If he will make a statement on the financial situation of the Worcestershire health economy. [142542]

Primary care trusts in Worcestershire will receive a total increase of £118.9 million over the next three years, representing a cash increase of more than 30 per cent. All primary care trusts in Worcestershire are forecasting financial balance for this financial year. However, as the hon. Gentleman will know, discussions are continuing between the strategic health authority and Worcestershire Acute Hospitals NHS trust to ensure that the trust achieves financial balance over the next two financial years.

I am grateful for that answer. The Minister will know that the budgetary problems of the South Worcestershire primary care trust, which were caused at least in part by an obligation to meet centrally imposed targets, led to significant cuts in local health services early this year. As the Worcestershire Acute Hospitals NHS trust struggles with its own precarious financial position, caused in part by an obligation to meet the new waiting time targets, can the right hon. Gentleman assure me that there will be no further cuts to patient services in Worcestershire, and that the new GP contract will be fully implemented?

Yes. There will not be any cuts in front-line health care services in Worcestershire—quite the opposite: we are looking to expand health care services in the county because there is a need for that. The new GP contract will be fully funded and it will be properly implemented, as we have repeatedly made clear. We are trying to address the issues, of concern to the hon. Gentleman and many others in Worcestershire, affecting the hospitals trust. That task would be greatly furthered if we had the hon. Gentleman's support for the additional investment that we are providing.

): Has my right hon. Friend made an assessment of the impact on the finances of the Worcestershire health economy of diverting cash from the NHS to pay for tax relief on private medical insurance?

Yes, I have made such an assessment—and it would wipe out the additional £118 million of investment, so I really do not think that the Conservative party's proposals would help to enhance the NHS in Worcestershire. Indeed, they would make the job of the NHS in Worcestershire immeasurably more difficult.

When will work begin on the long awaited new hospital in Malvern in Worcestershire? If the Minister does not know the answer to that, will he write to me about it by the end of the week?

I do not know the answer, but as the hon. Gentleman has asked me to, I will write to him by the end of the week.

Are not the people of Worcestershire being let down by the Government? Tax is up, spending is up, but activity has barely increased. Only six days ago, the NHS chief executive admitted that average waiting times are getting longer. Last year only one patient in 400 was able to exercise choice and then only if they had been waiting for more than six months. Against that background and in view of the delays to the NHS information technology project, will the Minister confirm that the promises made this morning by the Secretary of State in No. 10 Downing street about increasing patient choice are just pie in the sky?

No, I would not accept that, but I welcome the hon. Gentleman to his new responsibilities. There are no delays to the NHS IT programme, which will be delivered and implemented on time—because of the additional investment that we are putting into the NHS, which the hon. Gentleman is obviously not prepared to match. As to waiting times, they are falling, rather than rising as they did under the previous Government. Given the hon. Gentleman's desire to represent a new type of politics, he might have had the courtesy and the manners to acknowledge that in the House today.

If he will make a statement on his Department's proposals to improve access to NHS dentistry. [142543]

The Health and Social Care (Community Health and Standards) Act 2003 is the most radical reform of NHS dentistry since 1948, and means that the £1.2 billion currently held centrally will be devolved to primary care trusts to commission NHS dentistry. In the meantime we have allocated £59 million to improve access to NHS dentistry where there are currently acute short-term problems.

I thank the Minister for that response, but her predecessor told me in January that the Government would indeed strive to put more investment into NHS dentistry services in Cornwall. We have seen no visible evidence of that. Indeed, children are now being deregistered from NHS dentistry. Such inequity cannot be allowed to continue on. Can the Minister direct any specific investment into areas such as Cornwall so that NHS dentistry can be brought up to at least the average in the UK nationally?

I understand the points that the hon. Gentleman makes and, in the longer term, we will radically overhaul NHS dentistry. However, in the meantime, we have set up 22 new dental clinics in Cornwall since 1998. They provide treatment on the NHS to people who are not registered with an NHS dentist. We are also considering the hon. Gentleman's area as one of the pilot areas for the new system of local commissioning of NHS dentistry, so that we can ensure that dentists stay with the NHS and encourage others to return to it.

My hon. Friend will know that Burnley is one of the worst places in the country for obtaining NHS dental treatment. There is a gaping hole in provision. We welcome what the Government have done and the changes that will take place in 2005, but what can be done to provide urgent dental treatment on the NHS for people who need it now?

