What action he is taking to reduce the waiting time for radiotherapy treatment following cancer surgery. [135967]

We are increasing the numbers of therapy radiographers in post and in training, making better use of existing staff, making unprecedented investment in new radiotherapy equipment, and streamlining the patient journey.

May I thank my hon. Friend for that reply and take this opportunity to congratulate the Government on the 10 per cent. reduction in cancer mortality, which is very good news for all cancer patients? In January 2002, when I last asked a question about this issue, I was told that one way of coping with the shortage of radiographers was by using assistant practitioners who are not fully trained as proper radiographers, but can do some of the work. Can my hon. Friend give me any news on how that pilot scheme is going and on whether assistant practitioners will be in general use from now on?

I am grateful to my hon. Friend for her congratulations on the 10 per cent. reduction, which is in large measure the result not only of a lot of work by staff in the health service, but of the £570 million of extra investment that is going into cancer care.

The Minister is of course right that the number of radiographers employed in the NHS has increased, but may I gently suggest that her response is a little complacent? The three-month vacancy rate for radiographers has risen every single year since the data have been collected—now, at 10.7 per cent., it is the highest vacancy rate of any personnel category in the NHS. is the hon. Lady aware that, in west Kent, in my constituency, it is running at 19.6 per cent? Is not the reality that the growth in demand for technologically advanced radiographers is far outstripping the rate of increase in radiographers coming on supply, and that the result will inevitably be an increase in waiting lists?

I think that the hon. Gentleman is drawing the wrong conclusion from the data that he advances. Since 1997, we have increased the number of radiographers in post by 10 per cent. from 1,407 to 1,542, and doubled the number of therapy radiographer training places. As a result, many more are coming to serve in the NHS, as I indicated in my answer to my hon. Friend the Member for Cambridge (Mrs. Campbell). I think the hon. Gentleman is mistaken: what he is doing is drawing a conclusion about the vacancy levels that is partly based on the fact that there are now more posts and more equipment is coming on stream. We are not complacent, however, and he should understand that we are doing all that we can to ensure that all those posts are filled. Were his party to be in power, it would be extraordinarily difficult to make the investment that we are making, because there would be a 20 per cent. Cut—

Order. I call Mr. Michael Clapham.

The extra money that the Government have put into cancer treatment is bringing about great improvements, but there has been little improvement in one particular type of cancer—mesothelioma caused by exposure to asbestos. There are reports that treatments have been developed in Australia and America. Will my hon. Friend cause inquiries to be made into the kind of treatment that is being offered, with a view to drawing up a plan for mesothelioma sufferers here?

I am grateful to my hon. Friend for that question. I know that he has taken a particular interest in this subject for many years, and I commend him for his persistence in pursuing the case with us on every occasion. I certainly undertake to look into the points that he raised and to write to him or meet him to discuss them further.

May I urge the Minister to reconsider the so-called ambulatory model for radiotherapy that is being forced on the cancer centre in my constituency? Is she aware that that process has never been successfully used in this country in any cancer centre, and that it is vehemently opposed by all the clinicians in the Kent and Canterbury cancer centre? Is it not the case that that will to all intents and purposes amount to its closure as a true cancer centre, and that it will simply become a satellite working on an untested model?

I will of course look into the points that the hon. Gentleman makes, but I must evince some scepticism about this. We have made a £570 million extra investment in cancer care, cut premature deaths by 10 per cent. and achieved a 30 per cent. increase in the number of cancer consultants in the service. That does not square with the suggestions that the hon. Gentleman is making.

What plans he has to improve the provision of NHS dentistry in Herefordshire. [135969]

In the past three years, more than £3 million of revenue and £288,000 of capital has been invested in the Hereford dental access centres. Herefordshire will benefit from the provisions of the Health and Social Care (Community Health and Standards) Bill, which will give new duties to primary care trusts to secure primary dental services, which will be financed by the £1.2 billion currently held centrally. It will also benefit from the £44 million that I announced last month to assist those primary care trusts in which it is hardest to find an NHS dentist.

