What recent representations he has received concerning early retirement from the NHS by senior consultants. [182181]

My right hon. Friend the Secretary of State has not received any recent representations on that issue.

Why does the Minister think that the Health Service Journal reported in the past two weeks that trusts were being offered money to massage the figures on the number of consultants still in place at the end of March 2004? Does he think that it was connected with an internal policy document from the Department of Health, that warned of the short-term nature of some measures designed to maximise the consultant count in March, such as delayed retirement? Does he appreciate the damage done to the health service through the constant manipulation of all sorts of figures, which means that no one can trust anything that the Government say any more on the health service?

No, I do not accept any of the hon. Gentleman's points. It is a good thing, not a bad thing, to bring forward consultant appointments. It is a good thing, not a bad thing, to delay consultant retirements from the NHS, for one simple reason: it allows more patients to be treated more quickly in his constituency and in the constituencies of all his right hon. and hon. Friends.

Difficulties with continuity of care appear to me to be one of the most difficult factors with which consultants must cope. What plans has the Minister to address those concerns?

I agree with the hon. Gentleman, who speaks with some experience on these matters, that continuity of care for patients is an important issue. Equally, it is an important issue for NHS consultants and doctors. The best way to tackle those problems and others is to continue to expand the number of consultants and doctors working in the NHS, and that is precisely what we will do.

If he will make a statement on the impact of the cost of the private finance initiative contract for the Norfolk and Norwich hospital on the health service in Norfolk. [182182]

The Norfolk and Norwich university hospital private finance initiative scheme was the fourth major PFI scheme to reach financial close and sign contracts. The Norfolk and Norwich university hospital is a high-quality hospital and was recently named among the top 40 hospitals in the United Kingdom by an international company involved in measuring health care performance.

May I draw the Minister's attention to the fact that there appears to be a black hole of well over £20 million in the Norfolk health economy and that many people in the health service in Norfolk blame the extra cost of the PFI contract, compared with traditional means of financing public sector projects? Is not he concerned that Norfolk is paying the price for being a pioneer of this form of financing and that other services, such as cancer and learning disability services, are being put at risk? Will he do anything to help Norfolk, given that it was a pioneer of this PFI form of financing?

I am surprised that the hon. Gentleman is not celebrating the fact that he now has one of the best hospitals in Europe serving his constituency. When a new hospital is built, that is bound to put pressure on the local health economy. That pressure does not come about as a result of it being a PFI scheme; in fact, the PFI scheme is cheaper, if we also take into account the cost of risk, than a traditional building scheme would be.

Certainly, people in Norfolk do not begrudge this excellent hospital, but is the Minister aware that one of the big disappointments in relation to the project has been the lack of public transport access from the A47? Has he been briefed on that point, and will he do anything about it?

The hon. Gentleman knows perfectly well that those issues must be addressed by the local health economy. This is a 1,000-bed hospital that has been built as a result of this Government's PFI initiative, and it provides services for the whole Norfolk health economy. I would have thought that he would have joined in the celebrations of that and made sure that people were addressing those issues, which are best addressed locally.

Given that PFI projects such as those in Norfolk and elsewhere often result in fewer beds in the new hospitals, and given the Government's commitment to introducing payments by results—which is about rewarding increased activity—how will the recommendation of the Health Protection Agency that bed occupancy rates should be reduced in order to reduce infection rates be implemented? Surely the two are incompatible. There is potential for more infections in our hospitals as a consequence of the Government's policies.

The hon. Gentleman should recognise that 45 hospitals have been completed and are being occupied as a result of the PFI. This is a major hospital rebuilding programme. Each hospital has been rebuilt following a thorough review of local health needs by local people to ensure that the right number of beds is there for those people. I should have thought that the hon. Gentleman would join in the celebrations of a magnificent hospital delivering magnificent services to the people of Norfolk.

What facilities are available for renal patients on dialysis for treatment while they are away from home on business or on holiday. [182183]

A £60 million capital investment programme to expand renal services began four years ago. There are now at least 700 extra dialysis stations and 28 more dialysis units, which will make it easier for renal patients to take holidays and travel on business.

I know that tremendous advances have been made in Preston and Burnley in the north-west, but does my hon. Friend accept that the scheme needs to be improved so that people can arrange to go away in the knowledge that they can get a dialysis slot wherever they go? They should not have to be confined to taking holidays in this country. In this day and age, should we not be doing something to enable people to have dialysis abroad?

There are a number of arrangements that enable people to travel abroad—mainly within the European Union, but we have reciprocal arrangements with other countries such as Australia. We made it clear in the national service framework for renal services, published in January, that it is important for patients to be able to dialyse away from home, whether they are on holiday or on business. A group of renal commissioners, chaired by Robert Dunn of the National Kidney Federation, is considering how we can support the implementation of the framework and guidance.

What plans he has to improve services for patients with chronic diseases. [182184]

The NHS improvement plan sets out the Government's plans for providing personalised support for the millions of people with long-term or chronic conditions. All that will of course be free: there will be no charges for anyone.

