in the Chair]

May I ask the Leader of the House for the business for next week, please?

The business for next week will be:

MONDAY 22 APRIL—Continuation of the Budget debate, in which the theme for the day will be enterprise and opportunity for all.

TUESDAY 23 APPIL.—Conclusion of the Budget debate, in which the theme for the day will be health.

WEDNESDAY 24 APRIL—My right hon. Friend the Prime Minister will propose an Humble Address to celebrate the golden jubilee of Her Majesty the Queen. [HON. MEMBERS: "Hear, hear."] I am glad that there is an all-party consensus. Second Reading of the Nationality, Immigration and Asylum Bill will follow. That will be followed by consideration of a Lords consequential amendment to the Commonhold and Leasehold Reform Bill [Lords].

THURSDAY 25 APRIL—There will be a debate on international development on a motion for the Adjournment of the House.

FRIDAY 26 APRIL—There will be a debate on the quality of life in local communities on a motion for the Adjournment of the House.

The provisional business for the week after will be:

MONDAY 29 APRIL—Second Reading of the Tobacco Advertising and Promotion Bill [Lords].

TUESDAY 30 APRIL—Second Reading of the Finance Bill.

WEDNESDAY l MAY—Second Reading of a Bill making the necessary legislative changes to national insurance following the statement by my right hon. Friend the Chancellor of the Exchequer.

THURSDAY 2 MAY—There will be a debate on Wales in the world on a motion for the Adjournment of the House. [HON. MEMBERS: "Hear, hear."' I am grateful for the approbation of the House.

FRIDAY 3 MAY—The House will not be sitting.

I should also like to inform the House that business in Westminster Hall for May will be:

THURSDAY 2 MAY—A debate on women and information technology.

THURSDAY 9 MAY—A debate on the report from the Trade and Industry Committee on the end of life vehicles directive.

THURSDAY 16 MAY—A debate on the report from the Transport, Local Government and the Regions Committee on empty homes.

THURSDAY 23 MAY—A debate on the role of the United Nations.

The House will wish to know that on Wednesday 1 May, there will be a debate relating to the promotion of the use of biofuels in road transport in European Standing Committee A.

I am grateful to the Leader of the House for giving us that notification of the business. Will he please find Government time in the very near future for a debate on the future of agriculture? It is a very long time since we have had such a debate. Since the very damaging effects of foot and mouth, given that there was nothing in the Budget for agriculture or rural communities, and as it would appear that the countryside is in general revolt, I would have thought it was in the interests of the Government, and certainly of the House as a whole, that we had a full day's debate on the future of agriculture in order that we can sort out those matters.

I was interested in the announcement of consideration on 1 May of a Bill on national insurance. I know that I May used to have a political significance, of which the Government obviously do not want to remind us, but perhaps it is an appropriate day to debate such a Bill. As the Bill obviously has major tax and policy implications, will have an effect on both individuals and businesses and we will surely need a considerable amount of time in order properly to consider it, and in essence, reality and substance it is a taxation Bill, will it or at least its substantial aspects be dealt with on the Floor of the House? Will the Leader of the House guarantee adequate time in Committee, either on the Floor of the House or Upstairs, for all its implications to be considered?

National insurance increases of the kind the Chancellor mentioned yesterday represent a major policy and directional shift by the Government. I hope that we can have an assurance from the right hon. Gentleman that the House will be able properly to consider them in all their aspects.

On the Tobacco Advertising and Promotion Bill, the Leader of the House will know that, under consistent pressure, the Government have been forced to notify the Bill to the authorities of the European Union. It was only as late as 28 March that notification was finally made, as is required by a number of EU directives. Member states are obliged to notify Bills that have an impact on the internal market.

The purpose of notification is to provide an opportunity for the Commission and other member states to comment if they consider that the proposed legislation has the potential to create a technical barrier to trade. Given that, and given that it is also a requirement that any resultant substantial changes to legislation must be allowed for, can the Leader of the House tell me whether he believes we can embark on the Bill's Second Reading during the notification period or, more important, on its Committee and Report stages. I know that this is one of the obvious benefits of our membership of the European Union, but it strikes me that there are considerable implications for the procedures of this House and the timing of legislation, not least this Bill. I hope that the right hon. Gentleman can advise us how far he believes the Government can take this Bill during the period of notification, which may indeed be extended beyond the initial three-month period starting from 28 March.

Finally, I remind the House of the sensational developments that occurred in this place on 15 April when the hon. Member for Hayes and Harlington (John McDonnell) said to Mr. Deputy Speaker at col. 420:

"Can I ask you to reconsider the procedure for private Bills to prevent this abuse of the House by the Prime Minister?"

He went on to say in column 421:

"I believe that the process has been corrupted and tainted by the Prime Minister's intervention."

Later in column 421 he referred to communications between the City corporation and the Prime Minister, and asked in column 422 whether we could

"therefore clarify and investigate the relationship between the City corporation and No. 10".

The hon. Gentleman finally repeated his belief in column 422 that

"the process has been corrupted as a result of the Prime Minister's intervention".—[Official Report, 15 April 2002; Vol. 383, c. 420–22.]

In my 19 years in this House I do not think that I have ever heard a Government Back Bencher accuse his Prime Minister of corruption, of abuse and of tainting the procedures of the House. These are very serious allegations. Given that the Prime Minister is the custodian of the ministerial code of conduct, who will implement and police that code of conduct in the context of these very serious allegations? It is a matter for the House, and something to which we are therefore obliged to return. I hope that the right hon. Gentleman will allow time urgently and soon for the House to go into these very serious allegations, and possibly for the Prime Minister to appear so that he can answer them.

Let me seek to respond to the points that the right hon. Gentleman has raised; I will save until the end the serious issue of substance in respect of the forthcoming national insurance Bill.

On agriculture and the countryside, I am well aware of the feeling in a number of quarters in the House that it would be valuable to have a debate on the countryside. I am not resistant to that, but it has to join the many other things that we have to consider. However, I think that the right hon. Gentleman was rather unfair about spending on the countryside as farming and rural businesses have received substantial support in the wake of the foot and mouth outbreak.

On the Tobacco Advertising and Promotion Bill, the right hon. Gentleman is quite right to say that an issue is being pursued in Brussels that conforms with the regulations there. It is being pursued in parallel with the legislation here, and I would greatly regret it if the House decided to suspend proceedings on the Bill. It is a very important health measure that will literally save lives, and it has substantial support on both sides of the Chamber. I therefore hope that we can proceed in parallel with the discussions in Brussels. I am confident that my colleagues there will put up a robust case and that those in Brussels will agree with us. The Bill is not a barrier to trade but it is a barrier to cancer and therefore deserves the support of all Members.

Tell them to get stuffed.

I thought that I had just done so, but in a rather more parliamentary way.

I hope that the right hon. Gentleman gave notice to my hon. Friend the Member for Hayes and Harlington (John McDonnell) that he was going to name him in his question. I note that my hon. Friend is not here. Given the extent to which the right hon. Gentleman quoted him, it would have been fair to give my hon. Friend advance notice. In mitigation, however, I am sure that my hon. Friend will be intensely flattered to have been quoted at such length by the Opposition.

On the issue of substance, I think that the right hon. Gentleman rather overdid the synthetic rage. The City of London (Ward Elections) Bill has come before the House on many occasions and has been debated exhaustively. I thought that it was supported by the Conservatives, but I may have misunderstood the Opposition's relationship with the City of London. I am sure that people in the City will read the right hon. Gentleman's observations with interest.

Technically, of course, any business motion is tabled in the name of the Prime Minister. The motion to dispose of the Bill was a collective decision of Government as, although it is a private Bill, it has been before the House many times. I assumed that the motion would have been welcomed by those Conservative Members who support the Bill. I think that the right hon. Gentleman's indignation is especially synthetic because, whereas the motion was to suspend the 10 o'clock rule, proceedings on the Bill got nowhere near 10 o'clock but had been concluded by 8 o'clock.

The right hon. Gentleman raises an issue of substance in connection with the national insurance Bill. He reminded the House that 1 May is a date of deep significance. It is the anniversary of the historic landslide with which the Labour party pushed the Conservative party into opposition. It is the date from which we were able to address the previous Conservative Government's under-investment in the health service. We are proud that, over the course of two Parliaments since 1 May 1997, we will have doubled the investment in the national health service that we inherited. The national insurance Bill is important in enabling us to do that, and for that reason will be supported by all Labour constituents, and by most Conservative constituents.