I am grateful to the Minister for that answer. I pay tribute to the primary care trust access centre and to the local dentists. Does she realise, however, that a recent survey of 20,000 residents in south Herefordshire showed that, of those who were concerned about health care provision, 60 per cent. were particularly concerned about dentistry, compared with only 11 per cent. who were concerned about GP waiting times—next highest issue? A constituent of mine who came to see me at the weekend has still not found a dentist after two years and makes a 400-mile round trip to Essex to see his old dentist. I appreciate what the Government are doing, but will the Minister agree to talk again to the PCT, and to meet some of my constituents to discuss their very real concerns?

GP waiting times are going down because we are getting quicker access to the GPs. With regard to dentistry, I certainly understand the hon. Gentleman's concerns. I will ask the NHS support team to work with the NHS locally in Herefordshire to see what assistance can be provided. After those meetings have taken place, I would be more than happy to discuss with the hon. Gentleman and his constituents the conclusions that have been reached.

The trouble is that we do not have enough beds in our hospitals in Herefordshire. We have had complacent answers time and again from the Government about how much money they have spent, yet when we get down on the ground, there is nothing happening. What is the Minister actually going to do for my constituents—

Order. The question is about dentistry. I call Mr. Burstow.

Does the Minister accept that the position regarding dentistry in Herefordshire is mirrored nationally? In Herefordshire, almost half the population are not registered with a dentist; across the country as a whole, more than half the population are not registered. Indeed, 25 million people are having to find their way to treatment centres that are miles away from their homes. Is this not an indictment of the Government's record on investing in the health service? Have they not failed to put this matter right, and have we as a country not failed, as a consequence, to ensure that we have a comprehensive dental health care service?

We inherited a legacy of underinvestment from the Conservatives. Dentists were walking away from the NHS because of the way in which the Conservatives implemented the contract. However, we recognise that there are still problems. In the longer term, we are going to enable PCTs to work with dentists locally and to do the contracting there, so that they can deal with local problems. At the moment, money is returned to the centre if dentists no longer wish to undertake NHS work; that will now remain locally. However, in the mean time, to assist the NHS support team, we have allocated £43 million to help the areas with the biggest shortages. I believe that that will lead to better provision. I accept that we are not there at the moment, but we are working towards that.

If he will make a statement on mental health services. [135970]

Mental health services are being modernised in line with the standards set out in the national service framework and the commitments announced in the NHS plan. We are encouraged by the progress made, but we are also aware of the special challenges facing some services.

Does the Minister not realise that my constituents will see that answer as hopelessly complacent, against the background of the Berkshire Healthcare NHS trust, which looks after the mentally ill in Berkshire, having to make £8.1 million worth of cuts this year in services to the most vulnerable and dependent people in the community? How do I explain to my constituents that, while Ministers claim that more money is going into the NHS, those vulnerable people are going to suffer hugely in the forthcoming year?

Berkshire Healthcare NHS trust has consistently met the key national service framework targets, particularly in the development of a 24-hour service such as crisis resolution. In Bracknell especially, there are gateway workers in place who are key to service improvement for patients. I suggest that the right hon. Gentleman explain to his constituents how services would be provided after the 20 per cent. cut that his party would institute.

The Government deserve great credit for many of the improvements that are taking place in mental health services, particularly through the national service framework. One of the areas that remains a concern to many in mental health is the role of the special hospitals. In the light of the possibility of mental health legislation coming through in the new Session or the one after that, will there be any chance of reforming the special hospitals and following the various recommendations of numerous reports initiated by the Government themselves and suggesting that we ought to move away from the current model of special hospitals?

I know my hon. Friend has great expertise, particularly in the issue of mental health as well as in wider health issues. Of course, a number of changes in the way in which the special hospitals operate have been made in recent years. We are looking at the reports that have come forward, and I can assure my hon. Friend that we want to ensure that the special hospitals meet the needs of the 21st century. If that requires further changes to be made, of course we will do that.

The Minister's answer to my right hon. Friend the Member for Bracknell (Mr. Mackay) was exceedingly complacent; for "challenges" read "failure"—what the Government have failed to achieve so far. In 2000, the NHS plan gave a commitment to establish 335 crisis resolution teams by;2003, with 24-hour access by 2004. Our recent survey revealed that over 38 per cent. of mental health trusts do not have crisis resolution teams, over 50 per cent. do not offer 24-hour access and very few have anything like a full complement of staff in any case.

