What recent representations he has received from NHS trusts about the Government's plan for foundation hospitals; and if he will make a statement. [129948]

My ministerial colleagues and I have had a number of discussions with the chairs and chief executives of NHS trusts, and this dialogue will continue.

I thank the Secretary of State for that answer. If foundation status is really about giving hospitals greater freedom, will he look again at the strict rule under which no hospital can increase its income from private patients? Is he aware that Nuffield Orthopaedic hospital in Oxford, where NHS patients will always come first, has used private income to subsidise the NHS and help to pay for investment? It wants to continue to do so, but the base year is very restrictive. Will the Secretary of State ensure that foundation status will not make things worse in that regard?

I know that the hon. Gentleman takes a deep interest in health care and the health service. He will understand that we are trying to achieve a balance between the power that we decentralise and the maintenance of a balanced benefit for all the people of this country through the national health service. The cap that has been put on the proportion of patients who can be treated privately in the new foundation hospitals is intentionally set to be fair to the vast majority who rely on the NHS. It will be fixed as a percentage of the income derived from private patient activity that applied to each NHS foundation trust in the financial year ending April 2003. That will ensure that the cap applies fairly to all trusts, irrespective of when they make the transition to NHS foundation trust status.

What representations has the Secretary of State received about the Government's proposals, which I think are very opaque? Will people be able to vote if they have paid £1, or if they have pledged to pay £1? What estimates have NHS trusts made about the likely turn-out in the elections?

Discussions are under way in this House and in another place about the exact details, but let me make it clear that it is a good thing that we should reduce the amount of diktats from the centre and pass more control to people in local areas. If we are truly going to have a national health service capable of meeting the differentiated needs, ambitions and expectations of 60 million of our fellow citizens today, we shall have to decentralise. I commend to my hon. Friend the authority on these matters who said that he was deeply conscious that one of the great dangers of a Government health service was over-centralisation, and that the wider the decentralisation that could be achieved, the better it would be for everyone. That authority was, of course, the founder of the national health service, Nye Bevan, speaking in 1946.

Does the Secretary of State intend to ensure that the regulator gives precise instructions about the cap? Clause 15 of the Health and Social Care (Community Health and Standards) Bill, which is currently going through the other place, has confused people with regard to the capping of private health care. As it stands, the clause does not insist that the regulator should cap private health care.

I think that this issue is pretty clear to everyone, whatever opinion they may hold, except the Liberal Democrats. If the hon. Lady can show me anyone outside the Liberal Democrats who is confused about it, I will certainly consider their case. This is, however, a refreshing change for me. Having listened all week to objections from the trade unions, the producers organised, it is nice to hear the comments of the Lib Dems—the producers disorganized.

What steps he is taking to increase support available for older people to stay in their own homes. [129949]

Our published priorities set attainable but challenging targets for health and social care bodies to increase the support available for older people living in their own homes. We are supporting that with an average 6 per cent. annual increase in real terms in resources for personal social services between 2003 and 2006.

What steps could the Government take for people suffering from dementia and other long-term illnesses who are occupying hospital beds to help them to move back into their own homes rather than into a nursing home, if that is what they wish? There is definitely a demand from elderly people to stay in their own homes for as long as possible.

I entirely agree with my hon. Friend. We are getting the message loud and clear from older people that they want to have the choice of staying in their own homes. When people are awaiting discharge, a package of care should be put together that is based on their choices and their needs. The delayed discharge grants that we have made available are for improving services in a person's home. Discharge into their home should be every bit as real a choice as discharge into a nursing home.

Sir Nigel Crisp recently acknowledged before the Public Accounts Committee that planning for the discharge of older patients from NHS acute hospitals, which is related to the support available for older people in their own homes, is now worse than it was four years ago. Why is that?

If Sir Nigel Crisp said that, he is wrong. Delayed discharge grants have given resources to local councils and local health authorities to put in place a mechanism by which delayed discharges can be eradicated from our hospital system. Any local council that has been doing a reasonable job of planning for this eventuality will make a profit from the delayed discharge grants, because it will receive more in grant than it is having to pay in fines.