I welcome the increased emphasis on managing patients with chronic diseases, but a significant number suffer from more than one chronic disease. One of my constituents who has Crohn's disease was recently in hospital for an unrelated operation and there was clearly a lack of communication between the different specialties involved in her care. What is being done to encourage clinicians to co-operate more across clinical specialties in the management of patients with chronic diseases?

That is an important and pertinent question. The plans that we outlined last week will ensure that, over the next four years, we provide more support for patients, especially those who suffer from a number of conditions and therefore have the most complex health and social care needs.

The Secretary of State will be aware of the importance of respite care for those who care for family members with long-term conditions, but is he aware that no such care is available to many parents of children on the autistic spectrum because of the very specific needs of those children? What plans has he made to ensure that it becomes available?

The hon. Lady makes yet another important point. It is true that, in addition to the extra resources that we are putting in and the extra people to provide chronic care in the localities, I announced that an additional 3,000 community matrons—specialised nurses—would be provided to help out. We try wherever possible to provide for respite care. She has drawn attention to a particular illness with particular problems in respect of respite care for the carers. I promise to look at that and perhaps to write to her on it.

The Secretary of State just said that he is planning to provide additional community matrons. He might like to explain why, after seven years of a Government who have failed to deliver community nursing care, there are 800 fewer district nurses than there were seven years ago; why there are 15 per cent. fewer episodes of care from district nurses than there were seven years ago; and why there are 20 per cent. fewer episodes of care from health visitors than there were seven years ago.

I confess that I would like to have turned to this as a first priority seven years ago. Had we inherited something other than an impoverished and undernourished NHS in which there had been under-investment—[HON. MEMBERS: "Oh!"] The hon. Gentleman asked me what we did for seven years before we got the 3,000 community matrons. It is a fair question.

Answer it then.

I will answer it, if the hon. Gentleman will be courteous enough to contain his excitement. We have been providing 67,500 more nurses, 18,000 of them, incidentally, in primary care, exactly the sector to which the hon. Member for South Cambridgeshire (Mr. Lansley) referred. We have more than 19,400 new doctors. Sixty-eight major new hospitals have been built, are under way or have been improved, and 2,200 GP premises have been improved. In the past three years alone, we have provided 1,600 more general and acute beds than we inherited. We have 265 one-stop services. We have slashed the waiting lists and improved the health care of millions. On top of that, we are providing yet more facilities, including 3,000 community matrons. I wish that we could have done more but we followed a Government who could not have done less for the health service.

If he will make a statement on progress in implementing the new contract for NHS dentists. [182185]

Since the Health and Social Care (Community Health and Standards) Act 2003 received Royal Assent in November, my officials have had several meetings with the British Dental Association about the new contract. Further meetings are scheduled in the next two months. We will shortly be making a further statement on the implementation of the new contract.

What guarantee does the Minister think she may be able to give that the new proposals will improve access to NHS dentists? That is an enormous concern for my constituents. Given the latest research from the British Dental Association, which found that nearly 60 per cent. of high street dentists are likely either to reduce their commitment or quit the NHS, I seek reassurances from her today.

Our evidence that the new contract will work is based on five years of work in pilot sites around the country. We already have about 1,500 dentists coming over to the new system of personal dental services. The hon. Lady will be aware that we worked up the proposals for the new contract with the British Dental Association because it told us that it did not like the current way of working—the treadmill effect. We are changing the system so that all the money that is currently held centrally will go to local level and primary care trusts can plan properly, in conjunction with local dentists, the NHS dentistry that is required in their area.

I thank my hon. Friend for agreeing to visit Southampton on Thursday to discuss dentistry, and may I encourage her to do two things when she does? First, will she do everything that she can to reassure NHS dentists about the nature of the new contract, because the misconceptions about it are one reason why some are considering reducing their commitment? Secondly, I urge her to press the primary care trust to monitor dentists' intentions much more closely, so that it can intervene quickly if there are any signs of dentists planning to leave the NHS for erroneous reasons and fears in particular.

My right hon. Friend is right: there are some misconceptions about the new contract. On PCTs ensuring that they are aware of what is happening locally, we have dental leads in every PCT and in the strategic health authorities. Earlier this year, we announced £59 million to improve access, and dental personnel working at PCT and strategic health authority level have access to that money. They can work with local dentists, so that if dentists indicate that they want to leave the NHS, money can be accessed and ways of improving services considered so that they remain NHS dentists.

These are not just misconceptions. The dental profession seems to be united in its opposition to the new dental contract. Why does the Minister think that that is so? Could it be that, with nine months to go until the start of the contract, we have yet to be given the details of it? Could it also be because nine out of 10 dentists believe that PCTs are not up to the job of managing that contract, as the National Audit Office also seems to think?

One problem is that dentists were completely united against the contract introduced by the previous Administration and we have had to pick up the pieces resulting from that. On dentists' attitude to the new approach, 1,500 dentists are moving over to the new system and they say that they like the new way of working. The chairman of the British Dental Association said that there are many happy practitioners working under the new system—a fact that we should be celebrating. We have put together the dental work force review and worked with the BDA on the new contract—the new way of working—which, as we have demonstrated, is working after five years of piloting. I had hoped that the hon. Gentleman would support the action that we are taking, particularly given that we are putting right the problems created by his Administration.

