If he will make a statement on the work of University hospital, Durham and the North Durham Health Care NHS trust. [12105]

North Durham Health Care NHS trust was formed on 1 April 1998. Since then, its income has grown by an average of 9 per cent. year on year. The trust met all its waiting list targets in 2000–01, and the new state-of-the-art University hospital of North Durham was completed on time and within budget.

Does my hon. Friend agree that the success of the North Durham Health Care NHS trust is due, in no small part, to the chairmanship of Mr. Kevin Earley? Does he accept that Mr. Earley's removal from the chairmanship without any local consultation has left the trust leaderless and does nothing to help deliver the good health care that we expect in North Durham?

I certainly agree that the trust has performed, not least in getting the new hospital built on time; I am sure that the chairman of the trust made a significant contribution to that. However, it was right to move responsibility for appointments to an independent appointments commission. The procedures have been approved by the Commissioner for Public Appointments. Today, the NHS Appointments Commission confirmed that there will be a new chairman of the trust, and an announcement will be made in the near future.

From his answer, my hon. Friend is obviously aware that Kevin Earley, who was chair of the trust, has been unceremoniously dumped after doing an excellent job in delivering the new hospital to us. My hon. Friend the Member for North Durham (Mr. Jones) has tabled questions to the Secretary of State asking who was invited to interview by the new NHS Appointments Commission, which organisations were consulted and why Kevin Earley was not reappointed. Every single question went unanswered. Was that because Mr. Earley crossed civil servants in the north-east of England and, disgracefully, was sacked as a result? Is that not an example of transparency—

Order.

I am sorry, I cannot explain why those questions were not answered, but I shall certainly look into it. However, that has nothing whatever to do with the points that my hon. Friend made. We decided to set up the NHS Appointments Commission; that was the right thing to do. As I have made clear to the House, the commission's appointments procedures have been approved by the Commissioner for Public Appointments. How the NHS Appointments Commission goes about its task is a matter for it to decide, but I am quite sure that it did the right thing on this occasion.

If he will make a statement on progress in meeting targets for the recruitment of nurses under the NHS plan. [12106]

What plans he has to improve the retention of nursing staff. [12114]

Hurry up.

I am being as quick as I can.

I thank the Secretary of State for his response. Does he agree that having 20,000 extra nurses under the NHS plan is critical to the future health and well-being of the NHS and is in stark contrast to the previous Government's cuts in the nurse training programme? Does he also agree that high nursing costs are one of the biggest deterrents affecting nurse recruitment in the south of England? While the additional £1,000 a year cost-of-living allowance in parts of the south-east is welcome, it is inexplicable that it has not extended as far as Essex. I strongly urge my right hon. Friend to get his officials to look at that issue again.

Or else.

I am being barracked from the right and the left. As for Essex, my hon. Friend the Member for Harlow (Mr. Rammell) will be aware that we introduced cost-of-living allowances this year for the first time. By definition, there is an element of rough justice about that; I appreciate that, and accept that there is a pressing case for other areas to be included. We are keeping the issue under active review and want to be able to extend the cost-of-living increases both to parts of the country where the labour market pressures are greatest and to professional groups, apart from nurses and midwives, where recruitment is difficult.

Will the Secretary of State consider giving those returning to nursing greater help in meeting their retraining costs? Will he also consider a method of speeding up the re-registration of those who have returned to nursing, and will he comment on the fact that fewer than 50 per cent. of nurses working in the health service would be prepared to recommend nursing as a career with long-term prospects?

Since April 1999, more than 9,000 nurses who had left the national health service have returned to it. They have been attracted back to the NHS because we have made it more worth while for them to come back. We have increased their pay, the staging of pay that used to occur regularly is no longer occurring, and we are giving them, I hope, decent and fair pay rises. We want that to be extended in the future and, as the hon. Gentleman knows, we are renegotiating the way in which pay is decided in the NHS, to make sure that it is fairer and more transparent for all members of staff, but particularly for nurses.

My right hon. Friend will be aware of the evidence that shows that the private health care sector recruits its staff almost entirely from the national health service. In respect of the concordats with the private sector at local level, what steps are the Government taking to ensure that the increased use of the private sector does not have a detrimental effect on the local NHS?

