If he will make a statement on the ranges of expenditure in 200–02 by (a) acute trusts and (b) primary care trusts on salaries to non-NHS nurses, midwives and health visitors. [148784]

Expenditure on non-NHS nurses, midwives and health visitors by NHS trusts in 2001–02 ranged from nil to £17.7 million, with an average of £2.1 million. The range for PCTs was nil to £2.1 million, with an average of £150,000.

Does the Minister agree that a high spend on agency nurses carries with it a possible adverse effect on the continuity of care, and therefore on the standard of care? Is it not therefore unwise to have included in the list of trusts for foundation status the two with the highest spend on non-NHS or agency nurses?

We recognise that there is a continuing need for agency staffing as a result of the fast expansion in NHS services, but it is also important for the NHS to Supply—

Order. The hon. Member for Bosworth (Mr. Tredinnick) must be seated.

It is also a matter for the NHS to supply more staff itself. We are therefore working to reduce the costs involved, and to increase the role of NHS professionals in this regard. Currently about 40 per cent. of trusts are involved, and many more may see the advantage both to standards of care, as the hon. Member for Wyre Forest (Dr. Taylor) says, and to the cost benefits of using NHS professionals in future.

On the question of agency midwives, there is a shortage of NHS midwives across the country. Will my hon. Friend consider the suggestion from the Royal College of Midwives to provide midwives with a £10,000 bursary? Will she also consider giving graduate midwives maternity pay, because when they are on a bursary, they do not get it? The midwives who deliver other people's babies are therefore not getting any money for themselves when they go on maternity leave.

I agree that it is important that there should be more midwives, and I recognise that there are still needs in that area of the NHS. Lively discussions are taking place on the arrangements in further and higher education, and perhaps it would be best to get through those discussions before we move on to the suggestions that my hon. Friend has made. We will, however, bear them in mind when considering future developments.

Does the Minister agree that it is not only expenditure on health visitors and midwives that we should be looking at? We should also consider expenditure on a whole range of integrated health care services, given that 75 per cent. of the population want a wider range of services, including herbal medicine, acupuncture, osteopathy and chiropractic, which is effectively in the mainstream now. What is the Minister doing to ensure that, in this new world of greater consultation, she is listening to what the patients want?

I hope that the hon. Gentleman will accept that it is also important to see big increases in expenditure and doctors in the NHS as well as recognising a wider role for other services. I am sure that he will want to congratulate staff in his own constituency, where there have been big increases in numbers and in the projects that have been built in the acute sector, along with the completion of new hospital facilities. We all owe NHS staff many thanks for the work that they do.

The Minister will be aware that last year, for the first time, more than half the new entrants to the nursing work force were from overseas. The Government will also be aware that their own code of practice on ethical recruitment, although adhered to by NHS trusts, has not been signed up to by all the agencies that the NHS uses to recruit nurses from overseas, and that, partly as a consequence of that, Britain has taken about 7,000 nurses from South Africa since Nelson Mandela first pleaded with us in 1997 not to do so. If the Minister accepts that poor countries need their nurses even more than we do, and given the current reliance on agency nurses in the NHS, when will the Government stop poaching nurses from developing countries and ban the NHS from dealing with agencies that do not sign up to their own rules?

The hon. Gentleman is barking up completely the wrong tree. We only use agencies that have signed up to the protocol and code that we support, which involves recruiting staff only from countries that are happy to supply surplus staff in conditions under which the code operates. What the hon. Gentleman alleges is therefore completely untrue. The only staff working in the NHS are working under those arrangements.

What measures he is taking to improve access to speech therapy services. [148785]

The number of speech and language therapists employed in the national health service has increased by 22 per cent. since 1997, and the number of people in training has increased by 31 per cent. since 1999–2000. These are significant improvements on the very difficult position that the Government inherited, and we are driving further improvements by encouraging service re-design, by developing joint working between health and education, and by developing the roles of support staff to make the best use of professional skills.

I thank the Minister for that reply, but he may be interested to know that the Barking and Dagenham primary care trust has found it impossible to recruit speech therapists for a number of years, so it is quite unable to meet the demand. What hope can he extend to my constituents Mr. and Mrs. Handley for their son Ross, and Mr. and Mrs. Mee for their daughter Courtenay? Their children are simply not receiving the speech therapy that they so desperately need.

I should point out that although Barking and Dagenham may currently be having problems—I would be the first to admit that things are not yet as good as I would like them to be—the situation is a lot better than it was in 1997, thanks to the fact that there are now 1,090 more speech therapists working in this country, and thanks to the 32 per cent. increase in training places. As a result, there is hope that the hon. Lady's constituents will, in future, be able to find the speech and language therapy that they need.

