What the Government's policy is on the optimum size of mental health care hospitals. [188501]

It is for local trusts to determine the configuration of their provision according to their assessment of the needs of their population, the range of community and residential services already in place, and the resources available to them.

For many years, Banbury has had residential community mental health care, but that facility is being closed and will in future be centralised in Oxford. My constituents and many people in Oxfordshire want to understand how these ever-larger mental health care units are compatible with the concept of care in the community.

As the hon. Gentleman knows, it is for local primary care trusts to commission appropriate services for their population needs in the light of national guidance and the resources available. Care for people with mental health needs is increasingly being provided by the crisis resolution teams, home treatment teams and assertive outreach teams that are developing in all areas. The idea is as far as possible to keep people out of hospital and to provide care in people's homes, which is where they and their carers wish to have it.

Does my hon. Friend agree that there is a need to separate men from women and older patients from younger patients where they have incompatible lifestyles? Does she also agree that drug addicts and alcoholics can be a nuisance on wards, and that a larger hospital should be able to achieve such separations better than a smaller one?

I agree with my hon. Friend. Our evidence is that more than 99 per cent. of NHS trusts now provide single-sex sleeping accommodation. Obviously, patient safety is paramount, and we have recently issued further guidance on that matter. Since 1997, about £720 million has been spent on upgrading psychiatric facilities to deal with the points that my hon. Friend raises. Later this week, my right hon. Friend the Secretary of State, with the Secretary of State for Education and Skills, will publish information on these issues, including children's services.

What is the budgeted cost of the Mental Health Bill?

Overall, we have spent around £300 million extra on mental health over the past three years. "Shifting the Balance of Power" provides for local primary care trusts to use the massive amount of extra investment that is being made available as they see fit within the national service framework. That investment will have increased by up to £90 billion by 2007. Within that, an extra £300 million has already been spent on mental health services, and we expect that amount to increase within the next few years.

Notwithstanding the answer that the Minister gave just now, if she is taking the whole subject of hospital mental health services seriously, can she explain why Mind, in its report "Ward Watch", which was published last week, found that 23 per cent. of recent and current in-patient respondents were accommodated in mixed-sex wards a year after the Government claimed 99 per cent. compliance, that a third of patients did not have access to single-sex bathroom facilities, and that a climate of fear, harassment and abuse exists on mental health wards, with cleanliness leaving a lot to be desired? When are the Government going to treat mental health patients on an equal basis with everyone else in the NHS?

Perhaps the hon. Gentleman did not hear some of the facts that I stated earlier. I accept that Mind issued its "Ward Watch" campaign document. Its survey was fairly small, covering 4 percent. of people with experience of mental services, approximately only 2 per cent. of whom were being treated by mental health services when it was conducted.

What assessment he has made of the contribution that children's hospices make to palliative care.␣[188502]

Children's hospices make a very important contribution to the support of children with life-threatening illnesses and their families, and in providing emergency, respite and end-of-life care.

I am sure that the movement will be pleased to hear the Under-Secretary's endorsement in advance of next week's children's hospice week. However, does he share my concern about the much lower amount of funding that children's hospices receive from statutory sources, as compared with adult hospices? Does he understand that a hospice such as Acorns children's hospice, which will open in Worcester next year and serve a large geographical area—most of the south-west midlands and Gloucestershire—has to look for funding packages from up to 33 different primary care trusts? Has the time not come to consider again the quantum and management of funding for children's hospices?

First, the hon. Gentleman mentioned the children's national service framework, which we intend to publish tomorrow, not next week.

No, I mentioned children's hospice week.

My apologies—I thought that the hon. Gentleman referred to the children's NSF.

Further to the comments of the hon. Member for Mid-Worcestershire (Mr. Luff) about the Acorns trust in Worcester, and given that it serves the three counties of Worcestershire, Herefordshire and Gloucestershire, will my hon. Friend write to the range of primary care trusts and local authorities in those counties to ensure that they do what they can to provide a more secure statutory funding basis for it, thereby making sure that it is there for children who will need it in future?