I refer back to the £59 million that I have announced in the past few months that will be used to address exactly the problems that my hon. Friend mentions. That will happen through the NHS support team, which is funded by £9 million, backed up by around £35 million in revenue support. The NHS support team visited my hon. Friend's area in August, October and again in November. A local action plan is being drawn up to address some of the real problems that I know exist in his area and I will let him have further details in due course.

:When the Minister wrote to me in answer to a query that I raised about the critical state of dentistry in east Devon, she mentioned the figure of £65.2 million to support the changes. I notice that this morning that figure has fallen to £59 million. Does the Minister agree with me and my constituent Dr. Kenneth Croft that there is no point in improving access to dentists if they do not exist in the first place? Will she consider ensuring that some of the new money is spent on general dental practitioners, who are at the forefront of dentistry, rather than on IT training, recruitment and so forth?

Some of the money will go to dentists in general dental service. That is the whole idea. Some of the money can be used for capital expenditure—for example, if a dentist wishes to expand the surgery area or provide extra facilities in the clinic. In terms of revenue, extra money can be spent on more sessions for NHS patients. In the longer term, we are reviewing the dental work force to ensure that we have more trainees and encourage more people to return to dentistry, especially women. Overall, the hon. Gentleman should remember that this state of affairs arose because of the way in which the Conservatives behaved in the 1990s, which led to NHS dentists—

Order. I call Ian Lucas.

Will my hon. Friend join me in condemning those many dentists, some from the Wrexham area, who have unilaterally withdrawn from NHS practice? What sort of professional sends a patient of 20 years' standing a letter to say that they can no longer treat him unless he signs up to a private dental plan? That is disreputable behaviour. It is time that such dentists recognised that they have a professional obligation to offer health care, not just to seek private profit.

Dentists are independent contractors and, as such, they have the absolute right to withdraw their services if they wish to do so. The problem has been not necessarily the amount that dentists are paid but the way in which they are paid, leading to the treadmill effect of the current system. We are changing that round so that the money that is held centrally will be devolved to local level. The system of payment will change, and we believe that that will encourage more dentists to stay in the NHS and encourage more to join it in the first place.

Now that more than half the population are not registered with an NHS dentist, it is clear that access is not the whole story. What will the Government do to ensure that more people are registered with an NHS dentist?

Only some 5 per cent. of dentists offer only private care. Some 60 per cent. of dentists provide some 90 per cent. of NHS care. However, the hon. Lady is right to point to a problem. We need to improve access and encourage registration. The measures that I have outlined—including devolving money held centrally to local level, allowing local commissioning and addressing the issue of the dental work force—will change the situation round. It will be a radical overhaul of the present system.

Cosmetic teeth whitening is, I understand, a simple but costly procedure much beloved of some Opposition Front-Bench Members. Is cosmetic teeth whitening available on the NHS and, if not, how much would it cost the NHS, and what would be the impact on availability, if it were to be provided under the patients passport that the Opposition love?

If teeth whitening were for purely cosmetic reasons it would not be available under the NHS, which is purely for clinical procedures, unless there had been a recommendation that it was necessary for clinical purposes. I agree with my hon. Friend about the policies of the Opposition; not only will the patients passport undermine the NHS—[Interruption.]

Order. I call Dr. Murrison.

Deteriorating dental health in the UK is but the latest in a string of public health disappointments, including tuberculosis, obesity and sexual health, that have become more acute since the creation of the post of a public health Minister. Successive postholders have done little more than tweak management wiring diagrams, from the creation of directorates of infection control to the transfer of responsibility for primary dental care. Does the Minister agree in all candour that in public health terms the Government's impact on preventive oral health has been marginal at best? What comfort can she give the British Dental Association, which has highlighted its concerns to her on repeated occasions?

In fact, we are working extremely closely with the BDA. That is exactly why we have come up with our plans. The BDA told us that it did not like the present system of payment, which was introduced by the previous Administration—who, by the way, at the same time cut dental fees by 7 per cent. while we have increased them by 26 per cent. We have worked with the BDA so that the money currently being spent centrally will be devolved to local level. That is what the BDA told us it wants and that is what we are delivering.

My hon. Friend will know that I have been haranguing Ministers for some time about the appalling problems of access to dentistry in Grimsby and Cleethorpes. For example, a vulnerable adult on incapacity benefit, who cannot obtain NHS treatment, was quoted £500 for fillings, while a pensioner who is in severe pain following an accident and needs urgent treatment can get no treatment, not even private treatment, until the new year. I know that initial discussions on improving access in my area have taken place, so will my hon. Friend tell me what progress is being made to ensure that my constituents have access to good dental treatment?