I represent a constituency in the London borough of Havering—the same borough as the hon. Member for Upminster (Angela Watkinson). It is true that there is a shortage of speech therapists going back some years, particularly in outer London. That shortage is certainly connected to the high cost of living in the south-east. I recognise what my hon. Friend says about the increase in training provision and in the number of speech therapists, but can something be done to address this specific problem in the south-east, where the cost of living affects the recruitment of speech therapists?

My hon. Friend has made a very constructive suggestion that the local primary care trust certainly needs to explore. We are looking at service design and at different ways of working to improve the efficiency with which we use speech and language therapists. We are also looking at the use of support workers to achieve better value for money from speech and language therapists, but my hon. Friend's suggestion about the efforts in which the PCT ought to be engaging is a very constructive one.

Speech therapy is among the many services provided by the head injuries unit at the Townlands hospital, in Henley. How is it possible, at a time when this Government are allegedly pumping umpteen billions into the NHS, that it should be seriously contemplated that that hospital close? Will the Minister do everything in his power to live up to his Government's promises and stop the closure of this valued and much-loved local hospital?

The reconfiguration of hospital services, as the hon. Gentleman perfectly well knows, is a matter for local decision. We have devolved these matters to local areas so that local people can be involved in local decisions. If I were in a position to ask the hon. Gentleman the sort of question that he has just asked me, I would ask him how many speech and language therapists there would be if we carried out his plans to cut spending by 20 per cent.

What estimate he has made of the total projected deficits in NHS trusts in England for the end of this financial year. [148786]

Audited information on the financial position of national health service trusts will be published in their individual annual accounts. These data will be available centrally in the autumn. We have no plans to publish unaudited information.

I thank the Secretary of State for his response. Does he agree that many strategic health authorities, primary care trusts and acute trusts are suffering from years of underinvestment? Will he tell the House what assessment he has made of waiting times and of the number of beds and operations, in terms of requiring acute trusts such as my own, which I understand has a deficit of £8 million, to achieve financial balance in the year 2003—04?

I accept the hon. Gentleman's assertion that for many years—indeed, for decades—the NHS had been suffering from underinvestment. That is why the largest and longest ever sustained increases in investment under this Government are only now beginning to show distinct improvements: to some extent, trusts have been back-filling for the underinvestment that occurred in the years of the previous Government. I know that trusts in the hon. Gentleman's own area—Epsom and St. Helier, for instance—have been forecasting a deficit position for several months. However, with additional support provided by the local strategic health authority and local primary care trusts, it is expected to break even by the year end.

Is my right hon. Friend aware that some of the budget problems can arise, as in Chorley, where there has been a huge increase in population that has not been reflected in the NHS budget? We are talking about 10 per cent. growth year on year, so what can we do to ensure that the budget reflects that population growth?

As my hon. Friend knows, in the last internal redistribution of moneys to NHS trusts throughout the country, we tried to take a number of factors into account. For instance, need has now become a more important benchmark than in the past, which has affected the redistribution. In the next round, in addition to need, I shall have regard to demographic trends. If my hon. Friend can point me in the direction of any inequities of distribution resulting from under-assessed demographic trends, I shall certainly bear them in mind.

Everyone knows that more money is being spent on the national health service, and, alas, everyone knows that far too much of that money is not reaching the front line. That is why a 37 per cent. increase in spending has produced only a 5 per cent. increase in activity. Will the Secretary of State now admit that many individual trusts do indeed face deficits as they approach the year end—including the trust where the chairman of the British Medical Association himself works? James Johnson warned in the autumn of a possible £7 million deficit in his trust's budget. Is it not the case that tackling that problem at the individual level can only be done at the expense of services to patients in areas that are not covered by one of the Government's numerous targets through which the Secretary of State determines the priorities that local managers have to follow?

I know the hon. Gentleman has double the jobs of anyone else, but he must try to get to grips with at least half of his portfolio—the health service. It is absolute rubbish to say that there has been a 37 per cent. input and a 5 per cent. output in productivity. [HON. MEMBERS: "Your figures."] They are not our figures. They are figures that relate only to hospital consultants. They ignore, for instance, the 42 NHS walk-in centres and the 6.3 million calls made to NHS Direct—completely new services, only in existence for the past few years. They even regard the 25 per cent. reduction in deaths from coronary heart disease—because they result not from hospital consultants but from new drugs—as a fall in productivity in the health service. How perverse is that? The hon. Gentleman should at least give credit to NHS staff by accepting that in millions of ways—through NHS Direct, walk-in centres, more operations being performed in primary care trusts, better purchases of drugs, a 25 per cent. fall in mortality from cardiac-related disease, a 10 per cent. reduction in deaths from cancer—[Interruption.] Conservative Members sneer, but they should give some credit to NHS staff.

