What research he has commissioned on possible links between the use of cannabis and mental health problems. [177285]

Since 2000, the Department of Health has commissioned five research projects focusing on cannabis use problems and the dual diagnosis of mental health problems and substance misuse. We also continue to monitor the worldwide research and to draw on the advice of a range of expert advisers to inform our policy.

I congratulate my hon. Friend on the current research programmes, but she will recognise that other countries such as Sweden, the USA and Holland have established a link between mental health and cannabis use. Does she agree that our knowledge of the long-term effects of cannabis use is very poor, and will she therefore start a comprehensive research programme, funded by the Government, to ensure that we are not building up a crisis for the future?

I assure my hon. Friend that the Advisory Council on the Misuse of Drugs keeps the evidence of harm from all controlled drugs under constant review. There is evidence that cannabis, like any other drug, can cause short-term paranoia and psychosis, but at present there is no clear evidence that schizophrenia, for example, is caused by using cannabis. However, the advisory council keeps that under review.

The United Kingdom's leading scientists know, because of the research undertaken here and elsewhere in the world, that the use of cannabis does in fact bring on psychotic effects and cause schizophrenia later in life. Will the Minister concede that the policy of declassifying cannabis, which has sent out mixed messages to the young, will exacerbate the problem, causing tremendous personal problems to young people and great cost to the individuals concerned, their families, the national health service and society at large?

I assure the hon. Lady that the effects of cannabis use are closely monitored and that the evidence is examined by the advisory council, which is independent. Reclassification took place only as a result of the advice received from that council, which continues to keep the matter under review.

Australia and New Zealand adopt a policy similar to ours on the classification of cannabis, but the research from their national addiction centres says that skunk, in particular, creates psychosis. Why are we not copying those good Commonwealth friends, which adopt a similar policing policy, and learning lessons from their health messages?

We certainly look at all the evidence. There is an independent advisory council to do that and we are also investing in drug treatment areas. There has been an increase of 101 per cent. in the amount of money going into drug treatment facilities, which is now £260 million, and the work force has increased up to the target by 2008 of 9,000. As I have said, we keep the matter under review, but we want to ensure at the same time that we provide proper facilities for treating people who suffer from substance misuse.

If the Minister keeps all the evidence under constant watch, she must acknowledge the research that shows that up to 80 per cent. of all psychotic cases in inner cities in this country report a history of cannabis use, and that people's use of cannabis as teenagers can make them seven times more vulnerable to developing psychosis, delusional episodes or manic depression. There are also links with the exacerbation of schizophrenia, which already costs the NHS £1 billion. Why, therefore, when the Government decided to reclassify cannabis earlier this year and spent £1 million advertising the fact, was not a penny spent on highlighting the risks of the link between cannabis and mental illness, and why has the number of drug advisers in our schools been contracting?

It is certainly not true that we do not highlight the harmful effects of cannabis. The extremely successful "Frank" campaign has particularly targeted young people, pointing out to them the serious effects of cannabis.

Does my hon. Friend agree that, while the use of cannabis does not necessarily lead to the use of other drugs, it enhances their use because it provides access to them? Is it not time that, as my hon. Friend the Member for Hamilton, South (Mr. Tynan) said, we established a proper inquiry into the use of cannabis, the reactions to it and where such use leads?

I assure my hon. Friend that we monitor the effects of cannabis, like any other controlled drug, through the Advisory Council on the Misuse of Drugs, and we will not stop doing so. We look at the evidence and the research, and we receive independent advice from the council.

What the estimated cost to the national health service was of treating those injured in road crashes in the last year for which figures are available. [177286]

The national health service has not been asked to identify separately the costs of treating road traffic accident victims. However, where such a patient receives compensation the NHS can reclaim the treatment cost from insurers. Last year, £105 million was recovered for the national health service in that way.

While I am grateful to the Minister for that partial answer, in the interests of joined-up government, might it be worth while trying to establish exactly how much the public purse is funding the consequences of road crashes? May I also suggest that he discuss with his colleagues in the Department for Transport and with the Chancellor the Exchequer how investing in making road safety a top priority might lead to a reduction in the burden that road crashes and casualties taken to accident and emergency departments place on the NHS?

