If he will make a statement on progress with the clinical audit of general practitioners. [137636]

The NHS plan states that all doctors working in the NHS will be required to participate in clinical audit from 2001.

I am grateful for that answer. The Government deserve great credit for putting quality and clinical performance at the top of the NHS agenda. Is it not the case, however, that general practice remains a largely audit-free zone? Despite the Shipman affair and all that was said at the time by the General Medical Council and other organisations about the need to take action, particularly in relation to single-handed practitioners, there is no early prospect of clinical audit being introduced. Do not patients have a right to have it, and when can the Government give an assurance that it will be in place?

My hon. Friend is absolutely right that patients have a right to feel safe and secure. That is why we are committed to introducing mandatory clinical audits for general practitioners as part of their quality agenda. It is part of a package that we have introduced to improve safety, not just in hospital trusts but in GPs' surgeries. It has to be seen as part of a package that allows us to take quick action when doctors are failing in their duty. I refer in particular to the document "Supporting Doctors, Protecting Patients".

Does the Minister agree with the chairman of the British Medical Association that the access demands in the NHS plan would require an additional 8,000 to 10,000 GPs?

It is clear that delivering primary care service is a question not simply of the number of doctors, which we are increasing considerably—there are 2,000 extra GPs and 7,000 extra consultants—but of the way in which they work. The fact that, in the past year alone, almost two thirds of GPs are managing to do that because they have improved their services is a clear indication that the NHS plan with regard to that commitment is deliverable, and we shall deliver it with the help of the doctors.

I welcome the extra resources that have been directed to the Durham and Darlington health authority, which will undoubtedly have a beneficial effect on the overall health of people in my constituency. I draw the attention of my right hon. Friend the Secretary of State for Health to the increasing size of general practitioner waiting lists. The average is 2,300, with some in excess of 3,300. Will my right hon. Friend work along with officers from the progressive primary care group in Easington on any new initiative that will lead to a reduction in waiting lists?

Of course we expect the progressive practices in particular to work very actively in this regard. I understand that, before long, my right hon. Friend the Secretary of State for Health will visit my hon. Friend's constituency to see at first hand the good work that has been done to ensure that it is copied everywhere. We expect good, reliable services uniformly across the NHS, not just in isolated pockets.

The most advanced work in improving the safety of the treatment of patients is probably to be found in the United States. Last year, the chief medical officer published a report called "An Organisation with Memory". What will the Department do to incorporate those findings into its current political audit work?

The right hon. Gentleman is absolutely right—that is an extremely important and significant document. It focuses not just on detecting mistakes but on learning from them. The key outcome that we all want is safe medical treatment. We will build on that important and significant document, and I am grateful to the right hon. Gentleman for referring to it.

Nearly 50 per cent. of the general practitioners practising in my constituency are single handed. Is my hon. Friend aware that there is a feeling abroad that single-handed practices are now disapproved of and will she reassure GPs in my constituency that they can continue working in this way indefinitely? In addition, of course, I approve of clinical audits.

It is important to recognise that we must be certain that high clinical standards are being delivered, whether in single-handed or in group practices. Peer co-operation and peer review will be extremely important. That is why we encourage practices to work together, and also to work together in audit so that they can learn from each other. What is important is not the structure of the organisation but the quality of service that is delivered.

Does the Minister accept that concerns about audit are merely the tip of the iceberg, and that there is a growing crisis of confidence in the Government's whole handling of general practice? Yesterday, the British Medical Association chairman expressed his doubts about aspects of the NHS plan, and he is not alone. The Royal College of General Practitioners and the General Practitioners Committee expressed their profound disappointment at the limited expansion of 480 doctors per year, when the annual appraisal alone will require 600 extra doctors. Where will they come from? If the BMA, the Royal College of General Practitioners, the NHS Alliance and the National Association of Primary Care all think that the Government have got it wrong, what, apart from their own arrogance, makes them think the contrary?

The Tories simply could not match our commitment, in terms either of extra capital investment or of expanding the work force. I remind the hon. Gentleman that before 1997, the Tories did not seem to show a keen interest in regulating the profession or in ensuring patient safety. Since 1997, the Labour Government have introduced a framework that includes the National Institute for Clinical Excellence, the Commission for Health Improvement and the extension of audits to include not only hospital trusts but general practitioners. The Labour Government are expanding the service safely, reliably and sustainably, not undermining it as the Tories did.

I remind the hon. Lady that she is the Minister answering questions and that this is Question Time. Is not the real problem that GPs see a growing difference between the national health service that Ministers describe in the House and the NHS with which the rest of us have to live? When flu vaccine is in short supply, when care homes are closing, when casualty departments are shutting, and when GPs are drowning in red tape, Ministers have the nerve to talk about Labour's delivery. Was it not the final insult when the Prime Minister blamed GPs for abusing the admissions procedure? Did not that fully merit the rebuke of the chairman of the Royal College of, General Practitioners, who said:

Your remarks, coming at a time of low morale and change, have only served to heighten a feeling that primary care is not sufficiently valued by yourself and your government?