I welcome what my hon. Friend has said about extra resources for this purpose. In the past, people's perception has all too often been that they have been forced to remain in their own homes. Will he assure us that people will have real choice, and that it will be based on sound assessments of their needs?

I can give my hon. Friend that assurance. He is right that in the past it was assumed that people would go into nursing homes or residential care. We are getting away from that. It is sad that the Liberal Democrats and the Conservatives are devising policies to return to a system whereby people are forced into nursing homes instead of being given the choice of care in their own homes.

Why will domiciliary care workers in this sector from 1 October face an increase since July of 142 per cent. in the fees they have to pay for their Criminal Records Bureau check?

They will have to pay an increase because we intend to ensure that those who care for old and vulnerable people are of suitable character and reputation. Surely that is something with which the Conservative party would agree. We intend the CRB checks on care workers to be self-funding, but the employers will pay the bills for them.

I noted the reply that the Minister gave my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) on support for people in their own homes. Will he comment on the divide between medical and social care? Strategic regional health authorities have set up a matrix to guide people, because that division causes problems and has an impact on the care of people in their own homes and in nursing homes.

I think that the issue to which my hon. Friend refers—if I am wrong I would welcome a meeting with him afterwards—is the dispute that arose because the ombudsman discovered that certain people were not being properly assessed for NHS continuing care. The Government have acknowledged that there were some failures in some areas. Different criteria were being used and were not being properly applied. We have instructed all the strategic health authorities to come up with consistent criteria, and to review the cases of those who may not have been properly assessed for continuing care. Those people will be fully compensated for any financial losses that they incurred as a result of any decision.

If he will take steps to increase funding for the provision of long-term care. [129950]

The Government are committed to providing the investment that is needed to secure real improvements in long-term care. We are determined to see that older people get the support that they need to lead life with respect and dignity. We have announced an overall real-terms increase of £1 billion for older people's social services by 2006.

Does the Minister not accept that capacity across all sectors is approximately 74,000 places lower than it was at the peak of provision in 1996, and that in the 15 months leading up to April this year 13,400 elderly persons' places have been lost in residential homes—primarily independent and private homes? While the new minimum standards have clearly made a contribution to that by placing substantial burdens on small homes, the Minister must surely admit that underfunding is part of the problem. Will he please direct further attention to the situation, and try to ensure that the places that are required are provided?

I can give the hon. Gentleman an absolute assurance that we will look at the issues carefully; but the market contains 10,000 more care home places than there are people waiting for them, according to Laing and Buisson's figures.

Aston Hall hospital in my constituency provides long-term care for people with learning disabilities. I have corresponded with my hon. Friend about delays in its reprovisioning programme. Will he ask his officials to turn their minds again to the need for urgent solutions and assistance for a reprovisioning process that, although tortuously and complexly designed, has won the support of all concerned?

I will certainly undertake to look again at the details of that case. Support for learning-disabled people is one of my highest priorities in my new portfolio, and I intend to ensure that the substantial extra resources made available by the Government for their care will indeed go to them.

Does the Minister think it right for Birmingham city council to pay twice as much for places in its own residential homes as it pays for places in the private sector? Is that not a massive abuse of the taxpayer, as well as an abuse of the hard-working small business people employed in that sector?

We trust local authorities to make decisions about their areas. It is they who are in a position to assess the needs of their local care home markets, and they will pay the price set by those markets for the services that they require. They will tender for places, the marketplace will offer a price, and they will deal at that price. Why should they be expected to pay more than the market is asking them to pay?

Will my hon. Friend ensure that any increased funding that finds its way into private care homes leads to extra controls and regulations governing the standards operating in those homes? Is he happy that we are currently receiving value for money?

If my hon. Friend can give specific examples of our not receiving value for money, I shall be pleased if he brings them to me and I shall take them up with him. I am happy that in general we are receiving value for money. I think that the new standards we have set are a vital resource, ensuring that we drive up the quality of care for older people and for anyone who must live in a care home or nursing home. They are, I believe, an essential tool in the Government's armoury, enabling us to improve services for everyone everywhere.