That is an important issue. One part of our health care system cannot benefit at the expense of another. We are making increased use of spare private sector capacity—for example, in private hospitals—so that we are able to expand the care available to NHS patients. That means that we can get more NHS patients treated more quickly. It is a matter of record that many of the private sector providers—the BUPAs of the world—employ their own nursing staff. There are issues that we will need to keep under review concerning the contribution to costs that those private sector providers make.

Is the Secretary of State aware that many nurses are becoming increasingly unhappy about their conditions of work, particularly the fact that they are unable to give the time and attention to patients that they would wish? How many nurses fail their training course, and how many nurses do not go into the nursing profession, having completed the training course?

The attrition rate, to which the hon. Lady is referring, is 10 to 11 per cent. of the number who apply for a nurse training course leading to a diploma or a degree, but the rate is falling. It is important that in the selection process we make sure that the candidates selected are appropriate for the job. The number of nurse training places, which was cut under the Administration whom the hon. Lady supported, is rising rapidly. That is welcome, but perhaps even more importantly, as I noted earlier, the number of people who want to go into nursing and who are applying for a nurse degree or a diploma course, is rising rapidly. I hope that that is a good sign of progress. It is one of many signs of progress that people will see in the NHS, and it is worth bearing in mind that there are currently 17,000 more nurses working in the NHS than when the Government took office.

I am pleased to hear what my right hon. Friend says about nurse training, but does he agree that in constituencies such as mine in the south-east of England, where there is a high level of employment, we need to be rather more imaginative about enabling people to get into the nursing profession—for example, by enabling those who have been hospital auxiliaries to do nurse training? What plans does he have to make nurse training more flexible and available to people who are currently employed in the health service?

As my hon. Friend is aware, we have already taken steps in that regard. It is one of the absurdities of the way in which we have traditionally employed people in the NHS that staff are employed in ghettos, or in silos—nurses here, doctors there, health visitors over there, health care assistants over here. We are trying to develop the concept of a skills escalator, so that people can develop skills through their career and jump off into different careers as they develop professionally. We have certainly made it easier for health care assistants to become nurses. We needed to make it easier for nurses to develop their careers, too.

Will the Secretary of State clear up a discrepancy on the targets? The NHS plan claims that there will be 20,000 more nurses by 2004, but in Labour's manifesto the year was 2005. On which target is the Government's policy based, what is the baseline for the target, are the nurse figures based on targets for whole-time equivalents, and how can they be achieved when the Department of Health figures show that there are 9,400 nurse vacancies in Britain, 2,960 of which are in London alone?

The hon. Gentleman might have said that the number of nurse vacancies is falling, not rising, that the number of nurse training places is rising, not falling, and that the number of nurses is rising, not falling. With regard to the relationship of the NHS plan to the manifesto, the hon. Gentleman might have noticed that the general election came after the NHS plan was published. The NHS plan was based on a baseline of 1999 figures up to 2004. The manifesto, on which we fought the election, was based on a baseline of 2000 up to 2005. [Interruption.] There is no particular revelation there. I know that the hon. Member for West Chelmsford (Mr. Burns) is from Essex, but even for a man from Essex he is getting terribly excited. [Interruption.] I am assured that men from Essex do get excited. [Interruption.] I have brought my hon. Friend the Member for Thurrock (Andrew Mackinlay) back into the Chamber. I always think that it is nice to make people happy, which is a rare occurrence in my job.

If he will make a statement on progress on smoking cessation services. [12108]

The national health service smoking cessation services are making excellent progress. In 2000–01, 61,500 smokers successfully quit.

What will be the funding for the next financial year, and is it in place? Does my hon. Friend agree that it is shameful that Parliament has not grasped the nettle and introduced a ban on tobacco advertising? When will the Government face up to their responsibilities, so that we stop all people, particularly young people, starting to smoke in the first place, and thereby remove the need for such programmes?

My hon. Friend is right that smoking cessation is a top priority for the Government. Smoking causes 120,000 deaths a year and costs the NHS £1.7 billion. With regard to future funding, we are asking primary care groups and trusts to plan for the needs of their communities because the services are incredibly successful. As I have said, 61,500 smokers quit last year, and the target for this year is for 40,000 smokers to quit. Nearly 30,000 quit in the first quarter, so the services are successful and we must ensure that they continue in the future. It is right that we try to prevent people from smoking in the first place. We have a manifesto commitment to bring back the Tobacco Advertising and Promotion Bill in the lifetime of this Parliament. If it had not been frustrated by the Opposition, we might be further on than we are now.