I sometimes wonder which planet the hon. Gentleman lives on. When I go to hospitals or general practices, I see new investment in buildings, new staff and retraining. All my colleagues use the NHS because they are committed to it, unlike Opposition Front Benchers who use it only to find out what it is like for people who have to use it.

What advice has the Minister given to general practitioners on the prescribing of antibiotics? In my constituency, one doctor has been told that he is over-prescribing. Many of his patients are miners with bad chests or are from poor families. Have the Government any advice for general practitioners who are told that they are over-prescribing in this way?

It is important that prescribing practices within a general practice or a health authority area are carried out safely, reasonably and in response to the relevant health needs. We are committed to having a system in place in which everyone in a health authority area prescribes according to those rules, and we want to maintain that system.

What recent representations he has received on the future of community health councils. [137638]

A number of representations have been received about the future of community health councils and the new structures outlined in the NHS plan. A series of national seminars involving discussions with the Association of Community Health Councils for England and Wales, and others, is currently taking place to determine how best to implement the new arrangements for increasing patients' influence and representation in the health service.

The Secretary of State noticeably failed to tell us how many representations and expressions of opposition he has received. Perhaps, in his second answer, he will come clean about the level of opposition of which he is aware in the country. Has he accepted any of the arguments put forward by me, by many hon. Members on both sides of the House, and by patients, constituents, pensioners' groups, doctors, consultants and local organisations that say that people want an independent organisation, free of staff employed by the NHS, and able to stand up to the NHS and take complaints. The Government's proposal is entirely unacceptable, as is the way in which they introduced it, because they did not ask anyone before they came up with the idea.

The hon. Gentleman is wrong on that count, at least. I remember Opposition Members raising the fact that we had an extensive consultation about the future of the national health service, which covered all aspects of NHS care, treatment and structures. Structures for improving patient representation were among the issues raised by patients, NHS organisations and others. The hon. Gentleman is profoundly wrong in making that charge. I, and many other hon. Members, have long argued that there is a democratic deficit in the NHS and that it should be properly scrutinised by the local communities that it is supposed to serve. Who better, then, to undertake that scrutiny and monitoring function than those not appointed by Ministers but elected by the local communities served by the local health service? That is what local government is for. It is right and proper that we should locate that function with local authorities regardless of political party. If the hon. Gentleman thinks that local government is not independent of central Government, why on earth did the Conservative party spend 18 years trying to destroy local government?

When the Health Committee considered patient complaints, we proposed that patient advocates should be based within community health councils. My concern is that it is proposed that patient advocates should be placed within trusts, where they will not be seen to be completely independent, as patients need them to be. The NHS plan contains many positive proposals. Will the Secretary of State reconsider that issue?

As I said in my reply to the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), we are considering how best to take forward those elements of improving patient representation and the patient's voice in the NHS. As my hon. Friend will recall, there are three separate proposals. First, we will locate the scrutiny and monitoring function with the elected representatives of the local people—it is best located with those democratically elected by local communities, the local councils. Secondly, we are giving patients, for the first time, a patients forum within every NHS and primary care trust so that patients are elected directly to the trust board in each and every case, thereby increasing patient representation within the NHS. Thirdly, we propose a patient advocacy and liaison service, which we already have in some NHS trusts, which is designed to deal with patient complaints and nip them in the bud. Discussions are continuing on locating the PALS in the NHS locally, or slightly outside it. Where we have patient advocacy and liaison services and active mediation, the number of patient complaints and counts of clinical negligence brought against the health service declines. The system works.

The Secretary of State will be aware that I asked the Prime Minister a question about community health councils last Wednesday. In his reply, he seemed to want to ensure that we all understood that the matter was out for consultation. He agreed that the proposal in the NHS plan to scrap community health councils was bitterly opposed. Yesterday, I received a letter from the Prime Minister, who was clearly embarrassed by his answer—[Interruption.]

Order. The hon. Gentleman is not going to get away with that. The Minister will answer him.

I did not think that it was a good question, so I shall not give the hon. Gentleman a good answer.

Does my right hon. Friend accept that community health councils do good work in our national health service? Does he also accept that those councils genuinely represent the patients and their families—the consumer? As he is engaged in some necessary, far-reaching reforms throughout the health service, could he delay deciding his approach to community health councils until he has advanced his other reforms? As the system is working, perhaps we should not fix it too soon. Will he bear that in mind?

With the greatest respect, I am not sure that the system is genuinely working. When community health councils were formed in the 1970s, they were way in advance of any other form of patient representation in any health care system. Time moves on. It has become increasingly obvious to many inside the NHS, in local government and elsewhere, that trying to combine three distinct functions in one organisation has not delivered the goods for patients. Of course, the discussions that are taking place between the Department of Health and the Association of Community Health Councils for England and Wales will seek a smooth transition from the existing to the new arrangements, which will increase patient representation and improve the patient's influence within the NHS, rather than diminish it.