We will certainly look at the hon. Gentleman's suggestion, although we need to strike the appropriate balance between that point and avoiding imposing additional bureaucracy and burdens on the national health service. The Government and my right hon. Friend the Secretary of State for Transport are committed to reducing the number of road accident events and, in fact, the number of such events is falling.

My right hon. Friend will probably be aware of the large number of accidents that involve motor cyclists. That is a particular problem in my constituency, which has beautiful countryside where boy racers and others perhaps somewhat older do not exercise good behaviour on the roads. Has his Department discussed the matter with the insurance industry to try to improve motoring standards? It could be argued that that is a primary health care issue because, if motorists—particularly motor cyclists—behaved themselves in the first place,they would not end up in hospital.

It is very important that the Government do what they can to improve safety on our roads. My right hon. Friend the Secretary of State for Transport is fully committed to doing that and we in the national health service will do whatever we can to support the work that he is undertaking.

The Minister mentioned compensation and repayments to the NHS in such cases, but what consideration are the Government giving to repayments to the NHS in cases of proven negligence—for example, when it is proven that a person has wilfully ignored a speed limit and a crash has resulted? Is there a way of claiming the money back from such individuals or their insurance companies, or—even better—of extending such a scheme to those who assist and promote the denigration of speed limits?

If an accident results in injury to an individual and the NHS provides treatment for that individual, statutory provision exists to allow the NHS to recover the costs. We have recently legislated to extend the scope of that scheme to include other types of injuries.

If he will make a statement on the progress of outstanding applications for foundation hospital status. [177288],

Applicants for NHS foundation trust status in wave 1a are due to submit applications by mid-June for my approval. I expect to take a decision shortly after publication in July of the NHS performance ratings. I approved 25 wave 1 applications earlier this year. Ten applicants were authorised on 1 April and the independent regulator will make his own decision on whether to grant authorisations for the remainder.

My right hon. Friend will know that Barnsley district general hospital has applied for foundation status to take effect from October this year, but unfortunately the hospital now faces a financial deficit of around £3 million. To make matters even worse, the primary care trust also faces a deficit of £15 million and has difficulty providing any further financial assistance to the hospital, which has itself undertaken a recovery programme to try to balance the budget. Can he indicate whether the financial requirements for trust status will take account of those deficits? Can the Government take any further action to ensure that the foundation status application will go ahead from October?

Lest anyone should have gained the false impression from the details provided by my hon. Friend that the Barnsley trust has somehow been starved of funding over the past few years, let me remind him and the House that, in fact, Barnsley PCT received an increase in funding of more than 31 per cent. over the past three years. That is much higher than the national minimum. Like every other organization—not just every trust—in the NHS, the PCT has to ensure that it achieves financial balance. Every pound wasted in the NHS means that someone dies earlier than they should or that someone lives longer in pain. Of course, when it comes to foundation trusts, we an aware of the huge benefits that foundation status will bring to local providers of health care, so there is the most rigorous scrutiny—not just by myself, but by the regulator—of financial and other matters.

Does the Secretary of State believe that the fact that many trusts are dropping or deferring their applications for foundation status because they do not understand the financial implications of the new system suggests that foundation trusts are unworkable and burdensome?

The answer to both questions is no. Trusts are not deferring in any large numbers and, secondly, applications are subject to rigorous scrutiny by the independent regulator, whose background, as the hon. Lady may know, includes not only knowledge on the medical side, but knowledge of the retail and banking sector. Above all, the regulator is well versed in assessing the financial requirements necessary to embark on freedoms for the frontline of NHS foundation trusts, which will result in far better, move sensitive, quicker and more efficient service to patients. Surely that is what we all want—more patients having more treatment, more quickly and of greater quality than ever before.

Will my right hon. Friend outline the steps taken by the Government to encourage greater membership of foundation trusts, in view of the disappointing figures on membership of the first wave? On public involvement in health, can he clarify what is happening with the Commission for Patient and Public Involvement in Health? It has been suggested that it will be either abolished or merged with the NHS Appointments Commission. Can he give an assurance that in any future arrangements for patient involvement, the independence of the various bodies concerned with patients will be defended and retained?

