What estimate he has made of legal costs to the NHS incurred by patients taking legal action in the last five years. [82616]

The NHS Litigation Authority has only collected information on legal costs incurred by the NHS in respect of all clinical negligence claims since April 2002.

In view of the amount of money and time taken, including that of professional staff in those cases, could we not find a way in which people can avoid suing, possibly by having a no-fault system? Alternatively, my hon. Friend may remember that some months ago a Mr. and Mrs. Maude chose not to sue, but put their money into a charitable fund, which was used to set up an online diagnostic service. My own constituent Mrs. Braganza also wanted to give money to a hospital despite the fact that it had made a mistake. We need to find a way of doing so that would alleviate both costs and time.

I thank my hon. Friend for his comment. He may be aware that I was a clinical negligence lawyer before coming to the House—[interruption] I therefore know a little about the matter. The chief medical officer is currently reviewing clinical negligence and will report to Ministers shortly. As with all the options, a no-fault compensation scheme is one of the many things that he is considering.

Does the Minister agree that prevention is better than cure, particularly in the national health service, and that in the past the role of community health councils has been extremely helpful in raising patients' concerns before legal action may have been necessary? Will he tell the House what measures the Government are taking to ensure the transfer of skills, knowledge and experience of staff and members of community health councils to the new structures for patient and public involvement in health?

The hon. Lady will be aware that we are setting up the Commission for Patient and Public Involvement in Health, which will cover patients forums in all our primary care trusts across the country. We set up patient advice and liaison services to liaise with our constituents in hospitals, and a measure to establish a new inspectorate is going through Parliament. We are in close dialogue with the chair and new chief executive of the commission and I hope that I can make announcements shortly about the interim arrangements.

Does my hon. Friend intend to make an assessment of the cost of needle stick injuries to the NHS? Will he consider introducing a directive to encourage hospitals to follow Barnsley district general hospital in having a needle stick injury strategy?

My hon. Friend raises a serious issue, which the Department keeps under review. Guidance has recently been issued, but he is right to raise what is an important issue in all our hospitals.

If he will make a statement on levels of funding for children's hospices. [82617]

Funding levels for children's hospices are determined through negotiation between hospices and primary care trusts. In addition, the new opportunities fund is considering applications from children's hospices to undertake a range of projects in support of children with life-threatening illnesses, for which funding starts next year.

I am grateful for the Minister's response. Despite the Government's rhetoric on palliative care, is it not true that only £4 million of the £50 million payout allocated by the Government has reached the hospice movement? Even more disgracefully, in many areas of England, is it not true that no moneys have been received whatsoever? If that is coupled with the employers' national insurance increase, which will impact on hospices from April next year, when will the Government get their act together and what will they do to expedite the payment of that well-deserved and much needed funding?

The hon. Gentleman's question was about children's hospices, but he has clearly asked questions relating to adult specialist palliative care. I am delighted to bring him up to date, as his information is a little out of date. He will know that the Secretary of State announced an extra £10 million of funding for this year, in addition to the £50 million of funding that will be going in next year. If he was in touch with his voluntary sector organisations, he would know that they are delighted to be working in partnership with us to make sure that we get a new funding mechanism.

I am sure that my hon. Friend knows of the reputation of Derian house in Chorley and the care that is provided there. However, children and young people go there from all over the north-west and beyond, and it is difficult to get primary care trusts from a wider area to contribute money. Finance is always a problem. What help and support can the Under-Secretary provide?

My hon. Friend is right. I am well aware of the excellent services of the hospice to which he referred. He is also right that because hospices provide services for children from a wide area, we need to get PCTs working together. New funding from the new opportunities fund can help to pump-prime new and innovative services, often for palliative care at home and in the community as well as in hospices.

The Government's

"overall contribution to children's hospices is unacceptably low…Certain hospices have had their funds eroded…There has been a steady regression of funding for Children's Hospices since 1997."

Not at all. The Government are absolutely committed to helping children with life-threatening illnesses. That does not simply mean hospice care, although that is an important component. We are also dramatically increasing the carer's grant, which helps disabled children. The Diana Community Children's Nursing Network operates throughout the country and provides community nurses to help children with a range of life-threatening conditions. The Government take such an important issue extremely seriously.

Is not it clear that there needs to be a step change in our approach to funding the hospice movement? The level of care and the specialisms that hospices provide nowadays mean that they can no longer rely solely on voluntary contributions. Can we please have a more planned and integrated approach that involves the NHS in the provision of hospice services?