Does the right hon. Gentleman agree that to abolish CHCs is a retrograde step, bearing in mind that they are the only independent advocate for patients, and that they are needed to give expert advice and to try to identify poor practice? Will he think again about those flawed plans? I hope that he will tell the House that he will amend what exists already—that body of expertise in the CHCs; otherwise, he risks throwing the baby out with the bathwater.

Of course we shall try to ensure a smooth transition from the existing CHCs when introducing the new proposals advocated by the Government. Of course we shall try to maintain expertise where it exists; that is the right thing to do. However, no organisation has a God-given right to exist in perpetuity; time moves on. I certainly will not accept lessons about patient representation or independence within the NHS from the Conservatives, who when in government sanctioned gagging clauses on NHS staff.

Does my right hon. Friend accept that Leeds CHC has an excellent record for providing support to patients? As a former member of the council, I can testify to that. Does he agree that the CHC is concerned not so much about its own abolition, or about the loss of the services that it provides, but about the possibility that those services will be fragmented among a range of providers and that the patient's voice element will be dissipated rather than co-ordinated? There will be serious questions as to the independence of those service providers. Is there not a real danger that we shall create a tower of Babel rather than a tower of strength for the representation of patients' views?

I do not think that is the case, for two reasons. First, I cannot imagine organisations that are more independent than Conservative, Liberal or Labour local authorities. My hon. Friend would only need to look through my postbag from local councils to realise that they are pretty independent organisations and that they will remain so.

The Secretary of State does not seem to understand that the real problem is that, in the real NHS, those who are under the auspices of a trust board will not feel free to criticise that board. Let us be clear that CHCs are being scrapped because the Labour Government dislike criticism from any quarter—especially from independent bodies.

That is not very original.

As my hon. Friend points out, the hon. Member for Woodspring (Dr. Fox) did not make a very original comment.

Although I accept what the Secretary of State has said, does he recognise that the good community health councils do an excellent job, that all CHCs should be brought up to that better standard and that he should tread warily before he changes something that has widespread public support throughout the country?

I am sure that there are very good CHCs, and there is no doubt that CHCs have played an important role in the national health service during the past 25 or 30 years, but I genuinely think that if my hon. Friend were to ask most members of the public whether they had heard of their CHC—let alone contacted it—he would find that the answer would be a resounding no.

How many nurses he plans to recruit from overseas over the course of the next 12 months. [137639]

We have not set a target, but according to the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 7,361 overseas applicants were admitted to the nursing register in the year to 31 March 2000.

I thank the Secretary of State for his reply. What measures is his Department taking to ensure that the national health service is sticking to its own guidelines in not contracting nurses and midwives from South Africa, through private recruitment agencies, when there is strong evidence that those agencies are still actively recruiting?

The hon. Gentleman makes an extremely important point. We have issued guidance to the NHS—I think that we issued it either late last year or earlier this year—and it certainly tells the trusts that they should not actively recruit from any developing country. There are surpluses of nurses in some developing countries, such as India, Pakistan and elsewhere. Inevitably, nurses from those countries will sometimes apply, of their own volition, to come to this country, and they make an extremely important contribution, as the hon. Gentleman will agree. Certainly, from my point of view, we should not seek to recruit from developing countries; we want those countries to develop their own health care systems. Where appropriate, we shall recruit from overseas.

Will my right hon. Friend take this opportunity to thank all the nurses and doctors from overseas who are playing such a vital role in our national health service? Can I draw to his attention the nurses from the Philippines, who have made it possible for two new wards to be opened at King George hospital in my constituency in recent months?

I am happy to do that. Nurses and doctors and, indeed, other staff from overseas have long made an important contribution to the work of the NHS in many parts of the country, particularly London and the south-east. I know that that is the case in my hon. Friend's constituency. I tell those hon. Members who seem to be more concerned about the accents of those doctors and nurses that what counts is not their accents, but their excellence.

Is not the level of overseas recruitment simply an indictment of the Government's efforts to bring back our own nurses and to stem the tide of nurses leaving the NHS through frustration, exhaustion and despair? Raiding the third world is not the answer. I thank the right hon. Gentleman for his answer on the sources of recruitment to the NHS, but what measures will he take to ensure that there are guidelines for the private recruitment agencies to stop nurses being drawn from some of the poorest countries?

The hon. Lady seems to be on a kamikaze mission. She seems to think that we have problems in the NHS because a shortage of nurses suddenly arose on 1 May 1997. If she stopped to think about it and, more importantly, to examine the facts, she would realise that she is 100 per cent. wrong. Let me remind her of her record when the Conservative party was in office. [Interruption.] I like to think of these sessions at Health questions as a form of regression therapy for Conservative Members, to try to help them to face up to their past, rather than simply forgetting it.