I am sure that my right hon. Friend will have been following with interest details in the press of what is happening with ntl and ITV Digital. My hon. Friends the Members for Preseli Pembrokeshire (Mrs. Lawrence) and for Battersea (Martin Linton) and others met my hon. Friend the Minister for E-Commerce and Competitiveness this morning. We discussed the implications for competitiveness, the digital action plan, and for hundreds of jobs in the constituency of my hon. Friend the Member for Preseli Pembrokeshire—

Order. The hon. Lady is not getting us off to a good start. We do not want statements; we must have questions. A great many hon. Members wish to speak, and I appeal to them to be very concise.

Will my right hon. Friend the Leader of the House agree to an early debate on this very important topic, which is at a critical stage?

I fully understand the concern expressed by my hon. Friend and by many hon. Members about the current crisis in digital TV. It is very important that we take forward our commitment to digital TV, as we intend to do. We must make sure that we absorb the lessons from this matter and see whether we can mitigate its impact. My hon. Friend asks for a debate on the matter. Earlier, I announced a debate on women and information technology, which will take place in Westminster Hall. I am sure that many points relevant to digital TV can be raised in the context of that debate.

I thank the Leader of the House for his statement. Will he be able to find time for a debate on education? That is especially important, given that the Chancellor produced only a minimal amount of money for education in yesterday's Budget statement, and that there will be a national announcement on class sizes next week. My own local authority, Stockport, still receives £830 per child less than neighbouring Manchester. I know that the hon. Members for Staffordshire, Moorlands (Charlotte Atkins) and for Lichfield (Michael Fabricant) and my hon. Friend the Member for Somerton and Frome (Mr. Heath) are in the Chamber and that they share my view about the need for a debate.

Will the Leader of the House also find time for a debate on House of Lords reform? A remarkable silence seems to have fallen on that matter, which has led to rising fears of a split in Government thinking on what is a very important matter.

Will the Leader of the House also arrange for a debate on the state funding of political parties? A wide range of views appears to be emerging from the Cabinet, and some clarification of the Government's approach would be helpful. It might also help to clarify the Conservatives' approach. They have recently sent out an invitation to a

"Gold level briefing…£500 Membership…exclusive Policy Renewal Programme events, attended by…Shadow Cabinet Ministers."

Those kind of gimmicks might no longer be needed.

Perhaps I can suggest to the hon. Gentleman that he might usefully reread the Chancellor of the Exchequer's Budget statement yesterday. He will find, at column 588 of Hansard, a strong commitment from this Government to investment in education. The Chancellor clearly stated that not only did we increase the share of the national income going into education in the last Parliament, but we fully intend to raise it again in the course of this Parliament. Next to health, education is a priority for this Government's investment in public spending and we are proud of that record.

On Lords reform, the hon. Gentleman made the preposterous suggestion that there was a split within the Government on this question. As he is interested in progress on this matter, however, I advise him and the House that, this morning, I believe, the Lord Chancellor has given an interim response to the Select Committee. Of course, many of the major questions that must be addressed are those that we are considering in the period of reflection following the consultation. I assure the House that, as soon as we have reached a conclusion on this matter, I shall bring it to the House in the expectation of support. I hope that the unity that will then be shown in the House will reflect the harmony and unity within the Government on this question.

I am slightly surprised, however, that the hon. Gentleman should express concern about different views within the Government on state funding. We have made it clear, and the Prime Minister has made it clear, that we would welcome a public debate on the matter, and it is very important that members of the Cabinet should be free to take part in that public debate without necessarily first adopting a collective line and then seeking to impose that collective line on the party, on Parliament and on the public. I said the other day, and I am happy to read it into the record, that in 1974 I stood on the commitment of my party to introduce state funding. I believe that it would have been better had we acted on it then. Political parties are an important part of the parliamentary process. One cannot have a parliamentary democracy without healthy political parties. It is very important that we identify the least unacceptable way of making sure that they are healthily funded.

Could we have a debate early next week on the future of the London underground before the contract for that is signed? Is the Leader of the House aware of the very considerable concern in the Select Committee that the Chancellor or one of his Ministers is not prepared to come before the Select Committee to justify the policy that he is pushing through, which would be disastrous for the London underground?

I have, of course, seen the Select Committee report, and it is on a matter on which we have had exchanges in the House previously. My position remains the same as when we last had an exchange on this point. Treasury Ministers are willing to come before any Select Committee provided that it is on matters within the remit of the Treasury. That is why a Treasury Minister has appeared before the Transport, Local Government and the Regions Committee to consider matters in relation to the landfill tax, for instance, and has appeared before the Northern Ireland Affairs Committee on a similar tax and duty issue. It was a very important principle of ministerial accountability that those Ministers with responsibility for transport or local government, for example, should appear before the Select Committee and give evidence and answer questions on those matters. It is very important that we preserve that principle of ministerial accountability because all Select Committees would be undermined if it were broken.

Will the Leader of the House find time today to look at the case of Paul Drayson, who is the chief executive officer of PowderJect. One moment he gives £50,000 to the Labour party and, lo and behold, the next moment his company gets a £32 million order from the Department of Health for smallpox vaccine. That contract was not put out to open tender. Surely we should consider this matter. Is not a pattern of sleaze emerging in which we are seeing cash for favours? Can we have a debate on this, please?

First, PowderJect won that contract because it is one of five companies that bid for it, and it put in the best tender. That is why it got the contract; there is no other reason. If the hon. Gentleman really wants to have an honest and open debate on this question, there is one simple way in which the Conservative party can help. We have changed the law so that company donations are recorded and open, and everybody knows what companies have made donations to the Labour party over the past five years. Nobody knows, except the Conservative party, who made donations to the Conservatives in the last five years of the Conservative Government. If the hon. Gentleman really wants to pursue the issue, why does he not take it up with his own party and get it to publish—it has the information—all the data on who gave it donations in the last five years of the Conservative Government?

Events in the middle east have dominated the world headlines in the past few weeks, but another equally serious dispute has been raging in the state of Gujarat. The official figures for the number of dead there are 900, but the real figure is likely to exceed 2,000. As serious allegations have been made against the state government and, indeed, against the national Government, will my right hon. Friend arrange for a statement to he made in the House so that those hon. Members with many people in their constituencies with relatives and friends in the region can be made aware of the true facts?

My hon. Friend raises a grave issue that is of deep concern to many communities in Britain because of the strong ties between our country and the sub-continent. I have followed with deep concern the mounting death toll and will look with interest at recent reports. I cannot promise him a statement, but I shall certainly draw his observations to the attention of my right hon. Friend the Foreign Secretary and will invite him to write to my hon. Friend.

With reference to the answer that the right hon. Gentleman gave me last week saying that he stands ready to amend the data protection legislation so that Members of Parliament will be able to represent their constituents more adequately, will he tell us the Lord Chancellor's view on the matter?

I am happy to say that we are in discussions with the Lord Chancellor's Department, which has Ministers in this House. There is no division between us about the fact that there is an issue that needs to be addressed. Whether it needs to be addressed by legislation or by other means is a matter for exploration, but I am fully seized of the Alice in Wonderland results that some Members have experienced when pursuing constituency cases. The problem needs to be resolved.

I was pleased to hear that a response has been published today to the Select Committee report. However, we have been told that it is merely an interim response, so can we have a statement on how the debate on the future of the reformed second Chamber will be conducted and on when we will have some decisions from the Government?

I am sure that this issue will be ventilated repeatedly in the Chamber, and I look forward with anticipation and delight to answering my hon. Friend's oral question in 10 days' time. However, I cannot promise a statement until we have carried out our reflection and come to a considered view. In the meantime, we have given what I fully acknowledge is a holding response to the Select Committee. I hope that, in the fulness of time, we will be able to respond more fully to the major points that it raises. I welcome its report. It showed that it is possible to find a centre of gravity around which reformers can unite. I hope that we can find such a point in Parliament.

I urge the Leader of the House to reconsider his response to my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) on the issue of a debate on agriculture. We have just received the most damning report from the Countryside Agency about rural proofing across Departments, an initiative that this Government introduced. However, when I put a question about brown tourism signs to the Minister for Rural Affairs during DEFRA questions, he referred me to another Minister altogether. He suggested that I had asked the wrong person and did not seem to appreciate that DEFRA has the lead on this matter. If Ministers do not realise that, a debate on the Floor of the House may help them along the way.

I am not sure that that was quite the most convincing case that I have heard for a full day's debate in the House. I do not agree with the hon. Lady's characterisation of the Countryside Agency's report, but it certainly found areas in which further progress needs to be made. It was, of course, a report on the first year of what is a three-year strategy.

I repeat to her and to the House that I understand the real interest in the House in countryside issues. I shall certainly keep in mind the possibility of a debate on such matters should the opportunity arise. I will not disguise from the House, however, the fact that, as the Session progresses, we shall have a lot of business to get through.