My hon. Friend is right. We have embarked on exactly that course. Producing the National Institute for Clinical Excellence guidelines means that, at long last, we will have a proper service for palliative care. In the past, palliative care has been on the outside of the NHS. We aim to ensure that it is as much a part of the NHS as the rest of our treatment services.

What discussions he has had about funding for the Avon and Wiltshire Mental Health Care Trust. [82618]

At the request of my hon. Friend the Member for South Swindon (Ms Drown), I met representatives of Avon and Wiltshire mental health care trust, the strategic health authority and local Members of Parliament on 29 October. The meeting enabled us to discuss both the financial pressures that confront the mental health care trust and national and local work to tackle the financial position.

I attended that meeting, and it was deeply unsatisfactory. The mental health care trust and the other local PCTs are starting life with debt of £100 million that they inherited from previous organisations. They are trying to live within their means, but that will mean closures of beds at the Cameron mental health care ward in Chippenham, of the day care facility in Malmesbury and at Rowden Hill, and of the rehabilitation centre at Devizes. Does the Under-Secretary agree that there is precious little point in her paying out funds to the trust if they have to be paid back in debt repayment? Is not there a strong argument for considering a moratorium on debt repayment so that the trusts can start their lives sensibly?

Clearly, it is important that local health services live within their means. I know that much work is happening locally in the hon. Gentleman's constituency to ensure that we safeguard services.

Cuts.

The hon. Gentleman mentions cuts, but the mental health care trust received 12.8 per cent. more income in 2002–03 than in 2001–02. That is why it has been able to improve services, with six more crisis resolution teams, eight more assertive outreach teams, at least 12 more community gateway staff and at least 14 more staff to give carers breaks. It is a bit rich for the hon. Gentleman to argue for more money now; he did not vote for it when he had the opportunity to do so.

If he will make a statement on the incidence of hospital-acquired infections in the last 12 months. [82619]

Since April 2001, all acute NHS trusts have had to report methicillin resistant staphylococcus aureus blood stream infections. The first year's data show that rates tend to be higher in specialist trusts and in the south and east of the country. Early next year, surveillance will be extended to other micro-organisms and adverse incidents associated with infection.

Up to 5,000 lives are lost each year through hospital-acquired infections. Are not the Government being extraordinarily complacent about the matter? The figure is almost double the number of lives lost on the roads each year. Does not that show that all the spending announcements in the world do not add up to a row of beans if lives continue to be lost through inefficient procurement programmes of sterilisation and contamination equipment? They have been getting progressively slower. The Government should get a grip and act to improve matters.

I certainly agree with the hon. Gentleman that that is a serious problem. We should tackle it on three different levels. First, it is important that we start to monitor the rates of MRSA and other hospital-acquired infections; we are doing that for the first time this year. No previous Health Minister—Tory or Labour—has been able to tell the House what the rates of such infections are. That is our first port of call. Secondly, we need to get in additional resources to improve standards of cleanliness and hygiene in our hospitals. We are doing that: there will be £62 million for the clean hospital programme and a £200 million additional investment to improve sterilisation.

My right hon. Friend has rightly said that one of the keys to reducing MRSA infection is good hygiene on the wards. Does he not agree, therefore, that the disastrous privatisation of cleaning services under the previous Conservative Government seriously impeded efforts to tackle this problem? Will he tell the House how the agenda for change programme will facilitate involving cleaners and others in the ward team in raising the level of skills to remedy the problem?

I agree with my hon. Friend that the record of previous Conservative Administrations has not been anything to crow about. It ill behoves the hon. Member for Croydon, South (Richard Ottaway)—for whom I have a great deal of respect—to blame the Labour Government for problems relating to levels of cleanliness and hygiene. We have done more than previous Governments to tackle them, including—as my hon. Friend the Member for Warrington, North (Helen Jones) said—ending the disastrous experiment with compulsory competitive tendering, which had not improved levels of cleanliness in our hospitals. Agenda for change is a new pay modernisation framework for the NHS, which represents a significant step forward, particularly for low-paid workers, including cleaners. I hope that that will improve morale and retention among some of the most important workers in the national health service.

Those are complacent words from the Minister, nearly six years into a Labour Government. According to a new report from University college London, nearly 12 per cent. of patients suffer from what it calls "adverse events" within the NHS. That seems a long way from the Government's clean hospitals initiative. What actions is the Minister actually taking?