Will the hon. Lady confirm that it is not only patches that help people to give up smoking, but that there is a range of other alternatives, including hypnotherapy, reflexology, cranial-osteopathy and shiatsu? Is she aware that shiatsu is now available in the House of Commons Gym and that it can help with the cessation of smoking? Does she think that it is right that, although Members of Parliament can benefit from shiatsu, it is not available on the health service?

As usual, the hon. Gentleman is creative and imaginative, and suggests wonderful solutions. I agree that there is a range of therapies that can help people to give up smoking, and we should be exploring whatever works in helping people to do that. In terms of access to hands-on therapies, I am not entirely sure whether Members of Parliament should be taking that route. None the less, I believe that we should explore whatever therapies work for people.

Does my hon. Friend agree that when smoking cessation services are part of programmes carried out in health action zones, such as the Thurcroft healthy hearts programme in my constituency, they, too, should be evaluated? If they are providing what we believe to be major services for improving health in our communities, they should be funded in years to come.

Many of the health action zones have done marvellous work in this field. For example, many of them are training young people to act as peer mentors. Thus, young people are persuading other young people why it is good to give up smoking and not to take it up in the first place. That is far more effective than older people telling younger ones what to do. Health action zones have been incredibly innovative in those areas. That is why we are asking primary care groups and primary care trusts to plan their commissioning for the long term, so that these excellent examples of good practice can be put into the mainstream of the health service.

If he will make a statement on how the national care standards for residential care homes will reflect the treatment needs of those with drug and alcohol problems. [12109]

The standards will promote better quality care and help to prevent abuse by grounding practice in the principles of dignity, choice, privacy and respect. They will reflect the treatment needs of those with drug and alcohol problems by ensuring that their assessed and changing needs and personal goals are reflected in their individual plans.

I thank the Minister for that response. I welcome evidence from yesterday's Adjournment debate that the Government are softening their thoughts on the regulations. However, they have confused the needs of short-stay patients in treatment with those of residents whose care homes constitute their homes. There is a big difference. Does she agree that free access to mail and visitors would give freer access to illicit substances and that lockable bedrooms would increase the likelihood of deliberate self-harm by residents? Does she also agree that—

Order. The question is far too long, and the hon. Gentleman is reading.

The hon. Gentleman's first comment was right. Although this may be difficult for Opposition Members to recognise, the consultation was a real one. We have listened and we will respond to the concerns that were expressed. The particular concern that he raised related to the treatment regimes that will be allowed under the standards. It is important to emphasise that we realise that, sometimes, the overriding need is to ensure that people get the care and treatment that they need in a safe and secure environment. That is why the standards, at the request of representatives from the drug treatment world, include standard 2.7, which recognises specifically that there will be times when freedom and choice might need to be restricted. It asks only that that be discussed and agreed with prospective service users as part of their initial assessment.

I am grateful for my hon. Friend's response. Will she please note that the European Association for the Treatment of Addiction, Drugscope and Release, among others, have estimated that, if the care standards are adopted and unit costs are driven up, more than 50 per cent. of the care beds are likely to be lost in this sector?

I think that my hon. Friend is referring particularly to concerns about multi-occupancy rooms. The care standards will put in place the good standards that users of services have every right to expect, and ensure that they are provided and regulated uniformly across the country. When we consulted on multi-occupancy rooms, strong views were expressed by service users about the lack of privacy and dignity involved in sharing. I do not think that many hon. Members would be happy to share their bedroom with someone whom they had not invited into it, and we need to bear in mind the principle behind that when determining the standards.

How can the House have confidence in the Department of Health's awareness of the suicide risks and the potential for continuing drug and alcohol abuse among those patients when the draft standards stipulate that

"Staff enter service users"—

"bedroom…only with the individual's permission…Service users have a key to their own bedroom…which can be locked from the inside…Service users choose when to be alone or in company, and when not to join an activity"—

"Service users' own rooms include…lockable storage space"?