Get on with it.

If the hon. Gentleman will stop shouting and listen for a moment, I will give him some facts; he might learn something.

How much is planned to be spent on providing NHS nursing care to residents of private nursing homes in each of the next three years; and how many NHS hospital beds will be unblocked as a result. [137641]

The Government have estimated that the additional cost to the Exchequer of providing free nursing care, as outlined in the NHS plan, will be £420 million over the next three years. Free nursing care will form part of a package of measures to improve care for older people, including an investment of £900 million by 2003-04 in intermediate care and related services, which will help reduce delayed discharge.

The whole House will be concerned that £420 million over three years will not pay for the nursing care of all those people who are currently in private nursing homes. Was it really an announcement that the Government made, or was it simply spin? Perhaps I can ask the Minister another question, just to clarify the matter. By how much does he believe that fees will be reduced in private nursing homes as a result of the Government's announcement? How much per week will patients save because they are being paid for by the Government?

With the greatest respect to the hon. Gentleman, I do not think that he understands what he is talking about. The £420 million that I identified in my answer to him relates to those who are at present meeting all the costs of their nursing care. That additional money will help to reduce those costs. The service will be provided free as an NHS service, as it always should have been. For 18 years the Conservatives failed to grasp that. Of course there has been a significant change. The announcement will save about 30,000 people up to £5,000 a year. None of the changes will have the effect that the hon. Gentleman suggests.

Has my hon. Friend estimated how much local authorities would benefit from having available to them that amount of money to provide alternatives to private homes, which, after all, are in it for profit?

I think that the new investment that we are making available through the spending review provides an opportunity for a new relationship to be created between local authorities and the independent sector providers. That is to be welcomed. Of course we need to make sure that the quality of care provided in private homes meets the standards that we expect in the NHS. That will be done, but we have an opportunity to build important new services for older people, which will improve their recovery from illness, speed up their discharge from hospital and allow them to resume their independence and return home much more quickly than ever before. That is precisely what the public want us to do.

Is the Minister not concerned that 760 nursing and residential homes have closed in the past year, with the loss of 15,000 beds? Is he aware that one health authority alone has said that it already has 160 patients staying in hospital because there is nowhere for them to go out in the community? That is before winter pressures have seriously mounted. How many more patients do the Government maintain it will be possible to treat at home? Will that compensate for the 15,000 beds lost in the past year? Would not the best way of guaranteeing an end to bed blocking be to accept the royal commission recommendation of free residential or home-based personal care for all?

Of course, we look at the situation very carefully indeed. We want to ensure that there is sufficient capacity, both in the NHS and the independent sector, to ensure that the NHS works efficiently and that we do not have unnecessary delayed discharges. The hon. Gentleman might be aware that evidence that we submitted recently to the Select Committee on Health shows that the number of delayed discharges is coming down.

My hon. Friend will be aware that the new private finance initiative hospital in Dartford, serving the residents of Dartford and the constituency of my hon.

We will consider very seriously any requests for additional resources from the health authorities and social services in my hon. Friend's constituency. He might be aware that we recently made available nearly £1.8 million of additional resources to cover the winter period, for both the East Kent and West Kent health authorities. I hope that those resources will go a significant way to deal with what I know are quite acute pressures in my hon. Friend's constituency.

Will the Minister confirm that, over the past two years, there has been an unprecedented loss of nursing and care home beds, and that the result is an unprecedented level of bed blocking in many parts of the country, which is already undermining the Government's NHS winter strategy? Will he confirm that inadequate levels of social services fee funding and increased Government regulation are further exacerbating that problem? Will he tell the House who he holds responsible for that state of affairs?

All of us on the Government Benches know exactly what game the hon. Gentleman is playing. He wants his winter crisis for the NHS this year, and he will do anything that he possibly can—including ignoring the facts that I have tried to outline to the House today—to reach his conclusion that there is a crisis. There are problems in some parts of the country, and of course we accept that. We are looking very carefully at what we can do to improve the situation, and we are providing record resources to social services to help them to tackle that problem.

Does my hon. Friend recognise that, whereas some Opposition Members might savour the idea of a winter crisis, Labour Members very much support the joint bid by Kent county council and the health service in Kent for extra funds for domiciliary care? Will he also look carefully at the possibility of reopening a ward in Gravesend and North Kent hospital, to ease the burdens on the acute hospital this winter?

As I said earlier, we are aware of the problems in Kent and we are working closely with the health authorities and social services to find sensible solutions. The type of option that my hon. Friend has just outlined may be something that the health authority and social services need to consider together, but I do say to my hon. Friend and other hon. Members that the best way to ensure that all our constituents receive the best possible care and treatment during the winter is for health and social services departments in all parts of the country to work together as closely as possible. Perhaps then we shall see an end to the puerile party political posturing of the hon. Gentleman and his friends; I hope that we shall.