When the forecast for debts for NHS trusts is considered, what part will the strategic health authorities play in ensuring that such debts are not incurred? Will the debts of any local trust influence the future building of new hospitals in that area?

As I said earlier, we are confident that each trust, and indeed the NHS as a whole, will be in a position of balance at the end of the year. As in every business, certain trusts will be under pressure and will face temporary deficits. The rule is that they must be in balance over a cycle of up to five years. In the interim, they will be assisted either by savings found inside the trust in forthcoming years, or from the local strategic health authority, or from the primary care trust or from the NHS bank. That is perfectly normal business practice in the outside world. The NHS as a whole, and the individual trusts to which my hon. Friend refers, will be in balance by the end of the year.

I accept that the Government are desperately trying to reduce waiting lists and provide operations and treatment for those whose lives are in danger. However, if, after audit, it is clear that a hospital trust has created a deficit for itself because it has been doing precisely that—treating the people who need to be treated and providing life-saving operations and treatment—will the Secretary of State ensure that that trust has the resources so that it does not have to turn away those who need urgent treatment to save their lives?

Yes, of course. The point of the vast increase in resources that we are putting in is to enable more people to be treated more quickly across a whole further range of services. That is precisely what we are doing. When the hon. Member for South Suffolk (Mr. Yeo) attacks targets from the Opposition Front Bench, he forgets that, although the targets are general, they apply to what people want. They include reducing deaths from heart disease and ensuring faster access to heart surgery and clot-busting drugs. Which of those targets does the hon. Gentleman disagree with?

If she will make a statement on progress in implementing the new arrangements for patient and public involvement in the NHS. [148787]

If he will make a statement on the new arrangements for patient and public involvement in the health service. [148791]

Ninety-nine per cent. of places on patients forums have been filled. Every local authority has a health scrutiny committee, every trust has a patient advice and liaison service, there is independent support for complainants and thousands of people have applied to become members of the first wave of foundation trusts. Those changes give real control and influence to NHS patients.

I thank my hon. Friend for that answer. Will she accept my tribute to the Mid Staffordshire community health council, which has of course been compulsorily retired? It was always active and effective. May I tell her about my work to learn the new arrangements for patient and public involvement in Stafford, which has included meeting the senior managers of all the trusts? I have met Vanessa Day, the primary care trust patient advice and liaison service officer. I officially opened the PALS office at the hospital at Stafford, where I met Mandy Gibbs and Samantha Edmonton. I have also spoken to the forums co-ordinator Peter Goodman—

Order. The hon. Gentleman must ask the Minister a question, not tell us what he has been doing. I know that he is a hard-working Member of Parliament, but it is not the purpose of a supplementary question to tell the House that.

Does my hon. Friend agree with my conclusion that the new system is decidedly more comprehensive, modern and responsive than what went before?

I am grateful to my hon. Friend for playing such an active role in encouraging patient and public involvement in the NHS. He may recall that I wrote to all hon. Members on 1 December, informing them of the new arrangements and encouraging them to play exactly the part that he has played. I, too, pay tribute to the work of members of the CHCs and am glad that about 25 per cent. of former CHC members are now on patients forums. We have to build on the best practice that they showed us previously.

Is my hon. Friend aware that the all-party group on community health councils hopes to re-form tomorrow as the all-party group on patient and public involvement in health, to work with the Commission for Patient and Public Involvement in Health to support the new arrangements to which she and my hon. Friend the Member for Stafford (Mr. Kidney) referred and to ensure that the voices of NHS users are heard in the provision of services, to which the Government have committed record levels of investment? Would my hon. Friend like to come to a future meeting of the group?

I thank my hon. Friend for that invitation and I should be delighted to meet the group. I know that my hon. Friend has always played an active part in these matters; I believe that she herself was a member of a CHC before 1997. As I said, it is important that we in Parliament not only do everything that we can to encourage people to get involved in determining the provision of local health services but also that we thank them for the time that they give voluntarily. I should be delighted to accept my hon. Friend's invitation.