I am happy to ensure that the primary care trusts in those areas realise what their responsibilities are—I shall certainly do that for my hon. Friend. However, I assure him that they do understand those responsibilities. They are in active negotiation with the Acorns trust, have a close relationship with it as regards its two existing hospices, and are in discussion, which I hope will prove fruitful, about the one that is proposed for the near future.

My hon. Friend makes a reasoned case, but he should examine the inconsistency between the funding for adult hospices and that for children's hospices. The poor relationship between the two in getting direct funding is the important issue. Derian house gets so little funding. We get some from the local primary care trust, and although children come from as far away as Scotland and London, the funding must be raised locally. We should ensure that we get equal match funding as between adult and children's hospices directly from the NHS. The sooner that happens, the better. It will ensure that the required service continues.

While I share my hon. Friend's desire to see the children's hospice movement succeed, I cannot agree with the solution that he proposes. That is because children's palliative care is a very different proposition from adult palliative care. Adult palliative care tends to involve end-of-life provision, whereas children's palliative care tends to involve long-term provision, respite or emergency care, and managing chronic conditions. It is therefore important that primary care trusts ensure that there is proper balanced provision and full availability of home care in their area. It might not be appropriate to have the same level of funding for an adult hospice as for a children's hospice in any particular area, so I cannot agree with my hon. Friend's solution to the problem.

If he will make a statement on the availability of care home places for the (a) elderly and (b) physically disabled. [188503]

The independent Laing and Buisson survey shows that there is sufficient capacity to meet the demand for care home places nationally. We recognise that there are supply problems in some areas and have given councils extra funding to tackle them. However, going into a care home is not an inevitable outcome of growing old or being vulnerable, and we are giving people a choice as regards when and where they receive care.

I thank the Minister for that reply. He cited the survey a little selectively, because 9,600 places have been lost nationally in the last year, 2,100 of them in the north-west. Does he accept that that will mean more bed blocking and less choice for patients and clients? Will he undertake to make it easier for social services to pay a viable rate for high-quality care, to keep those places available for my constituents?

The hon. Gentleman has given us an object lesson in quoting selectively. He did not mention the fact that Laing and Buisson also said that the demand for care home places fell by almost the same amount as the number of places that were lost. He did not mention that Laing and Buisson said that there were now 486,000 places available, which is 16,000 more than they identified as being available last year. He did not say that his own council, Stockport, has had a 71 per cent. cash increase since 1997 to fund these measures. If the council is not taking strategic responsibility for ensuring that there are no problems in the hon. Gentleman's constituency, it will hardly come as a surprise to the rest of us, as that council is Liberal Democrat controlled.

Will my hon. Friend be kind enough to inform me how people with diminished responsibility who are incapable of making decisions on their own behalf can access health services to ensure that they do not become physically ill?

My hon. Friend will be interested in the forthcoming debate on the Mental Capacity Bill, which will allow for provision for people to receive the appropriate support when they have to make such decisions. Generally, in regard to older people's care and the care of people with learning disabilities and other problems that might diminish their capacity to make decisions, we expect councils and national health service bodies to work closely with those people and their families and advisers to ensure that they are able to access all services and to take the best possible decisions in their own interest.

On the question of the occupancy and availability of care home beds, will the Minister tell the House how many people have been wrongly charged for their care in a care home in the past seven years? How many people have been reimbursed for being wrongly charged since the health service ombudsman uncovered this scandal? Why, when many of these people are dying during the delays in sorting the mess out, has the Minister missed so many of his own targets relating to reporting to the House? Has he met the target that he set in June, which was that every outstanding case up to 31 March this year would be dealt with by 31 July?

First, the hon. Gentleman is referring to NHS continuing care, which is not necessarily provided in care homes. He is absolutely right to say that there were a great many cases in which we believe mistakes to have been made, and we are working hard to deal with them. However, those cases do not primarily involve people who are still alive. Strategic health authorities have prioritised ensuring that compensation claims are dealt with and wrong decisions are corrected in regard to people who are still alive. The backlog that remains relates to people who have passed away, and we are now dealing with their estates. The hon. Gentleman knows that perfectly well, because I reported the relevant figures in my last written statement. I promised to make another written statement to the House as soon as possible. I never promised to make a statement on 8 September; I promised to do so as soon as possible, and I will. It would be inappropriate for me to give the House figures now, before I have made a full statement to the House.