What the latest estimate is of the costs of the Paddington Health Campus. [129951]

£800 million.

The Minister will be aware that three years ago the estimated cost was £360 million. Three years later, when we have still not even seen outlined planning permission, why have the costs spiralled out of control?

Costs have risen because the new development at Paddington Health Campus will be bigger than the one originally proposed in 2000, so that we can provide more treatment for NHS patients in London—including in the hon. Gentleman's own constituency—better facilities and expanded research facilities. Most people in London will surely regard an £800 million investment in the NHS as good news.

Does the Minister realise that this is the most grotesque waste of public money, inasmuch as facilities of outstanding excellence exist at Harefield hospital, which the local community continues to support? As my hon. Friend the Member for South-West Hertfordshire (Mr. Page) knows, only yesterday the Moor Park Lions gave £37,000 of their own money to the Heart Science Foundation. It would cost only £18 million fully to modernise Harefield hospital; is that not what the people want and deserve?

I genuinely understand the concern of the hon. Gentleman and of the hon. Member for South-West Hertfordshire (Mr. Page) about Harefield hospital; indeed, all hon. Members will have some sympathy with the points made. However, the Government have to decide what is best for the NHS across the capital as a whole, and I have absolutely no doubt whatsoever that the investment in the Paddington Health Campus will produce for the NHS in London some of the best facilities to be found anywhere in the world. That is money well spent.

If he will make a statement on the development of ambulatory care units in the NHS. [129952]

The prevention of preventable pain for patients will always be this Government's top priority. That is why the national health service is developing a large number of new treatment centres, which will enable more patients to receive more operations more quickly. Some will be run by NHS providers and others by independent sector providers under contract with the NHS, but all will contribute to the relief of preventable pain.

I am grateful to the Secretary of State for that answer. In developing his plans for England, will he look at the example of the ambulatory care centre in the University hospital of Wales, in Cardiff, which is providing excellent, state-of-the-art treatment for patients very quickly? That is an example of the treatment that all of us would like to see from a world-class national health service. If the centres that he is developing in England are of the same standard as the one serving my Cardiff constituents, I am sure that hon. Members throughout the House will welcome this development.

I am grateful for those comments. What my hon. Friend says is true, and I have seen with my own eyes the results that treatment centres can produce. A centre in Bradford—it is part of the NHS; it is not in the independent sector—has reduced the waiting time for minor operations from about 12 months to six weeks. If we consider the vast reduction in the time that 22,000 patients in the Thames valley needing cataract operations will have to wait in pain, we can see the real benefits.

Will the Secretary of State explain the dual tariff, whereby the NHS pays more for operations and procedures in privately run treatment centres than in NHS treatment centres?

If such an unfair tariff existed, I would explain it; it does not, but I shall explain the mechanism, which has perhaps confused the hon. Gentleman. The tariff that will be paid to treatment centres, whether they are NHS treatment centres or centres in the independent sector, will be exactly the same as that paid by primary care trusts to normal, traditional hospitals inside the NHS. It is true that in the case of NHS establishments, we also pay other costs, including building costs; but we will pay the independent sector an additional premium from the centre, in order that it can set up quickly, acquire staff and maintain the buildings.

What plans the Department has to extend the private sector's role in the provision of NHS services in the coming year. [129953]

We will use independent providers where it represents good value for money, increases NHS capacity and reduces the amount of time that NHS patients would otherwise have to wait for their treatment. In line with our manifesto commitments, my right hon. Friend the Secretary of State announced last week the preferred providers who will operate 26 new treatment centres for NHS patients, some of which will begin to operate later this year.

The national health service has entered into a contract with the American company, UnitedHealthcare, to pilot its Evercare system of care for the elderly in 10 pilot areas. Now that the pilots have been up and running for a while, will my right hon. Friend tell the House whether the Americans are achieving the substantial growth that they forecast in the annual report, and whether the NHS is achieving the 50 per cent. reductions and consequent savings in the pilot areas?