The hon. Gentleman is quite mistaken. There have been significant steps to support the delivery of national targets through the National Institute for Mental Health in England. There are now more than 100 crisis resolution teams and more than 200 assertive outreach teams in place. Progress is being made on the targets for early intervention schemes. We know that £262 million extra was spent on mental health services last year.

Will the Minister look very closely at any conclusions that emerge from the mental health and learning disability review consultation which has just concluded in north and west Cumbria? May I join the Chairman of the Select Committee, my hon. Friend the Member for Wakefield (Mr. Hinchliffe), in welcoming the Government's determination to commit additional resources to mental health service provision—a decision that is long overdue and was never taken by the Conservative party in government? Is the Minister aware, and will she accept, that it is unacceptable in west Cumbria for crisis and acute bed provision to be removed and located in the centres to which my hon. Friend referred earlier? That is a backward step. We need care and provision in the community, not centralisation of those services.

I am aware that my right hon. Friend has expressed concern about that situation on behalf of his constituents and that he is meeting the Under-Secretary of State for Health, my hon. Friend the Member for Welwyn Hatfield (Miss Johnson). to discuss the proposed changes, the consultation and the real anxieties that he and his constituents have raised.

Anti-oppressive practice is central to mental health services, and to the Mental Health Act 1983. It was, however, conspicuously absent from the Government's legislative proposals last year. Can the Minister assure us that in any future legislation linguistically appropriate practice will be given due regard, particularly in Wales?

The 1983 Act does of course need to be updated to provide more safeguards for patients, and to take account of public safety issues. I assure the hon. Gentleman that we are taking on board comments made during the consultation, and that we will publish a Bill when parliamentary time allows.

What recent discussions he has held on the links between diet and health in children; and if he will make a statement. [135971]

The impact of diet on health is recognised, and we are committed to improving children's dietary intakes. Ministers regularly meet other Government Departments and external organisations to achieve that. Discussion to develop the Department of Health led food and health action plan will enable further action to be taken by all stakeholders.

I congratulate the Government on what they have already done, but in view of increasing evidence of poor diet among children, the likely effects on their health and the consequent likely demands on the health service, will my hon. Friend liaise with the Department for Education and Skills to establish how we might improve both the standard and the take-up of school meals? We need to send children a consistent message, and—as well as launching welcome initiatives such as the welcome fruit in schools initiative—ensure that they are given a healthy meal at lunchtime.

I thank my hon. Friend for her positive comments about the progress we have already made, especially with the fruit in schools programme. We do need to work closely with the Department for Education and Skills, and we are doing so. The food in schools programme, which is intended to provide healthy dietary options, is a joint initiative from that Department and the Department of Health. Ultimately, however, we must set ourselves a target. School meals must meet three criteria: they must be healthy, tasty and affordable. We are the first to admit that we have not achieved those standards everywhere yet, but we shall certainly be working on it.

Is the Minister aware of alarming reports from the medical profession about an increase in rickets caused by vitamin D deficiency? What plans, strategies or programmes exist for investigation of this serious matter? Has the Minister, for instance, any plans to legislate for compulsory cod liver oil?

I would welcome inclusion of that proposal in the next Liberal Democrat election manifesto. I suspect that it would win us a few more votes.

I recognise that many programmes and initiatives are emerging, especially in schools, but parents such as me and, I am sure, many other Members are concerned about the difficulty of ensuring that our children are not exposed to advertising and other means of forcing unhealthy foods down them. We try our hardest, but is there a possibility that a link with physical education and activity in schools would begin to make people understand we need to tackle problems of obesity now rather than later?

My hon. Friend is right—we must take an holistic view. It is a question not just of diet but of exercise, education and making sure that our children know what foods are healthy and how to create a balanced diet for themselves. On exposing children to undue influences, evidence from Strathclyde university, commissioned by the Food Standards Agency, shows that children are influenced by negative messages from TV advertising, for example. We are considering that evidence and we have an open mind as to how we shall deal with it in the future; however, my hon. Friend can be assured that we are going to deal with it.

Is the Minister aware that 13 per cent. of eight-year-olds and 17 per cent. of 15-year-olds are clinically obese, and does he share my concern about the dramatic increase in type 2 diabetes among young children? I recognise that the message that people, including children, should eat more fruit and vegetables is welcome, but does the Minister not accept that exercise is a crucial part of the equation in reducing these trends? Will he suggest to his colleagues in the Department for Education and Skills that more should be done to encourage more exercise, particularly in our schools?