If he will give the most recent rate of hospital-acquired infection for (a) the NHS and (b) private sector health care providers. [188504]

It is estimated that hospital-acquired infections affect 9 per cent. of NHS in-patients, which is broadly similar to the level in other European countries. For example, estimates for the Netherlands and Spain are 7 per cent. and 8 per cent. respectively, and it is estimated that rates could be as high as 10 per cent. in France. There are no estimates available for rates of hospital-acquired infections in the independent sector.

What is undeniable is that these superbugs are growing like Topsy. They are afflicting more and more people, and will continue to do so unless we tackle the issue. Does the Minister, who is an excellent Minister, agree that one way to tackle it would be to publish clear statistics for every single hospital in the country, and to give patients the right to choose? That would put the onus where it ought to be, and force the system to correct itself. The right to choose is the way forward.

The hon. Gentleman is an excellent Member of Parliament, too. I agree with him both in relation to publishing this information and giving patients the right to choose. Those are the Government's policies. In relation to publishing rates of MRSA infections, we have been doing that, and that information is available. In the case of Southend hospital, for example, which serves his constituency—it is also an excellent hospital, because both my mum and two of my sisters have worked there—last year, the trust reported an improvement in its MRSA infection rates. Obviously, there is more to be done, but it is equally true that many parts of the NHS are engaging properly with that debate right now.

When my right hon. Friend considers infection rates, will he take into account the fact that a significant number of patients entering hospital already have such an infection? Research shows that something like 17 per cent. of patients in nursing homes are infected, and University Hospital Birmingham NHS Trust found that something like 40 per cent. of patients had it in their blood culture. So the figures are not necessarily a direct reflection of the hospital's performance, but of a much wider picture.

My hon. Friend is right, for the simple reason that, as we all know, MRSA is widespread in the community at large. It is not a bug that is simply manufactured and cultivated inside hospitals—obviously not. What we record are incidences of bloodstream MRSA infections, which is important if the national health service is to have a proper understanding of the nature of the problem. There is concern on both sides of the House, which I share, and we need to do more. I understand that, and we are trying to do that. It ill behoves Opposition Members to point the finger of blame at us for not doing enough, given that they were the ones who refused to collect the information in the first place.

Can the Minister explain why, in the years during which I have been pursuing the issue of hospital-acquired infections, an increasing number of consultants, doctors and nurses have contacted me to say that in their hospitals the problem is made worse by the fact that clinical priorities are overridden by Government targets and bureaucratic priorities? Could that be the reason why the situation is worse in this country than in most countries of Europe, and according to the European Commission, is getting worse faster in this country than in the rest of Europe?

I pay tribute to the right hon. Gentleman, who has been clear in his concerns, which he has raised over several years, but there are no data connecting waiting times targets with levels of HAIs. Bed occupancy rates in the US, for example, are very much the same as here, and it has similar rates of hospital-acquired infections. We need to focus on initiatives that we know work: the hand hygiene campaign, for example, will make a significant difference. It is not the case, however, that all those unfortunate infections can always been prevented. We estimate that up to a third can, and it is important that the NHS does all that it can to focus on those cases on which it can do more. That is what we are doing.

Obviously, I am interested in the views of consultants who write to the right hon. Member for Hitchin and Harpenden (Mr. Lilley), but can we contrast those with the views of trade union leaders and nurses who write to me saying that the problem has got worse since the contracting-out of cleaning services, for which his Government were responsible?

I am grateful to my hon. Friend, who has restored a bit of balance to this debate. We have raised such issues with the right hon. Member for Hitchin and Harpenden (Mr. Lilley) previously, and we differ from him and his colleagues on this matter. I do not believe that the pursuit of compulsory competitive tendering led to an overall increase in standards of cleanliness in our hospitals—and the buck for that policy, I am afraid, rests entirely with him and his hon. Friends.

If the right hon. Gentleman is an excellent Minister, he will have taken steps to identify and investigate the circumstances reported by the National Audit Office in which infection control teams recommended bed and ward closures. What practical steps has he taken?

