If he will make a statement on allocations under the modernisation fund. [142896]

In the last two years, £4 billion worth of extra investment for the national health service has been provided through the modernisation fund. It has been used to expand critical care, cancer and heart services. Among other purposes, it has been used to cut waiting times for treatment and to increase the number of nurses in training.

On how many occasions have the Secretary of State and his ministerial colleagues overridden the advice of civil servants on the allocation of money to bids for the fund?

I think that the hon. Gentleman has confused the modernisation fund and the special assistance fund—perhaps he is starting the year as he means to go on. He appears to be alluding to the special assistance fund in calling for extra money for his health authority. It is true that we received advice suggesting that we put more money into West Surrey health authority than we initially put in under the special assistance fund, but we have agreed with official advice on how much money we should put into general allocations for that health authority. This year, £30 million extra will go to West Surrey as a consequence of the investment that we are making, and next year there will be extra investment of £31 million.

I welcome my right hon. Friend's determination to modernise the national health service, especially in west Cumbria and my constituency. I also welcome the substantial increase in the budget of North Cumbria health authority. However, does he recognise that money is not the sole issue? Will he examine specifically and urgently the collapse of breast services at the West Cumberland hospital in Copeland? There is widespread concern, not because the resources to sustain the service are not available but because it is proving very difficult to recruit radiologists of sufficient standing to fill the posts. When he considers the problem, will he also ensure that the solution is designed for the convenience and better health care of the women who need such services, and not for the convenience of administrators and consultants?

I shall gladly consider the concerns that my right hon. Friend has raised. He has already raised them informally with me and I shall be glad to examine the specific problem. It is true that we have a problem with the recruitment of radiologists and surgeons for oncology services. That is the position throughout the country and, in large part, it reflects the problems that the NHS faces today, which are no longer problems of cash, but problems of capacity. There is a shortage of trained and skilled nurses and doctors. Over time, we will put that right. As a result of the record levels of investment that we are making, over the next four or five years, the six major specialties that deal with cancer services will see a 25 per cent. increase in numbers.

I am glad that the Secretary of State has come clean about his intervention to reduce the amount of money recommended by his officials for West Surrey health authority under transitional funding arrangements, but does he not understand that if he fails to answer the questions of my hon. Friend the Member for Guildford (Mr. St. Aubyn) about how, when and why he departs from official recommendations when making allocations under the modernisation fund, he will not dispel the suspicion that it is being used as a multibillion-pound slush fund, dispensed at his whim in an attempt to buy friends and influence in the run-up to the general election?

I honestly do not know to what the hon. Gentleman and the hon. Member for Guildford (Mr. St. Aubyn) are alluding. Let me give them some examples of the use to which we have put the modernisation fund, then let the hon. Member for Runnymede and Weybridge (Mr. Hammond) substantiate his allegation.

What progress has been made in involving patients in primary care groups. [142897]

Excellent progress in involving patients has been made by primary care groups and primary care trusts. Those new organisations reflect and represent the interests of the community that they serve, partly through the lay membership, but largely by working together to engage and involve local people.

Sheffield has a good community health council that has stimulated an excellent community health forum in my constituency, but there is concern that, in the new system, the patients and public who participate in it will not have the same opportunities to get their voices heard. During the transition from community health councils to the new patients forums, how will my hon. Friend ensure that there will be no break in continuity when good initiatives, such as the one that I have mentioned, are in place?

My hon. Friend makes a very important point. The establishment of primary care groups has, so far as we can tell, led to an explosion in the number of patients forums throughout the country. Some are supported by CHCs and others are directly supported by the primary care group. The primary care group in my hon. Friend's constituency is one of several that want to become primary care trusts from April this year, and will therefore benefit from the proposals in the Health and Social Care Bill for every trust to have a statutory independent patients forum, which will not be appointed by Ministers, to represent patients' interests.

Does the Minister agree that the Government are introducing new mechanisms for public involvement in the national health service because of their policy unnecessarily to abolish community health councils? If the councils are unsuited to represent patients' needs, will he tell the House why the National Assembly for Wales will not be abolishing them?