I am afraid that I do not have that information to give to my right hon. Friend, but I shall certainly arrange to send it to him. On the Evercare arrangements, the American company is providing primary care trusts with a consultancy—a service and systems redesign service—to allow NHS staff to improve the care that they provide to NHS patients. It is a sensible and useful arrangement that has been entered into at a local level. All the research data in the US show the success of the Evercare model and I am confident that it will have a similar effect in England.

The Minister said that good value for money was a necessary factor for private sector operations, so does he accept that the cost per case at the Oxford eye hospital is less than £400 per cataract, whereas purchasers who want to buy services for patients at the best possible value are being forced to pay more than £750 per case under the private sector scheme, not counting the market forces premium? Why did the Secretary of State say that 20,000 people in the Thames valley were waiting for cataract operations when the Department's own website says that it is only 6,000? Is it not the case that only the dodgy figures make the position anything like value for money, and is not the proposal ideological rather than one that gives quality, value-for-money care for patients?

No. I have had many questions from the hon. Gentleman, but I have yet to hear him put one sensible question to any Minister in the Department of Health. He is in the unique position of agreeing with everything in principle, but opposing everything in practice. Labour Members have one simple word to characterise that—opportunism.

Will the Government undertake a review of the concordat with the private sector and examine the extent to which NHS consultants who have private practices are seeing NHS patients in those practices and are being paid substantial amounts to do so? Some of my constituents have raised concerns about how they have had to wait to see an NHS consultant. They find it bizarre then to see them in private hospitals and private clinics paid for by the NHS, especially when many of the NHS waiting list problems arise as a direct consequence of consultants' private practice.

We keep all those systems and arrangements under careful and close review. It might also be of some help to hon. Members, especially my hon. Friends, if I draw their attention to the new arrangements that I hope will apply in the new consultants contract, should consultants agree it, which would try to provide a better way to regulate the relationship between private and NHS practice. That is an important development that the NHS should seek to bring to a closure.

In a debate just before the recess, the Chancellor positively frothed at the mouth at the thought of moving patients into the private sector and he brandished a price list that claimed that operations by independent sector providers typically cost twice as much as in the NHS. If so, why have the Minister and the Chancellor already signed a concordat for 100,000 operations with private providers such as BUPA this year? Why are they now accelerating that process by signing up mostly foreign providers to perform an additional 250,000 operations in the new diagnostic and treatment centres? Or were the Chancellor's figures completely misleading? Will the Minister now publish the real comparable cost of all operations in the NHS, those purchased by the NHS from the independent sector in DTCs, and those performed on those NHS escapees sent to hospitals on the continent?

The hon. Gentleman has moved from using the language of total politics last week to talking complete rubbish this week. The treatment centre programme will introduce significant additional capacity into the NHS at good value for money prices—[Interruption.] The hon. Gentleman does not want to listen, and for good reason, because I will put him right on those matters. The big difference that he should recognise—the Opposition like to think of themselves as people of business—is that the NHS obtains a better price for the operations if they are bought in bulk, instead of being purchased on the spot market. The prices will be significantly lower. The final prices have still to be agreed, but my right hon. Friend and I are of the one view that this approach represents a sensible direction for the NHS that will provide value for money for NHS patients.

What plans he has to introduce private health insurance for non-emergency health care; and if he will make a statement. [129954]

I have no plans to introduce private health insurance for non-emergency health care as it would be inefficient and unfair, and would prolong pain for many people who could not afford it. The Government stand by the founding principle of the national health service of providing equal access to health care, free at the point of need.

I am glad that my right hon. Friend has put it on the record that the Government have no plans to introduce such a grossly unfair system into our NHS, or to introduce any barmy ideas such as the patient passport, which would destroy the NHS. Apart from being philosophically flawed, are not such plans financially flawed, because they would put an extra burden on the taxpayer to the tune of millions of pounds?