The guidance on ward closures still exists. It dates from the time when the hon. Gentleman's party was in government, and the Cooke report. We have made no changes whatever to the guidance that the hon. Gentleman—I assume—supported, as an active Conservative.

It is precisely in regard to that 12 per cent. that the Minister has told us that he has no information—no data. What steps is he taking?

As my right hon. Friend made clear in last week's debate, we have always believed that these are matters for clinical judgment and clinical priorities, which should always be dealt with on that basis in the national health service.

What change there has been in the provision of general practitioners since 1997. [188505]

Since 1997, there has been an increase of 3,081—11 per cent.—in the number of GPs, excluding retainers, registrars and locums, and an increase of 1,096—no less than 81.6 per cent.—in the number of doctors training to be GPs. In March 2004, there were 31,127 GPs, the highest number in the history of the NHS. I believe that those record numbers show the Government's commitment to expanding the GP work force.

Those figures are reflected in my constituency, which has historically been underprovided with GPs. There are still shortages, however, and to get around the problem local practices have been pooling resources, sharing information technology, appointment systems and the recruitment of positions' assistants. What steps are being taken to promote such examples of best practice in other areas with chronic shortages, and ensure that everyone everywhere enjoys the standard of service that we should expect?

I am aware of the steps that have been taken by my hon. Friend's local primary care trusts, particularly Wednesbury and West Bromwich PCT. In partnership with Birmingham and The Black Country strategic health authority and other local PCTs, it has been developing a fairly radical plan to improve its own GP recruitment and retention.

Is the Minister aware that one of the changes of which constituents are most conscious is the withdrawal of practices from night cover, which has resulted in my constituency in an area of 1,000 square miles having resident within it only one doctor on duty between midnight and 8 am? That has put great pressure on the ambulance service, and some health authorities have been reported as having to recruit doctors from Germany to provide night cover. One Scottish health board has had to pay £1,000 a night for health cover. Has this part of the new contract not gone rather worryingly wrong?

I do not believe that it has gone worryingly wrong. That part of the new contract, allied with the record number of general practitioners in this country, is meant to give a greater, better and faster service to patients. However, if the right hon. Gentleman brings to my attention examples about which he is concerned as the arrangements develop, I will certainly look further into specific cases. As a general point, it is necessary to make it absolutely plain—everyone must understand this—that we are committed to ensuring that patients have access to high-quality, appropriate and timely health care out of hours. I can tell the right hon. Gentleman that the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton) will shortly be publishing requirements that clarify exactly what is expected of out-of-hours cover. I can make it absolutely clear in the meantime that that will include access to home visits—this is very important—from a GP, should a patient's condition require it, and access to a Saturday morning surgery.

May I remind the Secretary of State that one aspect of the Government's policy and programme that both he and I enthusiastically support is the development of the Thames gateway? I should like to draw to his attention the need for him to discuss with the Minister for London and with my primary care trust the acute shortage that already exists in Thurrock—a new town with an urban development corporation and an awful lot of single GP practices. If we are to succeed in our policy objectives, we need truly joined-up government as between my right hon. Friend the Secretary of State and the Office of the Deputy Prime Minister, to ensure that my constituents' needs for GPs are met. I am currently facing a crisis and there must be sufficient GP provision as we build up the area and make it a quality place in which to live.

My hon. Friend will have heard what I said about the national picture in England and about the record number of GPs. He will also know that, throughout the country, about 19 out of 20 patients can now see a GP within 48 hours and a nurse practitioner within 24. However, I recognise that there are regional variations and particular problems in certain areas. Nineteen out of 20 implies that some people do not secure that access. On the implications of the Thames gateway project, I can tell my hon. Friend that we are aware of it; that we have made more money available because of it; and that we are ahead of him in that we are already entering discussions, through my right hon. Friend the Minister of State, with the local primary care trusts. I hope that my hon. Friend does not feel that the door is so open that he has fallen through it, but he is certainly pushing a door that is already ajar.