There were three points there. The first was about the openness to registration of members of foundation trusts. Of course, the lists do not close and they build up over a period of time. In Barnsley, for example, the trust has recruited more than 2,000 patient and public members. We would all like to see 20,000, but nevertheless, that is 2,000 more people involved in the local trust than have ever been involved before. Secondly, as far as the future of patient involvement and our commitment to it is concerned I can give my hon. Friend the guarantee that we will remain committed. Thirdly, with regard to the arm's length bodies, while we retain our commitment to involvement and to fulfilling their functions, I am going to bear down hard on the number of such bodies and organisations and the amount of money that goes to them. I have authorised a 50 per cent. cut in the number of arm's length bodies, with a 25 per cent. cut in the number of personnel in them. I have also authorised £500 million being taken from them, which will be put into front-line services. On top of all the other increases, another £500 million will be invested in nurses, doctors and better treatment.

The Secretary of State has promised an independent review of foundation trusts. Will he confirm that the review will be held and that it will report after waves 1a and 1b have taken place?

Yes, the review will go ahead and it will be honest, independent and objective. If it concludes that we have made mistakes or that there are shortcomings in the foundation trust idea or status, we will amend the errors. Equally, however, it might conclude that we have not extended enough freedoms to the front line of NHS foundation trusts. In that case, we will act on those recommendations.

Is my right hon. Friend aware of the disappointment felt when Hartlepool's general hospital failed to gain immediate foundation trust status and that the Tees health review may put a question mark over the hospital's long-term future? Will he reassure my constituents that that will not happen and that the town will retain a full and proper hospital service, for their benefit and for that of people in the constituency of my hon. Friend the Member for Easington (Mr. Cummings)?

My right hon. Friend is right to say that a review is under way. In respect of the application for foundation trust status, I shall say only that an initial failure does not mean that reapplication cannot be made in the relatively near future. I do not wish to prejudge matters, but I can tell him that Hartlepool will still have a full and proper hospital service after the review has taken place.

The Secretary of State will recall that, during the passage through the House last year of the Bill establishing foundation trusts, the Opposition said that all NHS hospitals needed genuine freedom if the best service was to be delivered. We said that, without that freedom, we would get a two-tier system. However, the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton) has told the Health Select Committee that £127 million will be available this year to compensate primary care trusts and foundation trusts for the introduction of payment by results, and that the Department has £104 million in capital to support the prudential borrowing limits of first-wave foundation trusts. That adds up to £231 million and to a two-tier system. How will the right hon. Gentleman defend that to his colleagues and to the Opposition? We said that we wanted a single tier of genuinely free NHS hospitals to deliver the best service to patients.

I am deeply moved by the hon. Gentleman's concern about my discussions with my Back-Bench colleagues. I am sure that they will be deeply moved as well by his concern about the two-tier system that could develop. I can tell the hon. Gentleman, in case he has missed the fact in his young life, that there has been a two-tier system in this country for 60 years. One tier has been the NHS, whose patients were treated with disdain by the previous Conservative Government for 20 years. Another tier was available for those who had the money, which allowed them the quick access to hospital care in the private sector that the Opposition have always supported.

What steps are being taken to reduce assaults on NHS staff; and if he will make a statement. [177289]

In December 2003, the NHS security management service published its strategy to make the NHS a safer place in which to work. The strategy has a comprehensive range of measures to tackle violence against NHS staff. These include the United Kingdom's largest ever training programme to equip NHS staff to deal with violent situations, a national reporting system for physical assaults and the establishment of a legal protection unit to work with the police and Crown Prosecution Service.

I welcome the initiatives that the Government have already taken in the area, but will my hon. Friend carefully consider the position of those NHS staff who work in clients' homes or in isolated units? What more can be done to protect them and equip them to cope with any dangerous situations that might arise in the course of their work?

I am grateful to my hon. Friend for her comments. Top-quality staff doing a top-quality job deserve a top-quality working environment, and that includes those who work in isolated areas. We are doing several things. Such staff will have the same access as any other members of staff to the advice of security management personnel and the same training in conflict resolution. They will also have additional services available, including technological assistance for lone workers that will allow them to report when they face difficulties, wherever they are when they are attacked.