I welcome the voluntary help that is being given, but does the Minister agree that in appointing non-executive directors we must ensure that they are equipped to deal with the issues that trusts require, and that they have business and other skills? The Minister mentioned complaints procedures. Is there not a danger that many people are complaining not because they want to but because when public representatives raise issues with trust boards and hospital authorities, they are told that the questions cannot be answered unless people make an actual complaint? Surely, that does not help the health of the nation.

The hon. Gentleman will be aware that an independent body undertakes appointments.

Without disclosing to the hon. Lady the contents of my diary, may I ask her to tell the House what the new arrangements are for mentally ill patients and the huge increase in the resources of the medical profession that they are taking up? Will the new arrangements also take into account the implications of the working time directive for doctors and nurses with mental health qualifications, who are spending huge amounts of time and resources? Will we need more doctors as a result of the directive?

Obviously, challenges lie ahead in that direction, and the Department as a whole is considering the issue. It will be for individual patients forums to look into the arrangements made locally, in conjunction with both acute and primary care trusts.

Anyone involved in public consultation on health knows that when an issue is big enough we can easily fill a room, but that it can be dispiriting to turn up to a meeting in a cold room on a Thursday night to find that only three people have attended. I am sure that it is not my hon. Friend's intention that the new public involvement in health excludes public consultation, especially on major issues such as the reconfiguration of hospital services. I, too, want to see greater ongoing public involvement in the health service, but can she reassure me that the new arrangements will not reduce public consultation when a matter concerns the whole community?

I agree with my hon. Friend. There are two ways of achieving that under the new system. First, the patients forums can set up separate sub-committees to consider particular issues of local involvement—[Interruption.] The Opposition sneer, but it is important that people get involved. We know that there is interest and that, for example, more than 1,000 extra people applied for places on patients forums. It is important that Members of the House do all that we can to encourage that. Secondly, overview and scrutiny committees will also have a consultative role, which they did not have before, particularly to consider the reconfiguration of services. Put together, that will increase consultation and encourage the type of involvement that we want.

The Minister will know that community health councils in Wales have been retained and, indeed, strengthened. What arrangements are in place to ensure that the NHS in England can learn about the rather more progressive practice in my country?

I am sure that the commission will take every opportunity to learn any relevant lesson from the Welsh situation. As I have said, we want to build on the best that community health councils provided. However, it is true that the service was patchy in some areas. We have tried to have a system that has national standards, so that we know that the same service will be available everywhere not only to consult patients, but to have a robust complaints procedure.

If he will make a statement on the reprovisioning of Aston Hall hospital. [148788]

Derbyshire mental health services NHS trust—together with the local social services authorities, Greater Derby primary care trust and the Trent strategic health authority—remains committed to the re-provision of services at Aston Hall hospital and to minimising any further delay.

I thank my hon. Friend for that response. Obviously, there has been a slow deliberate process, and rightly so. Very sensitive people live in the hospital at the moment, and they need to be re-provided for appropriately, which takes time. One major outstanding concern is the future of the leisure centre and the hydrotherapy pool, which are used both by residents and by external visitors to the site who need that kind of care. Will he ask his officials to consider very carefully how that existing service can be maintained or re-provided appropriately?

My primary concern, of course, has to be with the closure of the long-stay hospitals and ensuring that the people who are left in them at the moment, who have very complex needs, are properly managed and that their transfer takes place in the most efficient and beneficial way for them. That is also the concern of the local authorities in respect of Aston Hall. How some of those community facilities that are currently provided in the Aston Hall building are subsequently provided is a matter for local decision, rather than for me, but I will certainly ensure that my hon. Friend's concerns are passed on to the local authorities that have to make those decisions.

How many general practitioner vacancies there are in London; and when he expects Greater London to have sufficient GPs to meet residents' needs. [148789]

Between April 2002 and March 2003, a total of 459 general practitioner posts were advertised in London. Overall, NHS primary care capacity is expanding in London. There has been an increase of 175 GPs in London since 1999, London primary care trusts are planning to recruit more than 200 additional GPs by March 2006.

Given that the Minister will accept that people, especially the homeless and people with particular needs, still face considerable problems in some areas in initially finding a GP and finding another GP if they are removed from a list, will he think of an initiative—for example, talking to the teaching hospitals in London—to encourage those who graduate to come and do a period as a general practitioner in London, even if their long-term career plan is to work in hospitals elsewhere?

Yes, I will certainly do so, and I will let the hon. Gentleman know of the proposals that the chief medical officer published last year for reforming postgraduate medical education and training in England, which will provide a welcome new focus on training more doctors in a primary care setting. I hope very strongly that that will ensure that more doctors coming out of our medical schools will want to pursue such training. I will certainly pursue the hon. Gentleman's suggestion.