The hon. Gentleman obviously wrote and decided to deliver that question before he had listened to my previous responses. On his point about consultation, the standards were drafted and considered by experts within and outside the Department. They were subject to consultation meetings involving users, at which it is fair to say that users and providers expressed different views about them. This is a real consultation, and we are listening. I have already outlined, in relation to standard 2.7, how some of the concerns that he has mentioned might be overcome, but we will continue to listen and respond to people's concerns. When he sees the final standards, he will recognise that this is a Government who talk, but who also listen and respond to concerns.

The last time that the Government promised us consultation on similar regulations was in relation to care homes in general. The Minister might remember that, during those debates, we predicted that the result of their botched approach would be the loss of a large number of care home beds, and bed blocking throughout the national health service. Does she understand the anger of those who now see 15 per cent. of beds blocked in Birmingham, 17 per cent. blocked in Buckinghamshire and 18 per cent. blocked in Brent? How can anyone have confidence in a Government whose incompetence means that, nowadays, people have to queue up not only to get into hospital but to get out?

People will have confidence in a Government who put the needs of the users of care homes at the centre of their policy. The hon. Gentleman is restating his claim that 50,000 care home places have been lost. That is wrong, as we have already pointed out to him. We accept, however, that there is a problem with capacity in care homes. That is why my right hon. Friend the Secretary of State set up the strategic commissioning group to consider how we can improve commissioning at local level in partnership with the independent sector. That is also why, on 9 October, my right hon. Friend announced a radical cash for change programme worth £300 million over this year and next, to tackle the problem of bed blocking. Such money was never promised by the Conservatives, and such measures would never have been delivered, had they won the last election.

Is not the move to national standards and national inspection of care homes meant to take that responsibility from local authorities to achieve greater consistency? Does my hon. Friend share my concern that some local authorities appear to be aiming to continue inspection under the guise of contract monitoring? Is not such duplication a waste of resources and a nightmare for care home owners? Most of those I know welcome national standards.

My hon. Friend makes an important point, and I know that he has taken a close interest in the issue. He is right that the national approach to care standards is beneficial because there will be consistency across the country in regulation and inspection. The National Care Standards Commission, which comes into operation from next April, will ensure that that consistency exists while recognising the flexibility necessary to ensure that good provision continues.

If he will make a statement on the availability of digital hearing aids through the NHS. [12110]

What are his Department's plans for the funding of digital hearing aids during 2002–03. [12120]

National health service trusts may provide digital hearing aids for patients if clinically appropriate. Digital hearing aids are being provided by 20 NHS trusts in the modernising NHS hearing aid services project. Further decisions on digital hearing aid provision will be made in the light of the research evaluation of the project.

I am grateful to the Minister, but is she aware that millions of people with hearing difficulties will consider that reply to be deeply inadequate and wholly complacent? Is not it unacceptable that, in the 21st century, hearing aids in the United Kingdom continue to be based on outdated 1970s technology, whereas digital hearing aids are increasingly common in other parts of the world? Is not it time for the Government to stop posturing, push ahead faster with the trials and, particularly in the coming year, allocate the funds that are desperately needed to tackle the problem?

I am willing to take a lesson on posturing from Conservative Members, if necessary. The Government have invested practically in the whole process, which is necessary not just to give people digital hearing aids, but to provide them in a modernised fashion in the health service. In the pilot areas, people are being assessed in terms of their needs. They are fitted with digital hearing aids, which also involves the necessity for computer programming and skilled input, and then assessed to ensure that the hearing aids are appropriate.

The Minister will be aware that the audiology unit at Bath's Royal United hospital is one of the first-wave pilot schemes. Will she give it an absolute assurance that it will receive continued funding for the scheme from April next year? When, precisely, will that announcement be made? Is she aware that, even in the first-wave project areas, there is a difficulty in that some patients are given the new digital hearing aids and others the old aids?

"It is also very helpful if you can downplay the benefits of digital versus standard NHS hearing aids."?

I can say that, in the near future and subject to evaluation, we will make statements on the roll out of digital hearing aids and their continued provision in areas where that is clearly successful. I agree with the hon. Gentleman that it is important to ensure that we have strong evidence about the effectiveness of digital hearing aids so that, across the NHS, we provide not only the technology but the most appropriate procedure for patients. That will ensure that situations such as the one to which he referred no longer exist.