I am well aware of the problems that my hon. Friend has highlighted. She has been as assiduous as ever in bringing them to our attention and I hope that I can offer her some reassurance. The dental support team has made three visits to her area to meet the local primary care trust. As a result, grants have been allocated for about 3,000 extra patients to be registered on NHS dentists' lists, and £50,000 has been allocated for a new service for non-NHS registered patients who need urgent treatment. My Department has also allocated £95,000 to employ full-time salaried dentists in the area. Furthermore, the PCT is working with Sheffield university on a scheme to locate newly qualified dentists in the area. I hope that gives my hon. Friend some reassurance that progress is being made.

If he will make a statement on the number of dentists in NHS practice. [142544]

On 30 September 2003, there were 18,500 dentists in England—up from 16,728 in 1997. We have also undertaken a dental work force review, which we will publish shortly.

I thank the Minister for that answer. I am sure that she is aware, because she gave me the information, that in 1999 41 per cent. of adults in my constituency were registered with an NHS dentist. That figure has now slumped to 30.6 per cent. I have raised this matter with her predecessor. My PCT chief executive tells me that the Department of Health counts the Isle of Wight as

"amongst the twelve most challenged populations"—

I can quite understand why the hon. Gentleman's constituents feel rather challenged. I reassure him that the NHS dentistry support team has, as he suggests, visited his constituency and met the local PCT and the local strategic health authority. It is important that the priorities are agreed at that level because that is how we can improve the system. Of course I understand the point about the hon. Gentleman's constituents. We are very aware of the difficulties that they face, but we have to sort those difficulties out strategically. Not only have those meetings taken place, but a local action plan has been drawn up to ensure that the situation is improved. A recruitment package has been produced. That has been attempted before in the hon. Gentleman's constituency to try to recruit dentists to the area. It was not successful, but that is being looked at again, and emphasis will be put on the fact that the access should not be required off the island and that priority should be given to children. I hope that that will improve the situation.

Is my hon. Friend aware that many of my constituents cannot register with an NHS dentist? There are many good NHS dentists in Keighley, but unfortunately, there are none in Skipton, so people from Skipton flood the Keighley area to use our dentists. What help can my hon. Friend offer to my constituency?

Again, I can assure my hon. Friend that, through the NHS support team, we are trying to ensure that particularly challenged areas receive extra help. I will certainly ask the support team to consider the points that she makes and to find out whether we can do anything further to assist her area.

): I am the victim of an assault—an assault by treacle toffee offered to me by a seven-year-old at a school Christmas fair. I could find no dentist either in London or in my constituency, and I eventually had to pay £400 for emergency treatment. Given that many hon. Members will shortly risk their dental integrity at school fairs throughout the country, can the Minister assure us that emergency dental treatment on the NHS is available in all parts of the United Kingdom?

I can perhaps refer the hon. Gentleman to NHS Direct, which will he able to advise him on the nearest centre where he can get emergency care. That is what we pledged to do: to ensure that anyone who telephones NHS Direct can get advice on where the nearest source of emergency care is—either through a dental access centre, or through an NHS dentist who provides emergency treatment.

My hon. Friend has done much work with the British Dental Association, which she mentioned in an earlier answer, but crucial to maintaining the number of dentists is continued professional post-graduate training. A very good scheme has been developed on the Yorkshire coast in my constituency. Will my hon. Friend take the opportunity in the new year to come and see that work, which I very much congratulate her and her officials on helping to get started?

I thank my hon. Friend for those remarks. He is absolutely right. That is why we have undertaken the dental work force review to consider training, recruitment and how we can ensure that more dentists stay in the NHS when they have trained. I would be more than happy to visit my hon. Friend's constituency. The NHS support team has already visited the area to consider ways in which it can improve access for his constituents, following representations that he has made, but looking at some of the schemes that he has outlined would be extremely helpful.

): If he will make a statement on the provision of specialist children's epilepsy nurses. 142545]

We do not collect this information centrally, but we understand that there are around 100 epilepsy specialist nurses supporting the treatment and management of children and adults with epilepsy. In February 2003, we published the Department of Health's epilepsy action plan, and primary care trusts are able to develop more epilepsy specialist nursing posts to support the delivery of local epilepsy services.