My area has a high vacancy factor, but that is not the only problem that we face. We also face the difficulties of many single-handed practices and the lack of the broad range of services that can be provided locally. What action will my hon. Friend take through the new GP contract to deal with some of those shortcomings in services provided by single-handed GP practices?

I am grateful to my hon. Friend. I would be the first to acknowledge that there are still problems in many parts of London in recruiting the primary care staff whom we need. However, we are making progress, including progress in his constituency. The new general medical services contract will certainly help matters. It is a more flexible contract that does not tie resources precisely to the number of GPs currently in post, but instead tries to ally the needs of communities with their resources. It will give primary care trusts greater flexibility and will be allied with a 33 per cent. increase in resources for primary care. That, too, will address my hon. Friend's concerns.

If he will make a statement on sexual health among young people and teenagers. [148790]

The Government are determined to improve the sexual health of young people and teenagers through strategies to reduce unplanned pregnancies and sexually transmitted infections, and to modernise services.

Is the Minister aware that research from Harvard university, no less, shows that the safe-sex message about using condoms has had the opposite effect to that intended? It has resulted in more sexual activity with multiple partners and an increase in sexually transmitted diseases, and it has driven the AIDS pandemic. Bearing in mind the fact that one in 10 young women in this country are infected with chlamydia, which can lead to infertility if undetected, that syphilis rates have risen by 500 per cent. in the past six years and that gonorrhoea rates have doubled in that time, will the Government follow the example of the Ugandan Government, who have promoted the ABC campaign to highlight abstinence and faithfulness? The campaign has resulted in a 75 per cent. fall in HIV infection among 15 to 19-year-olds; that is great, is it not?

I am delighted to hear of the Ugandan Government's success. We too are pursuing successful strategies, such as the teenage pregnancy strategy. The latest data for 2001 show an encouraging 10 per cent. reduction in the under-18 conception rate against the baseline year of 1998, and the under-16 rate has declined by 11 per cent. I am not sure that I agree with the hon. Lady's suggestion that promoting the use of condoms and the safer-sex message are not working. I am sure that she will welcome the fact that our country is the only country throughout Europe, apart from Sweden, that is introducing a nationwide programme of chlamydia screening. The programme currently covers a quarter of all English primary care trusts, including that in her constituency of Congleton. We are, of course, also involved in giving high-level messages through the sex lottery campaign that has been run on television and in magazines to increase awareness of the need to use condoms to try to prevent both pregnancy and sexually transmitted infections.

I know that the Minister accepts that this is a serious matter, but does she agree that just pouring more money into sexual health services will have little impact unless it is accompanied by the notion of behavioural change?

Just say no.

Exactly. In other words, young people should be encouraged to delay their first sexual intercourse and to have faithfulness in their relationships.

Of course we believe in promoting responsible relationships, and we are giving young people advice to encourage that. A key part of our work has been to support the professional development and training of teachers and other professionals in the context of developing a good personal, social and health education programme in schools. We continue to roll out the programme, and there are plans to recruit 3,000 more teachers to qualify for the certificate from 2004–05. Ofsted is considering undertaking a survey in 80 secondary schools to determine the learning that should be disseminated. I agree entirely with my hon. Friend that the message is important. It must be coupled with advice on using condoms, and campaigns such as those that we have been running.

I wonder whether the Minister can tell us which is the greater cost: the cost of the infertility that will result from more than 1 million young women acquiring an infection with undiagnosed chlamydia by 2008, or the cost of bringing the chlamydia screening programme forward from 2008 so that it is implemented across the country as a matter of urgency.

As we are putting the biggest investment into the health service—the hon. Gentleman's party does not propose investing on anything like the same scale—we are doing the best we can to roll out the programme as quickly as possible. As I said, a quarter of all PCTs are covered. I agree that the issue is big and that the impact of chlamydia on people's health is important, particularly because it is an asymptomatic sexually transmitted infection, and because of its impact on fertility. It is for that reason that a third phase of the roll-out of the programme will take place later this year.

Is it not clear that the use of condoms is the most effective way of preventing sexually transmitted diseases and unwanted pregnancies? Is it not dangerous for anyone to advocate that that is not the case?

I am sure my hon. Friend is aware that the best way to avoid sexually transmitted infections is to abstain from sexual activity—that would have a 100 per cent. success rate. I agree, however, that we must accept the reality that that approach is not a lifestyle option that all individuals will be prepared to choose. That is why the promotion of correct and consistent condom use remains high on the public health agenda, and is consistent with the strategies that we are promoting.