As the user of a hearing aid due to industrial deafness, may I point out to my hon. Friend that the current NHS hearing aids give people all the noises that they do not want to hear and make it difficult to hear those who are talking? Something must be done to ensure that deaf people can hear when people are speaking to them.

I am not quite sure what sounds my hon. Friend does not want to hear in Chamber!

May I tell the Minister about the excellent work done by audiology staff at Fairfield general hospital in my constituency? The issue that concerns them, in addition to the supply of digital hearing aids, is the screening of young babies for deafness. Does she have any plans to introduce pilot schemes for that kind of screening, which will bring enormous advantages to children in my constituency?

My hon. Friend is right: the early screening of babies enables problems to be identified and better joint working to be undertaken. That is why screening the hearing of the newborn, which is done before they are discharged from hospital, or as soon as possible thereafter, is being piloted by 22 health authorities during 2001–02. Over the next three to four years, we intend to implement the scheme progressively across the NHS in England using the lessons that have been learned. It is important to recognise, however, that the programme involves screening rather than provision. We must therefore also ensure that we facilitate and improve joint working between the NHS, the education service and social services so that those children who are identified as having hearing difficulties are followed up and cared for. They will be identified earlier through the screening process, and we then have a responsibility to ensure that they get the treatment that they deserve from all those agencies.

The Minister can be thankful that she does not understand about shutting out unwanted noises from hearing aids. I have benefited from a digital hearing aid, and I trust that the NHS experiment will start to be applied faster than at present. If the Minister is not prepared to take lessons from the previous Government's experience of postcode rationing, I fear that certain areas will not benefit from the digital roll out.

On the speed of delivery, the modernised hearing aids services project was announced a little over a year ago by my right hon. Friend the Minister of State. Twenty NHS trusts now routinely fit digital hearing aids. It is from that experience that I shall take lessons, and make sure that we roll out the programme in the most effective way. By the end of October, 13,278 digital hearing aids had been fitted and 16,178 people had been assessed. By the end of March, we expect that more than 18,000 people will have digital hearing aids on the NHS for the first time.

Last week, in a speech characterised by such soundbites as "The modernised patient journey" and

"The patient, not the hearing aid, is at the heart of the fitting process"—[Official Report, Westminster Hall, 7 November 2001; Vol. 374, c. 132WH.]—

Conservative Members are high on commitments and a bit low on the practical details of how to meet them. My concern as a Minister is to ensure that patients receive not only the hearing aid, but the necessary assessment and fitting, conducted by a skilled work force. That is what patients of the NHS deserve. That is why we will evaluate the results of the pilots that we set up. We will announce how we will roll out the programme in the near future.

I appreciate what my hon. Friend says, but is she aware that there is a queue a mile long in my constituency for digital hearing aids because of their technological advantages over traditional ones, and that on 6 June last year my right hon. Friend the Minister of State made the plea that that technology be introduced into the NHS as quickly as possible? Can we introduce it more rapidly?

We want that technology to be introduced into the NHS as quickly as possible, but in a manner that provides support for patients, assesses them properly and ensures that the necessary computer and related equipment is available and that skilled staff are available to give the sort of service that people expect from the NHS. That is why it is right that we get it right. I assure hon. Members that we will look carefully at the results of the evaluation of our pilots so that we can use that information to roll out the benefits of technology across the NHS as quickly and effectively as we can.

If he will make a statement on sending NHS patients for treatment in overseas hospitals. [12111]

Following rulings of the European Court of Justice, I announced in August that NHS health authorities and trusts could commission treatment for their patients overseas. Three areas in southern England are working through the legal and practical issues involved, with the aim of offering, by the end of the year, treatment abroad to those patients who want it. I shall publish guidance for the NHS based on the experience in those three sites.

I am grateful to the Secretary of State for his response. He will know that in the Salford and Trafford health authority, the proportion of patients waiting more than a year for NHS treatment has doubled compared with four years ago. In that situation, he must know that his announcements have raised the expectations of many people who are waiting for treatment, sometimes in severe pain. When will he bring forward clear guidelines that will say under which circumstances and criteria people will be entitled to treatment overseas?