Indeed, my hon. Friend is right. Those plans would divert up to £2 billion from the NHS to subsidise those who, in many cases, are already paying for private health care. The difference between what we are doing by using the spare capacity of the private sector to supplement the big increases in capacity in the NHS, and what the Opposition would do, is that we are buying in bulk at a price that is near, at or below the NHS tariff and we are providing the service free to everyone. The Opposition would create a position—[Interruption.] Let us ask the hon. Member for Woodspring (Dr. Fox). Why should old-age pensioners have to pay £5,300 for a hip operation, which is what they would have to pay if the patient passport were introduced? Perhaps he could tell us why someone should have to pay £6,700—

Order. Perhaps the hon. Gentleman could tell us another time.

Does the Secretary of State now regret scrapping, in 1997, the tax rebate on private insurance—taken out voluntarily in many cases—for those over 65, and thus placing a huge burden on the NHS and adding to the increase in waiting lists when the Government came to power?

No, I do not. I have cited previously the US example, where 40 per cent. of all personal bankruptcies are related to the inability to pay medical costs. That reinforces my point. I repeat: this Government will not charge up to £1,700 for a cataract operation, or £9,000 for a heart bypass. People in this country should have their health care provided free at the point of need. This Government will provide that.

What his strategy is for recruiting professionals in the NHS. [129955]

The Government are implementing a range of measures to recruit more health care professionals. They include improving pay and conditions, encouraging the NHS to become a better, more flexible and more diverse employer, increasing training, investing in child care, and attracting back returners.

May I direct the Minister's attention to the serious shortage of midwives in the NHS? Will she confirm that today there are 5,000 fewer midwives than there were 10 years ago? That has led the prestigious Royal College of Midwives to say, with typical professional restraint, that that is putting mothers at unnecessary risk. Will she describe the Government's strategy for overcoming this undoubted crisis?

Our target is to take on an extra 5,000 midwives, and I am sure that the hon. Gentleman will be pleased to learn that so far we have taken on an additional 3,000 towards that target.

Will my hon. Friend support the work being done by the Liverpool School of Tropical Medicine, which is training medically qualified refugees and asylum seekers to enable them to work in our health service?

I am grateful to my hon. Friend for the information about that training programme. It is important to get new input into the NHS from people from diverse backgrounds. They will bring new ideas into the NHS, and some of them will be able to return to their own countries and take some of our best practice back with them. We welcome a diverse work force, and we are working to encourage that. I congratulate Liverpool on the scheme being run there.

In an earlier answer, the Secretary of State said that consultants do not want the Government's diagnostic and treatment centres because they will reduce their private practice income. Does the Minister really believe that that is consultants' main objection to the scheme? Is such rhetoric likely to help or hinder acceptance of the consultant contract, which is so crucial to the Government's delivery of their health plans?

My right hon. Friend did not say that. He made a comment about some consultants, and the hon. Gentleman is seriously distorting that remark. The hon. Gentleman does not mention patients in this matter. We believe that we need to nurture staff in the NHS, but most of all we need to ensure that the service provides the best treatment for patients, free at the point of need. The needs, pain and conditions of those patients are our first and foremost concerns. We are meeting that target. I appreciate that the hon. Gentleman may have difficulty with that, as neither he nor his party supported the investment that makes many of those developments possible.

One difference is that I have worked in the NHS and treated NHS patients. That is a lot more than any member of the Government Front Bench has done. The Government's attempt to characterise the medical profession in the way that they do is deeply disturbing. They lack understanding of the motivation of many staff. For example, I draw the Minister's attention to the proposed ophthalmology DTC in Thames valley. Nine consultants have written to say that the Thames Valley health authority assessment

"shows that there is no mismatch between capacity and demand for cataract surgery"

"Nevertheless managers in Wycombe PCT…have taken the lead in discussions with the Department…about a cataract surgery private DTC, based on information"

"Throughout these discussions there has been no reference to the Buckinghamshire Hospitals NHS Trust ophthalmic department".

Order. We are going a long way from recruitment. If the hon. Gentleman can mention recruitment, that might help me.