I welcome the hon. Gentleman to his new responsibilities. We look forward to further exchanges with him, although I hope that they will be of a better quality than the one that we have just heard. To be fair to him, however, I think that he is mixing up two issues. He is confusing adverse incidents—which include a much wider variety of potential harm that patients could experience in hospital, including operations that go wrong, and so on—with hospital-acquired infections. They are different issues. I tried to outline to the hon. Member for Croydon, South the three areas in which we are taking action to improve the problem of hospital-acquired infections. Because of the steps that we have taken, a Health Minister will, for the first time ever, be able to report to the House on whether we are making progress in tackling the problem. I agree with the hon. Gentleman that that is a first step forward, but it is not the only step that we are taking. I have outlined fully all the steps that we are taking to deal with this problem. It is a serious one, and we are determined to get on top of it.

Will my right hon. Friend give us a little more information about how he is collecting this data? Two years ago, when my father died from a hospital-acquired infection, I was surprised to discover that there was no mention of that fact on the death certificate. Why do we not record on death certificates the fact that a hospital-acquired infection has been involved? Are the other kinds of data that my right hon. Friend is collecting sufficient to enable us to get to grips with this issue?

I am truly sorry to hear of my hon. Friend's loss, as I am sure that all hon. Members will be. The details that are recorded on a death certificate are, as I am sure he is aware, a matter for the coroner to decide. I understand that a review of those procedures is currently under way, however, and perhaps that is the right place in which to consider that problem. In relation to the data that we are currently record, it is true that, this year, we have been collecting data only about MRSA. Next year, however, we will extend the data collection to include salmonella, for example, and glyco-peptide-resistant enterococci. That is part and parcel of our attempt to extend the data collection so that we can be in a position to deal with the important issues that my hon. Friend and others have raised.

I commend the Minister on the data collection; that is clearly the first step, and he is right to say that it has not been done before. He described the hospital cleanliness programme as a means of driving down hospital-acquired infection. Is he aware, however, that, of the 19 measures that went into that programme, part of only one of them deals with issues that might reduce hospital-acquired infection—that is, cross-infection as opposed to issues of cleanliness? A survey carried out by my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) and other colleagues showed that 60 per cent. of those who responded found that they had insufficient resources for infection control. Is not the Minister worried that some of the other targets that the Government are setting are taking resources away from infection control?

I do not think that that is a fair criticism. The hon. Gentleman, as I understand his position, is against pretty well any target of any kind for the NHS. He certainly knows how to spend more money, but he would be unable to account for any beneficial result of such expenditure. I agree, however, that it is clearly important to keep that whole area of work under review. I am not going to stand here for a second claiming that we have solved every problem—quite clearly, we have not. Removing such infections, particularly the avoidable ones, will be a long hard job. Remember, MRSA is resident in the community as a whole, and it is inevitable that it will come into hospitals as well. We have to focus on avoidable infection rates, which may be between 15 and 30 per cent. of the total, and working with the profession. The Chief Medical Officer is leading that work to find the right way forward, but concentrating on reducing waiting times in no way contradicts or gets in the way of reducing hospital-acquired infection rates.

If he will make a statement on further measures he proposes to combat smoking and tobacco use. [82620]

The measures that we have so far taken have helped over 200,000 smokers to quit. We will now make available extra resources to advertise the dangers of smoking and to extend help for people who want to give up.

Does the Secretary of State agree that the practise of smoking tobacco should be confined to consenting adults in private? Is it not time that he put pressure on his ministerial colleagues who are in charge of employment rights to protect, in particular, those people in the food and drink and entertainment industries, as well as others, who are obliged to endure and suffer the smoke of others? Will he ensure also that the Secretary of State for Trade and Industry and the Department for International Development are empowered to prevent British companies from trying to peddle that terrible drug among the poorest and most disadvantaged people in the world?

My hon. Friend makes an extremely important point. Clearly, smoking is the principal avoidable cause of death in our country—it kills about 120,000 people a year and is responsible for one death in five, so action across the piece is necessary to reduce it. He raises in particular the issue of workplace smoking, which is a genuine problem, although he will be aware that the Health and Safety Executive has been considering it, as have we. In the meantime, we have been trying to persuade employers, through our local tobacco control alliances, to take action locally. We want to encourage more of them, especially in the restaurant and pub business, either to make their environment smoke free or to at least make it clear to consumers and workers where smoking is allowed. Many employers want to take such action. I agree that there is a lot more to do, but we are beginning to make real inroads into a real problem.