If he will make a statement on the Government's initiatives to help victims of Alzheimer's disease. [137642]

The Government are working closely with organisations that provide help and support to people with dementia and their carers in order to improve services. When we publish the national service framework for older people, it will set national standards for the care of older people, including for mental health.

Is the Minister aware of the evidence that has been collated by the Alzheimer's Disease Society, among others, that demonstrates widespread abuse of patients with that condition in nursing homes in particular, as well as in hospitals? They are fed anti-psychotic drugs and sedatives. What action are the Government planning to take to ensure that people with this unfortunate disease are treated in a much more appropriate and dignified manner?

We are aware of the concerns that have been raised, and I thank the hon. Gentleman for drawing attention to this issue, in which I know he has a strong interest. I agree completely that we need a proper framework in place to protect vulnerable older people and to ensure that proper prescribing takes place. We have welcomed the guidance produced by Age Concern, and we will set standards as part of the national service framework for older people. We also have scope to work to improve the position through the operation of the Care Standards Commission.

My right hon. Friend the Secretary of State is visiting Wolverhampton tomorrow and he will receive a warm welcome. I know that he will be given information that will be to his advantage, and certainly to that of Wolverhampton, regarding the progress that we are making in mental health services, particularly those for Alzheimer's disease. While he is there, will he address the very important issue of the fourth cardiac centre for the west midlands, to be based in Wolverhampton? I hope that he—

Order. I have to stop the hon. Gentleman.

I am sure that my right hon. Friend has heard my hon. Friend's representations.

I welcome the Government's concern about care standards for Alzheimer's disease, but are they able to tell us whether there have been any advances in the treatment of Alzheimer's and whether movement has been made to make drugs available to deal with the disease?

We are concerned to ensure that people across the country receive the best possible treatment for Alzheimer's. Treatment should not depend on where people live. The postcode lottery for all types of treatment is completely unacceptable and that is why we have referred several drugs for the treatment of Alzheimer's to the National Institute for Clinical Excellence for it to provide clear guidance to be followed throughout the country. NICE is considering those drugs at the moment.

What plans he has to reform the process of regulation of the medical profession. [137643]

The NHS plan restated the Government's resolve that the regulation of the clinical professions, including the medical profession, needs to be strengthened and made more accountable.

Does my right hon. Friend understand the anguish of my constituents Mr. and Mrs. Khatib, whose daughter Wassan died earlier this year after being attended by a doctor whom the General Medical Council had already been investigating for gross misconduct for 16 months and who had previously received a severe admonishment from the GMC after an investigation that had lasted 14 months? In all, four and a half years were spent investigating a doctor for gross misconduct. The doctor attended my constituent, who subsequently died, and it was only two months after that that the GMC acted to strike him off. Is it not a totally unacceptable state for the health service to be in when a regulatory body does not take timely and effective action against incompetent and malpractising doctors?

The case that my hon. Friend has outlined is shocking. I am sure that the whole House would want to join me in passing our condolences to the family. Such cases clearly raise important issues about professional self-regulation. I have always made it clear that I believe in professional self-regulation in principle, but it has to prove its worth. Regulatory bodies must grasp some nettles that should have been grasped many years ago and, in particular, they must make their procedures much more transparent and faster. The case that my hon. Friend has raised shows that that is so.

Although we are all grateful for the skills of most NHS consultants, does the right hon. Gentleman agree that the power of the royal colleges is used most arbitrarily? I welcome some of his initiatives on that. Is he aware that in my constituency, the royal colleges are driving the reform of the Princess Royal hospital by threatening to remove the full accident and emergency service? Does he agree that the health service should be run for the convenience of the patients, not of the consultants, and will he take on board my constituents' grave concern about such high-handed behaviour by the royal colleges?

I am grateful to the hon. Gentleman for his comments. I think that he is aware from the NHS plan proposals that we published in July that we need to get to grips with the issue. We need to balance two, sometimes competing, factors—the training needs of doctors and the service needs of patients. We cannot have a situation in which the training tail sometimes wags the service dog. There has to be change. Our proposals for a medical education standards board, which I hope the Conservatives will support, will provide a forum in which royal colleges, the Department of Health and representatives of patients' interests can get around a table to sort out how best we can ensure that the NHS provides both adequate training for its junior doctors and high quality locally accessible services for patients.

What steps he is taking to provide better support for carers. [137644]

My right hon. Friend the Secretary of State announced on 27 September that the carers special grant will increase from £50 million this year to £100 million in 2003–04, providing extra respite breaks for more carers. The Carers and Disabled Children Act 2000 will come into force next year, giving local councils further duties and powers to help carers. In addition, my right hon. Friend the Secretary of State for Social Security has announced a package of measures that will provide an extra £500 million of financial support for carers over three years, from which more than 300,000 carers will benefit financially.

I know from the Milton Keynes carers project that the people whom it represents very much appreciate the recognition of carers' needs and the help that has been given so far by the Government. However, may I draw my hon. Friend's attention to the outstanding need for greater funding for respite care so that carers get some relief from their on-going responsibility, are able to recover themselves and guard their own health and sanity, and can continue to care for those people for whom they are responsible?