Following the question from the Liberal Democrats' spokesman, the hon. Member for Hazel Grove (Mr. Stunell), may I ask my right hon. Friend to find time for a debate on the future funding of political parties? The idea that state funding of political parties could be introduced is something that some of us oppose on principle. I pay my subs to the Labour party, and I do not want to pay them to any other party. The idea that my taxes could go towards funding that lot over there or even to those nice, cuddly Liberal Democrats is anathema and sticks in my craw. Could we have a debate or perhaps at least a statement on the issue?

I assure my hon. Friend that if he were to contemplate paying subscriptions to any other party, he would have severe difficulty receiving the Labour Whip in the House. Of course I understand his reluctance to subsidise other parties, but I put it to him that it is very important that we find a way in which political parties can be funded—not excessively, but appropriately—and in a way that is accepted as legitimate and proper. My hon. Friend has to ask himself whether he regards the Conservative party's present way of funding as necessarily legitimate and proper and, if not, whether he is prepared to contemplate other ways in which we might go about the possibly distasteful but necessary task of funding the Conservative party.

As the Leader of the House was in his place yesterday afternoon, he will clearly recall that my hon. Friend the Member for Mid-Worcestershire (Mr. Luff) asked the Prime Minister whether he thought it right that six Parliamentary Private Secretaries, including his own, had voted against the Government's policy on specialist schools on Tuesday. The Prime Minister replied:

"No, I believe that the position of the Government was right."—[Official Report, 17 April 2002; Vol. 383, c. 573.]

In the light of that and the fact that none of those PPSs have even resigned or been sacked, as would have been the case previously, can we have an urgent debate on the ministerial code and collective ministerial responsibility?

Of course my right hon. Friend the Prime Minister was right and the Government's policy is right, and the right hon. Gentleman would not expect me to demur on either of those propositions. However, it is fair to recall that the Division on that occasion was on a private Member's motion, about which other private Members decided on their own way to vote. We can possibly get a little too pi, simultaneously demanding that Governments should be open minded and permit open debates and that they should crack down, like Torquemada, on anyone who steps out of line, even on a private Member's motion. If we could restore a sense of proportion, it would help everyone.

Is my right hon. Friend aware of the serious allegations in the media regarding Dungavel immigration detention centre? If he is, will he consider, because of the seriousness of the situation there, whether the Home Secretary should make a statement to the House about those conditions to ensure that people understand that they are not as reported in the press, as that would give some comfort to my constituents who have raised the issue with me?

My hon. Friend raises that issue from a legitimate and proper perspective. I have seen some of the reports in the Scottish press, as he will be aware, and I am interested to hear that they do not necessarily reflect the correct and full picture, as is so often the case. That matter was raised at business questions last Thursday, since when we have approached the Home Secretary to draw his attention to it. I will ensure that my hon. Friend's remarks are also drawn to my right hon. Friend's attention.

The Leader of the House may be aware of reports emanating from Jenin this morning that survivors are being pulled from the rubble of demolished houses, but will he arrange for an urgent statement on that issue next week and, perhaps in the meantime, consider offering the services of organisations, such as Rapid UK, which are used to going into disaster areas, such as earthquake zones, to assist in bringing out people who have been buried in certain situations?

The House had a full day's debate on the middle east only this week, and it was absolutely right and proper that we made that day of debate available to the House. We shall, of course, continue to keep the situation under review and, if there is a case for a further statement or allowing the House to discuss that matter, we are open to taking that forward.

On the substantive issue, I am sure that the House will share the hon. Gentleman's concern at the evidence that is emerging of the humanitarian crisis in Jenin. It is vital that the Israeli Government facilitate the access of humanitarian and aid organisations to help those, especially the civilians, who appear to have been involved in the suffering during the military incursion into Jenin. I cannot respond to the hon. Gentleman at present on whether Britain could offer more specific aid or help, but I will draw his observations to the relevant Secretary of State's attention.

I wonder whether my right hon. Friend can find time to debate the working of the NHS Appointments Commission—in particular, the singular, apparent reluctance of the commission to appoint people from our more health-deprived areas to sit on health bodies? When I discussed the appointments to the Warrington primary care trust with the north-west appointments commissioner recently, he was able to tell me that only the best people are appointed, but not why the best people apparently come from a very small geographical area of Warrington. Does my right hon. Friend think that there is something in the water; or is there something wrong with the commission's appointment procedures? Can we have an opportunity to debate that issue?

I can assure my hon. Friend that since we came to office, we have made sure that all appointments follow a clear standard procedure—[Interruption.] Indeed, as all the evidence shows, people have been appointed on merit. That is quite different from many of the appointments made under the Conservative Government. I recall that the chairman of the Conservative Association in my constituency became the chairman of my health trust. Against that background, I cannot comment on the particular local case to which my hon. Friend referred, but I shall obviously make sure that her concern and comments are brought to the attention of the Department of Health.

Since we introduced the new system, trusts and primary care trusts have on their boards people who are much more broadly representative of their communities than was the case in the system that we inherited. That is important because the NHS belongs to the people, and local NHS trusts must belong to the people as well.

As has been widely reported in the Channel Islands press and some parts of the British press, the Treasury is planning economic sanctions against Jersey if it does not sign the European code of conduct. Bearing in mind that a Treasury Minister told the Treasury Select Committee that the code was voluntary; that the only impact will be that money leaves the Channel Islands where it is well regulated to go to other places where it is not; and that the Channel Islands have no representative in the House of Commons, will the Government at least have a debate on the matter or issue a ministerial statement of some sort? The Government have said nothing at all, despite the repeated stories, which are damaging to the Channel Islands.

I am not sure that I concur with the hon. Gentleman that the islands have no representative in the House; they appear to have a good affinity with Southend-on-Sea. I congratulate the hon. Gentleman on having time to represent people other than his own constituents. On the specific point at issue, it is important for the hon. Gentleman's constituents in Southend-on-Sea that the Government of the United Kingdom are able to negotiate, debate and commit themselves in debates in Europe that make sure that we deliver on the commitments we make.

The withholding tax, which is at the root of the hon. Gentleman's argument, was a success of British diplomacy and saw off what might otherwise have been a new European tax. We made sure that such a tax was not introduced, and dealt with the problem by providing information. It is important that all territories for which the United Kingdom speaks in foreign affairs are committed to the agreements that we make, and that embraces the Channel Islands as well.

During business questions on 7 March, I asked my right hon. Friend for a debate on the membership of Select Committees, because I was concerned about the continued inclusion in departmental Select Committees of Opposition Front Benchers. My right hon. Friend referred me to a Liaison Committee meeting that had taken place that morning. I dug out the Report of Session of that meeting, point 35 of which states:

"At present some official Opposition spokesmen or Whips are serving on committees. We are strongly opposed to this in principle."

Given that that situation has been ignored by the Opposition, who are abusing the independence of Select Committees, I repeat my request to my right hon. Friend for a debate on this important issue.

He is the Chairman of one.

Indeed, but the Liaison Committee did not object to that; its comments referred specifically to the official Opposition. Whatever my sins, I am not a member of the official Opposition. I think that the right hon. Member will confirm that.

On the specific point made by my hon. Friend the Member for South Dorset (Jim Knight), I urge him to try to be a little more understanding of the problems of the Opposition; they are the smallest official Opposition for 30 years and, frankly, I doubt whether they could fill those posts without occasionally raiding their Front Bench. The Liaison Committee has expressed a bona fide concern, and I can tell my hon. Friend that there will be a debate on Select Committees and their membership next month, when we introduce the Standing Orders arising from the recent report of the Modernisation Committee. It will be relevant and in order for my hon. Friend to make his points in that debate.

As the Leader of the House is in such a helpful and jovial mood today, will he consider holding an urgent debate on the arrogant disdain of Ministers for Back Benchers, in view of the fact that it has taken almost six months—five months and five days—for the Health Minister to respond to a letter that I wrote to him? Can the right hon. Gentleman tell the House whether that is a record, and would he advise us to set up yet another waiting list for replies from Health Ministers to our letters?

I always try to be helpful to the House, and perhaps I am in a particularly jovial mood today after such an excellent Budget statement from my right hon. Friend the Chancellor. I regret it if the hon. Gentleman has been kept waiting for correspondence and I will ensure that his comments are drawn to the attention of my right hon. Friend the Secretary of State for Health. We try to make sure that we achieve replies to hon. Members, both in written correspondence and in parliamentary questions, as quickly as possible. Some Departments are under particular pressure and some questions raise particularly difficult issues that require some time to resolve. I shall certainly make sure that the Secretary of State for Health is aware of the hon. Gentleman's concerns.