It is staggering to all of us to think that a patient would ever strike NHS staff, but it does happen. It happens increasingly on Friday and Saturday nights when patients are in accident and emergency, high on drugs or drunk. Can the Minister liaise with his Home Office colleagues to ensure that hospitals and accident and emergency units get community office support and police support to protect hospital workers? Will he send a message out clearly to anyone who dares strike a hospital worker that it is the quickest way of getting from a hospital ward to a prison cell?

That is absolutely right. We must have zero tolerance of all forms of violence. We must also ensure that proper security advice is available to all hospital departments, including accident and emergency departments, wherever they are and whatever night it is. We must ensure that we deal with every single attack on an NHS staff member with the utmost vigour and that we prosecute such attacks. The hon. Gentleman will have seen that an antisocial behaviour order was recently taken out against an individual that bans him from NHS premises anywhere in the country, and that is the sort of action that we need.

Further to my hon. Friend's statement about training, can he outline the extent of that training? Will it cover all NHS staff and will it cover both conflict resolution—to reduce the occasions on which assaults may take place—and how to deal with assaults when they happen?

Different types of training will be available. For example, every health body will have to nominate an individual to be responsible for advising on security matters. Those individuals will receive very specific and detailed training in such matters. Individual staff members will get conflict resolution training of the sort to which my hon. Friend refers and we estimate that at least 750,000 people will have access to that training. It will be thorough and it will be available to everybody.

What investment is being made in the national health service in north Staffordshire. [177290]

For the current financial year, 2004–05, the four primary care trusts in north Staffordshire have been allocated a total of £478 million, an increase of £41.4 million, or 9.49 per cent., since the previous year. For the next financial year, 2005–06, the increase will be a further 9.06 per cent., taking the total allocation to £521.4 million.

The NHS is indeed making great strides in north Staffordshire, including a brand new hospital, a new medical school at Keele university and brand new health centres across the whole area. However, after the next election, will it be the Government's policy to continue to invest in that way in the NHS, in north Staffordshire and across the country, or to drive the NHS out of existence within five years?

My hon. Friend makes the point that there is a need for long-term and sustained investment in the national health service to make up for the 20 years of under-investment before this Government came to office. We will continue that investment at the present level for another four years. We will not return to the days of under-investment and starvation of our hospitals with the previous number of nurses, nor do we intend to charge patients to allow them to jump the queues on the basis of how much money they have in their pockets to contribute towards doing so. The degree of power and choice for NHS patients should depend not on the size of their wallets, but on exactly what their medical needs are. The Labour party will always defend that principle.

I pay a warm tribute to the staff at the North Staffordshire hospital, but will the Secretary of State confirm that, despite their best efforts, three out of 10 out-patients at that hospital wait longer than 13 weeks for an appointment? Will he confirm that that hospital has under-achieved in readmitting patients whose operations were cancelled for non-clinical reasons? Will he confirm that, in the past year, MRSA rates have increased at the North Staffordshire hospital? In that respect, will he confirm that the problems that they face are typical of the whole NHS—that more operations are cancelled than in 1997, that the number of hospital-acquired infections is much higher than in 1997 and that far more people are waiting far longer for serious treatments, such as radiotherapy, than before? Is it not the case that, under Labour, administrators are being hired at three times the rate at which doctors are being hired? It is no surprise that, under Labour, taxpayers have paid for a 37 per cent. rise in spending and seen a 5 per cent. rise in activity.

Five minutes ago, Opposition Members talked about their affection for NHS staff. Now, once again, they brand them all as useless bureaucrats. That is the nature of the Opposition's commitment to the NHS. I cannot confirm any of the points that the hon. Gentleman made about North Staffordshire hospital. I can confirm, however, that, under this Government, that hospital has had two new theatres, additional critical care beds, a ward for surgical patients, a doubling in its capacity for cardiothoracic surgery with a new theatre and critical care beds for that purpose, a new catheter laboratory and a dramatic reduction in diagnostic waiting times for cardiac patients and that more than 90 per cent. of patients now receive accident and emergency care within the world standard of four hours. He talks about the national picture, which is represented there, but we have 67,500 more nurses, 14,000 more doctors, the biggest building programme in the history of the NHS, a 10 per cent. cut in premature deaths from cancer, and a 23 per cent. cut in premature deaths from cardiac heart disease. All that would be ruined if that lot ever got into power again.