Many CHCs have done a good job, but that has largely been owing to the qualities of the individuals involved as officers and lay members rather than to their legal structure and powers. We want a step change and improvement in patient influence in the NHS. That is why the Health and Social Care Bill will, for the first time, put a statutory duty on every NHS organisation to involve and consult patients. It will establish for every trust an independent patients forum with the power to oversee the advocacy and liaison service in each trust. We shall ensure that there is an effective complaints system for individual patients and an independent source of advice and support for patients who want to take their complaint through that system. We shall give democratic local government the role that it should have had of overseeing the local health service. All those measures give patients a greater say in the future of the NHS. The functions carried out by CHCs will be performed by other bodies and new functions added. That is a step forward.

I am pleased to hear about that progress, but can my hon. Friend assure me that the new system will not replicate the problems of health authorities and trusts in which the poorest and most health-deprived areas are consistently under-represented in the forums, as they are in my area? Will he ensure that people with the greatest health needs get their proper say?

We hope to achieve that through a number of mechanisms. First, an independent appointments commission will appoint members of the patients forums, and we will look to those bodies to ensure that they are properly representative of the communities that they serve. Secondly, we propose—I am sure that we shall discuss this in detail in Standing Committee—to find arrangements to draw on a representative cross-section of people who have recently used the NHS to be members of the patients forums. Both those methods will allow us to achieve the aim that my hon. Friend sets out.

If he will make a statement on the average out-patient waiting time for an ear, nose and throat consultation in the Avon health authority area in the last 12 months [142898]

The latest figures, for the quarter ending 30 September 2000, show that in Avon health authority the number of ENT out-patients being seen in less than 13 weeks increased from 54 per cent. to 57 per cent., compared with the previous year. On that date, the number of patients in Avon waiting more than 13 weeks was 7.8 per cent. lower than on the same day in 1999. Avon health authority, like others, will benefit from the action in the NHS plan to cut maximum waiting times for out-patients.

We in Weston-super-Mare must be very unlucky. Is the Minister aware chat the mother of a five-year-old suffering from a recurrent ear infection has been told that the child must wait a year for an appointment? I am sure that she will agree that that is a long time for a child to suffer discomfort.

I know that the Weston area health NHS trust has shown the greatest improvement in dealing with ENT long-waiters, with 63 per cent. having their out-patient appointment in less than 13 weeks, compared with 43 per cent. the previous year. However, I shall look into the case mentioned by the hon. Gentleman.

Has the NHS executive for the region covering Avon health authority been charged with ensuring that best practice is spread from one trust to another, so that those in Avon health authority can benefit from best practice elsewhere? My local trust, at Princess Margaret hospital, has reduced the number of people waiting 13 weeks for ENT appointments from 200 to 75 in only three months. We want such progress to be made throughout the country. No one should wait more than 26 weeks. Such best practice should be spread to Avon health authority and elsewhere.

My hon. Friend is absolutely right to say that we need to spread throughout the country the best practice used in many areas. That is what the action on ENT programme is all about. The pilot of the partial booking system in Basildon has already met the three-month wait target for out-patients set in the NHS plan, and we shall introduce that system throughout the country.

As one who shares the Avon health authority area with the hon. Member for Weston-super-Mare (Mr. Cotter), I can confirm that cases such as the one that he mentioned occur throughout the region. Does the Minister accept that the situation in Avon is mirrored throughout the country? Can she confirm that the waiting list for the waiting list, which is what the hon. Gentleman described, is now 55,000 higher than when the Government came to office; and that consultants throughout the country are now saying that the waiting list initiative itself means that they are spending a disproportionate amount of time in theatre dealing with minor cases, while the sickest patients often wait longer to see a consultant in out-patients? How many patients will have to suffer as a consequence of that policy before it is abandoned?