May I reinforce calls for an early and specific debate on the future of digital broadcasting in the UK? The difficulties faced by ntl and ITV show that there appear to be problems with two out of the three platforms for digital TV. That raises serious competition issues and has implications for the Government's plans to switch off the analogue signal. In addition, 900 jobs are threatened in my constituency and the neighbouring constituency in west Wales.

My hon. Friend raises a serious issue. It is important that we should reflect that the recent collapse of digital TV from the ITV stable has implications going well beyond the well-publicised concerns about the football teams. My hon. Friend is aware that my right hon. Friend the Secretary of State for Trade and Industry will be opening the Budget debate on Monday, so she may wish to contribute to the debate to make sure that the issue that she raises is fully ventilated. I can assure her that my right hon. and hon. Friends at the Department of Trade and Industry are following the matter closely.

The Leader of the House will be aware of the crisis in the automotive industry. We have seen the closure of the Ford car assembly plant at Dagenham and the closure of Vauxhall at Luton. Is the right hon. Gentleman aware that not only has there been a problem because of blockages in the channel tunnel, but that the new tax on jobs—the employers' contribution of 1 per cent.,—will cause an even greater crisis in labour-intensive industries such as the automotive industry? Can we have an urgent debate on the future of the automotive industry, in the west midlands in particular and the UK in general, and the veracity and honesty of the Government in putting a tax on jobs instead of a tax on national insurance or, rather, a tax on income tax?

If the hon. Gentleman wishes to make a speech on enterprise and manufacturing industry, he has an early opportunity to do so on Monday. I cannot do better than refer him to Monday's forthcoming debate. If he takes part in that debate, I hope that he will answer the question to which we will be seeking an answer from every Conservative Member: given that we are increasing the national insurance contribution to make sure that we can double the spending on the national health service, will the Conservatives tell us whether they will match that increase and sustain it? If they are not in favour of the measures necessary to achieve that increase for the health service, are they telling us that they want more charges for the health service or less spending on the health service?

As these business questions have shown, there is an urgent need for a debate on state funding to demonstrate that the Labour party is the only party in the House that does not enjoy any part of the £20 million of state funding that will be paid in Short money in this Parliament. Is it not right that if there is to be transparency in all donations to political parties, it should stretch back over the past 25 years, so that we can demonstrate the contrast between the fantasies about sleaze in the present Government invented by the piffle artists on the Opposition Benches, and the real corruption that existed in the 1980s and 1990s, when it was said that some Conservative Members had their noses so deeply in the trough that all that was visible of them were the soles of their Gucci shoes?

I cannot improve on that.

While I am delighted that my Welsh colleagues have managed to secure yet another full day's debate on the Floor of the House to discuss Welsh issues, may I ask what we in Scotland have done to offend or upset the right hon. Gentleman and his hon. Friends? When can we expect a full day's debate on the Floor of the House on Scottish issues? Perhaps I can belatedly remind him that there will also be no local elections in Scotland on 2 May.

I can assure the hon. Gentleman that Scotland has done nothing to offend me. Were it to do so, I am sure that he would be the first hon. Member to draw it to the attention of the House. I think that he is being slightly curmudgeonly. As he said, we welcome our Welsh colleagues' opportunity for a full day's debate. I remind him that we took action, in which I took a particular interest as Leader of the House, to ensure that the nationalist parties had an Opposition Supply day. If I remember rightly, his party had half of that day.

Events this week in Italy have served to highlight once again serious divisions on the economic philosophy of the European Union. On one side, there are those who want privatisation, extreme liberalisation, an attack on workers' rights and a weakening of welfare states, while on the other there are people such as our own Chancellor—he made this clear yesterday—who want to improve social protection, and those in our trade union movement who want to improve workers rights. Will my right hon. Friend make a day available for a further debate on the future economic direction of Europe?

I have just got into trouble for not having a day's debate on Scottish politics, so I would hesitate to offer a day's debate on Italian politics, although like my hon. Friend I noticed the massive number of people who took to the streets to express their commitment to ensuring a secure future for themselves at work. Of course, we have taken very powerful measures to ensure that the prospects of people at work are improved. In particular, we have taken measures ensuring that many more people are at work than when we came to office—1.5 million in total—and that we have the lowest unemployment that either his or my constituents can remember in a generation.

Will the right hon. Gentleman now kindly agree to a debate in Government time next week on the vexed question of rail freight passing through the channel tunnel? The Secretary of State for Transport, Local Government and the Regions gave evidence to the Transport Select Committee last week and said that the French would put up a fence to prevent asylum seekers from storming the tunnel, as they have again done this week. However, the trains' failure to materialise is affecting constituency companies such as Potters of Melmerby as well as English, Welsh and Scottish Railways, and is costing £500,000 a day. Can we now please have an urgent debate?

I congratulate the hon. Lady on the assiduity with which she has raised this issue. I have raised her concerns with my colleagues at the appropriate Departments. We have obtained commitments from both the French authorities and SNCF that security would improve, and efforts have been made in that regard. We are not there yet, but we will continue to try.

I remind the hon. Lady that we have so far made good progress on tackling the arrival of those who are the source of the insecurity. The number of clandestines and people without proper documentation who are arriving has dropped sharply. We will continue to do all we can on our side, and to press the French authorities to do all they can on their side.

I welcome the fact that the Government have today sent their interim response to the Select Committee on Public Administration on its report on the House of Lords. Will he give an assurance that there will be an opportunity for a debate once the Committee has had a chance to consider the Government's interim response and make its comments?

I am very happy to say to my hon. Friend that I am under no illusion that this issue will go away. There will be many opportunities for the House to return to it in future, including in two weeks' time when I answer oral questions. The Government will continue to make progress on the issue, so as to ensure that we will be in a position to examine it at some length at a future stage in this Session.

The Leader of the House will know that the Government will face probable defeat in another place today on the Export Control Bill, when my noble Friend Baroness Miller of Hendon moves with cross-party support an amendment that seeks to defend academic freedom. If the Government are to persist in their policy of trying to constrain academic freedom, can we have an early statement from the Department for Education and Skills about the likely effect on Britain's universities, how they will continue to attract international students, and the effect on our research base?

The hon. Gentleman creates a worry and a risk on stilts in relation to a modest aspect of the Export Control Bill. I am proud that we are introducing such a Bill; it is much needed and is based on a commitment that we made and are now carrying through. I am pleased to tell him that we are seeking to introduce amendments that will take care of concerns about academic freedom that we think are rather exaggerated, although we know that they are widely held.

May I press the point made by the hon. Member for Hornchurch (John Cryer), who is no longer in his place? If there is to be a debate on the state funding of political parties, as the Leader of the House says, surely that should include a debate in this Chamber. Given that he says that there is no collective Government position on the matter, will members of the Cabinet be able to speak in the debate, so that the Home Secretary can tell us why he thinks that it is inevitable, the Transport Secretary can explain how he is examining other countries' systems and the Leader of the House can take us on a trip down memory lane about his various political views?

The hon. Gentleman asks for a free debate. I should be tempted to have such a debate—having first reached agreement with the right hon. Member for Bromley and Chislehurst (Mr. Forth)—if the many right hon. and hon. Members who were Conservative Cabinet members in the past would take part and tell us exactly where they got funding from and which companies gave them donations.

With permission, Mr. Deputy Speaker, I wish to make a statement on the next steps on the NHS plan. I am today laying before Parliament a Command Paper setting out those next steps, copies of which have been placed in the Vote Office.

The NHS plan that we published in July 2000 set out a 10-year programme to rebuild and renew the health service in our country. It diagnosed the NHS problem as follows. The principles of the NHS are right—on this side of the House we believe in an NHS that is free at the point of use, funded from general taxation, and based on need, not ability to pay. But today's NHS is the product of decades of underinvestment. It is also the product of a failure to reform. Staff—the greatest asset that the health service has—work flat out in a system which still too much resembles that of the 1940s. The NHS plan set out a 10-year programme of investment and reform based on clear national standards, more devolution of resources, greater flexibility for staff and more choice for patients.

With the economy stabilised and the public finances sorted out, the 2000 spending review was able to give the NHS the largest ever real-terms increases in resources. Two years later, anyone who says that there are no problems in the NHS has clearly got it wrong, but those who say there has been no progress have also got it wrong. Yes, there is a long way to go—it is a 10-year plan—but those who point to an NHS black hole should in fact be pointing to dozens more hospitals, hundreds more beds, thousands more doctors, tens of thousands more nurses—and a better health service as a result.

In July 2000, we acknowledged that three years of sustained funding was not enough. My right hon. Friend the Prime Minister had already said in January 2000 that we needed to match European Union levels of spending. Yesterday, my right hon. Friend the Chancellor of the Exchequer put NHS finances on a sustained footing, not for three years, but for five. Years of failure to invest in the past are now being replaced with years of investment for the future. Today, I can tell the House what that investment will give us: 35,000 more nurses, 15,000 more doctors, 40 new hospitals and 500 primary care centres. As investment grows, so the capacity of the NHS will grow.