The information that we have just heard regarding north Staffordshire is very good news for the people of that area and for the people of Wolverhampton, because North Staffordshire hospital is very close to my constituency and the whole of Wolverhampton. Irrespective of the Opposition's carping, I congratulate our Government on that investment. May I add that we have also had major investment in Wolverhampton? We have a state-of-the-art, 21st-century heart and lung unit ready to be opened as I speak. I want the Secretary of State to assure me that it will operate to full capacity, when we have the official opening.

I can confirm that to my hon. Friend. Indeed, I think from memory that there is a new cardiac centre at Wolverhampton, but of course there will be more. The project in the North Staffordshire hospital, which the hon. Member for South Suffolk (Mr. Yeo) forgot to mention, involves another £350 million to develop a new acute hospital on the site of the city's general hospital and a new community hospital in north Stoke. All that, of course, is representative of the biggest building programme in the history of the NHS. When the hon. Gentleman and his colleagues left office, more than half the buildings in the NHS were older than the NHS. If the Government, by grace of the electorate, survive another term, by the end of it, almost half the buildings in the NHS will have been built by this Labour Government—something to be proud of.

How much extra money could North Staffordshire hospital get for its health service if it had foundation status; and what would be the extra costs of the bureaucracy and corporate governance of a foundation hospital?

The right hon. Gentleman misunderstands foundation status. Such hospitals will not get any extra money. What they will get is greater freedom to deploy their money without constantly having to obtain ratification and permission from Ministers and bureaucrats in Whitehall.

What action he is taking to reduce delayed discharges. [177291]

In January 2004, the Community Care (Delayed Discharges etc.) Act 2003 introduced a financial incentive to avoid delayed discharges. That is supported by the delayed discharges grant. The total number of patients delayed in an acute hospital bed on any one day is now about 2,900—a reduction of nearly 60 per cent. since September 2001.

The figures from my local hospital, Stepping Hill, indicate that the policy has been a great success in relation to acute wards. Essentially, that is because it has led to much better co-operation between local health and social services. However, delays in discharge are now occurring in intermediate and rehabilitation beds. Will the Minister consider making delays in discharge from non-acute beds subject to the same financial penalties as delays in discharge from acute beds, so that there is effective local co-operation for all discharges?

The delayed discharges reimbursement system has been such a huge success and has driven down delayed discharges to such a remarkable extent that, to be frank, it would be madness if we were not looking very closely at the suggestion that we extend it, not only to intermediate care facilities, but to mental health facilities. We have started that work and planning, and we shall make announcements to the House as soon as possible.

Does the Minister agree that in planning hospital discharges, it is important to ensure that the rules governing eligibility for free NHS continuing care are applied consistently and fairly across the country? Why has it taken the Government so long to begin to get to grips with the fact that 28 different sets of rules are applied in entirely different ways, with the result that people are, in effect, subject to a postcode lottery in relation to eligibility for free continuing care—care that should be available to them on the basis of their need, not of their means?

The hon. Gentleman might at least have started his question by pointing out that he was entirely wrong about the 2003 Act, which is now saving 1.5 million bed nights a year—equivalent to eight district hospitals—and which he is committed to repealing should the electorate ever be foolish enough to put his party into government. He was wrong from the start and he is wrong now. As for NHS continuing care, now before anyone is discharged from hospital they must go through the single assessment process, which includes consideration for NHS continuing care. For the first time, we will know whether anyone is entitled to such care before they are discharged.

The legislation is making a real difference to reducing delayed discharges and improving the discharge process in Sheffield. Does my hon. Friend recall that, during debate on the Bill, the Opposition spokesperson referred to it as a "nasty and flawed measure" and the Liberal Democrat spokesperson said that it "put beds before patients"? Is not the truth that the measure puts patients' needs first and only the Labour Government are prepared to take the action that puts patients first?

My hon. Friend is absolutely right. Every extra day that an older person in particular spends in an acute setting when they no longer need to be there makes it less likely that they will be able to retain their independence and return home, which is where most of them want to be. Conservative party dogma is that ending up in a care home is the inevitable consequence of old age, but we want to maintain people's independence.