I am proud that the Government have met our manifesto pledge to cut in-patient waiting lists by more than 100,000. It is absolutely right that we should cut waiting times in in-patients and out-patients, and that is exactly what is set out in the NHS plan. Perhaps the hon. Gentleman would like to explain why he said that patients should wait longer for certain treatments. Will he say which of his constituents in Avon he believes should wait longer as a result of his proposals?

What advice he has received about the medical properties of cannabis. [142899]

The Government have approved a number of clinical trials into the medicinal use of cannabis. Once the results of the trials have been properly evaluated, we will have an evidence base that will allow us to decide how to proceed.

I thank my hon. Friend for that answer, but it will come as little relief to the thousands of people throughout the country who suffer the torment of multiple sclerosis. They include a courageous but desperate constituent of mine: courageous because she has allowed me to use her name—indeed, she has encouraged me to do so—and desperate because she suffers the pain of MS. Until relatively recently, she was an undercover drugs squad officer with West Midlands police; it was her job to pursue and lock up people who peddle drugs. Now, she is out on the streets trying to secure her only relief from the pain that she suffers. Will my hon. Friend assure me that she and her colleagues will try to persuade the Home Office and the police service that such people are victims, not criminals? They are victims of the torment of MS, and they should not be made victims of injustice.

I sympathise with any patient who is suffering and feels that an effective medicine is not available. However, as with any chronic illness, it is important to evaluate the benefits and risks of treatment. It is therefore extremely important that the research that we are undertaking is properly supervised. It involves 660 MS sufferers and there will be a report in 2003. We shall make a decision based on that clinical evidence.

Does the Minister accept that there has for a long time been evidence of the benefit of cannabis to MS sufferers? Is it not time that the Government made more rapid progress to relieve those people of worries about potential law-breaking, or that they might be unable to get the cannabis that they need for their treatment? Will the hon. Lady give an undertaking that, if necessary, legislation will be introduced when she has enough evidence to make that decision?

That is precisely what we are doing. That is why the trials were set up in 1999 and why £950,000 has been put into them. They will be properly conducted and the results properly assessed. When those involved report back with their evidence, we shall take appropriate action. However, that action will be based on reliable scientific evidence and not on anecdotal evidence, which is what we have had so far.

Cannabis has been trialled and tested for 5,000 years in every continent by millions of people, and it has not had any serious side effect throughout that period. One hundred Members of Parliament, the majority of the British Medical Association and the House of Lords Select Committee on Science and Technology all agree that natural cannabis should now be used medicinally. Is it not ironic that Clare Hodges, who has gone to the Belgium Parliament and convinced it to change its law in the past three months to allow medicinal cannabis to be prescribed, has to go on the streets of this country to get her own cannabis? She is an MS sufferer. Another MS sufferer was dragged through the courts six months ago. The policy is stupid and cruel.

We need to draw a clear distinction between a drug that is illegal—that is, cannabis—and a medicine that is used within the NHS. The medicine will be used only when it has been properly trialled and tested under clinical conditions. That is what is happening in respect of the medicinal use of cannabis, and it is the right and proper way to proceed.

What assessment he has made of injurious impact of over-prescribing of drugs for patients with Alzheimer's disease. [142900]

All prescribing for older people, including those with Alzheimer's disease, should be undertaken and monitored carefully by the doctor responsible. The Department published advice in 1998 on prescribing in residential and nursing homes, which covered the use of neuroleptic drugs. The national service framework for older people will also contribute to improving the care of older people with dementia by setting new national standards for health and social care services.

I welcome that response and the standard that has been set. I also welcome the improved care for those with Alzheimer's disease and look forward to more discoveries that will help them and cure them. Having said that, does the Minister share my concern that, although some of us thought that the liquid cosh was a thing of the past, there seem to be more reports of people being drugged so that they are subdued and do not cause trouble to their carers?

I am grateful to the hon. Gentleman for his opening comments. There is little doubt that dealing with Alzheimer's disease and other forms of dementia is one of the greatest health and social care challenges that our society faces. Currently, 600,000 people suffer from Alzheimer's disease, and it is estimated that the number will increase substantially in the years ahead as the number of people in our society aged over 80 increases significantly.