I agree strongly with my hon. Friend, and that is precisely the purpose of the carers special grant. The grant will double over the next three years, which will allow thousands more carers to receive the respite care breaks for which my hon. Friend called. As a society, we must continue to do more to support carers because they provide a fundamental service to hundreds of thousands of disabled people in our society.

Speaking as the patron of the Macclesfield and District Crossroads, may I ask the Minister to take a personal interest in a constituency case of mine in which a 77-year-old man is having to look after his wife, who is suffering from a terminal illness, without any support from the health authority? Is that the care that a carer should receive for the job that he is doing?

No, it certainly does not sound as if it is. I would be happy to consider the details of that case and speak to the hon. Gentleman as soon as possible.

May I draw my hon. Friend's attention to children who take on major caring responsibilities, often for disabled parents? Can he assure me that the Government are paying special attention to their situation and to the concern not only that their needs are met, but that they have a proper chance to have a childhood while they are carers?

Again, my hon. Friend is entirely right. When we prepared the national strategy for carers, we were able roughly to estimate that there may be as many as 50,000 young people in England who have heavy caring responsibilities that might well compromise their ability to obtain a good education and enjoy the sort of safe and secure childhood to which my hon. Friend has referred. We have issued guidance to schools about their responsibilities towards young carers. I am sure that the Carers and Disabled Children Act 2000, which my hon. Friend helped to introduce, and which did a great service to the House and to carers, will make a positive difference and a contribution to the issues to which he has drawn attention.

What role independent and local authority care homes have in his strategy for intermediate care. [137645]

Intermediate care will be provided in a range of settings, including care homes. Maximising the contribution of all partners in health and social care will be central to building up our capacity in intermediate care. That is why intermediate care is highlighted in the concordat between the NHS and the private sector as a key area for future co-operation.

Does the hon. Gentleman agree that it is his policy of loading regulation, and the threat of more regulation, on the private care home sector that is responsible for the blight in that industry? For that reason, developers are queuing throughout the south of England to build on the land occupied by residential and care homes. The loss of those beds will blight the NHS, especially during winter, for years to come.

I tried to anticipate the hon. Gentleman's supplementary question, and I succeeded. His point about standards is completely wrong. I understood that the Opposition Front Bench and the Conservative party supported national minimum standards for care homes. I know that there is an argument about the level at which the standards should be pitched. We are determined to ensure that they will be introduced safely, sensibly and realistically. We have already made announcements about the key aspects of these critical standards. I shall give the hon. Gentleman a quote—he may not like to hear it— from Keith Ingram, who is a senior underwriter for residential and nursing care at the First National Commercial Bank. Last month, in Caring Times—I am sure that the hon. Gentleman studies it as carefully as I do—he wrote:

there are many reasons to think that we are now embarking on a long term period of steady growth.

Does my hon. Friend agree that intermediate care is a vital element in community or care packages, especially for elderly people? Does my hon. Friend agree also that a rapid development of intermediate care services needs to be pursued throughout the country, which means more co-ordination and co-operation between health services and social services? In spite of the increase in the social services budget, is my hon. Friend concerned that the widening gap between health service budgets and social services budgets might frustrate the objective?

I would be concerned if that were the case. My hon. Friend will be aware that we are strongly encouraging both health and social care providers to pool their resources, to ensure that we provide properly integrated care services for older people. It is a common cause for concern—we have all heard it in our constituencies and at our surgeries—that, although older people are the biggest supporters of the NHS, they are often among its greatest critics. We have never been able to put in place a range of effective services that can support the objectives that my hon. Friend and I would want to pursue. The Government's policy is entirely right and it is closing a serious gap in services. If we use the new resources that are becoming available and pool them, we can make a significant difference.

It is impossible, even in the constituency of the Secretary of State, for people to avoid the consequences of Government policy. What discussions has the hon. Gentleman had with the 135 residents of council residential homes who have had to move because there is no money to renovate the homes to the standards demanded by the Government?

The hon. Gentleman needs to be careful in his criticisms of these developments. Of course there will be change in any market; that is the nature of markets, and something that he and his hon. Friends espouse. We need effectively and sensibly to manage the changes that are taking place. If there is a need for older residents to move from one care home to another, that must be done sensibly and carefully. I hope that the hon. Gentleman and his hon. Friends will examine carefully what is happening. There has obviously been a reduction in the number of beds in the private residential and nursing care sector, and further figures will come out next week that will confirm that. At the same time, we are seeing a necessary and long-overdue investment in better home care services that can avoid the need for unnecessary admissions into residential care.

What steps he is taking to provide for the registration of health support workers. [137646]

Health support workers, such as health care assistants, operating department practitioners, pharmacy technicians and others, make a crucial contribution to patient care. The NHS plan underlines our commitment to acknowledging and supporting them in developing and expanding their roles, and to publishing proposals for their effective regulation. We have now received a report on the subject by De Montfort university, which we are currently considering.