Investment in the NHS must, however, be accompanied by changes in the way in which the NHS works. Ours is not an unconditional offer. Without those reforms, we will not get the best use of the money for the taxpayer and we will not get the improvements in service for the patient. Where we have had the courage to invest, we must now have the courage to reform. Our formula is simple: investment plus reform equals results.

First, building on the national standards already in the NHS plan, we will strengthen the system of inspection and audit to improve accountability to patients and the public. Where more resources are going in, people have the right to know what they are getting out. We will therefore legislate to establish a new Commission for Healthcare Audit and Inspection to inspect and to raise standards in health care across our country. We are clear that we need higher standards in NHS hospitals and also in private hospitals.

The commission will assess the performance of every part of the NHS so that the public can see that every extra pound in the NHS buys something better for patients and gets something more for taxpayers. Similar arrangements will be made for social care. We will discuss the details of both with the National Assembly for Wales.

The new commission will be independent of both the NHS and Government, and more independent than the current fragmented system. It will report annually to Parliament, not Ministers, on the state of the NHS, its performance and, most important, the use to which it has put the extra resources. The Government should not be judge and jury of the NHS. The commission will be the judge, the British people the jury.

Secondly, we can go further in extending devolution in the NHS, building on what has been achieved. The health service should not and cannot be run from Whitehall. The NHS is delivered in hundreds of different communities by more than 1 million staff. The relationships are between the local patient and the local doctor; the local community and the local hospital. However, those relationships will not work properly until central control is replaced by local accountability. After 50 years, the time has come when the sound of bedpans being dropped in Tredegar should reverberate only in Tredegar.

With national standards and inspection in place, power, resources and responsibilities must now move to the NHS front line. When we came to office, GPs controlled only 15 per cent. of the total NHS budget. Today, primary care trusts, with GPs and nurses in the lead, already control half the budget. In only two years, they will control three quarters of it. Just as the new commission will report nationally, so primary care trusts will need to report locally on how NHS resources have been spent.

The best primary care trusts, like the best NHS hospitals, should enjoy greater freedoms and more rewards. We will therefore establish new foundation hospitals and foundation primary care trusts, which will be fully part of the NHS, but with more freedoms than they have now. They will have more powers, including a right to borrow, to expand their services for patients.

Thirdly, further to the new powers that we have given nurses and others, we will radically alter the way in which staff work and introduce a new system of financial incentives throughout the health service. We will put in place new contracts of employment, not only for nurses and other staff, but for GPs and, yes, for hospital consultants, too. Our objective is to liberate the potential of all members of staff, rewarding those who do most in the NHS and, crucially, improve productivity throughout the health service.

New incentives for individual members of staff will be matched by a new system of financial incentives for NHS organisations. The hospitals that can treat more patients will earn more money. Traditional incentives work in the opposite direction. Indeed, the poorest performers often get the most financial help.

We will therefore introduce a new system for money to flow around the health service, ending perverse incentives and paying hospitals by results. The incentive will be to treat more patients more quickly, and to higher standards.

Fourthly, patient choice will drive the system. Starting with those with the most serious clinical conditions, patients will have a greater choice about when and where they are treated. From this summer, patients who have been waiting six months for a heart operation will be able to choose a hospital, public or private, which has the capacity to offer quicker treatment. This level of investment means that we can grow NHS capacity as fast as it is possible to do so.

I can also say today that it is our intention to draw into this country additional overseas capacity so that we can further expand NHS services to NHS patients. As capacity expands, so choice will grow. Within three years, all patients, with their GPs, will be able to book hospital appointments at a time and a place that is convenient to them. The reforms that we are making will mark an irreversible shift from the 1940s take-it-or-leave-it, top-down service. Hospitals will no longer choose patients; patients will choose hospitals.

Reductions in waiting times to get into hospital must, of course, be accompanied by cuts in waiting times to get out. Older people are the generation that built the health service, and they have supported it all their lives. This generation owes that generation a guarantee of dignity and security in old age. Bed blocking denies both.

Ah!

The hon. Gentleman ought to get a grip.

In recent months, the extra resources that we have made available have reduced the numbers of elderly patients whose discharge from hospital has been delayed. I am grateful for the help that local councils have given us in addressing this problem. Here, however, the long-term solution is not just investment, it is reform. I can tell the House today that, to bridge the gap between health and social care, we intend to legislate, as they have done in Sweden and other European countries, to give local councils responsibility—from their 6 per cent. extra real-terms increases—for the cost of beds needlessly blocked in hospitals.

Councils will need to use those resources to ensure that older people are able to leave hospital when their treatment is completed. If councils reduce the current level of bed blocking so that older people are able to leave hospital safely when they are well, they will have the freedom to use those resources to invest in extra services. If bed blocking goes up, councils will incur the cost of keeping older people in hospital unnecessarily. There will be similar incentives to prevent hospitals from seeking to discharge patients prematurely. In this way, we will provide local councils with the investment and the incentives to improve care for older people.

Taken together, the NHS plan and the next steps announced today amount to the most radical and fundamental reform programme inside the NHS since 1948. I want to pay tribute to the staff of the national health service—not just the nurses, doctors and consultants, but all the staff in the different medical disciplines, the ancillary staff, the secretaries, the receptionists, the porters and the cleaners. They represent the very best of British public service and I believe that, as a nation and as a Parliament, we should he proud of the work that they do. I know and understand the enormous pressure that they are under as the NHS plans to make these big changes. But I know, too, that they share this basic goal: to rebuild the national health service around the needs of its patients.

This programme of investment and reform will mean that each year, every year, waiting times will fall. Last year, the maximum wait for a hospital operation was 18 months. Today it is 15 months. By this time next year, it will fall to 12 months. By 2005, it will be six months, and by 2008, it will have been reduced to three months. By then, the average waiting time for a hospital operation will be just six weeks. It is our aim that people will no longer have to face the dilemma of having to wait for treatment or having to pay for it.

As a party and as a Government, we are committed to providing opportunities to all in our society and not just to some, so there will be more effort to prevent ill health, as well as treating it. Twenty-five thousand lives a year can be saved by the investment we can now make in preventing and treating heart disease alone.

The balance of services will shift, with more patients being seen in primary and community settings, not just in hospitals. Social services will have resources to extend by one third rehabilitation care for older people. Councils will be able to increase fees to stabilise the care home market and secure more care home beds. More investment will mean more old people will have the choice of care in their own homes rather than in care homes.

Yesterday's Budget and today's reforms mean that the NHS plan will be delivered.

I want to make two further points. First, it is a 10-year plan, as we said in July 2000. By the time of the next election, there will be real and significant improvements. However, that cannot happen overnight. It takes seven years at least to train a doctor and up to 15 years to train a consultant. Expectations will be high—I understand that—but they also need to be reasonable, and people need to understand that a 10-year plan is exactly what it says. It will take time to be delivered in full. At least now, public and patients will be able to see improvements made stage by stage, independently of Government, audited, monitored and inspected.

Secondly, there is consensus in the country on one thing: Britain needs to spend more on health care. There is no mystery about why there are no waiting lists in Germany. It has spent more, and has done so for years.

We can debate endlessly the system of finance, but one thing is beyond debate: the level of finance has to be raised. Once that is accepted, the choice is not between a system funded out of general taxation, which results in higher national insurance, and some other system that comes for free. Importing the German system of social insurance would cost the equivalent of an extra £1,000 per worker per year, and the French system would cost £1,500 per worker per year.

Labour Members believe in the NHS in our heads as well as our hearts. We believe it to be the best and fairest system of providing true health insurance, because it is based on the scale of the person's need, not the size of their wallet. It is the best insurance policy in the world.

It is now for those who want to see the NHS not reformed but abandoned, and who routinely call it Stalinist, to say honestly what their alternative is, what it would cost and how much families and pensioners would have to pay for it.

Yesterday we made a choice, and we ask the British people to make the same choice. We are proud of the NHS and of the people working in it. We are giving it the money that it deserves. We are making the changes it needs. Investment plus reform equals results. We will be happy to be judged on them.

I am grateful to the Secretary of State for his statement. He is right: there is a measure of consensus in the House. We all agree that more money should be spent on health in the United Kingdom. We believe that health care should be available to all irrespective of their means. The Secretary of State's statement must be judged against the criterion set down by the Chancellor yesterday, when he said that the scale of long-term investment would be matched by the scale of long-term reform. Have we had today anything like the indication of long-term reform that comes anywhere close to the increase in funding announced by the Chancellor? Indeed, the Secretary of State's words mark quite a shift in the Government's position. He said in his statement:

"Without those reforms, we will not get the best use of the money for the taxpayer".