Is my hon. Friend aware that some doctors in this country—I have in mind a constituency case—are urging dementia patients to take drugs that are banned in America by the Food and Drug Administration? We need a lot more information. Anybody who suffers from or has an elderly relative who suffers from one of the 200 dementing illnesses faces huge personal and social pressure, and it is wrong for doctors casually to say, "This drug will do the trick for you", when it may be banned in other countries. We are working through the National Institute for Clinical Excellence to achieve an even balance throughout the country, but we need more publicity, openness and information. I hope that his Department can help to provide that.

I am grateful to my hon. Friend for his comments. Of course, he is absolutely right. NICE is reviewing a range of available drug treatments for those who have been afflicted with Alzheimer's disease, and I understand that the final appraisal advice will be available shortly.

With respect to the hon. Member for Belfast, South (Rev. Martin Smyth), Alzheimer's sufferers would say that the problem is under-prescribing of the drugs that they need. In the west midlands, Aricept is not available on the NHS unless the patient is prepared to take part in a trial, which is unnecessary and merely aggravates the problem of postcode prescribing to which the Government have failed to deliver a solution. The Secretary of State said:

It is important … that we achieve our aim, which is to ensure the introduction of more effective treatments into the national health service more quickly than has been possible before.—[Official Report, 10 November 1998; Vol. 319, c. 136.]

I am afraid that that confirms that the modern Conservative party is the stupid party of British politics. The hon. Lady complains about the postcode lottery of care, but she might remind the House of the solution proposed by her party and the Conservative Government: they created the lottery of care and their NHS reforms made it impossible to deal with those problems. She is aware, as I hope the whole House is, that NICE is reviewing the evidence surrounding the use of such drugs and will shortly publish its final advice.

What action he is taking to improve access to primary health care. [142901]

The NHS plan sets ambitious targets to improve waiting times in primary care and expand the range of services available locally to patients. In June last year, we made £54.5 million available to kick-start a four-year programme to improve access to family doctors, nurses and other professionals and to extend the range of treatments and services that could be provided in the community.

Does my right hon. Friend agree that one way to improve access to primary health care is to make better use of existing skills and resources? I draw his attention to a new initiative by the South Manchester primary care trust, which is about to introduce a new primary care triage service in which practice nurses give telephone advice to patients who ring up to request a same-day appointment with their GP. The service will not remove their right to see their GP, but it will mean that they receive professional advice immediately.

I am aware of some of the South Manchester PCT's work following my visit, which my hon. Friend will recall. The PCT has been involved in the walk-in centre at Manchester airport and some sure start initiatives. It is doing good work, which goes to show, first, that, provided investment is made, an expansion in primary care services can be achieved—we can do a lot more in the community and in primary care than we have done hitherto. Secondly, the investment agenda has to run alongside fundamental reforms of the way in which primary care services and health care services as a whole are delivered. In some parts of the country, the first fruits of investment in modernisation are coming through to benefit patients. I very much hope that that is the case in my hon. Friend's constituency and in Manchester as a whole.

Does the Secretary of State accept—I have written to him on the subject— that the availability of complementary and alternative medicine through primary care groups has been reduced since the switch from GP fundholding? Now that the House of Lords Science and Technology Committee report on complementary medicine has been published and an early-day motion broadly supporting it has been signed by 160 Members of Parliament, should not the Government respond urgently to the report? Can he give a date for that response? What will he do to achieve greater availability of complementary and alternative medicine through primary care groups?

The hon. Gentleman wins the award for consistency at Health questions and for being unrelenting on that issue. I hope that we have responded to at least some of his concerns. As he is no doubt aware, last year, for the first time, we issued detailed guidance to all primary care groups in all parts of the country on the potential uses to which complementary therapies may be put. The report is important and we will respond to it in due course, but the position remains as it always has been: it is for the individual GP to decide what form of treatment—whether a mainstream treatment or a complementary treatment—is best suited to the needs of the individual patient.