The hon. Gentleman is right, but he obviously needs to wash his ears out because I just said exactly that. Exercise is vital and we must look at these issues holistically. On discussions with the Department for Education and Skills, the food and health action plan, which I mentioned in answering the first question from my hon. Friend the Member for Warrington, North (Helen Jones), is a cross-Departmental initiative that is working on all these issues and taking an holistic view of the health of our children.

What assessment he has made of (a) the availability of and (b) access to general practitioner services in Greater London. [135973]

The number of GPs, and the number of GPs in training, in London are currently at the highest recorded levels, helping more patients to be seen more quickly. Primary care trusts in London are also committed to further increases in the number of GPs and primary care professionals, which will help further to improve access to, and availability of, primary care services. Primary care in London will also benefit from £350 million-worth of capital investment in the next two years.

Is the Minister aware that a broad-ranging survey over the summer showed that more than one third of GP surgeries had closed their lists to new patients, and that more than half had closed their lists in the previous 12 months? As a result, thousands of people in London cannot get on to a GP list on a given day. What does the Minister propose to do to improve that situation substantially and quickly, and is there a target date—a number of days—by which somebody who wants to register on a GP's list can be sure that they will have a doctor to go to?

On the hon. Gentleman's last point, my understanding was that his party was against new targets of any kind for the national health service; perhaps he needs to talk to the hon. Member for Sutton and Cheam (Mr. Burstow) about that. I accept that his first point constitutes a serious and genuine concern, but I should point out that existing arrangements do permit a primary care trust, in some circumstances, to allocate a patient, or group of patients, to practices. Although everyone accepts that that is not ideal, it is possible to get an appointment with a GP through that route if it is the last one available. Secondly, I remind the hon. Gentleman that the general medical services contract that we have concluded with the British Medical Association provides a new mechanism for dealing with precisely such issues, which I hope will prevent some of the situations that he describes from arising as frequently in future. I accept that, clearly, there are capacity constraints, and measures are in hand to deal with that. The arrangements under the new GMS contract will provide a further strengthening of those measures.

What plans he has to increase choice in the provision of maternity services. [135974]

My Department is conducting an extensive consultation on what patients want in terms of choice and involvement in, and flexibility of, their care and treatment. Maternity services are a key theme of this consultation.

I thank my right hon. Friend for that reply, and I hope that he has had a chance to look at the Health Committee's reports on maternity services, which were published earlier this year. One of our recommendations was that the ability should exist to be referred to midwifery services by a midwife, rather than through the GP services. I should be grateful if he would outline what the Department intends to do to encourage that.

It is true that choice becomes substantial choice only if capacity is increased and investment to increase that capacity is made. That is the difference between our policy and the theoretical and cruelly deceptive choice that is offered by others to benefit only a tiny minority of people. We have therefore increased capacity through investment, resources and training in order to give women a real choice over maternity services. For instance, I understand that in my hon. Friend's area in Bristol, a number of midwives have proposed a midwife-led unit as an alternative to traditional hospital-based maternity services, and the primary care trust is now actively considering that option. We aim for the NHS to provide maternity services that offer women a variety of options through which they can receive care during their pregnancy and where they give birth.

What plans does the Secretary of State have to deal with the shortage of midwives, which risks curtailing choice for patients and specifically curtailing the midwife-led birth centres that he mentioned? I would be grateful to know that he attaches a great deal of importance to such midwife-led centres and I hope that, because of the shortage of midwives, he will protect them from attacks by the consultant-led obstetrics units.

On the hon. Gentleman's second point, it is crucial that we do not allow any vested interest to stand in the way of better-quality, quicker and better service and more choice for patients. When I say that, I mean any vested interests within the NHS or any vested interests from outside that want to undermine it. I can tell the hon. Gentleman that I will make sure that we protect and help to prosper the midwife-led opportunities.