I thank my hon. Friend for his reply and acknowledge the progress that has been made, but does he not agree that, when the Care Standards Act 2000 gives the power to introduce regulation for care support workers, it is nonsense that health care assistants doing a similar job in the NHS are not registered? Should not our priority be the protection of patients? I hope that my hon. Friend will act quickly to end the anomalies and give recognition to the important work done by health care assistants.

My hon. Friend is absolutely right to raise that issue. We have made a commitment to effective regulation, because we recognise the need to ensure that patients are protected from members of staff who have dubious histories. We are anxious to address the issue, which is why we commissioned the report from De Montfort university. My hon. Friend is right to draw attention to the General Social Care Council, which is one of several measures that the Labour Government were forced to introduce after years of neglect by the Conservatives: we have had to regulate social care, introduce regulation for private health care, strengthen the powers of the General Medical Council and introduce annual appraisal for doctors. All those measures should have been introduced years ago, but were neglected by the Conservatives. We have not yet done everything necessary, but we are making progress on a big agenda.

Is the Minister aware that many health support workers are also practitioners of complementary medicine? Given his remarks about regulation of other sections of the medical profession, does he not think that the time has come to set up a central register of complementary medical practitioners, so that accurate information is available to members of the general public seeking treatment?

I admire the persistence and imagination with which the hon. Gentleman raises the issue of complementary medicine at every turn. He will be aware that the term "complementary medicine" covers an extraordinarily broad range of practice, from therapies that some people regard as esoteric to those that are close to acceptance as mainstream therapies. One of the great difficulties with regulation, especially in respect of the latter group, is the divisive nature of the disagreements between practitioners of many of the therapies. I accept that there are occasions on which protection of the public from quack practices is important, but there must also be some sorting out done within those professions.

Following last week's announcement of additional resources for the NHS, can those professional support workers who are state registered, such as medical laboratory scientists, look forward to receiving levels of pay that are commensurate with their skills, the high qualifications that their jobs require and the role that they play as part of the NHS diagnostic team?

As part of the three-year pay deal, we have already taken steps to increase, quite significantly, the pay of at least lower grade pathology laboratory staff. That is an important step in the direction my hon. Friend advocates. He will be aware that we are working with the unions on "Agenda for Change", which sets out a new pay system for the NHS, which holds out to some staff the prospect of moving into the pay review body system, and to staff grades as a whole a proper job evaluation system, better career progression and fairer rewards for all NHS staff.

What plans he has to reduce wastage of prescribed drugs in the NHS. [137647]

In September, we published our pharmacy programme, "Pharmacy in the future—implementing the NHS Plan", which sets out a range of initiatives designed to help patients to get the most out of their medicines and to reduce waste. We shall invest at least £30 million in the next three years to support that work.

I am grateful to the Minister for that answer. First, I should like to express my gratitude to St. Thomas's hospital for recently allowing a visit by members of the all-party pharmacy group. Does the hon. Lady agree that the practice now established at that hospital, of identifying and using GP-prescribed drugs in the hospital, is an obvious example of good practice?

I am aware of the hon. Gentleman's visit, and I have read the reports of it. It was useful. We believe that it is important to encourage patients to use prescribed medicines and to bring them to hospital. That is why the NHS Executive regional office will be rolling out a performance management framework later this year, which will deal with medicine management in hospitals. With regard to the use of patient packs, considerable progress can be made by re-engineering hospital pharmacies, but there will always be some patients for whom patient packs will have to be broken up, and we must ensure that they receive the correct information. Hospitals and the pharmaceutical companies need to address that.

On a point of order, Mr. Speaker.

Order. I shall deal first with the application under Standing Order No. 24.

Any Parliament that decides to reform policing in Northern Ireland must, surely, have one simple objective: to ensure that the ordinary, law-abiding and decent majority of people in both communities are better protected from the men of violence and from terrorism.

Order. I did not wish to interrupt the right hon. Gentleman, but we are discussing the allocation of time motion. Perhaps those matters can be discussed when we come to the amendments.

Absolutely, Mr. Speaker.

My right hon. Friend the Member for Bracknell (Mr. MacKay) has articulated the general objection to the Bill, and I will therefore not repeat it. Let me say, however, that I have the strongest opposition to the use of timetables, both in general and in particular.

Does my right hon. and learned Friend agree that the Government are fundamentally mistaken in their assumption, and in the premise from which it works, that the presence on the Order Paper of a large number of amendments somehow justifies the imposition of a timetable? Is it not the case that the presence of that large number of amendments, even if technical and drafting, is testimony to the ill-considered, badly prepared, poorly conceived character of the Bill?

It is testimony to that in part, but it also points to the need for a more extended debate, for reasons that I will come to.