I know that my right hon. Friend is aware of the failure of the complaints system in respect of primary health care services. Will he join me in welcoming the appointment of the new chair and chief executive of the new National Clinical Assessment Authority? Does my right hon. Friend agree that that will provide much better protection for patients and support for doctors? Does he also agree that, if such an authority had been in place earlier, Harold Shipman would have been far less likely to be able to murder so many people over such a long period, particularly in Hyde and in Todmorden in my constituency?

I am aware of my hon. Friend's concerns about matters relating to Todmorden in her constituency and the sterling work that she has been doing to offer whatever help and support she can to some of the families who were affected. It is important that we get the case of Harold Shipman in perspective. Harold Shipman was a cold, calculating, evil killer. He abused his position of trust in an indescribable way, and it beggars belief that he got away with it for so long.

Does the Secretary of State agree that, in future, pressure on primary care services will be increased if children who need serious surgery do not get it in a timely fashion? Will he take a personal interest in the case of a 14-year-old constituent of mine, Joshua Bruer, who, with 67 other children, is awaiting spinal surgery at the Royal Manchester children's hospital in Pendlebury? Surgery has been delayed as a result of the collapse of the floor of one of the operating theatres, which was built only two and a half years ago. I have corresponded on the matter with the Under-Secretary of State for Health, Lord Hunt. The waiting time is now 14 months for such surgery. Children who need spinal surgery need it quickly, otherwise the injury that they have suffered will be compounded as they grow taller and they will have further problems in later life. Will the right hon. Gentleman take a direct personal interest in the problems of spinal surgery for children in Manchester?

Yes, I assure the hon. Gentleman that I will look into the case.

When he intends to publish a report on his review of the NHS complaints system. [142902]

The evaluation of the complaints procedure has been completed and the project team will submit its report at the end of this month. We will publish the report as soon as possible, once we have had the opportunity to consider its findings.

No doubt my hon. Friend has seen the report by Age Concern "Speaking Out", which expressed concern about upper age limits for treatment, negative attitudes to elderly people and the fact that a third of the respondents recorded the difficulty that they had in accessing the complaints machinery and their fear of recriminations. In the light of Age Concern's report, what action is being taken to combat age discrimination in the NHS and to ensure that elderly people have access to and confidence in an independent complaints machinery?

I am aware of Age Concern's report. It is important to put it on the record that we do not accept age discrimination within the NHS at any level, whether in the handling of complaints or in treatment. Many accident and emergency departments have fast-tracking for hip fractures, which particularly affect the elderly. We must distinguish between the process of making a complaint and providing support for that. With regard to speeding up the complaints process and giving people the support that they need, we are making progress with our evaluation at the end of the month, and the new patient advocacy and liaison services and the patients forums will provide independent support for all who need it, taking proper account of the needs of people of all ages.

How will the new complaints procedure work with the Commission for Health Improvement and, in particular, the National Clinical Assessment Authority?

It is important to recognise the Government's commitment that the NHS as an organisation should always learn from its mistakes, and complaints are one of the mechanisms by which we learn that mistakes have occurred. From the chief medical officer's report "An Organisation with a Memory" and our acceptance of that report, to the implementation of serious incident monitoring, to the relationship with the patients forums, whenever the Commission for Health Improvement or the National Clinical Assessment Authority investigates an area, there will be a two-way feedback mechanism whereby both organisations can learn from the complaints received. That two-way valve will allow not only the trusts but the NHS as a whole to learn from such feedback. In addition, there will be an assessment of the complaints made against all doctors as part of their review in our annual appraisal system. We hope that the whole package will reduce any necessity for complaints and ensure that serious incidents are picked up at every level.

Does my hon. Friend agree that a key component of any complaints system should be its independence? Does she accept that the placement of the patient advocacy function contained in the Health and Social Care Bill in the hands of the health authorities that will commission them seriously compromises that independence?