I thought that I had just set that out.

When?

I did say when. Three sites are currently working through the issues because, as the hon. Gentleman will be aware, we want to get this right. Patients who want overseas treatment will be able to go abroad—I repeat: patients who want that; there should be no question of sending patients abroad against their wishes. Not only will such an alternative be offered according to clinical need and a proper assessment of the patient's need, but that person will have to want to go abroad for treatment.

Is my right hon. Friend aware that one of the best ways of making a clinical assessment is to talk to and listen to the patient? Will he give an undertaking that no one will be offered care in a country where there are not sufficient doctors and nurses capable of performing that task? Will he also ensure that anyone receiving treatment abroad has a clear pattern of after-care, should that be needed, under post-operative treatment?

My hon. Friend makes a very good and telling point. It would be extremely foolish, as the hon. Member for Altrincham and Sale, West (Mr. Brady) seemed to be suggesting, to rush into such arrangements. We have to get them right to ensure not only that patients are fit and well enough to go abroad to be treated, but that they receive the appropriate support and after-care that they need in the country of treatment and once they return home. Those issues have to be worked through properly.

Does the Secretary of State recognise that there are plenty of patients in West Sussex and west Surrey—where one in 10 of those awaiting in-patient treatment are waiting more than one year—who would welcome not only the possibility of going abroad, but the opportunity to be treated in the Durham health authority or by his own authority, where the number of those waiting more than one year is almost nil? Such postcode delays could be sorted out without worrying about languages or going abroad. What is he going to do about that, and when will he do it?

That is a perfectly reasonable suggestion and, as the hon. Gentleman is probably aware, we are exploring ways in which we can make more choice available to patients. He is also quite right that waiting times vary in different parts of the country; even in London, the average in-patient waiting time varies from seven weeks in one hospital to 23 weeks in another. Very often, patients are locked into a contract with their local hospital that the local primary care group or primary care trust has negotiated. Although GPs have the right to refer to other areas, it is important that they should exercise that right in a more proactive manner. We are investigating whether it is possible to extend more choice to patients, precisely to enable them to take advantage of the shorter waiting times available in some hospitals.

I welcome my right hon. Friend's proposals to seek any opportunity to ensure that people in this country receive the treatment that they deserve. We will have to use whatever stop-gaps are necessary to deal with the 20 years of decline. In examining how the system might operate, will he consider issues such as travel to the destination, necessary support care during travel and especially the cost of travel? I should not like people on lower incomes to feel that they could not take advantage of the system because they might have to bear the burden of travel costs.

I strongly agree with my hon. Friend. As she is aware, the question asked by the hon. Member for Altrincham and Sale, West raises difficult and complex issues. The NHS already operates a scheme for patients, and particularly for low-income families, who need to travel to hospital, whether it is a local or more distant one. It seems obvious that we have to be able to extend the benefits of that type of scheme to those who might be travelling abroad for treatment. We have to assess that issue properly. Crucially, we also have to ensure that not only patients going abroad for treatment but their carers and families are offered appropriate support. We are seeking to address precisely those issues in the three pilot areas. Based on that experience, we shall be able to issue the appropriate guidance to the national health service.

If the initiative or stop-gap is to be taken seriously, it is the Government and not guinea pig patients on the south coast who must answer the questions. If patients have to pay for their own and their families' travel, where will be the fairness for those who cannot afford to pay? If the health authority or PCT pays for travel, how will value for money be delivered?

The hon. Gentleman began by asking good questions—precisely those to which we seek answers. Believe it or not, it is not easy. I know that the hon. Gentleman thinks that it is easy, and that a magic wand can be waved to solve every problem in the national health service; but this is not the Harry Potter appreciation society. Difficult decisions are involved. Perhaps at some point even the Liberal Democrats will have to make a difficult decision.

Oh, no!

Well, let us hope not.

What plans he has for involving district nurses in profiling the health needs of their community. [12112]

District nurses play an important role in profiling the needs of health communities, through their knowledge of local communities and also through their work with individual patients. They will support primary care trusts as part of their responsibility for preparing health improvement plans from 2002. They are also eligible to serve as members of the professional executive committee of primary care trusts. The process for their selection is determined by local nursing colleagues.