How many women have benefited from the extension of the breast cancer screening programme to those aged between 65 and 70 years. [182186]

Over 250,000 more women have been invited for breast screening in England since the extension to women aged 65 to 70 began in April 2001.

My hon. Friend will know that statistics show that currently, a third of all women aged over 70 suffer from breast cancer. Although I congratulate the Government on extending the programme to those aged 70, will she consider a further extension to take into account giving an automatic recall to those aged over 70?

We have looked at the evidence on screening for the over-70s and the Advisory Committee on Breast Cancer Screening is currently reviewing it. However, there is little evidence to suggest that screening would be effective for that age group; indeed, I understand that no major country offers routine screening for the over-70s. It is possible, however, for women aged over 70 to continue to be screened, and such screening is already freely available. Women who have participated in the programme will be informed of that right at the age of 70.

The expansion in screening is to be greatly welcomed and it is to the Government's credit, but for women suffering from breast cancer it is by no means the whole picture, particularly if follow-up care is not available. In my part of the world, we are extremely worried about the situation at the Maidstone and Tunbridge Wells NHS Trust, the chief executive of which wrote to all Members of Parliament in our area. He said that waiting times for breast cancer patients needing radiotherapy is now an urgent issue, and that

"waiting times have started to increase for all patients who require radiotherapy treatment, the longest waits now being for those with … breast cancer".

As the hon. Gentleman said, we have improved outcomes enormously through the screening programme. About a third of cancers are being detected in this way and we have detected 1,500 extra cancers through the programme in the last couple of years. I welcome his congratulations on the work of staff across the country, including, no doubt, his constituency. To a degree, we are the victims of our own success: as a lot more women are identified, a lot more women need treatment. There is a maximum waiting time for front-line treatment and, in terms of follow-up treatment, we have doubled the number of radiography training places and increased the number of clinical oncologists by a quarter since 1997. We recognise that there is still more to do to address the issues raised by the hon. Gentleman, which is why we have asked the national cancer director to undertake a stocktake on the issue.

"Celebrate" seems to be the in word this morning and I do celebrate, if modestly, the huge improvement in detection and treatment of breast cancer in this country; that should be recognised. However, the causes of heart disease are now well known and much has been done to prevent heart disease. What resources are we putting in to the causes of breast cancer so that we can prevent this terrible disease and not just treat it when it occurs?

I welcome the hon. Lady's congratulations on and support for the achievements so far. A number of research programmes are going on, but we already know that some things will reduce people's risk of getting cancer—including breast cancer—such as eating five pieces of fruit or vegetables a day. The hon. Lady screws up her face, but such things clearly improve outcomes across the board in relation to several cancers and coronary heart disease. There are a number of things that people can do already such as undertaking more physical activity, and we will come to those as part of the White Paper in the autumn. I am happy to undertake to write to the hon. Lady on the details of the research programmes.

We welcome any extension of the breast cancer screening programme, but the fact remains that three quarters of all breast cancer cases are still diagnosed through the GP referral system, with which there are a number of problems. For example, whereas the Government's two-week target for women urgently referred by their GP to see a specialist is being met, Breakthrough Breast Cancer, among others, has pointed out that something like 10,000 women each year are routinely referred by their GP and subsequently misdiagnosed with breast cancer. Those women have to wait, on average, six to eight weeks—and, in some cases, up to 17 weeks—to find out whether they have breast cancer. The Government's two-week target is not helping the large number of women who are, in effect, misdiagnosed because they have been routinely referred and who must wait much longer to see a specialist at a time when they may be suffering much anxiety and stress. That also puts GPs in a difficult position, as around half of them have expressed the view that they find it difficult to distinguish between urgent and routine referrals, upon which so much depends. What is the Minister going to do to correct this lottery in breast cancer care?

Order. Before the Minister replies, I want to explain that when I call Front Benchers, it means that Back Benchers will not be called, because I have given Front Benchers that privilege. I therefore expect shorter questions—indeed, I demand them.

Obviously, women are hugely better off than they were under Conservative Governments. Presently, 98 per cent. or more of women with urgent referrals are being seen within two weeks. The hon. Member for Billericay (Mr. Baron) dismisses that out of hand, but those are people categorised by their doctors as the most important cases. They are now receiving speedy treatment, which could never have been guaranteed—and, indeed, people did not receive it—in the past, when only a comparatively small percentage were getting hospital referrals within two weeks.

How many additional scanners have been provided in the NHS in the last year; and how many of these are in the north-west. [182187]

Forty-five scanners—29 CT and 16 MRI scanners— were delivered to the NHS through centrally funded programmes in 2003–04. Of those, six were delivered to NHS trusts in the north-west. In addition, we announced last week that NHS MRI scanning capacity will be increased by a further 15 per cent. as a result of procuring 12 state-of-the-art mobile units from the private sector. Three of those will be based in the north-west.

I welcome that news. The New Opportunities Fund has provided the Royal Bolton hospital with a new —700,000 scanner, which will detect cancers. Unfortunately, it is being used only for six half-day sessions a week because the hospital cannot provide suitably trained staff who can interpret the images from the scanner. What account is my right hon. Friend taking of the budgets necessary to staff the new scanners? Can he please comment on the provision of adequately trained staff?