If one strips all the spin and gloss from the Minister's words, one can see that the Government are fiddling the figures, basically by categorising more and more beds as intermediate and placing patients in them to meet their political targets. If his policy is working so well, why has the number of people receiving domiciliary care been reduced by 2 per cent. in the past year and by 10 per cent. over the past three years? Surely, more should be done to make sure that patients whose discharge is delayed receive appropriate domiciliary care after hospital, rather than being sidelined in an intermediate ward.

The hon. Gentleman is another person who was entirely wrong about the Community Care (Delayed Discharges etc.) Act, and has been made to look foolish for preaching doom and gloom. He said that the success of the scheme is entirely due to the roll- out of intermediate care beds, but in the six months since the shadow scheme came into effect we have reduced delayed discharges by another 1,000. How can he tie that purely to intermediate care beds, unless he thinks that we have suddenly magicked up tens of thousands of such beds around the country? The fact of the matter is that he and his party would not match our proposed spending—

Orler.

Does the Minister agree that delays are partly caused by lack of funds in social services departments? Does he also agree that the massive increase in health funding has not been matched by increases in social services funding, and will he look at that problem?

In fact, since 1997, the average increase in personal social services funding by the Government has been 30 per cent. above the level of inflation. Another 6 per cent real-terms increase is promised for next year, so we are making money available and making sure that it is being used to provide intensive home care. Contrary to what the hon. Member for West Chelmsford (Mr. Burns) said, there has been a 30 per cent. increase in the number of people receiving intensive care at home—people who would otherwise be forced into care homes.

If he will make a statement on the findings of Sir John Blofeld's report into racism in the NHS. [177292]

Our formal response to the Blofeld report into the death of David Bennett will be published in July this year as an integral part of our action plan to deliver race equality in mental health services. While the detail of our response must therefore wait, I want to make it clear that racism and discrimination will not be tolerated in the national health service. Our commitment to change will be through action, not complacent words. These are real issues for people from black and ethnic minority communities, and they will be addressed.

I thank my right hon. Friend for his reply. I am sure that he will welcome the remarks made by Sir John Blofeld during his inquiry into the death of David Bennett. One of his findings was that black men are six times more likely to be sectioned under the Mental Health Act 1983 than white men. Will my right hon. Friend join me in congratulating Sir Nigel Crisp, chief executive of the NHS, on his decision to appoint a director in the NHS with responsibility for ensuring equality for staff and patients alike? Does he share my concern about comments by the hon. Member for South Suffolk (Mr. Yeo) that such an appointment would be a waste of money?

Yes, I join my hon. Friend in congratulating Sir Nigel Crisp, who is not only permanent secretary to my Department but chief executive of the national health service, on the robust leadership that he has shown, particularly on this question. This week of all weeks, when we are remembering D-day and the liberation of the European continent from the worst and most poisonous racist regime, we should remember the contribution made to the NHS by people from black, ethnic and coloured backgrounds. I must correct myself, because earlier I said that there were 14,000 extra doctors since we came to power. I apologise for my mistake, as the figure is 19,000, and many of those doctors are from black and ethnic backgrounds. It is very disappointing indeed that the hon. Member for South Suffolk (Mr. Yeo) should attack the appointment of a national director on equality and human rights. On the issue of tackling racism, the Conservative party is at best confused and at worst open to the accusation of complacency.

I welcome my right hon. Friend's comments about tackling racism in the health service. We have not tackled it well enough and it is still prevalent. My particular concern is how staff are treated by patients. By virtue of being ill, patients are almost excused for being racist. That is not acceptable and should not be tolerated.

I agree with every word that my hon. Friend said. I know that over many years, before she came into Parliament and afterwards, she has been involved in fighting to make sure that we have public services free of racism, institutional or otherwise. Those on the Opposition Front Bench may have been perturbed by my remarks, but I made them in all sincerity. When we appointed a national director for equality and human rights, the words that were used by the Opposition Front-Bench spokesman were that that appointment was "a misuse of resources". It is no good using fine words about combating racism and being committed to equality, and willing the ends but not being prepared to put in the means. If the Opposition will the ends publicly and say that they are committed to them, but then attack the means of tackling the problem, they will be criticised.