We wish independence to be established at every level. The Health and Social Care Bill, which will have its Second Reading tomorrow, contains a clear statutory provision for patients forums, part of whose function will be to ensure that independent support is put in place. Whether local health authorities should provide such independent support or whether there should be some other mechanism will be an ideal subject for debate in Committee.

What real redress will patients have when they find themselves in a situation such as that described by Mr. Ross Carter, consultant in gastroenterology and pancreatic surgery, who said today that his unit had inadequate theatre access to deal with emergencies and malignancies, let alone

those unfortunate patients currently languishing on our waiting lists

We have … reached the stage beyond the every day chaos … I feel the clinicians and nurses involved within our unit can no longer be held responsible for patient safety.

Patients already have means of redress and they will have even more as a result of our increased investment in the NHS which will provide us with more doctors and nurses. Just for the record, if the hon. Gentleman is interested in what has happened since the Government took office, there have been some 290,000 more emergency admissions than under the previous Tory Government, as well as 623,000 more routine admissions and 686,000 more first out-patient attendances. There is a continuous improvement and that will go on. The Tories' proposal to privatise the NHS is no solution.

I am sure that my hon. Friend will agree that the part of the NHS complaints system which has the complete confidence of patients because of its independence is the ombudsman system. The ombudsman also has regular dealings with community health councils as they attempt to negotiate people through the complaints system. Has there been consultation with the ombudsman about the Government's proposals for the abolition of CHCs—and, if not, could there be?

It is important to recognise that only something like 50 per cent. of CHC 's support individual complainants. To assume that the current structure of dealing with complaints is completely covered by CHCs is not the whole picture. Regarding consultation with the ombudsman, that is something that we can take forward.

Pursuant to his letter to the hon. Member for New Forest, East of 7 December, what progress his Department has made in making artificial limbs with lifelike silicone coatings available to NHS patients. [142903]

In cases in which silicone cosmesis is clinically appropriate, we wish to see equitable access across the country. In 2001–02 and recurrently, funding will therefore be provided for the NHS to increase existing provision of high to low definition cosmesis which, in future, will be available through a new contract from the NHS Purchasing and Supply Agency.

I welcome the Minister's response, but may I express concern about whether that provision will ever appear? Does he recall the case of my constituent, a little girl called Laura Giddings, whose lower leg was blown off in the Planet Hollywood terrorist outrage in South Africa? Does he recall the campaign that was waged throughout the second half of 1999 to enable the parents of children in that position to get realistic-looking limbs for them? Does he recall the meeting that we had in October that year, and the letter that he wrote in November 1999? In that letter, he said:

I am looking at ways in which we can make improved silicone cosmesis available through the NHS

We have just had a classic example of an hon. Member reading out a pre-rehearsed question and completely disregarding the answer given by a Minister from the Dispatch Box. The hon. Gentleman was clearly not expecting me to announce that, from April 2001 onwards, the new high definition/low definition cosmesis will be available on the NHS—[Interruption.] I am sorry, but that is going to happen. I know that the hon. Gentleman and his right hon. and hon. Friends do not like that, but I must point out to him that his party had nearly 20 years in which to make that provision available, but they never did. I have just announced that the new cosmesis will be available on the NHS, and it is a great shame that the hon. Gentleman could not find any words to welcome that important announcement.

I pay tribute to the response of the Department of Health to the campaign that was waged locally by the hon. Member for New Forest, East (Dr. Lewis), a number of other people and me on lifelike prosthetic limbs, and which was supported by our local newspaper, The Southern Daily Echo. Does my hon. Friend accept that the provision will make a tremendous difference to the life chances of children for whom this treatment will now be available, as it will enable them to wear lifelike limbs out and about, to school and wherever they go? I assure him that Justin Gregory and Hannah Rideout, who are children of my constituents, will benefit directly from the change and will regard the provision as a great step forward, enabling them to lead a life enhanced by this change in NHS policy.