In terms of the budgets, even our most churlish critic would accept that an increase in the Bolton Hospitals NHS Trust budget from about £108 million to £130 million between 1999 and this year is a significant increase in revenue funding. As to the scanners themselves, my hon. Friend will be aware that one MRI scanner was delivered last year and I believe that two CT scanners are scheduled to be delivered in the next couple of years. In terms of staff, yes, it is difficult. We are expanding NHS staff and 84 per cent. of them are involved in direct patient care, despite the constant refrain from Conservative Members that everyone in the NHS is a useless unproductive bureaucrat. It is difficult to get radiologists, but I can tell my hon. Friend that there are more radiology staff than ever before. Since 1997, the number of clinical radiologists has increased by 26 per cent. and the number of diagnostic radiographers by 13 per cent. We will boost those figures further by an additional £3 million investment.

The Secretary of State for Health has mentioned mobile scanners. Will he ensure that they will be made available to rural areas around the north-west of England, including Clitheroe in Ribble Valley, whose needs are as great as in any other place? Will he also ensure that trained staff will be made available to local residents so that they secure the level of service that they are paying for?

We are certainly trying to do that. The point of having mobile scanners is not just to add to capacity, although the announcement last week by the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton) spoke of adding some 500,000 to 600,000 scans to our capacity over the next few years, which is an enormous increase. The fact that they are mobile means that they can be taken to the places where the needs are greatest and also to rural areas. There will be two mobile units in London, two in north-east Yorkshire and Humber, three in the north-west and west midlands, two in the east midlands and the east and three in the south. That, to adopt the word of the morning, is cause to celebrate, not least in Leicester where two MRI scanners have already been delivered and Birmingham where three MRI scanners and nine CT scanners have been delivered.

What initiatives are in place to encourage the retention of general practitioners in inner-city areas. [182188]

The Government are committed to increasing the number of GPs working in under-doctored areas, which include many inner-city practices. A range of measures have been put in place to achieve that, including the allocation of extra training places and payments of up to £12,000 for GPs beginning their careers in those areas.

Obviously, my right hon. Friend's answer is very helpful, but may I draw his attention to the specific problem of population change in the inner cities? There has been a very rapid decline in some areas, and in others—such as the centre of my city of Manchester—the increase has been extremely rapid. A decline in population places a significant strain on GPs in financial terms, while a rise poses difficulties in terms of patient numbers. I hope that my right hon. Friend looks very seriously at the problem. The rapid population growth in the centre of Manchester is a major issue. We need more GP services to serve the new population. The problem is not unique to Manchester but is apparent in other cities, such as Birmingham and Leicester, where the Government's many achievements are already celebrated. However, people are listening to the debate on this matter.

I very strongly agree with my hon. Friend. Central Manchester's population is booming because of the significant success of local regeneration schemes. I agree too that there is a need to ensure that primary care trust funding allocations keep abreast of population changes. I accept his criticism that that may not always have happened in the past. That is why we are looking very carefully at the problem that he highlights as part of the next wave of allocations to PCTs, and I am sure that he will agree that it is a priority.

The Minister will know that GP retirements are concentrated in inner-city practices run by a single doctor—and especially in practices where the retired doctor was Asian. The Government have promised some 2,000 more GPs, but have not specified that they will all work full-time. The British Medical Association says that we need an extra 10,000 GPs. How do the Government intend to square that circle?

I hope that the hon. Gentleman at least will welcome the fact that 2,000 more GPs are working in the NHS—but perhaps he was coming to that. There has been a significant increase in the number of whole-time equivalents as well. We need to continue the investment and to support PCTs in using a variety of mechanisms to expand the GP work force. The hon. Gentleman's strictures today would have had more credibility if he and his party had any plans to increase the size of the primary care work force. Sadly, they do not.

On the question of retaining GPs in inner-city areas, will my right hon. Friend take into consideration the problems that arise in urban areas? When two GPs left a practice in my constituency, the withdrawal of the satellite service caused much inconvenience for people. Is there any incentive to encourage doctors to work in urban areas? The PCT has done all it can to fill the vacancies, but more assistance is needed.

Again, I agree with my hon. Friend that there remain parts of primary care in England that experience difficulties in recruiting more GPs, and he referred to problems in his area. In my earlier answer, I set out some of the incentives that we have put in place, but I can tell the House that we are looking at ways to increase them further. I hope to make an announcement on that very shortly.

If he will make a statement on the implementation of the new general practitioner contract. [182190]

The new primary care contract was approved overwhelmingly by a ballot of general practitioners, and is being implemented successfully. All but five practices working under general medical services arrangements have signed the contract. Payments under the new contract have all been made on time.

People can see a doctor within 48 hours only if they declare themselves to be an emergency, and in parts of the country it is impossible to see a doctor out of hours in the evenings or at weekends. Will the Minister apologise for that? Does he accept that the new GP contract is an abject failure, and that his Government have let this country down?

No. In the light of recent exchanges in the House, I hope that the hon. Lady will understand why I will not take at face value any of the so-called facts that she has just brought to our attention. They are not the case. She might be better off having a word with the motley crew on the Opposition Front Bench about the new GP contract, because I understand that the hon. Member for South Cambridgeshire (Mr. Lansley) has said that he supports it.