A consultant paediatrician in my local hospital, Dr. Owens, has vividly described to me the enormous benefit that specialist epilepsy nurses can bring to families with epileptic children. Yet in my area, as in many others, those specialist services do not exist. Before putting all the responsibility on primary care trusts, would the Minister listen to what Dr. Owens has to tell us—indeed, I forwarded this letter to him a month ago—

"Whilst the present Government has undoubtedly increased funding for the NHS, moneys are centrally controlled and streamed into specific areas. There is not much funding reaching children's services in district general hospitals.-

First, there is less ring-fencing of money now than ever before. Eight-Five per cent. of the money is passed on to primary care trusts, which can make decisions about how they want to deliver epilepsy services in the best interests of local people. It is ridiculous to suggest that specialist nurses—important though they are—represent the totality of the delivery of services for children with epilepsy. I would refer the hon. Gentleman's constituent to the complete and comprehensive improvement in the priority that this Government have given to epilepsy compared with our predecessors. We have the epilepsy action plan, the national service frameworks for children and long-term conditions that are being produced next year, and two sets of NICE guidelines being produced that are also of direct relevance to epilepsy.

The lack of children's epilepsy nurses is another example of the chronic shortage of specialist children's nurses highlighted in the study by the Royal College of Nursing and the Royal College of Paediatrics and Child Health, and has been identified as a major factor in avoidable death. It underlines how children's health does not fit into this Government's target priorities. Does the Minister acknowledge the figures from the royal colleges, which point to the fact that another 2,700 children's nurses are needed just to meet demand? Can he now tell the House the number of pre-registration children's nursing training places being made available to overcome that deficiency? Will that serious problem be addressed in the children's national service framework, when we eventually get it?

First, there are now 48,000 more nurses in the national health service as a result of the investment made by this Government. How many would there be if we were cutting expenditure on the national health service by 20 per cent? Out of those 48,000 will come a substantial number of specialist children's nurses, including those for epilepsy. If the hon. Gentleman were genuinely reflecting the views of people working in children's health, he would be saying that this Government are dramatically improving prospects for children's health in this country, and that the national service framework is going to be one of the biggest steps forward in children's health in the history of the national health service.

):What measures he is taking to improve general practitioner premises in east London. [142546]

We have begun to transform the face of primary care in east London. In my hon. Friend's constituency, the local primary care trust is investing more than £1 million in opening, renewing and refurbishing general practice premises. By early next year, Tower Hamlets PCT will have opened three additional practices, bringing much-needed general practitioners to east London.

I thank my right hon. Friend for that reply. Clearly, I warmly welcome the new premises that are being replaced, refurbished and reopened. In places such as east London, however, many older GPs, often operating from single practices that were inadequately housed, are retiring, and we are having something of a problem in ensuring that the new premises are duly improved and in the right places. Can the Secretary of State write to me outlining what measures his Department might take to work more closely with developers, the Office of the Deputy Prime Minister and others involved in regeneration initiatives to ensure that we have improved premises in the areas that need them?

I will certainly undertake to write to my hon. Friend. In the meantime, I can say that she is absolutely right that we need to unleash the capacity that exists in the public or private sector to bring together all capabilities to address health care, whether that relates to buildings or other matters. She may know that we have developed a groundbreaking initiative for the NHS that is referred to as LIFT—the local improvement finance trust—to develop and encourage a new market for investment in primary care facilities. East London contains two LIFT projects, in Barking and Havering, which are bringing investment worth more than £47 million to London. Included in the east London scheme is a £4.9 million one-stop primary care centre in Church road, a £2.6 million primary care centre in Barking road and a £12 million one-stop primary care centre in Vicarage lane. All of that is vitally important, because if we do not put capacity into the NHS, we cannot give people the quality or choice that they should have.

rose—

Order. I have no wish to ignore the hon. Gentleman, but South Norfolk does not exactly come under east London.

What progress has been made in developing the role of nurse practitioners; and if he will make a statement. [142547]

Over the past five years, the number of nurses working in primary care has increased by 18 per cent., and many of them work as nurse practitioners. Their roles have expanded to include prescribing and ordering some diagnostic tests for patients. The Department also remains committed to developing further the role of nurses in secondary care through the establishment of new modern matrons, nurse consultant posts and greater clinical responsibility for nurses.

I am grateful to the Minister for that reply, but will he tell the House how he proposes to extend further the role of nurse practitioners in primary care? Many patients find that extremely useful—it is very popular in my area. How might the arrangements for the new GP contract impinge on that process?

I agree with my hon. Friend that nurses have a hugely important role to play in delivering an improved range of services in the community and primary care. I know that she assiduously follows such events, so she knows that the new general medical services contract that we successfully concluded with the British Medical Association will allow nurse-led practices to be developed in GMS for the first time. That will allow nurses to continue expanding and developing their role to improve services for patients in all parts of the country, including those of my hon. Friend.