However, the Chancellor told The Sun in November:

"I'm going to insist any additional resources must be matched by reforms so that we get the best value for money. There is not to be one penny more until we get the changes."

We believe that reform is needed, but we are not willing to give the Government a blank cheque—especially after a statement such as this, high on waffle and low on detail. I should like the Secretary of State—yes, he can get his pen ready—to give us some numbers, and some of the details of what the plans actually mean.

First, let me ask about national insurance. What will the changes announced yesterday cost the NHS as an employer, and what will be the additional cost in taxes to a consultant, a senior house officer and a ward sister on average salaries?

Where will the new auditors come from to deal with the Secretary of State's new auditing system? Please let them not be the Prime Minister's cronies in Andersen! How many are envisaged, and how much will it all cost? Who will appoint the new auditors? Will they be free to set their own budgets? The last thing we need is a new set of bureaucrats. Perhaps the most important question is this: will the auditors be able to audit private hospitals? That is especially important when NHS patients are being treated in such hospitals. Will we see the Commission for Health Improvement and the National Care Standards Commission merge with the National Audit Office, or any potential mixture involving the three bodies? [Interruption.] I see that the Government Chief Whip is up to her usual intellectual standard today, although that is not saying much.

When it comes to the question of devolved power, the Secretary of State is pulling a confidence trick. He talks of more money being available on the front line, but he does not say that there are so many strings attached that those on the front line are not free to choose how to spend it. Last week I visited the chairman of a primary care group, who told me that of the extra £13 million made available last year only £55,000 was discretionary money that he could choose how to use.

Perhaps the Secretary of State can give us one or two more details about devolved power. He talks of devolved bodies being able to borrow. Where will they be able to borrow from? Will they be able to borrow from the markets? Will the borrowing happen with or without an underwriting by the Government, and how will this affect PSBR calculations?

The Secretary of State said that there would be

"New incentives for individual members of staff".

What sort of individual financial incentives will those be, how much—typically—will they be worth, and at what level will they be negotiated?

I was delighted to hear the Secretary of State talk of money following the patient: I had thought that that was one of the phrases new Labour had banned. At least he is returning to some of the right ideas. But what exactly does he mean by "importing additional overseas capacity"? Who is being imported and from where, and how will the process be funded?

Perhaps the most appalling part of the statement related to bed blocking. For more than three years, the Government were warned about the consequences of their policy of running down care homes in the community. They were warned that when they lost beds in the community they would block beds in the NHS, and that they would see an increase in the number of cancelled operations and a rise in waiting lists as well as inappropriate care. What is the Secretary of State going to do now? [Interruption.]

Order. The Opposition spokesman must be given a fair hearing. We cannot have repeated sedentary interventions.

With respect, Mr. Deputy Speaker, some of the sedentary interventions were better than what we have heard from the Government Front Bench.

The Government are shifting the blame, which they always do. The blame for bed blocking now lies with local government, rather than with those who created the problem—central Government. The financial burden and the penalties will be transferred to local government: in other words, council tax payers will be fined for the Government's incompetence in terms of their care homes policy. That is a terrible indictment of this Government.

We seek detailed answers to those questions, because several things have become clear over the past 24 hours: that the Government now believe that one of the ways of helping recruitment and retention is to tax NHS staff more; that the Government have now returned to tax and spend: and that the third way and new Labour are gone.

When the Government came to power, they said no internal market, no money following the patient and no GP fundholding. Having broken their promises on taxes, they have now gone back to many of the reforms that they said in opposition they would never tolerate. They are admitting that they wasted five years for all those who use and work in the health service. They were wrong and we were right. The one word missing from today's statement was "Sorry".

The hon. Gentleman either misunderstood or has not read our proposal on the new independent audit regime. In fact, it will mean less rather than more bureaucracy. We will put together the current arrangements, with the Commission for Health Improvement, the value for money work of the Audit Commission and the private health care work of the National Care Standards Commission, in one single new body. That will make for less confusion and bureaucracy in the national health service, with clearer accountability to the public.

The hon. Gentleman did not say one word about matching extra investment either in the national health service or in social services. It is a bit rich for him to bleat about bed blocking and problems in care homes—which exist—and not to commit his party to matching the extra resources that we are allocating to social services.

On the hon. Gentleman's question about borrowing, we will put in place a new prudential borrowing regime, along the lines of the one that we are considering for local authorities. The details are in the document.

On importing staff, we envisage bringing in spare capacity from abroad—from Europe. The hon. Gentleman is very keen on his travels in Europe. Normally, the purpose of travel is to arrive at a destination. This must be the only instance of travel narrowing the mind. His mind is made up. The challenge for him is threefold: will he match our extra investment, match the extra sources of that investment and match the reforms that we have outlined? The answer for all three is no.

The public will see that, rather than wanting to reform the national health service, the Tories want to abandon it. The hon. Gentleman gave the game away when, in his secret speech in Harrogate, he said that the Tories' strategy was first to talk down the national health service, and then to run it down, as a prelude to their real agenda of selling it off. That is not the right choice for the British people.

I warmly welcome my right hon. Friend's statement and the reforms that he outlined, but those who will be paying the extra taxes will want a copper-bottomed guarantee that their money will be spent wisely. They will want improvements to be made, and quickly. Will he assure me and the people outside who will pay the extra taxes that this massive investment will find its way to front-line services and not be lost in more red tape and bureaucracy?

My hon. Friend makes an important and telling point. It is important that people who work in the national health service and the managers who are responsible for delivering care understand that the extra resources do not come for nothing—this is not an unconditional offer. The days have gone when public spending worked on the something-for-nothing rule. We are offering something for something and we expect big changes and improvements, but we do not expect them overnight. No magic wand can be waved and no silver bullet can be fired, but people have a right to expect a steady improvement year by year, as capacity grows and the NHS plan is implemented over 10 years, providing more staff, more beds, more buildings, new hospitals and new ways of working backed by the reforms that I have announced today.

When people put more money into the national health service they have a right to expect more out of it. That is why the new arrangements for audit and inspection, which are not supported by the Opposition, and the new obligations on primary care trusts are being brought into being as quickly as possible. Some will require legislation and some will not, but in my view it is important that taxpayers see that extra resources deliver real results for patients.

On the rise in tax, including a not so brave 1 per cent. on top earners such as the Secretary of State—and the Prime Minister and Chancellor, who are leaving the Chamber to count their money—to give the NHS the funding boost for which we have been calling for years, we would like to resist the temptation to say, "I told you so", but we cannot. Nor can the people who have died while waiting, the patients who suffered poor care during years of underfunding and the elderly who are stuck in hospital and who will still have to sell their homes to pay for the personal care that they thought they would get on the NHS.

The funding is welcome, but it would be more welcome if the Secretary of State apologised for his five years of the 23 years of underfunding and the two income tax cuts, for which the Conservatives also voted, because without them we could be halfway through a 10-year programme of NHS investment rather than at the start.

If the Secretary of State is serious about reform, why does he not consider truly decentralising decision making to publicly and democratically accountable local decision-making bodies instead of simply decentralising the blame and centralising the praise?

On the new financial incentives for hospital performance and the distortions, if the Secretary of State really thinks that doctors and nurses will treat patients better if he stuffs their mouths with gold, he simply does not understand the motivation of public sector health care workers. Does he really think so little of doctors and nurses? If he believes that these new people's foundation, grant-maintained hospitals that give financial incentives for admitting, discharging, operating and not operating, and the creation of an accountant's paradise, will produce no clinical distortions and improve clinical care, he misunderstands doctors and nurses in the health service. He is moving from stethoscope to spreadsheet, and that will damage patient care.

On social services, it appears that the Secretary of State, like Conservative Front Benchers, has just discovered social services underfunding and bed blocking. He has announced that he will suddenly get a grip. Does he not understand that the 1.2 per cent. real growth between 1999 and 2001, as set out in the Wanless report, was grossly inadequate, as was the real-terms cut in social services funding in the previous two years? Is he about to insist that local councils not only punish council tax payers, but cut services to the mentally ill, the vulnerable young and the disabled to avoid his fine? The real-terms increase in funding is only 3.5 per cent. now, rising to 6 per cent. this year. That is around £200 million, which is grossly inadequate for the amount of underfunding in health services.

Finally, can he assure people in Oxfordshire facing £9 million in social services cuts in the fifth year of a Labour Government that they will not have to face more cuts this year? Unless he can make that commitment and unless he apologises, people will not believe that he is serious and the Government will appear even more arrogant than they have to date.