I welcome the Government's target of 2,000 new GPs, but does the Secretary of State agree that simply referring to the total number of GPs does not reveal the difference between whole-time equivalents and part-timers? After all, the British Medical Association says that we need 10,000 new doctors. Will the Secretary of State tell the House how and when this target will be achieved and what plans he has to recruit more GPs?

That is an excellent question from an excellent Member of Parliament. First, I welcome her support—[Interruption.] Indeed. She followed another excellent Member of Parliament in the previous question. I welcome her support for sensible targets and objectives for increasing the number of doctors. Secondly, I can assure her that we not only have a record number of GPs in terms of head count, but the biggest ever increase in terms of whole-time equivalents as well. Thirdly, I would say that this is a slightly different thing from saying that we have as many GPs as we want and need. We do not: there is still a shortage. The addition of 19,000 doctors in our seven years in office is something about which we can have some satisfaction, but it does not make us in the least complacent.

May I congratulate the Secretary of State on his admirable bedside manner? Does he agree that the best general practitioners are those who know their patients as individuals? To revert to a point made by the right hon. Member for Berwick-upon-Tweed (Mr. Beith), what percentage of GPs offer an out-of-hours service, compared with the percentage that obtained in 1997?

The number of GPs offering out-of-hours services is changing as a result of the new contract, but I would not like to say that it has changed dramatically. There has been a gradual change in such provision over the period as, for example, more co-operatives and locums have come to be used. Opposition Front-Bench Members should not pretend that that did not happen under the previous Government. Things are changing because of the new contract, and we will keep a close eye on that, but I have made it plain already that we fully expect that those who need a GP call-out can get one, and that Saturday morning surgeries will be provided. My right hon. Friend the Minister of State will repeat that message in more specific terms later this week, and he may even offer more detail later today.

If he will make a statement on progress in the north-west in providing NHS dental services. [188506]

An extra £7.5 million was allocated in July to strategic health authorities in the north-west to improve immediate access to NHS dentistry. In the longer term, we are radically reforming the way in which dentistry is delivered, supported by £368 million of additional investment. That includes recruiting the equivalent of 1,000 extra dentists by October 2005, and training an extra 170 dentists each year.

I thank my hon. Friend the Minister for that answer and for her personal interest in the provision of NHS dentistry in Burnley and east Lancashire. I am pleased to hear what the Government are doing to address the problem, but I am sure that she will know that more constituents write to me every week about this matter than about any other. One of the biggest problems is that people who are entitled to free NHS dental services often cannot afford to go to the places where they can receive them. What can we do to deal with that matter as a priority?

My hon. Friend is right to say that there are problems with immediate access and that one of them is the distance that people have to travel to obtain NHS dentistry. That is why we have asked each primary care trust to draw up a dental action plan, saying how they will use some of the extra money that we have made available now to overcome those problems. I have looked at the plan in my hon. Friend's area and can assure him that it will improve access for about 37,500 people. Not all of those will be new patients because some will be NHS patients who will not have to travel as far as they do at the moment.

Is my hon. Friend aware of any innovations, either in the pipeline or being tried out, that could help the situation in the north-west and in my constituency, where there is a severe shortage of NHS dentistry provision? For example, would it be possible to use mobile dental surgeries?

My hon. Friend is right, and a number of dental action plans will involve mobile surgeries. At the same time, we are looking at international recruitment and at encouraging dentists who may not be practising at the moment to return to work. We have had 186 inquiries in response to our advertisements about that. However, we also want PCTs to look locally at how they can attract dentists into their areas, perhaps by moving people to the new contract more quickly or by considering some of the ideas in respect of international recruitment or mobile surgeries. Every PCT is drawing up a plan to say how it will spend the extra money with which we have provided it.

If he will make a statement on the financial situation of the Mid Yorkshire Hospitals NHS Trust. [188507]

The West Yorkshire strategic health authority is currently working with the trust to agree a sustainable financial recovery plan that delivers an appropriate level of health care for the local community.

Is my hon. Friend aware that I have been told that, in order to meet financial targets, senior managers at the trust are considering bringing forward proposals within the next month that would involve the closure of the accident and emergency unit at Pontefract general infirmary? Such proposals would be completely unacceptable to the people of mid-Yorkshire as far east as the villages of Sherburn-in-Elmet and Osgoldcross in my constituency. Can she provide me with any reassurances and will the Secretary of State agree to meet local Members of Parliament to discuss the financial situation of the trust?