May I tell my right hon. Friend that my constituents welcome the news that Harwich is going to get a new community hospital, which includes a new maternity unit? That will continue to give my constituents a choice about where to give birth in their local community. However, at the moment, the existing maternity unit is temporarily closed because of the shortage of midwives. To ensure that the new hospital and new maternity unit is a success, will my right hon. Friend do all that he can to ensure that we recruit, retain and encourage midwives back into the profession? We want the investment to make an improvement, which counters the suggestions of failure from Conservative Members—[Interruption.]

It's closed.

Despite the baying from Conservative Front Benchers, that is a helpful question because it is important to have an honest appraisal of where we are with the health service. It is light years better than the health service that we inherited from the crowd on the Opposition Benches, but we still have a long way to go—[Interruption.] I can do no better than quote Professor Mike Salmon, chairman of the Essex Rivers Health Care NHS trust. When the Government gave the go-ahead in 2001 to the project mentioned by my hon. Friend, he said:

"This is the best local health news since the creation of the NHS itself in 1948".

It is unfortunate that the Secretary of State allowed some party political banter to creep into what had until then been the helpful answer that he was determined to put women's interests first when deciding on maternity services. Will he bring his influence to bear on the Avon, Gloucestershire and Wiltshire strategic health authority, which is currently consulting on closing down maternity services in Trowbridge, Devizes and Malmesbury?

I do not understand the logic of the hon. Gentleman's question. My God, if in the context of the biggest annual increase in the NHS for the longest period in history, he is keen to point out to us where difficulties occur, what will he do when there is a 20 per cent. cut in that investment?

That is no answer. What a disgrace. Get back to Scotland.

Order. The hon. Gentleman should not say too much about Scotland. He knows where I come from and it is not so long ago that he lived in my constituency.

What additional funding his Department is making available for the improvement in the (a) premises and (b) facilities available at general practitioners' surgeries in England. [135975]

The Government are committed to investment of £1 billion by 2004 in improving primary care premises and facilities through NHS LIFT—local improvement finance trust—and other investment routes. The NHS LIFT scheme in east Lancashire, which I was able to visit last Friday, has reached financial close and work has now started on the first of several new developments, which will include my hon. Friend's constituency.

As my hon. Friend mentioned, he was in Bacup last week and he will know that many surgeries in my constituency do not meet the standards for primary care in GPs' surgeries that the Government want to deliver in 2003. Does he believe that the LIFT programme and what Burnley, Pendle and Rossendale primary care trust is doing will ensure that we have such facilities, and will they be value for money?

I do believe that. As my hon. Friend knows, the primary care trust has started with three developments initially, in Bacup, Nelson and Darwen. I understand that GPs in his constituency will be in the second tranche of development and I hope that that will proceed as soon as possible. I agree with him that it is desperately important that we improve the primary care estate in the NHS. It is where 90 per cent. of all patient journeys begin and end and, as GPs would themselves acknowledge, it is true that many surgeries are not up to scratch. They are not capable of delivering modern, 21st-century health care. That is why we are making a record investment in primary care, and there is no more pressing case than my hon. Friend's constituency.

Will the Minister direct some of the additional funding for primary care to areas where GP lists are well above the national average, such as in my constituency, or will he continue to be a party to the fiddling of formulae that will continue the crisis in public service provision in the south-east of England?

No, we do not fiddle any formulae. Health spending is directed to the areas of greatest need. That is precisely the methodology we use to distribute money across the national health service. The hon. Gentleman has recently had something of a reputation for espousing the causes of the vulnerable. I imagine that that is why he is especially pleased to see what has happened to the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith), who must surely now be included on a list of the vulnerable. There are 42 LIFT schemes across the country and I am more than happy to send the hon. Gentleman details of them so that he can judge for himself whether the figures have been fiddled, as he alleges.

There is overwhelming public support for the Government investment programme in the renewal of GP facilities, but will the Minister look carefully at the value-for-money aspect? The first of the LIFT proposals in my constituency includes plans for a £5 million health centre that will be rented back to the NHS at a cost of £25 million, an effective interest rate of more than 20 per cent. I asked some of the high street building societies what they would charge me for a mortgage to build it myself and discovered that it would cost £8 million. Can the Minister look carefully at the long-term costs and constraints imposed on LIFT companies to ensure that we get the modern facilities that we need but not at the Barclaycard interest rates that we do not?