Does the Secretary of State recognise—I do not doubt that he does—that the Blofeld committee report has wide implications? Will there be a programme of action, and along what lines will action be taken?

Yes, indeed. I made it plain that this would not be a matter of words for us There is a robust programme of action across the national health service led by the chief executive of the NHS and the permanent secretary at the Department of Health under my political leadership. It will include a new national director for equality and human rights. A practical programme of action has been outlined already and will be carried through.

If he will make a statement on the cancers for which he proposes to introduce NHS screening programmes. [177293]

We are committed to introducing new screening programmes where it is clear that they will save lives. We will introduce a national bowel cancer screening programme which is currently under development, and a prostate cancer screening programme if and when screening and treatment techniques are sufficiently developed.

I welcome the expansion of screening programmes, but can the Minister be a little more precise about nationwide screening in respect of bowel cancer, which kills 17,000 people a year? When does she expect to be able to roll out a nationwide screening programme, and when do the Government expect that sufficient staff will be trained in endoscopy to enable such a programme to be fully effective?

We have run the first phase of a screening trial based in Nottinghamshire and we are reviewing the results. We are in the second phase of that trial, and as part of it we need to consider aspects such as hard-to-reach groups. We anticipate having some results by 2006–07. In the meantime we are making £9 million available over three years to train more GPs, nurses, surgeons and gastroenterologists to meet the rising demand for endoscopy—that is a key issue—and we have established three national and seven regional centres to train medical staff in endoscopy.

I, too, welcome the expansion of the screening programmes, but does my hon. Friend agree that there is still a problem at the GP level, as GPs have difficulty in deciding whether patients require routine or urgent referrals, particularly in some of the rarer cancers? Will she ensure that better guidance is given to GPs about these matters?

I agree with my hon. Friend that that distinction is important. Some 99 per cent. of patients with suspected cancer are urgently referred to specialists and seen within a fortnight, and premature deaths from cancer have fallen by 10 per cent. since 1995–97. I agree with my hon. Friend that we must continue to work with GPs and the royal colleges on improving awareness, particularly of those cancers on which it is more difficult for GPs to decide whether to make an urgent referral.

The Minister will also be aware of success in screening for aortic aneurisms—a pilot scheme is currently being run in west Sussex, and it saves hundreds of lives. When will she announce her decision whether to expand that pilot scheme nation wide?

In due course.

What the latest estimate is of the cost of a hip replacement paid for by Merton and Sutton primary care trust in (a) the South West London Elective Orthopaedic centre and (b) the private sector. [177294]

The latest national figures indicate that the average cost incurred by the NHS in conducting a primary hip replacement operation is £4,660, and that the average cost outside the NHS is £6,848. South West London Elective Orthopaedic centre forms part of the Epsom and St. Helier University Hospitals NHS Trust, where a primary hip replacement cost £5,865 last year.

I thank my right hon. Friend for that answer. He knows that the South West London Elective Orthopaedic centre is the largest orthopaedic centre in Europe, that the Queen opened it only three months ago and that it has the capacity to conduct 3,150 hip and knee replacements this year. Will he do everything he can to ensure that it is used to full capacity to benefit people in south-west London, and in my constituency, Mitcham and Morden, in particular?

I can certainly give my hon. Friend that assurance. The centre currently runs with 65 per cent. occupancy, and that figure is expected to rise to 85 per cent. during the course of this year, which is a sensible way in which to build up capacity. I agree with my hon. Friend that the centre is an important new asset for the NHS. and I was present when Her Majesty the Queen opened it. It is a brilliant investment, and I am sure that it will help further to reduce waiting times for patients in my hon. Friend's constituency. Unlike the proposals from Conservative Front Benchers, the service provided by the centre is available to all NHS patients, none of whom needs to make a top-up payment or an additional payment—

Order. I call Paul Marsden to ask Question 11.

Where is he?