The essential point is that, without professional satisfaction, there will be no further recruitment of any staff. When consultants, talking about their patients, say:

"Our ability to manage chronic ocular disease, provide sub-specialty care and an ophthalmic casualty will be severely curtailed",

Order. I think that the Minister might manage an answer.

First, the hon. Member for Woodspring (Dr. Fox) is completely wrong in his first assertion. I have worked in the national health service—not treating patients, it is true, but I have worked in the NHS. Perhaps he would like to research a few more of his facts so that he gets something right.

What work has been done regarding the accreditation of health service professionals who gained their qualifications in European Union applicant countries, especially, but not exclusively, in relation to dentistry and stomatology? Is there not a chance that some of the UK royal colleges will drag their feet and not facilitate things so that such people can work in this country from 1 May to our benefit and theirs? What is the position for professionals from EU applicant countries?

We need to make sure that the quality of people coming to work in our NHS is up to our standards. I am sure that my hon. Friend entirely shares that view. We also need to ensure that recruitment of professionals from elsewhere is not to the detriment of countries that are experiencing difficulties, which is why we have agreements, for example, with the Governments of the Philippines, Spain and India on those issues.

What about the European Union?

I was just coming to that. Within the EU, we are recruiting a lot of general practitioners and other doctors, but that tends to be where there are surpluses. My understanding is that there is no major difficulty, but if my hon. Friend has evidence of difficulties we shall, of course, look into them, to cut them down and make things easier.

How will the Minister encourage GP recruitment in outer-London boroughs such as Havering, where the primary care trust has found that newly qualified GPs are attracted either to inner cities or to rural areas but not to suburban areas? In Upminster, in particular, GP practices offer salaries well in excess of the average yet still cannot recruit.

Over the past few months, we have recruited another 300 GPs. We recognise that there is an issue in London. For the first time, we are improving the standard of primary care right across the capital in a marked and systematic way. A lot of investment is going in. For example, there are golden hellos for GPs returning to or coming into the NHS. There is also the LIFT—local improvement finance trust—scheme, which is especially designed to improve recruitment and retention in the London area.

What progress his Department is making with improving NHS dental service provision. [129956]

The Health and Social Care (Community Health and Standards) Bill will give new duties for primary care trusts to secure primary dental services using the £1.2 billion currently held centrally. In the meantime, an NHS support team has started work with primary care trusts to overcome problems in areas where it is hardest to find an NHS dentist.

My hon. Friend will know that two additional NHS funded dentists' posts were announced for Burnley last month, but that is just one small step in dealing with a major serious problem in Burnley. Does she recognise that 20 per cent. of calls to NHS Direct in Lancashire are about dental health problems? Where are those people who are entitled to free dental treatment supposed to get the care that maintains their dental health, rather than emergency care, which they can get when it is absolutely essential?

I am very much aware of the problems that my hon. Friend mentions. I think that the new support team has already been once to Burnley, but it will return there with an action plan to look at how the situation can be improved. There are short-term measures, but, as I say, in the longer term we have a comprehensive programme in place to ensure that local commissioning of dental services can take place and that the £1.2 billion can be used locally, rather than centrally.

The Minister will be aware from recent figures that 1.5 million fewer people are registered for NHS dental treatment than in 1998. Only last month, the British Dental Association said that

"millions of people are unable to register with an NHS dentist."

"40 per cent. of dental practices do not accept children or adults for continuing care."

One of the problems that we face is clearing up the mess left by the previous Tory Government. Conservative spokesmen should know very well that the contract that they introduced, and the way in which they implemented it, led NHS dentists to walk away. We are putting that right. We recognise that there is a short-term problem and we are backing that up with proper resources, while in the longer term we have a comprehensive plan to provide proper primary care dental services, commissioned locally.

Is the Minister aware that it is impossible for a new patient in the Forest of Dean to find an NHS dentist? That problem has been exacerbated recently by the fact that two very good NHS dentists have transferred to the private sector because they say that they cannot cope on their fee level. Is she aware that that is a particular problem for the disabled, the unemployed, children and people on low incomes? If we believe, as we do, that health care should be free at the point of need and that we should build capacity in that NHS service, why are we not doing so in dentistry?