Given that the Government's own figures show that more and more young people are smoking, will the Secretary of State explain why the Government yesterday tried to block new European Union measures that will ban cigarette company sponsorship of Formula 1 a year earlier than planned? It appears to many that they were trying to help their friends in Formula 1 at the expense of the public's health.

I begin by welcoming the hon. Gentleman to his new post.

He will be gone in two weeks.

I am getting some advice. Sometimes it is worth taking, the hon. Gentleman will find, although not from his own side. He started with a slight factual error, if I may say so, on the proportion of young people who are smoking. He may know that figures published today from the general household survey show that in 1996 about 13 per cent. of 11 to 15-year-olds were regular smokers. That had fallen to 10 per cent. by last year. Clearly, however, a lot more needs to be done to combat smoking, particularly among girls.

I welcome my right hon. Friend's commitment to a reduction in smoking, and his work in making nicotine replacement therapy available to all NHS patients. That was a wonderful move. May I remind him, however, that 400 pupils are still dying every day in this country from tobacco-related diseases? The industry therefore needs to recruit 400 more young people a day, particularly teenagers, to this dreadful habit. What can my right hon. Friend do, in addition to what he is already doing, to discourage people from taking it up in the first place?

My hon. Friend is right, and he speaks with some clinical experience and expertise. Four steps are necessary. First, we are now enacting the Tobacco Advertising and Promotion Bill. From next spring, all tobacco advertising on hoardings and in the media will be banned, because we know that it is the recruiting sergeant for young people in particular. Secondly, from next year there will be stronger health warnings on cigarette packets, and misleading doublespeak from the industry about certain products being "light" or "mild" will go. The strengthened health warnings will include warnings about the link between tobacco consumption and impotence. Thirdly, for the first time the Government will publish a list of the additives that go into every brand of cigarette, including everything from solvents to sweeteners. Fourthly and perhaps most important, in conjunction with the British Heart Foundation and the Cancer Research UK campaign, we will launch a £15 million advertising campaign pointing out the dangers of smoking.

I welcome that news, but the Secretary of State expressed concern about the European directive. What action have he and the Government taken to put pressure on the European Community to stop subsidising the growth in tobacco exports from Greece—and in our own exports, which are adding to the plight of the developing world?

The hon. Gentleman makes an extremely important point, which I should have made in response to my hon. Friend the Member for Dartford (Dr. Stoate).

When he next plans to meet the chief executive of the Food Standards Agency to discuss the Meat Hygiene Service. [82621]

Ministers have regular meetings with the chairman, deputy chair and chief executive of the Food Standards Agency to discuss issues of mutual interest, including the Meat Hygiene Service.

Is the Minister aware of the grave concern being expressed by vets throughout Scotland about the way in which the recent contract for official veterinary surgeons was awarded, and in particular about allegations that officials from the service pressurised vets by telephone into lowering their tenders? Is not such horse trading posing a real threat to both the quality of the service and the quality of meat for human consumption?

I am sure that the hon. Gentleman will agree that it is absolutely vital that the Meat Hygiene Service puts quality first and has due regard to public health. He will know that the procurement process has been carried out in accordance with the Government's rules through the clear drawing up of a specification, the inviting and evaluation of tenders, and the making of awards. I am informed that there are 13 contracts in the highlands and islands, eight of which have been retained by local vets. A deliberate attempt was made to ensure a variety of suppliers, and local vets were encouraged to take part in the tendering process.

The Minister will know that obesity in children has been a cause for concern in the past couple of years. I wonder whether she has discussed with the Food Standards Agency applying to food the same principle that has been applied to tobacco: labelling food that has all the wrong sugar content, so that parents can know how dangerous such foods are.

Order. That point has nothing to do with the question before us. I call Mr. Fabricant.

When does the Minister meet Ministers from other Departments to discuss the illegal importation of meat? Is she aware that, from time to time, meat that should be banned is being brought into this country and is entering the food chain? Is she further aware that in Australia, New Zealand and the United States, sniffer dogs are used to prevent such importation? When will she have discussions with Treasury and Home Office Ministers to ensure that ports of entry are tightly controlled to prevent such illegal meat importation?

The hon. Gentleman will be aware that Ministers are in constant contact with Ministers in other Departments and in other jurisdictions to ensure that the meat that enters this country is of a high quality. As I said to the hon. Member for Caithness, Sutherland and Easter Ross (John Thurso), public health concerns are obviously a key issue in all our considerations. The hon. Member for Lichfield (Michael Fabricant) will also know that we have had considerable success in discovering criminal gangs involved in the adulteration of meat in this country. They have been prosecuted by local authorities, and substantial penalties have been imposed on them. This Government take the issue of ensuring that our meat is of the highest quality, and that the supply chain has integrity, extremely seriously.