Does my right hon. Friend accept that, as well as playing a major role in improving people's health—allowing them to be maintained in their own homes, and avoiding unnecessary hospital admissions—district nurses, precisely because they work in the community, often have a better idea of its health needs than people sitting in offices elsewhere? Will he ensure not just that district nurses are eligible for involvement in PCTs, but that PCTs make a real effort to consult them when drawing up health improvement programmes and trying to improve primary care? These are the people with a real knowledge of their local communities.

I strongly agree. District nurses do a brilliant job, and will have an increasingly important role to play in the pattern of NHS services that we want to be delivered in future. I certainly want all PCTs to consult fully, and to involve district nurses in the development of their local strategies. We aim to devolve more and more responsibility and power to the front line of the NHS, and I do not think anyone is closer to the front line than district nurses.

Would the Minister be willing to consult the district nurses of Southend-on-Sea, where, with their encouragement, the John Grooms establishment for severely disabled people carried out a massive, costly improvement to provide separate residential units? It was then hammered by separate rating demands, which increased its rates by 300 per cent. The arrangement has only just started, although I understand that it has now been applied to another establishment in Wells, and will also be operated elsewhere. Will the Government review the law to ensure that homes providing care facilities do not receive separate rating demands? This is a new situation, and the Minister's help would be greatly appreciated.

I am not aware of the situation in Southend, and I am concerned about what the hon. Gentleman has said. If he is prepared to write to me about these matters, I shall take certainly them up with my colleagues in Government.

When he expects the National Institute for Clinical Excellence to publish its recommendations on the prescribing of atypical anti-psychotic medicines for schizophrenia. [12113]

We anticipate that the National Institute for Clinical Excellence will publish guidance on atypical anti-psychotic drugs in March 2002, provided that there are no appeals against the draft guidance.

I thank my hon. Friend for that reply, and I welcome the fact that NICE is appraising this class of drugs at the moment. I hope that there is no slippage in that programme. Is my hon. Friend aware that, although the traditional anti-psychotic drugs used at present on patients suffering from schizophrenia are useful, they also have some worrying long-term effects? Those effects include irreversible involuntary facial and body movements, which have long-term consequences for patients' employability and care needs.

My hon. Friend makes an important point about the consequences of side effects on the wider lives of people suffering from schizophrenia, and I assure her that the NICE appraisal will look at the side effects of both traditional and atypical anti-psychotic drugs. It is important that a wide range of stakeholders—including users, carers, professionals and industry representatives—should be consulted and provide evidence to NICE.

Will the Minister confirm the general point that drugs licensed in the United Kingdom—including the atypical anti-psychotic drugs and the anti-TNF drugs for rheumatoid arthritis currently under consideration by NICE—can still be prescribed and funded by local health authorities? Will funds be made available to local health authorities to enable them to prescribe the drugs permitted or encouraged by NICE?

We have made it clear that local health authorities should continue with their prescribing activities, but the problem highlighted by the hon. Gentleman is the reason that we have introduced NICE. NICE is a key component in ensuring that there is a common-sense way to end postcode prescribing: without it, the mess of variable access to treatment under different local policies would have continued. Where NICE has laid down guidelines already, rapid progress has been made towards giving people access to treatments on the NHS.

The Minister will be aware of the widespread concern in the House that these modern medicines should be made available to patients, and she will have seen the reports from the Zito trust and heard the representations from the National Schizophrenia Federation, MIND and other bodies. Will the Minister say whether NICE has already reached its provisional findings in relation to those medicines? If so, will she insist that they be published? That would give those of us who want to argue and make further representations a chance to do so?

As I said earlier, it is right that NICE should undertake the detailed analysis and consultation with stakeholders that is already under way. Provisional appraisal decisions are made available to the consultees, so that there can be continuing input into the decisions being made by NICE. Having set up an independent way of determining both the cost and the clinical effectiveness of drugs, I do not believe that it is right for Ministers to intervene in the approach that NICE is taking, but I can assure the hon. Gentleman that—as I pointed out earlier—the evidence of the effectiveness of NICE is that it has brought into the NHS, for the benefit of NHS patients, many treatments that were previously available only on the basis of a postcode and random prescribing process.