Will the right hon. Gentleman ensure that nurses who have trained in therapies such as acupuncture, herbal remedies and perhaps even homeopathy will not be discriminated against in hospitals? Will they be able to use such therapies as they should—to assist patients and reduce the pressure on doctors and other nurses?

I certainly would not want to dismiss that. I have recently become something of a convert to some of those treatments. I had some reflexology recently and it was very nice indeed—I do not really want to say any more about that.

May I first, through you, Mr. Speaker, thank the Secretary of State for his morale-boosting visit to Portsmouth last week, which was welcomed by everyone? In welcoming the development of nurse practitioners, may I ask the Minister whether that will give nurses the authority to cope with the MRSA problem that affects most hospitals?

My right hon. Friend the Secretary of State raises the morale of everyone in the NHS wherever he goes. My hon. Friend makes an important point about MRSA. The chief medical officer published a set of proposals last week that will help us to get on top of what we accept is a serious problem for the NHS. I agree that a key way in which we could make a significant improvement would be to develop the authority and role of nurses, which is precisely what modern matrons are doing in our hospitals today.

What the latest average waiting time is for a scan for patients with a suspected stroke. [142548]

The information is not collected centrally. The target in this area is to achieve a CT or MRI scan in less than 48 hours. The 2001–02 national sentinel stroke audit reported that more patients than ever had had brain imaging, with at least 83 per cent. meeting that target.

I hope that the Minister is not complacent about those figures because they mean that almost 20,000 people did not receive the required service in the required time. As such targets are part of the national service framework, does the fact that the information is not monitored centrally mean that NSFs are not worth the paper that they are written on?

I do not think anyone in the Chamber or outside it will give any credence to that line. One target in the priorities and planning framework for 2003 to 2006 requires the establishment of specialist stroke services by April 2004, which are important in all hospitals that care for people who have a stroke. At least three quarters of hospitals already have specialist stroke services. The local delivery plans show that 94 per cent. aim to meet that target soon.

Will the latest average waiting time for a scan for patients with a suspected stroke be recorded in the national programme for IT in the health service, the contracts for which have been signed with unseemly haste despite the concerns of many in the industry? Can the Minister confirm whether a significant financial bonus has been given to the director general of IT, Mr. Richard Granger, for signing the contracts by a specific date?

I am surprised at the hon. Gentleman's line of questioning. The third national sentinel stroke audit said:

"there has been a revolution over the last few years."

Is the Minister aware that if someone has a stroke at the back of the head, it affects their balance, and that the test for that reveals whether someone has multiple sclerosis or has had a stroke? It is assumed that if a person is young, he has MS, and that if he is old, he has had a stroke. That is not exactly scientific because there are other possibilities. The proper way to diagnose people in those circumstances is to do a scan. It is important that that service is developed throughout the country.

I am enormously grateful to my hon. Friend for improving my medical education further. That is a useful point. The number of scanners has grown considerably since 1997. Altogether, the number of MRI scanners is expected to increase from 110 in 1997 to 276 by 2004. That is an increase of 151 per cent.

): The Minister referred to the national sentinel stroke audit, which said that only 27 per cent. of stroke patients spent the majority of their time in a specialist stroke unit. Does she agree that what matters most is the character of the specialist unit and whether patients spend time in it? What milestones or targets does the priorities and planning framework suggest for the proportion of patients who receive specialist care?

By next April, 95 per cent. of all hospitals will have specialist stroke services. I agree that it is important that services are appropriately tailored to meet patients' needs. We are investing in the NHS to make such provision available, which we base on best practice, spread across the service by the Modernisation Agency. That allows patients to receive the standard of care that Labour Members think they deserve, backed by the investment that will deliver that standard of care.

If he will make a statement on the change in the number of care home beds since 1997. [142549]

In 1997, there were 534,410 care home beds. In 2001, there were 528,000 beds in England. Data on care home capacity have not been collected by the Department of Health since 2001, but data collected independently by Laing and Buisson indicate that at July 2003 there were about 10,000 vacant care home places in the United Kingdom.

Does the Minister acknowledge the figures published by Laing and Buisson last summer, which show that capacity in the care home sector—throughout all sectors—was 74,000 places lower than the peak in 1996? Does he really believe that this catastrophic loss of care home places is of the care sector's own choosing? When will he admit that care homes are closing because the Labour Government's illthought-through policies are forcing them to do so?