What assessment he has made of the Buteyko method of asthma management. [82622]

Following the Adjournment debate on the Buteyko technique in June, the chief medical officer asked his special projects officer to investigate the claims made for the technique. He found that the technique was helpful for some patients with asthma, but that more research was needed into it.

I thank my hon. Friend for that reply. Will she look carefully at the trial in Nottingham, which is being funded by the National Asthma Campaign, and at the trial at Glasgow university? The latter has shown that asthma patients who are taught to breathe correctly can achieve a 98 per cent. reduction in reliever medication, and a 92 per cent. reduction in preventive medication. Does she agree that that is an excellent way to save on the NHS drugs bill?

I understand that the chief executive of the National Asthma Campaign wrote to the chief medical officer in September, giving some of the preliminary results of the Nottingham inquiry to which my hon. Friend refers. The trial in Scotland, which is being undertaken by Jill McGowan, is still in progress and will not be finished until April 2003. At that stage, conclusions can be formally evaluated using peer review. I agree with my hon. Friend that, given the success that we have already achieved in reducing the incidence of asthma, we must continue to ensure that, where well-researched and successful interventions exist, they are available to patients on the NHS. What is important is that we do the research necessary to show that this method would be as clinically effective as the drug treatments that are proving effective at the moment.

Surely the Minister must recognise that sufficient evidence has been provided in this regard by the 1995 Brisbane trial alone. That trial showed that broncodilator use declined by more than 90 per cent., and that steroid use decreased by 49 per cent., through the Buteyko breathing technique. She has referred to other treatments that might be considered in the health service, but is she aware that some 12 complementary therapies—such as yoga, nutritional medicine and the Alexander technique, which deals with posture—could be inexpensively deployed? When will the Government take seriously such treatments, which are very effective, instead of just paying lip service to them?

I am the lucky Minister who has to answer the hon. Gentleman's question on complementary medicines today. Obviously, approaches and techniques that give asthma patients lasting relief and greater control of their lives are to be welcomed. That includes the use of complementary therapies, which primary care trusts can commission if they consider them to be effective, in clinical and cost terms, for a particular health need. However, although techniques such as the Buteyko method and others to which the hon. Gentleman referred may have significant benefit, there is no robust scientific evidence that any complementary therapy on its own can provide a lasting cure for asthma. It would therefore be wrong to build up patients' hopes that their asthma could be cured without resort to an existing drug therapy. However, as I made clear to my hon. Friend the Member for Cambridge (Mrs. Campbell), the chief medical officer and the Medical Research Council have accepted that more research is needed. Having been an asthma sufferer for some years myself, and I hope that that research will be undertaken.

Should not we consider asthma in the context of chronic obstructive pulmonary diseases? Is my hon. Friend aware of the COPD patient manifesto, launched on world COPD day in November? Will she join me in congratulating the British Lung Foundation, and local Breathe Easy groups such as the one in my constituency, on their work in raising awareness of these ailments, and in providing support for sufferers? Will her Department make a formal response to the COPD patient manifesto?

My hon. Friend makes an important point about the role of professional, voluntary and patient organisations in raising awareness of conditions, and of some of the effective techniques that patients understand can be used in treatments. I am sure that my hon. Friend will be aware of the Department's expert patient programme. By means of a series of pilot schemes, it is looking for ways to ensure that professionals and patients can work together more effectively to enable patients to manage their conditions. I shall certainly look at the patient manifesto to which my hon. Friend has referred with close interest.

If he will make a statement on funding for Eastbourne district general hospital in 2002–03. [82624]

Eastbourne district general hospital is now part of the new East Sussex hospitals NHS trust. The total income for the trust this year is £178 million, an 8.5 per cent. increase in funding for its component sites over 2001–02. In the course of this year, the trust received an additional £440,000 to support additional activity.

Is the Minister aware that that answer is a disgrace? Has he not seen my letter to the Secretary of State of 21 November, in which I raised the specific issue about which I want to hear—the trust's current deficit of £5 million? Where will that money come from? Will it come from the primary care trust, central Government, or from cuts in services in my local hospital?