NHS LIFT schemes do represent value for money. I understand that my hon. Friend has an ideological opposition to involving the private sector in the construction of NHS facilities. I respect that, but I profoundly disagree with him about the implications for NHS LIFT. All NHS LIFT schemes must pass a value-for-money test, and they do so. However, I can tell my hon. Friend and anyone else who is worried about the matter that the priority is to get the investment in place so that primary care facilities for NHS patients can be renewed. NHS LIFT represents a once-in-a-generation opportunity to make a significant and real difference to the improvement of primary care facilities in my hon. Friend's constituency, and in the constituencies of hon. Members of all parties. That should be our priority.

What progress has been made in reducing the waiting times for diagnostic testing. [135976]

The NHS is committed to reducing the length of time that people wait before their treatment starts. The NHS plan has set targets for staged reductions in waiting times for first out-patient appointments and for in-patient treatment, which will help contribute towards reducing waiting times for diagnostic testing. By the end of 2005, patients with suspected cancer, for example, will be guaranteed that their treatment will start within two months of being urgently referred.

Does not the Minister recognise that some of the longest waiting times in the NHS are not for inpatient and out-patient appointments, but for diagnostic tests? Is it satisfactory that the Government are not publishing information that would allow us to judge what is happening to those waiting times? Will the Minister take up the suggestion by the independent Statistics Commission that the Government should publish the waiting times for diagnostic tests? That would allow us to see how long people wait for all aspects of NHS treatment.

We shall certainly look carefully at all the recommendations made to us. Of course we want to reduce the length of time that patients have to wait before their diagnostic tests start, and before they get the results. That is obvious. We have made an important start in relation to cancer, about which people have the greatest anxiety. That will help to reduce the length of time that people have to wait for diagnostic services. However, Liberal Democrat Members are the least able to lecture the Government about waiting times, as they are against any waiting times targets whatsoever.

Is my hon. Friend aware that, although good progress is being made in relation to work with cancer in my NHS trust in Coventry, the difficulties posed by coronary problems are of similar dimensions? A surgeon in my area has been suspended for nearly two years, at a cost of some several hundred thousand pounds. Could not he be reinstated? Will my hon. Friend take a personal interest in this matter and ensure that a fair compromise proposal that would get the surgeon back to work and reduce waiting times is agreed, with both sides dropping charges and no blame being apportioned?

I am aware of that case, and my hon. Friend the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson), who is responsible for public health, answered an Adjournment debate on it only recently in this House. Such matters are for the local trust to resolve, but I agree with my hon. Friend that it is important that they are dealt with as quickly as possible. He will be aware that the National Clinical Assessment Authority has recently been in touch with the trust, to see what further progress can be made in relation to that dispute. I very much hope that progress can be made as quickly as possible.

Can the Minister confirm the story that appeared in this morning's press that No. 10 intervened to ensure that Dr. Lee Kuan Yew's wife had her diagnostic treatment speeded up? Is that a proper way for No. 10 to behave? If No. 10 is able to secure preferential treatment for the wife of a visiting dignitary, why can it not intervene to ensure that no one has to wait for life-threatening periods for vital scans?

No, I think that the position in relation to that case has been made clear already by a spokesperson for No. 10.

How many general practitioners are in training; and if he will make a statement. [135977]

There were 2,157 general practitioner trainees in June 2003. That is an increase of 814 since 1997, and the highest number ever in the history of this country. We promised more GPs, and we have kept that promise.

I thank my right hon. Friend for that answer, and for his efforts in ensuring that general practice is an attractive option for trainee doctors. In my constituency, however, one GP vacancy was advertised for 18 months before being filled. As we approach the winter months, everyone is more acutely aware than ever of the need for GPs. Will my right hon. Friend redouble his efforts with the royal colleges and the British Medical Association to improve capacity yet further?

Yes, I shall certainly do as my hon. Friend suggests. The truth of the matter is that we have achieved our initial trainee target ahead of schedule; as I said, there were 2,157 GP trainees as of June this year—highest number ever recorded. However, there is no doubt in my mind that we need to achieve a great deal more than that, not least because of the underinvestment during the 20 years before the Government took office. To point that out is not to make a party-partisan point, because every one of the 1.3 million people in the NHS and the 60 million people of this country knows the truth: the NHS was starved of investment. That is why, in a paradoxical fashion, I can tell my hon. Friend that we have the highest number of doctors in history, yet the number is still insufficient, because we are making up for the lost decades under the Conservatives.