Care home places are being lost because older people do not want to go in them. We are giving people choice. There are 81,500 people receiving intensive care home packages so that they can stay at home. If the hon. Lady studies the performance indicators published only a couple of weeks ago, she will find that we have increased the number of people being supported at home by 30 per cent. since 1998. We are giving older people choice. The Conservative party wants to force them all, against their will, into care homes.

Does my hon. Friend agree that a continuing concern about the provision of care for the elderly—particularly in respect of elderly care beds—is the artificial divisions that exist between the national health service and social services? Is it not time that the Government redoubled their efforts to encourage these authorities to merge and to establish care trusts for the elderly so that the necessary focus can be placed on the comprehensive requirements of the elderly when they are in need of care?

I very much agree with my hon. Friend. Care trusts to support older people are a valuable tool. I encourage any local council and primary care trust looking for opportunities to improve care for older people to think carefully about building up the partnerships, co-operation and trust that are necessary to improve working, and then to cement those partnerships by forming a care trust that can deliver the comprehensive service that I know my hon. Friend supports.

The care home sector will be deeply distressed that the Minister seems to be in total denial of the crisis in care. At a time when care homes are under severe financial pressures, will he tell us what justification there is for the fact that an enhanced check fee that was £12 per check in April 2002 will, by next April, have risen 175 per cent. to £33, placing more financial burdens on care homes? It will be seen by many as another stealth tax.

I am surprised at the hon. Gentleman and his constant attacks on Criminal Records Bureau checks. If we ever needed any confirmation of why such checks are necessary, we saw it recently in the "Panorama" programme. That is what the Government have implemented—[Interruption.]

Order. Let the Minister answer in his own way.

Thank you, Mr. Speaker.

May I encourage my hon. Friend to concentrate on the care that most of my elderly constituents prefer to receive—domiciliary care? Will he ensure that social services departments are capable of providing the high-quality care that people need when they are living at home?

My hon. Friend is right. I am glad that at least on the Government Benches we are consistent in our support for the choice that 80 per cent. of elderly people tell us that they want to make, which is to stay in their own homes. We must work much harder to ensure that social services are aware that people want to make choices and that they have all the facilities that they need at their disposal to make such choices a reality for everybody.

Does the Minister realise that his claim that care homes are closing because elderly people do not want to go into them will sound risible to people in west Kent, where all the care homes are full and elderly people have to be shipped off to the south coast because homes are still closing? Does he acknowledge that one reason why they are closing is the pattern of condescending regulation imposed on care home managers, such as the requirement for experienced care home owners and managers to do a four-year national vocational qualification in management, despite the fact that they have been running perfectly good homes for many years?

It is our intention to drive up standards in care homes. The hon. Gentleman represents Tunbridge Wells, so may I suggest that he read the last edition of Caring Times, in which he will see a report from a property consultant saying that the care home market has turned around, and that a care home in his constituency was recently sold for far more than the asking price because serious investors are coming back into what they regard as a healthy marketplace. I am sure that the shadow Secretary of State, the hon. Member for South Suffolk (Mr. Yeo), will confirm that fact, because he has a declared interest in the care home industry and is presumably making good money out of it.

How many people infected with hepatitis C through NHS treatment will benefit from the ex gratia payment scheme. [142551]

Work on the detail of the scheme is ongoing, so the exact number of potential beneficiaries is not yet known.

I am sorry that the number is not known, but does the Minister agree that, despite the goal of patient choice, those people had no choice? They were infected as a result of a mistake by the health service, and should all be compensated. Some of them have died, but their relatives have not been compensated either.

Because we recognised that there were compassionate grounds, my right hon. Friend the Secretary of State announced that, in principle, he would introduce ex gratia payments on compassionate grounds for patients infected with hepatitis C following treatment with contaminated blood and blood products. A scheme is currently under construction.

I hope that my hon. Friend noticed that the annual "Carpet of Lilies" campaign was held last week by the Haemophilia Society and that, sadly, we presented 232 lilies to No. 10 Downing street last week. I hope that she will take into consideration the fact that the relatives of the 232 haemophiliacs who died as a result of contracting the hepatitis C virus deserve compensation. All HCV strains are rather miraculous, as they mutate rapidly and even disappear. so will she take into account the fact that although people contracted HCV years ago they may not be HCV-positive today? However, because of the trauma that they have suffered they still deserve compensation.