I am grateful to my hon. Friend, and pay tribute to the work that he and others have done in drawing attention to this issue. Making the new equipment available is an important step change for the NHS. It is long overdue, but we are now taking action. It is obviously important, especially for young people, but also for everyone who has had a limb amputated, as they should have access to the latest technology and the widest range of choice in prosthetic limbs. We are taking action, and this is a good example of what we mean by modernising the NHS. It is a great pity that the Opposition do not recognise that.

If he will make a statement on the availability of domiciliary care for the elderly. [142904]

The NHS plan is providing an extra £900 million by 2003–04 for investment in intermediate care and related services to promote independence and improve quality of care for older people. These additional resources will enable 50,000 more people to live independently at home through additional home care and other support services. In 1999–2000, the number of people aged 65 and over who were helped to live at home rose by 20,000 compared with the previous year. Overall, the total revenue provision for social services in 2001–02 will be £9.848 billion, which represents an increase on provision in 2000–01 of 6.2 per cent. in cash terms.

I thank my hon. Friend for that reply, which will be warmly received in Cambridge, which has a huge domiciliary care shortage that causes severe problems, especially for elderly people. Will he tell me whether the Government plan to ease recruitment and retention problems in places such as Cambridge? Will he also comment on the situation that might arise if we had, say, £24 million worth of cuts in the constituency? Would he like to say how that might impact on the situation?

Yes, I might like to say how that would impact. We all recognise that we need to do much more to support and promote independence, especially to allow older people to stay at home for longer, and we are beginning to take that action. I pay tribute to the work that has been done in Cambridgeshire, where the council provided home care support to an extra 6 per cent. of people this year.

Ministers have said several times in recent weeks—indeed, the Prime Minister made the same comment before Christmas—that there has been a big rise in the number of domiciliary care packages during the past year and that that offsets the loss in care home places. If that is so, and 20,000 new domiciliary care packages are available, will the Minister tell us where the packages are and how they are being costed and paid for? Will he publish an area-by-area list showing where they are? Even at this late stage, on the eve of introducing legislation, will the Government reconsider the report of their royal commission on the matter? It recommended that all personal care, whether provided on a domiciliary basis or in residential care homes, should be paid for. Is the hon. Gentleman genuinely satisfied with the current circumstances, which are so illogical that those with long-term chronic conditions do not get their personal care paid for, while those with acute conditions do? That cannot be right or just, so will the Government reconsider the matter before introducing legislation?

The initial figures that the hon. Gentleman wants have already been made available by the publication of the performance assessment framework. The collection of the statistics was overseen by the Office for National Statistics. Figures are available by authority, so he and other Liberal Democrat Members might wish to consider those statistics. I am sure that he will find the information that he seeks.

Will my hon. Friend tell me whether Ministers have concluded their response to Professor Edwards's report into elderly care provision in north Staffordshire? If they have done so, when will the response be available?

I am afraid that I cannot answer that question specifically, but I shall ensure that my hon. Friend receives an answer as soon as possible.

Now that the Prime Minister has started to count the beds of patients who are receiving domiciliary care as NHS beds, can the Minister confirm that the Prime Minister believes that he has potentially created 20 million beds? Will he also tell us whether a double bed now counts as two beds and whether a room with two beds now constitutes a ward in the Prime Minister's fantasy NHS?

What a bunch of hypocrites members of the modern Tory party are!

How many additional doctors will be employed in the NHS under his national plan. [142905]

Under the NHS plan, we will provide 7,500 more consultants and at least 2,000 more general practitioners by 2004. We will also provide 1,000 more specialist registrars, to provide further growth in consultant numbers beyond that period, as well as 450 more GPs in training.

As the 2,000 extra doctors announced in the NHS plan included both those who were leaving general practice and those in training, is it not time for the Secretary of State to consider the proposals of the British Medical Association, and to discuss with the association how the number might be increased?

Yes; and I have always made it clear to the BMA and others that we regard the 2,000 figure— which, incidentally, represents a net increase of 2,000, consisting of extra recruits minus those who will be retiring and so forth—to be a floor, or minimum. If we can do more, we will.