When the Prime Minister talks about public services, he says that it is about schools and hospitals. What message does that send to those who work in primary care, who deliver the majority of health care?

First, may I congratulate the hon. Gentleman both on his incipient move and on actually asking me a question? Since I became Secretary of State, that is the first time—

Rubbish.

It is the first time since I became Secretary of State that the hon. Member for Woodspring (Dr. Fox) has fulminated inside the Chamber rather than outside it.

That was an interesting answer, but not to the question that I asked. My question was about what Government soundbites tell us about their approach to the acute sector in relation to the community sector. There is poor morale in primary care, so let us see whether the Secretary of State can actually answer me in detail. One in six doctors currently in general practice graduated from a south Asian university; two thirds of them will retire by 2007. How many extra doctors will be required to fill those posts? A recent study by the British Medical Association found that 20 per cent. of all GP time is taken up by administration. How many doctors does that effectively take away from patient care? According to the Government's figures, the number of doctors per thousand patients has gone down since 1997, not up. When will the Secretary of State answer the real questions instead of giving us soundbites, statistics and complacency?

Well, if ever I heard a soundbite it was "soundbites, statistics and complacency", which does not quite match "Veni, vidi, vici" in the resonance of historical sweep. When the hon. Gentleman asked his question, he implied that we had merely promised more "schools and hospitals". That was his first soundbite, so he did not like being told about more doctors, more nurses and more midwives. Of course—[HON. MEMBERS: "Answer the question."] I will, therefore, answer the questions. We have more doctors than ever in history. We have recruited some of them from overseas, not least because under the crowd on the Opposition Benches all the investment in doctor training was run down, unlike the situation under the Labour Government. In primary care, we have—[Interruption.] The Opposition can bay as much as they like; the truth is that we all know that all the increases in primary care, public health, secondary care, chronic care and care for the elderly would be destroyed by their reduction in investment and their criminal plans to charge our old folk up to £10,000 for their—

Order.

May I say that my constituents are not interested in the sound bites that come from the Opposition? What they are interested in is being able to see a GP when they need to. Although I applaud the extra 814 GPs that are in training, may I tell my right hon. Friend that there is a serious short-term problem? We have had too many GPs retiring, and we need to attract more into part-time work. We need to ensure that we can deal with the immediate emergency crisis that we have, certainly in Stoke-on-Trent. Will he look at that and consider how the Government can support what the Stoke-on-Trent, North PCT is doing at the moment?

Yes, I will certainly look at that, and I do not for a moment underestimate the challenge, even with the record number of doctors that we have. I have already said that, because of expansion, retirement, past under-investment and other factors, there is a huge problem and we need to recruit even more. That is why, although we are on course to deliver our target of 2,000 extra GPs, we need to do more. There has been an unprecedented expansion in medical school places in England: 2,150 more places were announced between 1999 and 2001, so that increase will contribute to the future number of GPs.

I welcome the improvement. How many of the university posts that have been opened actually spring from a decision taken many years previously? I discovered that universities that were supposed to be opening more places for medical training were not doing so. How many training posts have not been occupied by young people who want to become GPs? Such vacancies have been one of the standing failures of our medical training for many years.

On the first question, frankly, I cannot tell the hon. Gentleman the answer off the top of my head, but I will write to him about that. On the second point, if I understood the question, he was implying that the great demand for places at medical schools or universities was not being met because such places were not available. All I can say to the hon. Gentleman is that we have carried out the most rapid expansion in places. We have four new medical schools, for instance. I visited one of them only a couple of weeks ago, welcoming another 120 young people coming in to train as doctors. A greater problem than the lack of places is the fact that there are cyclical trends. Sometimes large numbers of people who train as doctors choose to go into general practice and, at other times, they do not choose to do so. We are attempting to attract more people into general practice, not least through the recent new contract, which gives opportunity and flexibility to GPs and was overwhelmingly accepted by the profession itself.

Order. We have five minutes left, and we are only at Question 9 on the Order Paper. The next time that we have Health questions, I do not want the record to be full of what the Opposition did when they were in power. Questions should be answered briefly, and that is the end of it.