The hon. Gentleman said that my right hon. Friends the Prime Minister and the Chancellor of the Exchequer have left the House, and I now know why they did so. If I were the hon. Gentleman, I would be very cautious about raising national social services funding issues, given that the Liberal Democrats are cutting such funding at a local level. Indeed, as I have told him before—he has failed to answer this charge—the biggest complaint that I heard on my recent visits to Liverpool and Sheffield was the cutting by Liberal Democrats of social services expenditure for the elderly, the disabled, people with mental health problems and vulnerable children; yet the hon. Gentleman has the temerity to complain about a 6 per cent. increase in social services investment.

The problem with the hon. Gentleman and the Liberal Democrats is that they always want more money but never want change. He must recognise what everybody else recognises: if we are to get the best from the resources and improve services for patients, investment and change must go together. It is about time that he learned that lesson.

rose—

Order. This is a very important matter and many hon. Members are seeking to catch my eye. May we please have shorter questions, and perhaps shorter answers?

On any test, this is a defining moment for the health service, and I congratulate the Government on what they are doing. People simply have to make up their minds: do they want to rebuild the health service, or not?

The Secretary of State talked about giving a guarantee to heart patients who face a wait of more than six months, and about introducing a true insurance approach to the health service. Under such an approach, people pay in and they know what they will get out. In talking about making step changes and step improvements to bring down waiting times, can we not tell people that that is a commitment? Can we not say, "A commission will ensure that we do that, and we will give real patient guarantees, so that we know what you have paid in, and you know what you will get out"?

On my hon. Friend's first point, the decisions relating to the Budget and the reforms were of course important. The simple observation—I hope that it is widely shared—is that if people want world-class health care, it has to be paid for somehow. The issue is not whether we pay for it but, I suppose, how. The argument and debate about that will continue in the weeks, and perhaps years, to come. When people examine the issues carefully—as we have done, and as the British Medical Association did in 2000—they will conclude, not on the ground of destabilising the current system, but on the grounds of principle and of values, that the national health service is the right way forward for the country. However, we must ensure that we grow the capacity, and I am afraid that we must make some big changes.

We want to grow the capacity in stages. The biggest capacity constraint is the shortage of qualified staff, be they doctors, nurses, scientists or therapists. We must be straight and honest with people: it will take time to grow capacity. It is no use the Opposition yelling about a 10-year plan. Yes, it is a 10-year plan, and it will take time to get there. As we improve services and cut waiting times, the offer that we can make to individual patients will of course improve. However, it is important that people understand that an enormous pot of money is now going into the national health service, but that it will be released in stages. We have to ensure that the NHS works for patients, and we will improve the services that they use progressively, rather than overnight.

The Secretary of State has put great store by his improved audit arrangements, but who will set the criteria by which success will be judged? Will the auditors set it, or will he set it? In his statement, he also mentioned improvements in waiting times, but not for the first consultant appointment. What will he do to reduce targets for that?

The right hon. Gentleman will be aware, as a Treasury Minister in a previous Conservative Government, that the Audit Commission works very independently. It has done a first-class job and its integrity and independence must be maintained at all costs in the new system. It decides what value-for-money studies it wishes to undertake and, similarly, the new commission will decide which studies it wishes to undertake. There are two forms of standard setting, including the new national service frameworks for cancer, coronary heart disease and mental health, which are drawn up between the Government, the NHS, clinicians who work in the NHS and patients who use it.

On the subject of out-patient appointments, I did mention the cuts in waiting times for in-patient treatment that are taking place. Getting the waiting times for out-patients down has been a long haul, but they are now down below the level that we inherited. As we grow the capacity, put the extra resources in and—crucially—make the reforms, we will continue to bring waiting times down so that by 2005 no one will wait more than three months for an out-patient appointment either.

Bolton has welcomed the considerable amounts of money that we have received for our health service and our social services department, but a problem remains. In 1997, we were 6 per cent. away from target funding. A letter that I received this week from the Under-Secretary revealed that the new primary care trust began its work 6.02 per cent. away from target funding, so the situation has not improved. I seek assurances for my constituents from my right hon. Friend that in the next five years the real inequalities that exist in areas such as mine will be addressed once and for all.

My hon. Friend will be aware that a review of the way in which we distribute resources is being conducted, both in local government and in the NHS. As I have said before, I cannot give an absolute assurance for Bolton, but I recognise that the area has its fair share of problems, with high levels of morbidity and deep health inequalities. Our new formula for distributing growing NHS resources is designed to address such problems.

Will the Minister cast his mind back some five years, when the Labour Government introduced a whole new inspectorate system for local government called best value? That immense gendarmerie is now so complicated and complex that his Government are saying that they must start to dismantle it. What assurances can he give us that the inspectorate that he has announced today will not be such an enormous consumer of management time that it will divert people from the task of looking after patients? Does he realise that he has now announced a sort of amalgam of nationalised and local responsibility, so that nobody will any longer have the faintest idea of where the buck stops? Can he decide whether he or the people who know about it are running the NHS?

For once, the right hon. Gentleman is remarkably confused on the issue. Normally, he is a beacon of light in a sea of darkness on the Opposition Benches. The position is clear. We will not have three bodies inspecting and regulating health care in our country. Instead, one body will inspect and regulate health care to common national standards, whether in the public or private sector, in primary care or in hospital-based care. Nobody, with the best will in the world—even someone with the right hon. Gentleman's creative accounting mind—can possibly make that add up to more bureaucracy when it will mean less bureaucracy.

The right hon. Gentleman knows as well as I do that we must get the right balance of national standards in a national health service, because the last thing that we want to do is to return to the position that the Government inherited in 1997, when there was a lottery of care for cancer services and drugs. We have put that right. What we have recognised, as I have been able to announce today, is that services have to be delivered locally. We need greater freedoms and more rewards for the best. We must step in where there are problems, but we must step back where there is progress.

Barnsley has exactly the same problem as Bolton: we are moving further and further away from our target funding, and that means a £6 million shortfall, which the primary care trust must address. I very much welcome what my right hon. Friend has said about the independent audit, but will it be empowered to compare health authorities throughout the country in order to show exactly where value for money is delivered, so that in areas such as Bolton and Barnsley, which administer their funding very well, we can benefit from the extra resources going into the service?

The straightforward answer to that question is yes. That is precisely what it will be doing, so that people both locally and nationally, and particularly in this House, have an opportunity to judge how well different health services are doing in different parts of the country. That is a welcome step forward and a recognition that the national health service belongs not to me or even to the people who work in it, but to the British public, who have a right to know how well it is doing.

The Secretary of State is well aware that health matters have been devolved to Northern Ireland and Scotland. Can I have an assurance that the increase in health service funding will be allocated at the same level in Northern Ireland? I have to raise the issue because this is a national health service, and over the years Scotland, Northern Ireland and England have shared the situation, providing doctors, nurses and specialists.

I want also to press the Secretary of State on whether he is absolutely sure that there will be less bureaucracy under the independent inspection—or will fewer people do the job, which has not been done well in the past, and we will continue to suffer? The British people are the jury. They have been long-suffering, but are beginning to turn and become more demanding. They will still be demanding if we do not deliver.

It is not really my responsibility to comment on issues either to do with Northern Ireland or to do with finance in Northern Ireland. However, my understanding of what my right hon. Friend the Chancellor of the Exchequer said yesterday is that the funding increases are not just for England but for other parts of the United Kingdom.

Inspection and ensuring that we have the right number of people in place is more than anything else a matter for the new independent commission; that will not so much be a matter for me. It must decide on the level of resources and the number of staff needed in order to do the work that it needs to do, which is about improving standards and accounting for where public money is spent.

Is my right hon. Friend confident that he will have the full co-operation of the royal colleges and the British Medical Association in his effort to reduce waiting lists? He will be aware that those mighty vested interests have in the past been part of the problem rather than the solution. Is it true that the consultants are demanding a 29 per cent. wage increase in return for their co-operation? If it is, will he politely tell them that that is not on?

I do not know about the specific figures but, clearly, negotiations are taking place with the BMA about the future of the consultant contract. There will no doubt be different points of view. It is important that people recognise that, although these are large increases in NHS investment, they must go to the right place so that we can improve services and, of course, motivate staff. As my hon. Friend will recognise, we require some profound changes—not just increases in the number of staff but changes in their working practices. We cannot have ancient, traditional demarcations among those working in the NHS standing in the way of improved patient care.

What is it about the Audit Commission that makes it insufficiently independent or professional to continue to monitor the outcomes of this Government's policy? Why is the Secretary of State dropping the Audit Commission in favour of a body that will be both judge and jury, setting targets and monitoring outcomes?