If my hon. Friend's constituents are facing problems with NHS dentists, she might like to consider whether emergency facilities and dental access services are available, and I certainly undertake to write to her about that. She is right to suggest that, of course, we want a proper system of dental care provision in the longer term. One of the other problems that we have to consider is the number of dentists who are being trained. We have undertaken a dental work force review, so that, in the longer term, working with the professions and the British Dental Association, we can ensure that we improve the number of dentists who come forward in the first place.

What progress has been made in encouraging health care assistants to retrain as nurses; and if he will make a statement. [129957]

We have increased the training commissions for health care assistants to retrain as nurses from 1,249 in 1999, to a planned 3,340, starting training this year. That will be matched by an increase in salary support from £11.8 million in 1999 to £122.9 million this year.

That is very encouraging news and an excellent Government policy initiative. However, may I point out to the Minister that my local trust has simply stopped all secondments for health care assistants to train as nurses without any negotiation or proper communication with its staff? What would she say to the women in my constituency who have paid for their access to higher education courses, got themselves places on nurse training and then found themselves blocked? Are not those exactly the kind of dedicated people whom we want to encourage into nursing? Is it not a short-sighted policy for a trust to be doing that when it is having to recruit nurses from abroad?

I can well understand my hon. Friend's concern about this matter. I understand that the trust is reviewing the current situation following the appointment of a new chief executive and a new finance director—[Interruption.]

Order. Opposition Front-Bench Members are being very rough in not allowing the Minister to address the House.

I also understand that the idea is to start the secondments again from next year. The strategic health authority is working with the trust to try to resolve the problem. In the meantime, I will certainly ask the local work force confederation development group to keep in touch with my hon. Friend about the situation.

Will the Minister tell the House what action the children's national service framework care group work force team is taking to address the current and projected deficiency in the children's nursing work force, and what measures are being taken to address the retention of specialised nurses in areas such as neonatal and children's intensive care?

The hon. Lady is right to raise the issue of specialist nurses, what more we can do to encourage those specialisms, and ensuring a career development path so that when shortages exist we can look at constructive ways of filling them. With regard to the point about the national service framework, I undertake to write to her about the details of the question that she asked.

If he will make a statement on the enhanced role that he plans for (a) nurse practitioners and (b) community pharmacists in the provision of health care. [129958]

Nurses and community pharmacists are central to our plans to modernise and improve access to high-quality NHS services. We have a comprehensive strategy to increase the numbers and skills of nurses, developing new roles such as nurse consultants, extending prescribing responsibilities for both professions and expanding the services that pharmacies provide.

I agree with my hon. Friend about the importance of using the skills of those two professions much more effectively in the national health service. In the case of community pharmacy in particular, what plans does she have to encourage pharmacists to provide places for confidential consultations on their premises, which will go a long way to ensuring that patients are willing to seek the excellent advice that is available and that is currently underused?

My hon. Friend is right to raise that issue. There are a number of ways in which pharmacists can play a greater role in primary health care. In our vision for pharmacy, in the new contractual framework that we are designing and in our response to the recent Office of Fair Trading report, we are putting together a series of measures to give primary care trusts, too, the ability to talk with local pharmacists about commissioning services so that exactly that kind of project can be undertaken.

May I ask the Minister to add optometrists to the list of professions that she uses in that way? is it not sensible not only to use the skills of those professionals both pre-operatively and post-operatively in the management of patients, but to extend the use of those professionals, and particularly their high-street facilities, for minor diagnostic tests and screening?

There are a number of ways in which we can examine the roles of such professionals, especially through the delivery of primary and preventive health care. Obviously, we are considering closely how that may be done through community pharmacists, but the opportunity to consider other areas that could make exactly such a contribution is always open.