If she will make a statement on her policy on the treatment of hepatitis C. [177296]

In recent years, increasingly effective treatments for chronic hepatitis C have become available. In January 2004, the National Institute for Clinical Excellence recommended a combination of pegylated interferon and ribavirin for the treatment of patients with moderate to severe chronic hepatitis C, which successfully clears the infection in around 55 per cent. of patients.

My own father died of hepatitis C when I was eight years old—he probably contracted the disease in Palestine during the first world war—so the Minister will understand my personal grudge against the disease, and my concern for the 250,000 people in England alone who have the disease and do not know it. Why are the Government not showing more urgency in dealing with the looming hepatitis C crisis? Why, for example, does the advisory group on hepatitis website state this morning that the agenda and minutes of meetings

"will be available starting with the meeting due to be held on the 8th October 2003"?

I understand why the hon. Gentleman is particularly passionate about the subject. I shall correct one figure that he gave: we estimate that about 200,000 people in England, 0.4 per cent. of the population, are infected with hepatitis C—in some cases, the infection clears spontaneously. On current action, we have, as I said, improved the drug treatments. I assure the hon. Gentleman that the Department of Health will publish a hepatitis C action plan, which will highlight the need for prevention and for increased identification and treatment of infected patients.

Where? When?

I am just coming on to that subject. The plan will be forthcoming over the summer and into the autumn, and it will lead to more diagnoses of hepatitis C, which will allow more people to be considered for treatment.

What plans he has to review the criteria and procedures by which the NHS acquires and disposes of estates. [177297]

The latest guidance on the conduct of land acquisitions and disposals is contained in the Department's "Estatecode", a copy of which is in the Library. An updated version of that code was published last year. The guidance is kept under regular review.

I thank my right hon. Friend for that reply. Does he recognise, however, that the wider public interest concerns—not least the quality of our urban environment—that are often involved in the disposal of NHS estates should be properly taken account of by the executives, who may be legally constrained, who undertake such disposals? Will my right hon. Friend undertake to review the guidance notes?

Yes, I can give my hon. Friend that assurance. I pay tribute to his work in representing his constituents on the development of the Atkinson Morley's site. I understand that the trust is in the process of submitting a revised planning application for the use of that land in order better to reflect some of the concerns expressed by my hon. Friend and his constituents. I am sure that he and they will welcome the fact that because it is metropolitan open land, there are restrictions on the extent to which it can be redeveloped. We always try to identify best practice across the NHS, and some of the work done by trust in my hon. Friend's constituency certainly counts as that.

What the estimated cost is of a hip replacement operation paid for by the NHS in (a) an NHS hospital and (b) the private health sector. [177298]

The latest figures indicate that the average cost of a primary hip replacement operation incurred by the NHS was £4,660 and that the cost outside the NHS was £6,848.

I welcome my right hon. Friend's comments on the Atkinson Morley's site.

Certainly, the NHS is a very efficient health care system, as has been confirmed by international evidence and research. The costs of administering our national health service are lower than those of any other country or private sector provider.

Of the hip replacements carried out in the NHS, how many are conducted by foreign-trained consultants, who are often foreign based and only temporarily based in the UK? Where the NHS is required to take action against such a consultant, how can it do so if they have returned to their home base?

I shall provide figures for the hon. Lady on the specific point that she raises.

If he or one of his Ministers will attend the Nottingham health network conference on 12 November to listen to the health concerns of the local community. [177300]

The Under-Secretary of State for Health, my hon. Friend the Member for Welwyn Hatfield (Miss Johnson), is considering an invitation to that event.

I put on record my thanks for the way in which the Government have bolstered the local health service, especially by providing the highest ever number of nurses and doctors in our two hospitals in the city of Nottingham and by putting additional money into our primary care trust. However, in view of the appalling statistics that the Under-Secretary recently revealed about high levels of infant mortality and poor levels of sexual education, among many other things, will my hon. Friend urge her, or another ministerial colleague, to attend the Nottingham, North health conference to put on record what still needs to be done, despite the Government's excellent record?

My hon. Friend is right. My hon. Friend the Under-Secretary will seriously consider the possibility of attending the conference. I emphasise that the ministerial team has attended 152 official engagements already this year. We are certainly consulting people in the field and we perceive no issue as more important than health inequalities and the need to ensure the provision of equal standards of care to everybody, everywhere.