Lowestoft is not a city like Manchester, Birmingham or Leicester, but it contains some of the deprivation associated with those cities. In assessing the new GP contract, will my right hon. Friend take into account the difficulties of recruiting and retaining GPs in the poorer parts of Lowestoft, which do not benefit from the incentives that are offered elsewhere? Will my right hon. Friend look at that situation?

Yes, I certainly will look at the point that my hon. Friend raises. The incentives for new GPs who are starting their careers are all targeted at under-doctored areas, and that will include the constituency that my hon. Friend so ably represents. The key is to continue the investment in primary care, which is set to increase by 33 per cent. over the next couple of years and to ensure that we seek to improve the health of the poorest communities in Britain at a faster rate than any other community. That is what this Labour Government are committed to doing.

Does the Minister really think it is successful that last weekend in Norfolk half the GPs who provided the out-of-hours service had to be flown in from Germany? Is the Minister doing anything to prevent the inevitable chaos at weekends for the out-of-hours service as GPs cease to have surgeries on Saturday mornings, and the pressures on the service in the evenings during the week as patients cannot get appointments?

I know that the hon. Gentleman has a vested interest in spreading doom and gloom about the national health service. In relation to the points that he raises, some 40 PCTs have now successfully negotiated opt-out arrangements in relation to the new contract with their local practices. The general view is that those opt-out arrangements are working effectively. The hon. Gentleman raised the issue of Norfolk and I understand that it is looking at finding some doctors from Germany to support the work of GPs.

Order. The right hon. Gentleman will withdraw that remark.

Of course, Mr. Speaker—

Order. He should say nothing else; just withdraw the remark.

I am happy to withdraw that remark.

GP services in Birmingham have improved tremendously and the contracts are working. It is a fact that 98 per cent. of people in Birmingham can see a GP within 48 hours. However, GPs do not operate in isolation. We must continue to drive down the waiting lists for referrals to see a consultant. Will my right hon. Friend remind the people of Birmingham—especially those in Hodge Hill, who will be voting soon—which party represents their interests, is driving the NHS forward and will continue those improvements, not jeopardise them?

I am very happy to do that. People face a clear choice between a party that is committed to investment and giving patients guarantees about when they will be treated and by whom, and the Opposition, who would do none of those things.

What progress has been made with making wards in child and adolescent mental health services units single-sex. [182191]

The data are not collected centrally, but the Royal College of Psychiatrists' quality network for in-patient child and adolescent mental health services conducts annual reviews of services. Of the units reviewed in 2002—03, 89 per cent. fully or partly met its standards for single-sex privacy, and for units reviewed so far in 2003–04, that has increased to 98 per cent.

I am grateful to the Minister for that reply, but can he tell the House what action is being taken to stop young and adolescent mental health patients being placed in adult mental health wards, and what measures the Government propose to take to ease the crisis in resources for such patients?

I congratulate the hon. Lady on her recently bestowed honour.

If we are "motley", I dread to think what unparliamentary language would be required accurately to describe the shower on the Treasury Bench—

Order. I dealt with the remark that was made. I want temperate language at all times.

Why did a recent British Medical Journal survey of psychiatrists and paediatricians reveal that nearly two thirds of under-18-year-olds with mental health problems were admitted to inappropriate wards, many to adult wards? They were the lucky ones, given that the mean number of adolescent in-patient beds is only 7.1 beds per 100,000 of the population, leading to the conclusion that there is an absolute lack of capacity in child and adolescent in-patient psychiatrist units. Given all the Government's bluster about eradicating mixed-sex wards for adults with physical illness—unsuccessfully—why have they done nothing to end mixed-sex wards for adolescents with mental illness, potentially the most vulnerable of all?

I would not have thought child and adolescent mental services an obvious subject for levity, but perhaps my sense of humour is not quite as refined as the hon. Gentleman's.

What plans he has to increase patient capacity within the NHS. [182192]

The NHS is expanding capacity as never before, with 19,400 more doctors and 67,000 more nurses since 1997, and the largest hospital building programme in its history. That will allow us to offer faster, more responsive services and more patient choice, all free with no charges for anyone for operations or treatment.

I thank my right hon. Friend for that answer and—to use the word of the morning—celebrate the fact that there has been a 35 per cent. increase in overall staffing at Queen's hospital in Burton, and a 68 per cent. increase in the number of doctors there. A new GP surgery at Winshill in my constituency is serving a local population that has not had one for between 20 and 30 years. May I also tell my right hon. Friend—

Question!

Order. I chair the proceedings in the House.

There are concerns about the number of GPs, especially in the inner wards of Burton, and about the shortage of dentists in east Staffordshire. Will my right hon. Friend give the primary care trust guidance on how to address those issues?

We always stand ready to give whatever assistance and guidance we can, although as we drive forward reforms in the national health service and increase capacity we are trying simultaneously to pass down to local level as much of the power for decision making as possible. My hon. Friend has given a balanced picture of where we are. We have made huge and significant progress on capacity over the past seven years, although we still have a long way to go, as she pointed out. However, the choice before people is plain: what we offer, in increased capacity, extended choice, more personal care, all delivered free at the point of need; or the alternative, which is to reduce NHS capacity, to scrap all targets so that there will be unlimited waiting lists, to introduce charges and give preferential treatment to the better-off, and to return to the jungle of the free market where health policy benefits only the financially fittest in this country.