Does the Minister agree that there has been a growing epidemic in STIs over the past six years, with syphilis increasing by 933 per cent., gonorrhoea by 105 per cent. and chlamydia by 141 per cent.? If the Government are serious about tackling this epidemic, surely it would be better for them to introduce a national service framework as opposed to their current strategy, which, as they have admitted, is merely a wish list.

The hon. Gentleman seems to be suggesting that we should have more targets—but he and his hon. Friends were arguing just the opposite a few moments ago. I cannot understand that. We have a proper framework in the sexual health strategy, which has standards and a commitment to funding. The funding is an extra £47 million, plus a further £20 million committed for the next two years, to tackle a wide range of issues, including chlamydia testing, to pump-prime genito-urinary medicine services, to address the problem of queues and to increase contraception and prevention work.

When will the Government have sexual health campaigns on prime-time television, so that a nation that is obsessed with sexual activity will also become obsessed with the prevention of sexually transmitted disease and unwanted pregnancies?

We are doing all we can to raise the profile. I have told the hon. Lady before that the promotion of the sex lottery campaign has been very successful, and the evidence shows that it is working effectively. It is obviously not designed to reach 50-year-old Members of Parliament, or other age groups of that ilk, so hon. Members may not have seen it because it is often on television, and in magazines, that are targeted at late teenagers and those in their early 20s—who, sadly, are underrepresented in the House.

How many performance indicators relating to cardiac treatment (a) are in place for NHS trusts for 2003–04 and (b) were in place in 2001–02. [148792]

There are five targets for cardiac treatment arising from the NHS plan. The total number of performance indicators across the whole of cardiac services, covering primary care, ambulance services, diagnosis, surgery and rehabilitation, is 37. None has been added since March 2000.

I am grateful to the Secretary of State for that response, but as the Royal Statistical Society said, many of the clinical indicators for cardiac treatment are unreliable. Even with constant quality of clinical care, there are widely different outcomes. Despite his claims to the contrary, is it not the case that too many performance indicators are still being imposed on trusts? Given that between a third and two thirds of heart attacks occur outside hospital, often within the first few minutes of the onset of symptoms, should not the Government concentrate their efforts instead on training and encouraging paramedics in the administration of thrombolytics before patients get to hospital?

As I pointed out to the hon. Gentleman, the performance indicators cover ambulance services, paramedical primary care, diagnosis, surgery and rehabilitation. I am glad that he agrees with us on that point. On the question of whether we need to take more action to try to give relief to people who feel a heart attack coming on, I agree with him, and am glad that he supports the Government's introduction of rapid access chest pain clinics. I believe that he would also support all our five targets, some of which I outlined earlier: reducing deaths from heart disease, faster access to heart surgery, faster access to clot-busting drugs, improved services for patients with heart failure, and better primary care. We appear to be almost entirely in accord, which is heartening—along with the 25 per cent. reduction in deaths from heart disease. What a pity that the hon. Gentleman wants to cut by 20 per cent. all the investment that has contributed to that.

Just over two years ago, a committee was set up in Bolton with the aim of raising £1.3 million to bolt on a new coronary care unit to the existing facilities. Will my right hon. Friend join me in congratulating the committee on its success, as the building was opened a few weeks before Christmas? Will he also thank all the members of the public who have freely given their time and money to make that achievement possible?

Yes, I have no hesitation in joining my hon. Friend in thanking those people, and I hope that he will join me in thanking the 1.3 million staff of the national health service who are doing such a marginal—[HON. MEMBERS: "Oh!"] —such a marvellous job. I have no hesitation in saying that they are doing a marvellous job. Unlike Opposition Members, I am the last to belittle their efforts, which have brought such improvements. They are doing a marvellous job in Bolton and throughout the country.

The Secretary of State will be aware that one of the principal recommendations in the Kennedy report on the tragic child deaths at Bristol royal infirmary was that we should ensure that there was adequate throughput for surgical teams engaged in paediatric cardiac surgery. In November 2002, the review group said that it would seek a minimum of 300 such operations for a surgical team of at least three consultant surgeons. Given that the Secretary of State had the opinion of an expert review group, why has he preferred his own view and rejected that recommendation?

Because it would require us to close some of the most successful cardiac centres in the country, and I am not going to do that.

Does the Secretary of State not agree that performance indicators have a role to play in pushing up the quality of cardiac care? In that context, the clinical decision unit at my hospital in Milton Keynes is now affording a route for GP referrals on cardiac disease, so that people can be referred there and thence to the wards, rather than going through accident and emergency? Would he like to confer with the hon. Member for South Cambridgeshire (Mr. Lansley), who visited that unit yesterday and is reported in the local press as commending it and its staff, as well as the efficient use of resources provided by the Government to improve health care for my constituents?