I noted with interest that when the Minister of State opened the debate, he referred to the consultation on the Bill and the implementation of the Patten report. May I say at the outset that this is the first time that I have ever dealt with a Bill about which there was no prior consultation? I believe that the Minister of State is fully aware of that and that the House is fully aware of the implications, to the extent that this has become a fractious, divisive debate on the issue.

It is worth remembering that we are discussing the allocation of time, rather than the substantive amendments. The fact that so many hon. Members feel tempted to discuss the content of the motion shows how important it is to move to the main debate as quickly as possible.

The beauty of following the hon. Member for Montgomeryshire (Mr. £pik) is that the Liberal Democrats always say, "Let's get a move on—but not until I've spoken." That is the situation that we are in.

What has this to do with the timetable motion?

The right hon. Gentleman is twittering from the Opposition Front Bench. I am pointing out that the timetable is of little relevance because many of the important matters will be decided outside of it. It would therefore be helpful to know about particular matters. As the right hon. Gentleman talked a lot about what happened in another place, which had little to do with the timetable, and as his comments on amendments moved there had little to do with it, he is the last person who should comment from a sedentary position on these matters.

I am sure that the House listened with interest to the hon. Member for Newry and Armagh (Mr. Mallon). In the previous debate on the Bill, he made it clear that his party would not call on its supporters to support the new police service as it is set out in the Bill. At his party conference, as leader of his party, he said that one does not proceed by ultimatums and that the trouble with the Unionists is that we are always making ultimatums. We have heard the ultimatum from the Social Democratic and Labour party—it is a list of matters that the hon. Gentleman has said must be clarified tonight by the Secretary of State.

Order. Perhaps the hon. Gentleman is putting a case that could be put when the amendments are before the House, rather than during the timetable motion—[Interruption.] Order. I am calling the hon. Gentleman to order. Hon. Members should not point across the Chamber.

I am arguing why we should discuss these matters. I am sorry that I did not make that clear to you, Mr. Speaker. I am arguing not the rights or wrongs of the issues but that we should be able to discuss them. As an hon. Gentleman has argued that the flag should be removed from police stations, and that was completely in order, I should be in order when I point out that I do not agree and should like to discuss such matters. That is my argument. When we come to the marrow, I am sure that you will be under no misunderstanding, Mr. Speaker, about which side we are coming from.

I do not intend to detain the House for long. I had the honour of being a member of the Government in two Administrations who, from time to time, used the guillotine. I do not object in principle to it being used, although we never even fantasised about the sort of use and centralised control that has become normal for this Government.

I could not disagree more fundamentally with the conclusions of the right hon. Member for North-West Cambridgeshire (Sir B. Mawhinney). He made many valid points, but I shall support the timetable motion because I believe that the time has come for action and reform. It is clear to anyone who reads the Bill that it envisages major changes in the policing of Northern Ireland. I was privileged to be one of a small number of Members of Parliament who, on a recent cross-party visit to the constituency of the hon. Member for Newry and Armagh (Mr. Mallon), talked to people of all views in Northern Ireland.

I join other hon. Members who are opposing the timetable motion, because I believe that there are important issues to do with policing in Northern Ireland that we need to debate, but which we shall not have the opportunity to discuss tonight; and this may be, and probably will be, the final opportunity in the House to address these issues before we move beyond the legislation.

Order. The hon. Gentleman may get an opportunity to catch my eye later this evening, but at the moment he must direct his remarks to the allocation of time.

I am dealing with the issue of time, Mr. Deputy Speaker. I am lamenting the fact that I shall not have adequate time to deal with these issues; that is my argument. If I had time this evening to deal with the implementation of the Bill, which I believe that we should debate because there are important issues to be addressed, I would be telling the Secretary of State that he should be cautious about downsizing the police in the context of an increased security problem and growing criminality. Those issues must be properly addressed.

In discussing curtailing the time available for the debate, we should consider the mischief that the Bill is intended to cure. The Bill is intended to provide a police service that is supported on all sides of the divided Province. It is vital that all sides are heard, because there are divided opinions on what sort of police service will achieve what the Bill sets out to do.

There are important issues to cover, so I shall be brief and raise one general matter.

When the House debated the remaining stages of the Bill under a guillotine motion on 11 July, prior consideration was not shown to the Select Committee and it was not advised that that would happen. As 12 July is a fixed rather than a moveable feast, most Committee members missed the debate. The Secretary of State was good enough to assure us that that would never recur, and I am grateful to him on this occasion.

The first guillotine on the Bill when it initially came to the House was perhaps the most notorious of this Parliament. As we have heard from both sides of the House, people who are intimately involved in the process have been denied the opportunity to discuss something that is fundamental to their communities. That is a disgrace, but the Government no longer care. This is edict, not debate. We have no justification for being here other than to represent those communities that sent us here. Without that function or ability, we are nothing, and the Government are a shallow, wasted thing who impose their will on this country and on Northern Ireland.