I welcome the increase of £23.4 million for Shropshire health authority, which is more than double the increase achieved—if that is the right word—in the last full year of Tory government, 1996–97. Does my right hon. Friend agree that what our health service needs is certainty of funding in the future, so that planning can take place and doctors and nurses can be recruited? Does it not also need an administrative structure that is responsive to patient needs? Finally, does it not need another Labour Government?

My hon. Friend is light about that, as he is about so many other things. Whit the NHS needs is sustained investment, not just for one year but over a period of years, and that is precisely what is happening. For instance, health authorities will receive average real-terms increases of 6.23 per cent. this year and 5.85 per cent. next year. Let me remind my hon. Friend of the position during the last two years of the last Government: the increase was 1.1 per cent. in 1996–97, and 0.85 per cent. in 1995–96.

Does the Secretary of State agree that additional doctors will not complete the picture unless there are additional staff beds for those doctors to treat patients in? In Oxfordshire, the John Radcliffe is absolutely full to bursting, with no beds in nursing homes available for patients to be discharged into and no beds in community hospitals available for patients to be discharged into. Will he today urge the health authority to use the money that he has given—I accept that, this year, he has finally given a generous settlement—to reopen the community hospital beds that he closed, which are desperately needed? It is bad enough not letting people into hospital, without failing to let people out of hospital, too.

One of these days, the hon. Gentleman will have something positive to say about the NHS. I look forward to the day. On the situation in Oxfordshire, he is right: we have made more money available. As he and the Conservative party are always complaining about the need to ensure that local health services are in the driving seat in determining how best to spend the money, that is an issue for the local health service to resolve.

If there is to be a continuing and separate regulatory structure for midwives within the new national plan for the NHS. [142906]

Our proposals for a new Nursing and Midwifery Council provide for the separate registration of midwives and the regulation of their practice.

I am grateful for that answer. My hon. Friend will know that, in the review that was commissioned by the Department on the delivery of midwifery services, recommendations were made about the creation of a statutory midwifery committee and about the nature of the representation of midwives on the new Nursing and Midwifery Council. In response to representations that have already been made by midwives in the House before Christmas, can he say whether midwives will have equal representation with nurses on the committee and whether they will have a separate and independent midwifery committee?

My hon. Friend will understand that it would be premature to anticipate the result of the consultation, which is still continuing, but I can confirm that midwives will have equal representation with the other professions that will be regulated: nurses and health visitors. The new council will have a duty to set training standards for midwifery. The issue of a separate midwifery committee has been raised during the consultation. I simply confirm that we are considering those representations.

We know that, for the first time in many years, the number of students applying to become doctors has declined. Is it the same for midwifery?

I am pleased to say that we have more than enough midwifery applications, despite the fact that there are now 55 per cent. more training places for pre-registration midwifery than three years ago. There are not enough midwives at the moment. As so often, the reason is that the previous Government failed to invest in training enough professional staff for the NHS. This Government are investing in those extra training places. We are attracting the applicants and those midwives will become available to the NHS.

I welcome my hon. Friend's announcement that there will be a separate body for midwives. I met midwives in the Medway maritime hospital. They were concerned about their ability to be able to influence policy at both a national and local level. They were particularly concerned about the number of midwifery-led units in hospitals and wanted an increase. Obviously, recruitment is crucial, but does he not agree that midwives have a distinct and unique role to play both in influencing and in assisting NHS policy as we move forward with the NHS plan?

I welcome my hon. Friend's comments, but for the avoidance of confusion I should make it clear that I did not say that there would be a separate body for midwives. There will be a Nursing and Midwifery Council on which midwives will be represented, as will nurses and health visitors. I was responding to the proposal that there should be a separate midwifery committee. I can confirm that that issue has been raised in consultation and we are actively considering it now. We accept the importance of the midwifery profession and will look to reflect that in our final proposals.