If he will make a statement on the measures taken by the Government to reduce shortages of general practitioners. [129959]

As part of our commitment to increase the number of GPs, a range of measures have been implemented including financial incentives, extended opportunities for flexible working and improved family-friendly working practices. The latest figures show that the total number of GPs working in the NHS has increased by 1,500 in the past three years. In addition, we have met our target of recruiting an extra 550 GP registrars a year ahead of schedule.

I am grateful to my right hon. Friend for that reply. May I recommend to him a report that has been compiled by Barnsley council on the acute GP shortage there, which is one of the worst in the country? The report draws attention to an ageing population of GPs and list sizes that border on the excessive. It makes several recommendations including a mixture of independent and salaried GPs, golden hellos, retention bursaries, training and recruitment and assistance with administration and premises. Will he work with Barnsley council to try to address the shortage as soon as possible?

Yes. I am grateful to my hon. Friend for drawing the House's attention to that piece of work by Barnsley council, which is a model of the contribution that local authority scrutiny committees may make. He is right in his analysis—the council's view is right, too—that there is a specific problem in Barnsley, which the primary care trusts and the strategic health authority are trying to resolve. The report to which he draws attention points in the right direction. Additional resources have been made available this year to try to improve GP recruitment. We are recruiting more GP registrars—GPs in training—this year in Barnsley than we have been able to do in the past. I think that investment in the local LIFT scheme will help to improve premises and the infrastructure of primary care, which will all help the recruitment and retention efforts that are necessary.

What estimate has the Minister made of the additional number of GPs who will have to be recruited to meet the requirements of the working time directive? If those doctors are not available because there has not been long-term planning, does he expect that the shortage will result in cuts to patient provision or that the directive might not be implemented in some instances?

I do not think that there will be a particular problem with primary care and the working time directive. Obviously, we talk closely with the British Medical Association and the NHS locally to resolve those issues; I do not underestimate the fact that they are serious for the NHS. The principal concern about the working time directive is focused on emergency out-of-hours care, maternity and paediatrics, which is where the bulk of the work is being done. The growth in the GP work force will help to ease the pressure. I am sure that all hon. Members share our desire to ensure that GPs work fewer hours in a more family-friendly environment. That would be good for doctors and, certainly, for NHS patients.

I welcome the work that the Government are doing to train more people and I am sure that it will reap benefits. However, as in Barnsley, there is an acute shortage of GPs in Stoke-on-Trent, North. It is a short-term problem because so many GPs are retiring at the same time. Will my right hon. Friend visit us to discuss specific things that could add to schemes such as the LIFT project and others because we cannot tolerate the present situation?

I am grateful to my hon. Friend. As I said, I do not underestimate the issues that must be addressed. There is a shortage of GPs and we are actively trying to recruit more, with some success. I hear what she says about Stoke and I am happy to discuss her worries further. However, we should not lose sight of the important fact that more GPs are working in the NHS than at any time in its history.

If he will meet the Haemophilia Society to discuss the proposed financial compensation scheme for those who contracted hepatitis C from contaminated blood products. [129960]

I am meeting my hon. Friend and the Haemophilia Society on 29 October when the ex-gratia payment scheme announced by my right hon. Friend the Secretary of State on 29 August will be discussed.

I thank my hon. Friend for that reply. I put on record what I said when the Secretary of State announced the scheme—that it was a marvellous step forward and a very compassionate move by this Government after 20 years of campaigning. She will recall that we met her predecessor to present the Haemophilia Society's expert working group's analysis of a proper compensation scheme for the harm that is caused by hepatitis C to people with haemophilia. Can she assure me that the structure of any payments will be based not just on a token payment, but on a logical analysis of the loss that is suffered by people, in order to ensure that we do not draw negative comment from the haemophiliac community regarding what should be a very welcome scheme?

I thank my hon. Friend for his comments about the scheme and recognise in return his contribution, along with those of several other hon. Members, to recent campaigns on this front. It is an ex gratia scheme, and we shall work out the details in relation to eligibility, size of awards, payments and so forth. I look forward to a dialogue with my hon. Friend and others on how it should proceed.