First, may I extend our sympathies to everyone who has suffered as a result of contracting hepatitis C, and say that we were aware of the "Carpet of Lilies" day last week? Secondly, we are well aware of a number of concerns expressed by my hon. Friend about the proposed scheme. We are in discussion with the chairman and chief executive of the Haemophilia Society, who have also met my officials in the Department. We are considering those concerns, but the fact is that we have to decide how to use the money to the best effect. As with all things, it is not an unlimited pot.

:If he will make a statement on plans for provision of local treatment centres. [142552]

The national health service is developing a large number of new treatment centres, which will enable more patients to receive more operations more quickly. The programme will also enable the NHS to offer patients a greater choice about where they are treated.

Is my right hon. Friend aware that for many years we have had a severe shortage of hospital beds in north-east London? In my own trust —Barking, Havering and Redbridge Hospitals NHS Trust —we have an average 98 per cent. bed occupancy. Will my hon. Friend join me in welcoming the decision by my local trust and the Anglo-Canadian Group to establish from March 2005 a treatment centre on the King George hospital site in my constituency, which will treat 12,000 elective surgical patients every year? Will he join me in acknowledging that that is another example of success and investment by the Labour Government?

Yes —[Laughter.] Indeed I will, but the proof of the pudding is not whether the Government give accolades or whether those on the Opposition Front Bench laugh and sneer; it is whether the people who are receiving treatment from the national health service in my hon. Friend's constituency get a better quality service quickly, in greater numbers than before. As he points out, there is no doubt that that independent sector treatment centre, which will treat an average of 11,800 patients a year over five years, will be a major boon and another indication of the results of the investment that we are putting in. Incidentally, 4,300 of those treatments will be additional operations. The proof of the pudding is in the eating, and our investment will not only give a better quality of service to patients, but mean that the vast majority of people, rather than just the rich or the privileged, can get a better choice and better quality of health care.

Does the Secretary of State agree that it is important that the local aspect of treatment centres is considered? Will he give me an assurance that, if a primary care trust votes against a diagnostic and treatment centre because it believes that it is not in the interests of local people, it will not be subject to improper pressure from the Department of Health or the strategic health authority to change its mind? Can he assure me that that has not happened, and will not happen, in the case of the South West Oxfordshire primary care trust?

If the hon. Gentleman were a cautious person, he would wait and see the outcome of the discussions in the area that he mentioned. I will be prepared to accept them, and all reasonable people will accept that local primary care trusts have to make their own decisions, but the public will want to be sure that those decisions are based on the interests of local patients and are not unduly influenced by the interests of local providers and producers, especially consultants. It is essential that in all these decisions the interests of patients are put first. That is why we are achieving such success in improving the national health service.

What contribution to the policies of his Department on controls over secondary smoking in public places has been made by the chief medical officer for England. [142553]

The chief medical officer's annual report that was published in July, which highlighted second-hand smoke, is an extremely valuable contribution to the debate on this important public health topic.

As chair of the all-party group on smoking and health, I welcome the present taxpayer-funded campaign highlighting the dangers of second-hand smoke, but regret the reluctance of the Government to abandon the failed voluntary approach on these matters. Should we not follow the imaginative legislative example of New Zealand and others listed in my early-day motion 225? Is it not the Secretary of State who is the outrider on these issues, not the chief medical officer?

The chief medical officer is certainly no outrider, nor is the Secretary of State. We have done 98 per cent. of what the chief medical officer advised with regard to smoking. We have introduced a world-leading smoking cessation service, an education campaign with a specific hard-hitting campaign on second-hand smoke, a ban on tobacco advertising and new health warnings on tobacco. Let us be clear. The chief medical officer's role is to provide medical advice, and we as politicians have the responsibility for balancing that advice with protecting the freedom of individuals.

What estimate has the Minister made of the loss of revenue for each percentage drop in smoking in the population at large? What proposals does she or the Chancellor have for making good the revenues lost every time people stop smoking?

That is a matter for the Chancellor, as the right hon. Gentleman knows. Let us not forget that taxation has been crucial in encouraging many people to kick the habit and better still, never to start. For every 10 per cent. increase in price, there is a 3 per cent. fall in smoking. Also, we have funded over 1,000 extra Customs officers and a national network of X-ray scanners to combat smuggling, so we have made considerable progress. The high price of cigarettes in the UK is a contributory factor to that success.

If he will make a statement on NHS funding for Milton Keynes. [142554]

The resources available to Milton Keynes primary care trust will increase over the next three years by £47.8 million or 31.3 per cent. It is for primary care trusts in partnership with strategic health authorities and others to determine how best to use their funds to meet national and local priorities.