My hon. Friend will probably be aware that all six Health Ministers had the pleasure of a visit to Yorkshire at the start of September. Indeed, the Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), visited the accident and emergency department at Pontefract as part of that visit. I assure my hon. Friend that 24-hour A and E services will be maintained at the Pontefract general infirmary and I assure other hon. Members who represent the area that no closures of A and E departments are proposed. We will of course consider any requests for meetings that we receive and see if we can provide any further assistance.

In the local media last week, the finance officer for the trust gave a positive picture of the way in which it is addressing the deficit. However, will my hon. Friend examine the amount of money that the trust has spent out of the additional money allocated by the Government on securing care in the private sector locally to meet Government targets and ensure an improvement in star ratings? That is a significant factor in the problem of the deficit that the trust faces.

I am grateful to my hon. Friend for his question. There has been and continues to be an unprecedented level of investment in the NHS, including in Yorkshire and the Wakefield area. We are investigating whether we can get an even better deal out of the provision that has been made through purchasing in the private sector and we are always seeking to achieve a more cost-effective use of resources. I am sure that my hon. Friend will join me in welcoming all the additional investment that Yorkshire has received from this Government.

How many acute hospital trusts have three stars; and how many trusts have lost this status since it was introduced. [188508]

In 2003mdash;04, 74 acute NHS trusts received three stars, compared with 35 in 2000–01. That demonstrates that overall trust performance has improved. Twenty trusts lost their three-star status in the most recent year's figures.

Does the Minister agree that the star system is misleading the public and is grossly insulting to medical and support staff in those trusts that have gone from three stars to two stars and then to one star, given that their work rate has not diminished? The staff are working their socks off, but for other reasons such as the way in which the accounts are done or the privatised cleaning services, the star rating has been dragged down. On the clinical focus measure, one-star Colchester comes ahead of two-star Ipswich, two-star Chelmsford and three-star Southend. Given the choice, where would the Minister prefer to go and which of those hospitals provides the best clinical focus for patients?

The hon. Gentleman completely misunderstands the purpose of the star-rating system. It is, first and foremost, a tool to help management improve the overall standard of the hospital. Secondly, it is a tool to ensure that local people understand in a simple way what is happening in their local trust. He says that financial management and accounting are unimportant. Does not he realise that every £1 wasted means less treatment for his constituents? Every £100 or £1,000 that is not spent properly means delays to someone's operation. That is why financial stringency is important in the ratings system.

Does my hon. Friend agree that both attaining and retaining three-star status is a challenge for everybody working in the national health service? Will he congratulate both my local hospital, Rotherham general hospital, which for the third year running has retained three-star status, and the primary care trust, which has attained it for the first time? Does he agree that hard work locally and increased funding nationally is improving health care and the health of the people of Rotherham and the surrounding area?

I entirely agree with my right hon. Friend. As he says, attaining and keeping three-star status is difficult, and it is doubly difficult because, of course, we make the standards higher every year. The fact that the hospital had three stars last year and this year means that it is continuing to improve and my right hon. Friend should be proud of, and congratulate, all the people in the NHS who have contributed to that, as well as the Government for the funding that made it possible.

What warning did the Department of Health give hospitals seeking foundation trust status that they would not receive the £1 million achievement award under the capital bonus scheme for maintaining three-star status if they were successful in achieving foundation status? I hope that, as a reasonable Minister, he will reconsider that decision, given that it is causing particular problems for hospitals that had expected to receive that £1 million bonus.

The Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), who deals with those matters, takes a sympathetic attitude and he assures me that such hospitals are receiving the £1 million.

Will my hon. Friend look closely at the fine detail of the process for assessing performance for star status? My local hospital, the James Paget Healthcare NHS Trust, was a three-star hospital and worked out that this year, if in a particular month it had carried out fewer operations, it would have retained its three-star status. Does he agree that we should not have a system in which through some bizarre quirk a hospital can lose a star because it did more work?