The hon. Lady has not listened to what I have said; fair enough. Perhaps she can read my statement. I shall briefly explain. The commission will be more independent not less. At the moment, I appoint people to the Audit Commission. She might think that that is a perfectly reasonable, independent system; I do not. In future, the people appointed to the Audit Commission—the commissioners—will be appointed independently from me. What is more, the commissioners will appoint the new chief inspector, who will have overall responsibility for ensuring that standards and accountability work in the NHS.

Does my right hon. Friend accept that his statement will be warmly welcomed by my constituents, not least, I suspect, because one of the new hospitals that he mentioned is likely to be the community hospital in Gravesend? He will be aware that, despite quite substantial increases in resources, we have had considerable problems with social services in Kent. Will he give us an assurance that the annual report to Parliament on delivery in health services will include local authorities that, given the extra resources that they will be receiving, are failing to deliver effectively on social services?

My hon. Friend makes an extremely important point. It is incumbent on all parts of the public services—particularly if extra investment is going into them, as it is into social and health care—to account for how money is spent and, indeed, for how standards are improving. As I said in my statement, just as we will have a new independent commission to ensure that standards are high and performance in the NHS is improving, so we will have a new independent commission for social services—effectively bringing together the social services inspectorate, which is currently part of the Department of Health, and the National Care Standards Commission. Once again, the new commission that will deal with social care inspection will be more, rather than less, independent than current arrangements.

Just how will the increases in national insurance contributions and taxation help the NHS in the Thames valley, where due to very high housing costs, we are suffering a desperate shortage of staff and difficulty in recruiting doctors, nurses and all forms of health professionals? Surely such increases will make matters much worse.

All of that was taken into account in discussions on the Budget and the spending review. People are talking about £200 million for the NHS in increased national insurance contributions. To put that into perspective, it is worth remembering that the NHS will be getting an extra £5 billion. The question for the Conservative party is whether it backs that level of investment—yes or no? It is a very simple question.

I too congratulate the Secretary of State on his bold measures. I am particularly glad about the extra resources for social services because, as I am sure he will be aware, one factor that contributes to bed blocking, especially in my part of the world, is a lack of capacity in the private and nursing care home market. Will he consider encouraging where necessary public reprovision of long-term care beds?

In the end, those decisions are best taken not by me, but locally. It will be a matter—[Interruption.] The hon. Member for Oxford, West and Abingdon (Dr. Harris) says no, but he is the one who continues to argue that the NHS, social services and local government are too centralised. Then, he rails against our saying that decisions are best taken locally. It is for social services and the health service to decide how best to spend the resources. There are many models of providing health and social care. Indeed, it would be good if there were more joint ventures between the public and private sectors precisely so that we could reap the benefits of both, and that way improve patient care.

Will the Secretary of State assure the House that the extra doctors and nurses who he has trumpeted this morning will not be recruited either directly by the health service or indirectly through private agencies from developing countries that need them much more than we do?

Yes, we are very clear that we will not be doing that.

In warmly welcoming the statement, I ask my right hon. Friend how successful innovatory practices are being communicated, as there are many in existence. I bring to his attention the Medical Assessment Unit at the James Cook hospital in Middlesbrough. It is in the process of putting together a multidisciplinary, rapid reaction force—if Members will excuse the use of Ministry of Defence language—with outreach nurses and social services. It is effectively discharging 40 per cent. of patients who would otherwise have remained in hospital. This is an excellent piece of innovatory medicine—other hospitals are discharging only 10 per cent. of such patients. How are these good practices being communicated?

First, throughout the health service and social services, as in my hon. Friend's area, there are many examples of innovation, reform, modernisation—call it what we will. The Conservative party would like to pretend that reform has not taken hold when in fact it has taken hold in all aspects of the health service. The way in which we ensure that we learn from best practice is straightforward. First, we now have a modernisation agency that can help people to improve their services. In that way, we take good practices out of the ghetto and spread them to all so that they are not just for the benefit of the few.

Secondly, it is important to get in place the right incentives. I believe profoundly that we cannot simply tell people to change but must provide the incentive for them to change. The truth is that there has never been a system using the right incentives in the national health service and perhaps in social services too. By changing the way in which money flows around the system, we are trying to put the right incentives in place so that those who do best get most money and those who do less well have an incentive to improve.

The Secretary of State makes much of this independent inspectorate reporting to Parliament. Can he guarantee that when it does report to Parliament, there will be an opportunity, in Government time, to debate that report on the Floor of the House every year? Can he explain to my constituents how it will improve the morale of people who work in the national health service if their take-home pay is cut by national insurance increases?

On the first issue, that is not a matter for me. I am trying to get rid of powers, not take them on. The Leader of the House deals with such issues. On national insurance contributions, I think that doctors, nurses, therapists, scientists and everyone who works in the national health service recognise that if we want world-class health care, we have to pay for it. The choice that we have made is to put the investment into the national health service. The choice for the hon. Gentleman, with respect, is whether he will match those extra resources.

I applaud the additional investment, especially in social services, and the announcement of additional resources to care for elderly people. That will certainly be welcomed by residents of Lancashire care homes and elderly people supported in the community. Will my right hon. Friend also discuss with local authorities the need to invest in children's services? There are increasing numbers of children at risk who need support and this is an opportunity to offer them that support.

I agree with my hon. Friend. I am very aware of the pressures in Lancashire, which she has raised with me in the past. We have taken fully into account the problems and pressures that social services face not just in providing better elderly care services but in improving children's care services. I hope that there is an opportunity for social services to plan ahead with confidence for the medium term with a very generous settlement over three years that allows some of these problems to be addressed in a stage-by-stage way. I also hope that social services will recognise that the best way forward for children's care and elderly care is for the health service and social services to work more co-operatively together.

Does the Secretary of State agree with Mr. Stuart Emslie, a risk control expert in his Department, that the NHS loses between 16 per cent. and 20 per cent. of its budget each year through fraud and mismanagement? If he does not agree, will he tell us the correct figure?

No, because he did not say that. The figures that the Conservative party bandy about include the costs to the national health service of staff who are off sick. I know that the NHS is a good service, but not even we have been able to solve problems universally of staff sickness for all our staff.

Although the chief inspector will be independently appointed, may I suggest to my right hon. Friend that one criterion for appointment might be not having been a chief inspector of any other public service?

I know of my right hon. Friend's commitment to mental health services. Waiting for treatment, either in hospital or in the community, can be debilitating for people with a mental illness and their families. Mental health is a primary problem in trying to resolve the issue of rough sleepers. Will my right hon. Friend make a commitment that the additional funding will be aimed at mental health services as well as all the other health services?

It is very important that mental health services get their fare share of the additional resources. It is also very important, in my view, that we keep a clear eye on the key priorities for the national health service, not just to get waiting times down but to improve outcomes from cancer and coronary heart disease and to improve elderly care and mental health services. I say to my hon. Friend, in the spirit of friendship and also candour, that if we try to do everything at once, we will achieve nothing at all. It is very important that we keep focused on the issues that count.

Before the Secretary of State imposes this new level of audit and inspection, will he undertake to read last night's Reith lecture on the subject? Will he tell my constituents why they should have any confidence in his NHS plan when he has shown himself prepared to corrupt the administration of government, compromise the health care of my constituents and the welfare of health workers in my constituency in order to promote the political interests of the Labour party?

Frankly, those comments are beneath even the hon. Gentleman.

Is my right hon. Friend aware that many hundreds of cancer patients in Grimsby and Cleethorpes have to pay £5 to cross the Humber bridge to gain access to treatment in Hull hospitals? Will anything be done, using the extra funding, to make journeys to hospital much easier for those people? I am finding it hard to convince them that the NHS is based on need, not ability to pay.

I was not aware of the problem that my hon. Friend raises. Again, such decisions are best taken locally rather than nationally. There will be scope, more freedom and, of course, extra resources, for local health services to decide what their priorities are. However, people in the health service must understand that the extra resources do not come easy; there are strings attached. Most importantly, the health service must understand that every penny of extra investment must be properly accounted for. I do not provide the extra investment, the taxpayers do, and they must have a good deal, just like patients.

I could not agree more with the Secretary of State when he says that the NHS cannot be run by Whitehall. He will be aware of the significant staff recruitment problems that exist in parts of the country. Can he clarify what new flexibility he is prepared to give to foundation hospitals and whether those hospitals will be able to pay in accordance with local labour market conditions as opposed to being constrained by national wage bargaining?

As far as the foundation hospitals and pay systems are concerned, I think that the hon. Lady is aware that we are negotiating with the various trade unions a new system of pay called "Agenda for Change" for the national health service. It will seek to combine a national framework of pay with local flexibility. Foundations hospitals will be able to use those local flexibilities to give appropriate rewards to NHS staff.

Order. It is important that we move on to the next business. However, we will be returning to debate this subject on Tuesday of next week.