I am sorry to have offended the hon. Gentleman. I was going to thank him for writing to my right hon. Friend the Secretary of State and giving us an indication of what his supplementary question would be. I have no intention of avoiding the question that the hon. Gentleman has raised. He will be aware that the NHS in East Sussex received an additional £60 million in total for this year, an increase of more than 10 per cent. in cash terms. It is incumbent on me to point out that the hon. Gentleman voted against the NHS receiving those additional resources. However, I know that he rightly takes an interest in the NHS in his constituency, so I am sure that he will know that the trust board met last Wednesday to discuss how to resolve the matters to which he has referred. The board has developed an action plan to deal with precisely the point that the hon. Gentleman has raised. If he is not aware of the decisions taken last week by the trust board, I will ensure that he receives a full copy of its report.

What recent assessment he has made of the health of prisoners. [82625]

Since 2000, all prison service establishments and their NHS partners are expected to complete prison health needs assessments and prison health action plans. These identify, on a regular basis, the services required to meet prisoners' health needs.

In a series of written answers, Home Office Ministers have shown themselves to have a lamentably low grip on the mental health of people in our penal institutions. I welcome Health Ministers' assumption of some of that role from April this year. What plans do they have for improving the mental health of people in prisons, particularly for increasing the rate of prescription of atypical antipsychotics? Can they assure the House that there will be the necessary transfer of funds from the Home Office to the NHS?

The use of antipsychotic drugs is being considered by the National Institute for Clinical Excellence. However, our mental health strategy, published in December, makes it clear that all prisons and their NHS partners should review annually their mental health needs and develop action plans to deal with them. At the same time, the NHS has funded mental health inreach teams; the number will rise from the current 22 to 70 by April 2004. Of course, that takes money and investment, and I wish that the hon. Gentleman's party would match our investment in that regard.

We heard on "Newsnight" last night from Mr. Hellawell's assistant, Mike Trace, that the £50 million allocated to the prison service for drug treatment is not getting through. Will my hon. Friend carry out an audit and ensure that that money gets through?

It is getting through. Some 25,000 initial assessments have been undertaken and there are 60 intensive drug treatment programmes, plus additional funds, announced this morning in the drugs strategy.

The Minister should be aware that in the first six months of this year, the prison suicide rate increased by an alarming 40 per cent. Figures show that 70 per cent. of prisoners may be suffering from some form of personality disorder, yet the medical inspector of the inspectorate of prisons, John Reed, called care for mentally disordered offenders in prison a disgrace. Does the Minister agree that a prison spell should be an opportunity to administer proper treatment for mental illness, not to make it worse? When the ill-fated mental health Bill re-emerges, will he make sure that it focuses on providing appropriate and early mental health treatment and care for prisoners and other citizens alike, rather than banging up yet more people, adding to the thousands with mental health problems banged up already?

I will not seek to make a party political point on such a serious issue. The prison service is part way through a three-year programme of work designed to reduce the incidence of suicide and self-harm among our prisoners. Close watch is paid to the mental health of young offenders at Feltham and other institutions, and extra provision made to prevent suicide.

As part of its health improvement programme, Woodhill prison in my constituency has agreed an ambitious series of targets with our local primary care trust. Will the Minister clarify where the funding is coming from to make sure that those targets are met? Is it from the prison service or the PCT?

Since 2000, there has been a close partnership between the NHS and the prison service. That means that by 2005–06, the NHS and the Department of Health will have increased funding by £46 million across the country, which will benefit my hon. Friend's local primary care trust.

If he will make a statement on access to primary care for disabled people. [82626]

We are committed to delivering primary care services that offer prompt and convenient access to all, including disabled people. The NHS plan sets a primary care access target that by 2004 all patients will be able to see a primary care professional within 24 hours and a general practitioner within 48 hours.

But does the hon. Lady accept that in some parts of the country, including mine, it is difficult to get on a GP's list? It is even harder to do so for disabled people and it is exceptionally hard for people with a history of mental illness or with learning difficulties. What specific action does she plan to take to ensure that those very vulnerable people obtain the services they need and to which they are entitled?

The hon. Gentleman makes an important point, especially about people with learning disabilities. If they have been in institutional care, or are still in such care, they are often not on GPs' lists. That is why the White Paper, "Valuing People: A New Strategy for Learning Disability for the 21st Century", made it clear that people with learning disabilities needed the same access to GPs and to primary care as everybody else. That is why, by summer 2003, we expect the local partnership boards to have put in place health facilitators, to help people with learning disabilities to access health services. That is why we have already issued for primary health care teams good practice guidance on meeting the needs of people with learning disabilities. In various parts of the country, there are already good and innovative training schemes, whereby staff and GPs in primary care receive training about and are made aware of the particular needs of people with learning disabilities.