I can give my hon. Friend the assurance that he seeks. The Commission for Healthcare Audit and Inspection—a body completely independent of Government—is responsible for both devising the mechanism for inspection in the star-rating system and carrying it out. The commission is reviewing the inspection process to ensure that some of the anomalies are removed and that there is richer and broader representation of issues about which the public have every right to know—a right that the Conservatives would take away from them.

With regard to the Minister's answer to a previous question, he should at least accept that public confidence in the star-rating system is very low, with recent research by the Consumers Association showing that 50 per cent. of patients would not use star ratings to help them choose a hospital. Is that any wonder when star ratings tell a person whether their local hospital has long waiting lists but not about the waiting list for their particular condition and when star ratings unfairly tar all departments, whether good or bad, with the same brush? Will he recognise that stars may be a good way of measuring hotels but not complex organisations such as hospitals and will he stop fiddling with the system? Will he scrap it and replace it with clinical standards and better information, which would be far more useful to the patients?

I wonder how members of the public would know anything about their local hospital if we implemented a policy that took that information away from them. Of course, the Consumers Association found that a significant proportion of people would not rely only on the star-rating system to judge their local hospital; I would not either and nor would my hon. Friends. We all make judgments based on a mix of information, including local experience, family referrals, the views of local staff and the star-rating system, but at least the star-rating system gives a basis for people to make sensible decisions and obtain objective information.

In determining star status, how much weight is given to whether a dedicated stroke unit has been established in a trust? Unfortunately, the Chesterfield and North Derbyshire Royal Hospital NHS Trust has not yet established such a unit, so what action is being taken to assist, encourage and press trusts to set up such essential units?

First, I can tell my hon. Friend that an indicator on stroke care is part of the clinical focus score card used in assessing star ratings. Every acute trust ought to have a dedicated stroke unit. That is one of the priorities that we set under the national service framework for older people. I am sorry to hear that his local trust has not yet achieved that, but I assure him that it should be working to achieve it as soon as possible and I will certainly do everything that I can to encourage it to fulfil that objective.

What progress has been made in implementing, "Winning Ways", his Department's policy on hospital infections. [188509]

The Department and the national health service are both actively implementing the initiatives contained in "Winning Ways", for example, through new local directors of infection control and a new hand hygiene campaign, which will help to meet our objective of reducing the incidence of MRSA—methicillin-resistant Staphylococcus aureus—in the NHS.

I thank the Minister for his response. He will be aware that isolating patients is a key tool in tackling MRSA and severe acute respiratory syndrome, yet I understand that no figures are available centrally on what isolation rooms are available in hospitals. Will he instigate a review to look at their availability nationwide to find out whether sufficient isolation facilities are available?

I am grateful to the hon. Gentleman for those comments. We obviously keep such things under careful review, and one of the things that we have been saying to the NHS is that we want more single rooms to be built into new hospital provision. That is an effective way to help the NHS and hospitals to deal with incidents of MRSA infection because, as he says, isolation is very important. We are looking carefully at all those issues.

I welcome my right hon. Friend's initiatives on this matter, but when he publishes the data that he is collecting, will he be careful not to publish a crude league table, as that could be extremely misleading to people? We need to ensure that we are comparing apples with apples. When he publishes that data, will he also include some information about the risks, putting them into perspective? One of the difficulties is helping the public to understand that we are talking about a very small risk.

Again, I am grateful to my hon. Friend for those comments. We have been publishing information about MRSA bloodstream infections for some time. That information is widely available. Next year, we will publish further information about, for example, glycopeptide-resistant enterococci, DNV and orthopaedic surgical site infections. That is part of a suite of information that we want to be available to the public so that they can make informed and sensible choices—very much in the way that we have been encouraged to do by others.

We had a very constructive debate on this issue last week, but may I ask the Minister specifically about the patient environment action team inspections and the rate of hospital infection? My local hospital in Tunbridge Wells was recently subject to an undercover investigation by the BBC that resulted in very worrying revelations about the standards of cleanliness, and the ubiquitous Professor Hugh Pennington declared it to be the worst that he had ever seen. That hospital was declared to be acceptable by the PEAT, as were all NHS hospitals last year. Will the Minister now accept that what was acceptable to the PEATs is now no longer acceptable as a standard in an MRSA world and that those inspections need thoroughly overhauling to be much more based on taking account of the general standard of hygiene and discipline in hospitals and probably involving microbiological tests specifically for MRSA in high-risk areas?