May I ask the Secretary of State about capacity as regards dental patients in the NHS? In large parts of my constituency, it is now practically impossible to register with an NHS dentist. People must go to a practice well outside the constituency to do so. In Hockley, in my constituency, there is a particular problem. The residents association has come up with some innovative proposals to address it, but those in the local health economy appear to be pooh-poohing them at present. Will the Secretary of State allow me to write to him specifically about that very difficult situation to find out whether he can do something to address the black hole in NHS dentistry in my constituency?

Of course I look forward to receiving any representation on that from any Member on either side of the House. I have not hidden—nor has the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton)—from the huge challenges that we face with dentistry. Again, let us try to get a balanced picture. There are more dentists in this country than ever before. There has been a 15 per cent. increase in the number of dentists in this country. There are more dentists in training than ever before, but there are problems that relate to the contract. I make no party political point, but that is not merely a problem under this Government. There is a problem with getting in extra dentists in the short term, as well as with training them for the long term. I will address all those points in the coming week, because this issue should not separate us on party political grounds, but I certainly look forward to receiving any ideas and representations. One idea that I will not accept is to reduce the capacity that we are putting into the NHS— an idea that could only make the situation worse.

We need more home-grown doctors because, very often, doctors will stay in the area where they were trained. May I ask my right hon. Friend whether there is any plan to establish a new medical school in the north-west, based on the university of Central Lancashire?

It is not always that I can start with the words, "I agree entirely with my hon. Friend," but I can today. That is why we have got 60 per cent. more home-grown doctors, and more medical students and a higher number of applications to medical colleges than ever before. We have opened four more medical colleges as well.

When he expects Enbrel to be available for general prescription throughout the NHS. [182193]

Enbrel is already available on NHS prescription.

It may be in England, but I understand that it is not yet available in Northern Ireland, where patients are crying out for it. Will the Minister have a chat with her colleagues in the Northern Ireland Office to find out whether Enbrel may become free on prescription not in three years' time, but to meet patients' needs at the moment?

As I said, Enbrel is available on prescription. The hon. Gentleman may be referring to the National Institute for Clinical Excellence guidelines, which are implemented in England and Wales, but the implementation of NICE guidelines is, in fact, a devolved decision. However, I can assure him that officials in the Northern Ireland Office are considering more formal ways of working with the relevant national standard-setting bodies, including NICE, which will address the problem that he raises.

What steps he plans to take to reduce hospital waiting times for residents in Hendon. [182194]

Maximum waiting times for hospital treatment in my hon. Friend's constituency have halved since 1997. On 24 June, the Government set out our plans to reduce further waiting times for treatment, which will bring further benefits to my hon. Friend's constituents.

May I celebrate my right hon. Friend's answer and the fact that he, rather than the Conservative party, is running the health service in London? There is still some spare capacity at Edgware hospital. Will he work with Barnet and Chase Farm trust and others to find out whether that extra capacity can be brought into use by some of the consultants there, who seem a little reluctant to travel the short distance involved?

I will certainly look into the matter my hon. Friend has raised.

What assessment he has made of the potential for patient choice in remote rural areas.[182195]

Increasing patient choice offers all patients, including those in rural areas, the opportunity to have more control over their health care. Choice should also lead to better quality services as health care providers respond to the choices that patients make.

I am grateful for that reply, but does the Minister accept that the reality in rural areas is a choice between whether people have a hospital or not, and a consideration of whether there are enough acute and primary care beds and front-line staff, and sufficient diagnostic capacity in the NHS in such areas, rather than a synthetic argument about the choice to join some elective queue or other somewhere else?

So in the hon. Gentleman's opinion, Cornish mothers do not want to choose between midwife-led units and obstetrician-led units for their births, and the 3,000 people from the health economy in his area who have already chosen under existing plans to travel to shorten their waiting time for coronary heart disease operations do not want that choice. It is absolutely true that part of what we must do is to drive up capacity and ensure that that is available everywhere. However, one of the great drivers for that—it is also a driver for increasing quality—is giving people choice, and that is just as relevant, and perhaps even more relevant, in rural areas as it is anywhere else.

May I join a modest celebration and congratulate Ministers on the way in which they have expanded the choice available to my rural constituents by making use of the availability and capacity of the private sector? Does the Minister, in accepting the success of that scheme, believe that it is time to expand it further to alleviate the suffering of people who have had to dip into their savings to afford life-changing, or life-saving, treatments?

The hon. Gentleman's party's policy is to force people to pay from their own pockets if they want choice, while our policy is to give people choice without their having to spend extra money. He would unleash inefficiency on the health service by allowing people to buy from the private sector one at a time. When we choose to use the private sector, we negotiate and buy in bulk, and get cost effectiveness as a result.

What estimate he has made of the impact on health service spending of the increase in life expectancy. [182197]

The Wanless review reported that the impact of ageing on future health expenditure is likely to be small compared with other cost drivers.