Is it not true that, more than anything, disabled people want to remain independent in their own home? Will my hon. Friend consider how the primary care sector of the health service can work with local authorities to bring down—almost to nothing—waiting times for people who want to adapt their homes or to put in bathroom conversions for level access showers to enable them to remain independent?

My hon. Friend makes an important point about the role of adaptations and equipment in enabling disabled people to remain independent. Some of those issues are the responsibility of the Office of the Deputy Prime Minister. I have discussed the matter with ministerial colleagues there, and the Department of Health has made a contribution to the home improvement agencies in order to ensure that those types of adaptation are in place, especially for people who leave hospital. As my right hon. Friend the Secretary of State announced during the summer, we are also extending by 500,000 the number of pieces of community equipment available and that will benefit another 200,000 people over the next three years. Furthermore, I am sure that my hon. Friend is aware that the Community Care (Delayed Discharges etc.) Bill, if passed by the House, will also ensure that such community equipment is provided free to everybody who needs it.

If he will make a statement on the financial and legal relationship between the Department of Health and foundation hospital trusts. [82627]

NHS foundation trusts will be part of the national health service but they will be owned and controlled by the local community, not by the Department of Health. This modern form of local public ownership will be spelled out in detail in a guide to NHS foundation trusts that I hope to publish before too long.

Although we shall welcome that guidance note, the Secretary of State needs to be aware that many of my constituents are confused by the conflicting statements from Ministers on the issue. Will he provide a definitive answer today on financial matters in foundation hospitals—for example, borrowing—and explain to the House who will have the final say? Will it be his Department, the Treasury or the regulator, or will it be locally elected governors?

The hon. Gentleman will have to wait for the guide—[Horn. MEMBERS: "Why?"] The hon. Gentleman would like a guide so I will give him a guide and a hint. He asked about local governance. As I told the House during the debate on the Queen's Speech, the membership of those organisations will be drawn from people in the local community served by the local hospital. Those members will be able to elect governors who will oversee the work of the hospital board. As a consequence, for the first time there will be a genuine form of local public ownership that will put the public at the heart of our key public service. It certainly will not be national state ownership. It will be a genuine form of local ownership.

Although the proposals are relatively controversial, as I am sure that the Minister would agree, does he accept that the cooperative and mutual role could play a really positive part in delivering those hospitals, if they go ahead?

My hon. Friend has made an extremely important point. Certainly for those on the Labour Benches—perhaps not those on the Conservative Benches—there is a well-established tradition of cooperation and mutualism, which is at the heart of the founding of our party and the wider Labour movement. In terms of their governance, those organisations will be firmly grounded in those traditions. They will be owned and run by members of the local community. Therefore, for the first time since 1948, there will be clear national standards and NHS hospitals, serving NHS patients, according to NHS principles. They will provide care, according to NHS standards and inspected by an NHS inspectorate, that is free and which is offered on the basis of need, not the ability to pay. The difference is that members of the local community served by the local hospital will have some say over the decisions that are taken by that local hospital. That is not a form of privatisation, which the Conservative party advocates; it is a genuine form of local public ownership.

On 7 August, the Secretary of State said:

"For some on the Centre Left the idea of transforming the public sector monopoly is heresy…In health, this means primary care trusts having control over budgets with explicit freedom to purchase care from the most appropriate provider—public, private or voluntary…And existing NHS hospitals should be able to become NHS foundation hospitals".

"there will be problems in health if you try to introduce market forces. There is no way markets work in health care. If they did, you would have this extreme power of the producer over the consumer."

It is the hon. Gentleman who is fixated on market forces. Indeed, I think that one year he managed tell his party conference that, as an unreconstructed Thatcherite, he was wedded to the market inside the national health service. As I have explained to the hon. Gentleman, foundation hospitals have nothing to do with market forces, still less to do with privatisation. It is about public ownership. It is about ensuring that the local public, who are served by the local hospital, are at the heart of the governance of that local hospital: so no longer will the hospital be owned by Secretaries of State of whatever political persuasion. It will be owned and controlled by the local community.

Instead of treating us to philosophical gobbledegook, the Secretary of State would be more honest if he said that his view was right and that the Chancellor—the psychologically flawed, downgraded Chancellor—was wrong. But since he cannot answer the ideological questions, perhaps he can answer a practical one. He has told the House that three-star hospitals alone will become foundation hospitals. What happens if a three-star trust becomes a two-star trust during the transition period? Will the process be stopped? And once a hospital has become a foundation hospital, what then? Will it still be subject to the star rating or, once it reaches foundation status, will that no longer apply?

