,000 across the board, but by expanding the number of senior nurses, including nurse consultants. My right hon. Friend the Secretary of State has announced that an extra 141 nurse consultants will be appointed.

I take that rather second-rate evasion to mean that, yes, Christine Hancock was telling the truth. I wonder when Ministers will start to take responsibility for the health service, more than four years into their term of office. [How. MEMBERS: "Four?."] They are well into their fourth year, and were they to be in office for 40 years, they would still be harking back to the Conservative Government. Is it not true that the 15,000 nursing vacancies and the 12,000 nurses who leave each year are a testament to the Government's failure in office? Is not that compounded by the lack of morale generated by the Government's endless political interference; the lack of authority for ward sisters; the lack of vaccine for patients; the return of TB to our cities; and a winter crisis that now goes on all year—all of it under a Prime Minister who says that Labour never understood the size of the problem? How can nurses, or anyone else, have any faith in a health policy that is such a complete shambles?

Given that the hon. Gentleman is clearly so sensitive about looking back at the previous Government's record—for example, the cut in nurse training places from 15,000 to 11,000 in two years and the failure to restore the figure to the previous levels under the previous Government—perhaps we should look to the future. The Government are already increasing the number of nurses in the NHS. We have a commitment to expand the NHS and to invest additional money, year on year, in increasing the NHS—[Interruption]

I cannot have the hon. Member for Woodspring (Dr. Fox) shouting across at the Minister. He asked a question; the hon. Lady is answering it.[Interruption.] She may not be answering it to his satisfaction, but she is answering it.

Thank you, Mr. Speaker.

If he will make a statement regarding the representations he has received on his national plan for the NHS relating to hospitals. [131858]

The, NHS plan was formulated with the help of doctors, nurses and managers from hospitals and other parts of the service. It is now being implemented with their help. I have received many representations about the expansion in hospital services set out in the NHS plan. There will be more new hospitals, providing more care to more patients.

I thank my right hon. Friend for that answer. However, I want to raise the question of diagnostic and treatment centres for out-patients. Most people who have contact with hospitals are admitted through out-patient departments, and the throughflow of patients causes those departments a lot of wear and tear. The diagnostic and treatment centres represent an important way to keep waiting lists down, but many out-patient departments would benefit from refurbishment.

That is a very important question. Public and media attention focuses, understandably and inevitably, on in-patient services. There is a very good reason for that, but my hon. Friend is right to say that most people who go to hospital are seen in an out-patient department or in an accident and emergency department.

The Secretary of State belongs to a Government who talk a great deal about devolution, but is he aware of the growing dissatisfaction among many members of health trust boards, who feel that the amount of discretion that they have is daily being whittled away by increased centralisation when it comes to setting targets, rules and so on? Is the Secretary State not worried about that?

I would be worried if that was what was happening. However, although I have a great deal of time and respect for the hon. Gentleman, it is clear that he has not read the NHS plan. I shall send him a copy, so that he can ask me a more relevant question next time we have Health questions. The plan sets out the Government's proposals to devolve greater authority and autonomy not only to managers and trust boards in hospitals and elsewhere but, most important of all, to the front-line clinicians—the doctors, nurses and physiotherapists—who, day in and day out, do such brilliant work treating patients.

I, too, welcome you to your post, Mr. Speaker.

That is very much the case. I understand the concerns expressed by hon. Members of all parties about the plan's proposal to abolish community health councils, but many people—in this House and outside it—have long argued that there is a democratic deficit at the heart of the NHS. They have said that we should strengthen rather than weaken the ways in which we monitor what the local health service, which services local communities, is up to.

If he will make a statement on the resources allocated by the NHS to mental health. [131861]

In 1999–2000, nearly £3.5 billion was spent on mental ealth services in the NHS. The NHS plan set out further proposals for investment in mental health services, including new teams for crisis support and primary care, and for young people.

Is the Minister aware of the report that was published over the recess by the Zito Trust, which documented the enormous obstacles facing the severely mentally ill in getting access to the new generation of anti-psychotic drugs which limit the side effects of their treatment? Can he explain why only 12 per cent. of the country's 250,000 schizophrenics have access to these drugs? Is the reason clinical or financial?

The hon. Gentleman, who takes a great interest in these matters, and rightly so, will be aware that when we published the national health service framework for mental health, we made it clear that our first priority was to improve services for people with severe and enduring mental illness. That is exactly the right clinical, ethical and moral priority for us to have reached. The use of the atypical anti-psychotics has, as the hon. Gentleman will know, been referred to the National Institute for Clinical Excellence, and we are awaiting its guidance on the wider use of those drugs.