Does the Minister agree that bed blocking by elderly patients remains a major difficulty in the health service that causes many problems for the medical services? Does he agree that the problem should be faced up to seriously because it will obviously get worse if we have more elderly patients? Does he think that the matter should be examined independently and carefully to determine whether we can find a real solution to bed blocking?

I do agree that we need to examine such issues carefully. I am glad to be able to tell the hon. Gentleman and the House that bed blocking in the national health service has reduced hugely, largely as a result of the new legislation and extra investment that we have put in place, both of which he and his hon. Friends opposed in the House.

If he will increase the amount of NHS funding being channelled towards children's hospices. [182198]

Children's hospice services are funded from a number of sources, including services commissioned by national health service primary care trusts on the basis of their assessment of children's needs and their priorities. There are no limits to the amount of funding that may be provided—that is for local decision.

I am sure that the Minister is aware of my early-day motion 667, entitled "Review of NHS Funding for Children's Hospices", which highlights a differential that exists whereby children's hospices receive only 5 per cent. of their funding through the NHS while adult's hospices receive up to 38 per cent. of their funding in such a way. There is genuine concern throughout South Yorkshire about the disparity, so will the Minister meet me to discuss the matter in greater detail?

I would be happy to meet my hon. Friend, but I must stress again that services for children's hospices need to be based on the needs of individual children, not on the basis of a blanket figure that he or I might think appropriate.

If he will make a statement on the nutritional content of meals for young people. [182199]

The latest national diet and nutrition survey of young people aged 14 to 18 in 2000 showed that they consumed too much saturated fat, sugar and salt and too few fruit and vegetables.

I thank the Minister for her answer as far as it went, but will she have discussions with her colleagues in the Department for Education and Skills, as successive attacks on the school meal service by this Government and the previous one have seriously affected the health and well-being of children? Will she also ask her colleagues in the national health service why they are promoting unhealthy products through the NHS "Popzone", as it is not acceptable for the NHS to promote such products?

I am happy for the hon. Gentleman to send me anything about which he is discontented so that I can have a further look at it, but we are in regular discussions with the DFES about initiatives to encourage and enable children and their families to make healthier food choices, including national healthy school standards, the food in schools programme, the school fruit and vegetable scheme, the healthy living blueprint and healthy start. A range of initiatives is therefore under way to improve children's health as well as the food that they eat during and outside the school day.

I beg to move, That the clause be read a Second time.

With this it will be convenient to discuss Government new clause 10—Manufactured payments under arrangements having an unallowable purpose.

As I explained briefly with regard to the ways and means motions, the new clauses introduce anti-avoidance measures to prevent a loss of tax through arrangements involving leasing and manufactured payments.

On the face of it, these two anti-avoidance clauses are perfectly reasonable and, indeed, a fair cop. I would, however, make the point that we have had 180 and more new clauses and amendments tabled for Report, which has left quite insufficient time for the various professionals to pore over them in detail to ensure that there are no unintended effects. I note that the Paymaster General mentioned that the guidance notes would only be published today, so there is clearly no chance to review those guidance notes ahead of reviewing the two new clauses. It also struck me that the measures being blocked by new clause 9 are, to some extent, a reaction to what have been seen as retrospective changes in the tax position relating to sales and lease-backs.

We support the two new clauses. The only question for the Paymaster General—I hope I did not miss the point in her earlier comments—is how the Treasury identified these abuses, particularly when she indicated in respect of new clause 9 that the abuses seem to have arisen very recently, even since the Finance Bill was first drafted. Will she say a little more about that?

I start by endorsing the hon. Gentleman's last suggestion. It would be helpful if, when the Government bring forward last-minute measures to deal with tax-avoidance schemes, they could describe in more concrete detail what the schemes actually consist of.

I shall begin by dealing with the series of questions posed by the hon. Member for Grantham and Stamford (Mr. Davies), who wanted to know whether these proposals amounted to the introduction of a general anti-avoidance rule. I assure him that they do not. The rule is targeted at a narrow area of tax in which abuse, unfortunately, is rife. I shall then move to the question, raised by the hon. Member for Yeovil (Mr. Laws), of when and how the Revenue became aware of two specific schemes.

I hope that the Paymaster General does not proceed on a false premise. I said in my remarks that this is not a general anti-avoidance rule, as such a rule would apply, by definition, to all transactions. However, with this new clause—and the same thing happens elsewhere in the Bill—the Government seem to want have recourse to individual anti-avoidance rules. As a result, a series of anti-avoidance rules is being built up in the tax system in a pretty haphazard fashion.

I remind the hon. Gentleman that the Government consulted in 1998 or 1999 about whether a general anti-avoidance rule should be introduced, with the pre-clearance mechanism that he rightly says would be necessary. The consultation was generated by the frustration—also experienced by the previous Government—that ever more complex avoidance schemes give rise to ever more complex legislation to counter them. The clauses under discussion are examples of our approach.

I beg to move, That the clause be read a Second time.

With this it will be convenient to discuss the following:New clause 1—Gift aid and non-taxpayers—

New clause 11 amends legislation providing income tax relief to a donor making a gift, or disposal at under value, of shares or securities to charity. The legislation, introduced in the Finance Act 2002, which was welcomed at the time on both sides of the House, enables a donor to offset the market value of a gift of shares or securities to charity against their income for tax purposes. The market value is the value of the gift in the hands of the donor at the point of disposal to the charity. In the first two years that the relief has been available, £370 million has been donated to charity.