Yes, I am glad to do so. A peculiarity of Opposition Front Benchers is that they join in praise for the achievements of the Government and the staff whenever they make local visits, but condemn those achievements whenever they speak at the Dispatch Box. I certainly join my hon. Friend in congratulating everyone involved in that unit. The proof of the pudding is in the eating. There has been a reduction of approximately 24 per cent. in mortality for the under-75s from heart-related disease in five years. Surely, as there has been a reduction of almost 25 per cent. in the scandalously high figure that pertained before, even Opposition Front Benchers can find it in themselves to congratulate, if not the Government, at least the staff who have contributed to that reduction.

How many information reports by NHS trusts were made to his Department in 2003. [148794]

In 2002—03 the NHS was asked to make 123 regular information reports to the Department of Health, typically on a quarterly or a monthly basis. This compares with 134 such reports in 1996–97.

Is the Minister aware of the major concerns of the NHS Confederation outlined in its publication of December 2003, "Smarter Reporting", which states that the current system of reporting is time-consuming and poorly co-ordinated and is often viewed by those compiling the data as unnecessary? What action has the Minister taken to cut out all unnecessary requests and to carry out an audit of what Information is needed and why?

The hon. Lady is right to raise that issue. She is probably aware of the NHS Confederation's view recently expressed that the NHS is making progress in reducing the weight of unnecessary bureaucracy and administration. As my answer made clear, we have reduced the number of regular information reports that we expect the NHS to deliver to the Department and we will continue to bear down on that, but we need to strike a balance, as I am sure the hon. Lady would accept, and make sure that we have the right information which allows patients and the public to know what is going on in the NHS, allows the NHS to do a better job in improving services and, fundamentally, allows hon. Members to hold Ministers properly to account. We need to strike the right balance, and we are determined to continue to make further progress. I finish with this: in the last year of the previous Administration, 228 circulars were issued by the Department to the NHS, one famously dealing with how we should cook turkeys in NHS kitchens. Last year there were 12 such circulars, none of them dealing with how we cook turkeys.

The Minister's reply severely underestimates the number of ad hoc reports that trusts are required to furnish on an almost daily basis, as I found out when I visited my local acute hospital on Friday. The right hon. Gentleman will be familiar with the phrase that he gives hon. Members all the time in response to parliamentary questions—that the information requested is not available centrally and could only be provided at disproportionate cost. That is fair enough, but does he agree that a similar system should apply in respect of his Department? The NHS Confederation's excellent report "Smarter Reporting" proposed the idea of a yellow card. The Minister should consider that carefully, so that unnecessary data are not constantly requested from NHS trusts by the centre.

We look seriously at everything the NHS Confederation does, and I hope that the hon. Gentleman and the Conservative Front-Bench team will do so as well. Perhaps he would like to be reminded of what Gill Morgan, the chief executive of the NHS Confederation, said in response to the attack on the NHS by the Leader of the Opposition last week, when he misquoted the NHS Confederation's view. On the subject of targets, interference and bureaucracy, Gill Morgan said last week:

"We believe the tide has turned. The last two years have seen significant improvements, including a genuine reduction in the number of targets and a cull of the guidance and central directives sent from the Department to the service."

May I remind the Minister that we are not opposed to clarity of reporting? What people in the health service find demoralising are the continuous changes in reporting requirements and targets. For instance, of the 148 performance indicators last year, 51 were the same, 54 were changed and 43 were altogether new. When does the right hon. Gentleman think there will be stability in the reporting requirements for the health service?

I believe we are making progress in the right direction. I know that, to be fair to him, the hon. Gentleman is an expert on all these issues, but I am surprised that he does not have the good grace to acknowledge that. The policies and priorities framework that we issued last year for a three-year period sets out clearly the direction of travel for the NHS. The more stability we can create in the system, the better. That is what we are doing, and it has never been done before.

If he will make a statement on his policy towards community hospitals and their relationship with acute hospital trusts. [148795]

We want to see a new lease of life for community hospitals. Our guidance on service change, "Keeping the NHS Local", was published in February last year. It emphasised the important role community hospitals can play in a network of care across the whole health and social care system.