What his latest estimate is of the number of premature deaths in England in the last year for which figures are available; and what action he is taking to prevent them. [135978]

In 1995, an estimated 98,800 people died from smoking in England. We have developed a comprehensive strategy, including legislation banning tobacco advertising, a mass media information campaign and a national network of NHS stop smoking services. Early figures, published by Cancer Research UK, indicate an encouraging drop in smoking prevalence, but we are awaiting publication of the latest general household survey data for confirmation.

I congratulate my hon. Friend the Minister on realising that I meant to refer to premature deaths from smoking in my question. Will she join me in congratulating the Secretary of State for Health on having given up smoking for 11 months? What are she and her colleagues doing to encourage other people to follow his example? Will the Government now consider introducing legislation to ban smoking in public places?

Of course I join my right hon. Friend in congratulating the Secretary of State on his period of abstinence from tobacco. To share the progress that we are making on services to stop smoking, across England £138 million has now been allocated over the next three years to help reach the target of achieving 800,000 four-week quitters by 2006. The latest statistics show that we are on target, and around 124,000 people had given up smoking at the four-week follow-up quit stage. He mentioned the question of smoking in public places; he will know that we have considered the matter, but believe that substantial progress can be made through voluntary means

The Minister talks about premature deaths. Is she aware, however, that people's lives are being put at risk today by the mounting crisis in emergency care? We have the unedifying sight of queues of ambulances outside accident and emergency departments unable to get patients admitted to hospitals, and the extraordinary situation in which ambulance trusts have contingency plans to erect tents outside accident and emergency departments for patients, because they cannot get them admitted to hospitals. When will Ministers do something to end this appalling situation?

That is absolute poppycock; what is more, the hon. Gentleman knows that it is. The fact is that nine out of 10 patients are seen within four hours in A and E departments across England, and, to the best of our knowledge, tents have never been used and are unlikely to be needed other than for dealing with patients at the scene of a major incident such as the Selby rail incident or the decontamination of patients in the event of a chemical or biological attack. The Opposition are trying to get up a story that is 100 per cent. spin and zero percent. truth.

What proportion of nurses working in the NHS have been internationally recruited. [135979]

As at September 2002, the number of nurses employed by the NHS was 367,520. In the years 1999 to 2002, 33,000 non-European Community nurses registered with the Nursing and Midwifery Council. However, not all of those nurses will currently be working in the NHS.

I welcome the fact that the NHS has a code of conduct about recruiting nurses from countries where recruitment would otherwise affect health services in those countries. The private sector in hospitals, nursing homes and care homes, however, does not exercise similar restraint. I ask the Minister to look carefully at ways in which the private sector can be made to adhere to the same code of conduct, and if necessary to have discussions with colleagues in the Home Office to ensure that the private sector in this country is not pillaging health services abroad in countries where those health staff are needed much more than here.

My hon. Friend is right to raise this issue, which we take very seriously, and my right hon. Friend the Secretary of State has had a number of discussions about it. There is a limit to the control that we can exert on the private sector, but we have made it absolutely clear that agencies that recruit nurses for the private sector contrary to the NHS code of conduct will not be allowed to recruit nurses for the national health service. That lever is available to us. In addition, some measures can be taken by the Department of Trade and Industry if, for example, agencies charge an exorbitant fee to nurses for recruitment. Our Departments are continuing to work closely on that matter.

What recent estimate he has made of the cost to the NHS of a hip replacement operation (a) in an NHS hospital and (b) in a private hospital. [135980]

The most recent estimate of the cost to the NHS of a hip replacement in an NHS hospital is £4,356. BUPA currently advertises an inclusive care price for a hip replacement as being within the range £7,150 to £8,900.

I thank my right hon. Friend for that answer. Does he agree that the way to tackle hip and knee replacement waiting lists is through exciting projects such as the south-west London hip and knee centre rather than by subsidising the private sector, as the Conservative party would do?

I entirely agree with my hon. Friend. The south-west London NHS treatment centre for hips and knees in Epsom that will open in January will benefit her constituents and those of other hon. Members. It is planned that the centre will have the capacity to treat some 3,150 orthopaedic cases in the 12 months to the end of September. She is absolutely right, and I make it absolutely plain, that the Labour party, which is the only party for which I can speak, will never force old folks to be charged out of their savings to pay for their own operations.