I hope that the hon. Member for Arundel and South Downs (Mr. Flight) will welcome the clause as he did the last as a reasonable and fair cop.

As I recall, the income tax relief received when one gifts something to a charity is set against one's income for income tax purposes, so it is 40 per cent. for top-rate taxpayers. As I understand the Economic Secretary's description, it would still be worth practising the scheme because the gift to the charity might be two and a half times the effective benefit.

We believe that the new clause will prevent such abuse. Our concern is that the amounts that can be donated—and therefore the tax relief that can be claimed—are virtually limitless. We are, however, keen to ensure that we do not introduce a measure that discourages genuine acts of philanthropy or removes the incentive to the donor to give in the first place.

In the spirit of the questions I put earlier to the Paymaster General, can the Economic Secretary tell us how long the abuse has been going on and how much it might have cost?

As I said earlier, we uncovered evidence of the scheme relatively recently. It is not yet widespread, but it has the potential to become so. As my right hon. Friend the Paymaster General said, a responsible Government have the duty to act as soon as evidence of such schemes is uncovered, to prevent the loss of potentially very large sums. We have uncovered evidence of a potential donation of close to £100 million. If a single donation of such size were to be channelled through the sort of scheme that I have described, the extent of the abuse would be obvious, as would the potential exposure of the public purse.

"We welcome this measure which defends the tax breaks designed to encourage giving to charities. Any abuse of charitable reliefs by donors rebounds on the whole charity sector by tarnishing its reputation; we support all initiatives that protect the integrity of the sector."

I shall comment briefly on new clause 11. On the face of it, the new clause causes us no great difficulty, although it was tabled rather late and we would have liked longer to consider it. I was at the Vote Office not two hours ago, yet I was unable to obtain any guidance notes on the new clause.

May I welcome the hon. Member for South Norfolk (Mr. Bacon) to the Dispatch Box? He offers distinguished service to the House on the Public Accounts Committee. I understand that he is making only a temporary appearance at the Dispatch Box, but I fear that his permanent presence cannot be far off, and I look forward to that.

May I ask the Economic Secretary how new clause 11 will work? He said that the income tax rebate cannot exceed the net value of the benefit to the charity. I am not sure whether or not the net value includes the tax rebate. However, if it does not include the tax rebate, for example, someone could give £100 and take back £80. The charity would get £20. The individual would get back £18 on his £100, so he would be out of pocket by only £2. In effect, that could be used to make all giving to charities tax deductible. If the net value includes the tax rebate to the charity, someone could give £100 and take back £100. The charity could still have £22, and the individual has benefited by £18. I just want to understand whether the new clause will be an effective deterrent to the abuse that the hon. Gentleman describes.

Order. We are in danger of getting ourselves into disorder. I was assuming that the hon. Gentleman's remarks were by way of a long intervention, to which the Minister may reply in concluding his speech, but if he does not wish to respond that is in order.

I beg to move, That the clause be read a Second time.

With this it will be convenient to discuss the following: Government new clause 13—Non-UK schemes: application of certain charges.

The new simplified regime for taxing pensions will provide a more flexible regime that is much less heavily regulated than the existing eight regimes. That should prove attractive to individual pension savers and reduce costs and increase flexibility for the industry. Our aim is to make saving within the new simplified regime as simple, fair and attractive as possible for all pension savers. However, there will be some groups—individuals who come to the UK from overseas—for whom it makes sense not to move into the UK's tax-favoured regime. For example, individuals may prefer to continue to contribute to their home state pension schemes, or might even be obliged to continue to be members of such schemes.

The Financial Secretary said that the measures were simple, fair and attractive, but anyone who has tried to plough through new schedule 2 over the past couple of days would not agree that they were simple. It was not especially fair that the provisions were it introduced at the last moment because that meant that the industry did not have the chance to comment on them at all. As for whether they are attractive or not, we will have to take the Financial Secretary's word that they are more generous than the current arrangements.

"a pension scheme … which … is established in a country … outside the United Kingdom"—

"and … satisfies any requirements prescribed for the purposes of this subsection by regulations made by the Board of Inland Revenue."

"is very dangerous and very costly to UK schemes, and because the rules cannot be scheme-specific, will no doubt lead to endless battles in the courts. It is ridiculous; it is not in the real world."

I shall start with negative strictures and concerns before making some positive points.

There has been an extremely interesting exchange covering all sorts of issues. I can only apologise to the House for the fact that the new clauses were introduced at such a late stage. Clearly, it would have been desirable to introduce them in Committee. The new rules for migrant member relief are based on proposals that were set out in the December 2003 consultation paper, so they should not come as a complete surprise to hon. Members.

Will there be a restriction on the countries in which an overseas scheme could be registered?

As I understand it, the regulations will cover all overseas schemes. To get it absolutely right for the record, I will write to the hon. Gentleman specifying the countries to which they apply.

I intend to elaborate further on how the scheme will operate. If the hon. Gentleman waits for a few moments, I may answer his point.