As for the rating, yes, NHS foundation trusts will be subject to the star rating system, just as every other part of the national health service will be, whether it is a primary care trust or other NHS trust. As for what would happen in the event of a three-star NHS foundation trust losing its three-star status, when the hon. Gentleman reads the guide he will see that the independent regulator whom we will appoint will have various intervention powers to deal with precisely those circumstances.

Order.

If clinical outcomes and the quality of care in a foundation hospital decline markedly, will the guidance that the Secretary of State is issuing to the regulator include the possibility of the hospital losing its foundation status?

Yes.

If he will make a statement on the amount spent on agency and bank nurses over the Christmas period 2001. [82628]

Data on the amount spent on agency nurses are collected annually. In 2000–01, £435 million was spent on non-NHS nursing, midwifery and health visiting temporary staff. Information on the amount spent on bank nurses is not held centrally.

I thank the Minister for that reply. May I draw his attention to the fact that the Norfolk and Norwich hospital spent £1.1 million on agency nurses last year—nearly double the amount spent in the previous year and five times the amount spent in 1996–97? The cost of agency nurses appears to be spiralling out of control in Norwich and nationally and NHS Professionals appears not to be working as intended. Does that not demonstrate a failure of work force planning in the past five years? What steps are the Government taking to address that massive cost to the NHS to ensure that the extra money going into the NHS is spent in the most effective way?

I agree that spending on commercial agency nurses is far too high, and we need to take action to reduce it. We shall do so, first, by establishing NHS Professionals, on which we are making progress. For example, nearly 2,000 additional staff have been recruited to NHS Professionals in London in recent months. It is making progress, but we need to do more. Equally important, one of the principal ways that we will reduce costs, if that is the hon. Gentleman's concern—it is mine—is by extending nationally the terms of the London agency project, which is working well in London, to reduce the number of commercial agencies that we use and the amount that we pay them for those services. We will be able to extend the London agency project nationwide in the spring of next year, which will help significantly in reducing the costs.

One of the reasons why many nurses choose to work through agencies is that they can thereby obtain more flexible work patterns that reflect modern lifestyles and family demands. What is the Minister doing to encourage hospitals to offer that to directly employed nurses, so that the cost of agency nurses does not spiral even further out of control?

My hon. Friend makes a very good point. I draw his attention to the fact that we are investing significant amounts of additional money in improving precisely the conditions of service that he mentions, especially child care and flexible working. The new agenda for change proposals will make a significant difference to the flexibility of employment in the NHS and, I hope, help to provide, at least in part, the solution that he and I are looking for.

Whether general practitioner vacancies have gone up since 2001; and if he will make a statement. [82629]

The NHS recruitment, retention and vacancy survey shows that there has been an increase in the estimated three-month vacancy rate for GPs from 1.7 per cent. on 31 March 2001 to 2.7 per cent. on 28 February 2002. The higher number of all GPs working in the NHS, excluding GP trainers, has increased by 1,469, or 5 per cent., since 1997.

Will the Minister explain why the Secretary of State announced the golden hello scheme twice in March 2001, yet failed to provide any guidelines, including the start date—1 April 2001—until November 2001?

We announced that we had reached agreement on the scheme and, in November, we announced and confirmed its details, but the payments were backdated to April, so no GP lost out. I am sure that the hon. Lady will be pleased to note that, last week, I confirmed that the golden hello payment has been increased to £12,000.

If he will make a statement on progress towards meeting his targets on cancer care. [82630]

Thanks to the hard work of those working in the NHS, we are already making real progress in implementing the NHS cancer plan. Patients are benefiting from improvements across all aspects of cancer care, and cancer mortality rates are falling.

Does my hon. Friend agree that specialist oncology trusts have a key part to play in maintaining standards in cancer care? Does she also agree that any review of trusts needs to be driven by patient interests rather than by pre-judgment on an organisational or numerical basis?

Specialist trusts remain an essential part of the cancer care system. I am delighted to confirm that at the Clatterbridge centre for oncology in my hon. Friend's area, a new CT scanner, three linear accelerators, a radiotherapy treatment planning system and an MRI scanner have already been delivered. I am also delighted to confirm that the patient's interest will be uppermost in our minds in relation to the whole of the cancer care system and the design of any new cancer care services for my hon. Friend's community.