My constituents welcome the generous extra funding that Milton Keynes has already received, but the Minister will be aware that it is one of the Government's housing growth areas and we are concerned about future health spending. In particular, given that health funding is set for a three-year period based on the population figures in year 1, we are concerned about how future health funding will take account of the very fast population growth in our area. Will the Minister consider a special mechanism for Milton Keynes to meet those growth problems, and will he ask the Secretary of State for Health if he would be prepared to meet me and my hon. Friend the Member for Milton Keynes, North-East (Brian White) to discuss the issue in more detail?

Yes, of course we are happy to discuss with my hon. Friends any aspect of the funding formula for primary care trusts. I add two brief comments to what my hon. Friend said. It has benefited primary care trusts to have three-year allocations because that has allowed them to plan more effectively how to use those resources to the maximum effect. Making three-year allocations has been a positive rather than a negative step for the NHS, but any change to the funding formula has to apply equally and fairly to every primary care trust. That is at the forefront of our minds, but we are happy to discuss in further detail any of my hon. Friend's concerns.

If he will make a statement on the incidence of infections acquired in NHS hospitals. [142555]

We believe that around 9 per cent. of hospital patients acquire an infection while in NHS hospitals. The chief medical officer has published his report on how to prevent and reduce hospital infections, and my right hon. Friend the Secretary of State has accepted the recommendations in full. We are confident that that will improve patient care in this area.

Is the Minister aware that the Secretary of State's refusal to make a proper statement in this House about his initiatives to tackle a problem that kills between 5,000 and 20,000 of our constituents every year is a disgrace? Is it because the initiative that he announced on the "Today" programme on Friday when the House was not sitting was treated with derision by doctors in my constituency who say that appointing another layer of management to an already over-managed health service is not the way to bring back the Florence Nightingale culture that we need?

On the right hon. Gentleman's first point, I am surprised that he should make such a statement. He knows very well that if this were new policy it would have been brought to the House. It is not new policy; it is a review of the policy that is being carried out, and my right hon. Friend has written to him to that effect. The right hon. Gentleman might like to think what effect his policy of compulsory competitive tendering had on hospital infection rates—

Order. It is not for the Minister to worry about such matters.

In contrast to the right hon. Member for Hitchin and Harpenden (Mr. Lilley), I welcome the announcement that was made last Friday, particularly in view of the problems being experienced at Barnsley district general hospital. The cleaning contractor, Initial Cleaning Services, has this year had a turnover of 200 staff and has about 40 vacancies on the cleaning contract. It was recently forced to admit that it had lied to the hospital management about the methods that it was using to clean the hospital. Do we not need such an initiative to keep in check companies that abuse their contracts within the NHS?

My hon. Friend is right to draw attention to the weaknesses of the policies introduced by the previous Administration. I am also glad that he has welcomed this initiative, which is not about introducing new bureaucracy but about ensuring that a health care professional has the authority to put together all the various issues, including hand washing, the environment and the design of buildings, to ensure that such infections are brought under control.

What his policy is on the proximity of maternity services to patients. [142556]

It is up to local health organisations, working with their communities and other local partners, to provide high-quality maternity services that are as safe and as accessible as possible to women and their families.

The Secretary of State has noticeably failed to answer the question. which was about how close maternity services should be to patients. He will know that, thanks to chronic underfunding by this Government, the Kennet and North Wiltshire primary care trust is consulting on the closure of maternity services both in Malmesbury and the constituency of my right hon. and learned Friend the Member for Devizes (Mr. Ancram). Does the Secretary of State acknowledge that it is important that at least antenatal and post-natal services should be situated as close as possible to the women concerned? Will he intervene with the Kennet and North Wiltshire PCT to try to ensure that it provides precisely what he has previously said he would like to see—services at close proximity to the women concerned?

Of course, it is absolute nonsense to speak about reduced input, investment or finance being provided when this Government have provided historically high levels of finance. We want to see maximum choice and access for women and maternity services, but it is not possible always to maintain every single unit. The hon. Gentleman talks about Malmesbury, which is a very small maternity unit. Fewer than two births a week occur there and the total cost is almost £7,000 a birth, which is many times the cost of other births, even in the same area. Of course, we want maximum access and choice, but the primary care trust in the hon. Gentleman's area has a responsibility to ask itself whether that money is best spent in that fashion in that area, thus depriving other services. I think that the trust is conducting the public consultation very responsibly, and I only wish the hon. Gentleman was acting as responsibly.