Will the Minister join me in congratulating my hon. Friend the Member for West Worcestershire (Sir Michael Spicer) on his successful campaign to create a new community hospital at Pershore, financed by Wychavon district council and built in partnership with the South Worcestershire primary care trust? Will the hon. Gentleman also reassure me that when the time comes, as it must, to redevelop and renew Evesham community hospital, its crucial role in support of the county's acute hospital will be fully recognised, and there will be no reduction in services when that redevelopment takes place?

The development of community hospitals has to be a matter for local discussion, and I am not prepared to intervene in what is still clearly a local issue. I entirely agree with the hon. Gentleman that the community hospitals in his area have an important role to play. It is important that the trust develops that role, but does so in conjunction with, and in discussion with, local people.

The community hospitals in south Worcestershire predominantly serve the rural areas to the east, south and west of the city of Worcester. As a result, my constituents in the city, as well as people north of the area in Droitwich in the constituency of Mid-Worcestershire, do not get the benefits that can be provided by community hospitals. Will my hon. Friend look favourably on any plans that may come his way to provide community hospitals in areas that cover patients in my constituency and in the north of south Worcestershire?

My hon. Friend identifies exactly why those have to be local decisions and plans must be developed locally. We have to balance the needs of different parts of any particular area to ensure that everyone is getting the services that they require. Of course I will look favourably on any plans that are put to me, but only once they have been developed by the local population to meet local needs.

What plans he has to increase the number of psychiatrists employed by the NHS. [148797]

Since this Government came to power in 1997, the number of consultant psychiatrists employed by the NHS has increased by 31 per cent. Nevertheless, we recognise that we still have a long way to go to make up for the deficit that we inherited. That is why we are planning a further increase of 8 per cent. between March 2004 and March 2006.

Sadly, I am not much comforted by that response. Does the Minister recognise that in areas such as Merseyside the shortage of psychiatrists is now so acute that it seriously threatens the community health programme?

I certainly recognise that there are challenges ahead. We are doing a lot of work with the Royal College of Psychiatrists and others to increase training places and to ensure that different working practices ease some of the burden on psychiatrists. I should also say, however, that the number of consultant psychiatrists in Cheshire and Merseyside strategic health authority has risen by 45 per cent. while the national average has been 31 per cent., and that the number of vacancies is lower there than in other parts of the country.

What is his definition of franchising in relation to hospitals and health trusts. [148798]

NHS franchising is a way of introducing new senior management teams to poorly performing NHS organisations as a means of improving their performance.

We are all in favour of improving performance. However, when the Royal United hospital in Bath was failing and it was announced that senior management was to be franchised, that was widely perceived as being a kind of stealth privatisation, the senior management all resigned, and the franchise proposals were pulled, yet when the chief executive of the Kennet and North Wiltshire primary care trust resigned through overwork and stress, it was announced that her job was to be franchised, which apparently means a job-sharing agreement with the next-door PCT. Is franchising privatisation or job-sharing—or is it just new Labour drivel?

None of the above. What a load of complete poppycock from the hon. Gentleman, who has nothing positive to say about the national health service. What happened in Bath and Bristol took place on the advice of the chief executive of the strategic health authority. The hon. Gentleman and his motley crew of Front Benchers are always complaining about micro-management by Ministers, but this was a case of the local NHS deciding how it wanted to proceed, and that is precisely how it should be done. As for the hon. Gentleman's local primary care trust, I agree—this is one issue on which I can agree with him—that we have to tackle poor performance, which we are doing by looking to strengthen management teams.

How many general practitioners are in training; and what the equivalent figure was in 1997. [148799]

There were 2,157 general practitioners in training in June 2003 compared with 1,343 in October 1997. That is an increase of 60 per cent.

I am sure that, like me, my right hon. Friend wishes to pay tribute to the general practitioners who came here in the 1970s from east Africa—Indian doctors who provided the backbone of the national health service. They are now approaching retirement. In the next five years, especially in towns where there was a large immigration of those doctors in the early 1970s, there will be a genuine problem. Will my right hon. Friend do all that he can, not only to pay tribute to those people who gave their lives to the NHS but to ensure that more doctors from the Indian sub-continent and elsewhere can come into the NHS and use their skills here for its benefit?

I certainly join my hon. Friend in paying tribute to the work of doctors in the NHS. They have done a brilliant job over many decades—indeed, many continue to do that—and we all owe them a significant vote of thanks. My hon. Friend is right that in many parts of Britain they are the backbone of primary care in the NHS. He knows the steps that Brent primary care trust has taken to expand primary care in his constituency, and I hope that he can support them. The NHS in London faces specific challenges in expanding primary care—he will be aware of that. The major capital investment programme—£350 million for London primary care services in the next two years—will help to resolve some of the difficulties that he described.