Again, the hon. Gentleman is quite right: we had a constructive debate last week, and it shows the value of trying to approach these issues in that way rather than by jumping on political bandwagons and shroud-waving to raise anxieties and fears as, I am afraid, some have tried to do. I agree with him about that. I also agree that it is important that we take into account the best scientific advice and intelligence that is available to us on standards of hygiene and cleanliness in our hospitals. That is very much what the chief medical officer is trying to do and I will draw his attention to the hon. Gentleman's remarks.

What recent representations he has received about out-of-hours cover for general practitioners; and if he will make a statement. [188510]

I have received representations from right hon. and hon. Members, as well as from a number of different organisations. As a result of changes agreed by GPs and by the House last year, primary care trusts now have responsibility for arranging the provision of out-of-hours services, which must comply with national quality requirements, ensuring that patients continue to have access to GP home-visiting services.

I thank the Minister for that reply, but is he aware that, in west Oxfordshire, out-of-hours cover will no longer be provided by a doctor, but by a paramedic? Those requiring to see a doctor may have to travel to Abingdon, which can take up to an hour. If the point of all the extra money going into the NHS was to ensure a better service, can he explain why many of my constituents seem to be facing a worse service? Does he agree that the policy will have failed if all we get are longer queues at accident and emergency departments such as at the John Radcliffe? Will he ensure that the review that the Secretary of State announced earlier looks specifically at the situation in west Oxfordshire?

I will certainly look at the situation in the hon. Gentleman's constituency. The advice that I have received is that the primary care trust is now providing the service itself, that local GPs are available as part of a multi-professional work force and that GP home visits are being made when that is necessary.

Can the Minister give the House any estimate of the difference in costs between the new methods of out-of-hours cover and the old methods?

Sadly, the information that we used to collect on the cost of out-of-hours-services was not the most robust information that we had. The latest figures that I saw showed that the cost incurred by providing out-of-hours services was about £120 million. This year, we are providing £316 million to provide effective and comprehensive out-of-hours services. It is obviously crucial from our point of view as Ministers and for our accountability to the House that we can satisfy right hon. and hon. Members that that money is being spent to provide a sensible and comprehensive service. We will discharge that responsibility, because all of us understand the importance for our families and friends of people being able to access GP services out of hours. That will continue.

If he will make a statement on the launch of the new five-in-one vaccine. [188511]

On 10 August, we announced that a new combined vaccine would be introduced for babies from the end of September onwards. While the current vaccines are very safe, the new vaccine is even safer. A range of clear factual information resources for parents and health professionals has been produced to support the programme.

Can the Minister explain the terrible confusion that arose at the launch when the Department of Health leaked to the press information about the new vaccine before GP surgeries had been informed of the detail? That resulted in the leading medical centre in my constituency approaching me because hundreds of calls had been received from anxious parents. In particular, can she clear up the issue of the safety of the old stock of vaccine?

There are no issues about safety in relation to this. As I said, the old vaccine is very safe and the new vaccine is even better for reasons that I can explain later.

What plans he has to establish new dental schools. [188512]

On 16 July, I announced that we are to fund 170 extra undergraduate dental training places as part of a £368 million funding programme to revitalise NHS dentistry. Capital investment of £80 million over four years will support this expansion.

The extra 170 training places is marvellous news, but the dental work force report told us only in July that there is currently a shortage of 1,850 dentists in England and that the figure may well double by 2011. Will the extra 170 training places close the gap or is the capacity problem so acute that we need to open new dental schools?

May I first say that, although this does not deny the challenge on dentistry that we face in any way, the figures that my hon. Friend cites are from an older report published before we changed the system of commissioning? [Interruption.] The hon. Member for New Forest, West (Mr. Swayne) and his colleagues laugh, but they closed two dental schools, which contributed to the problem. One reason why we have a problem is the closure of dental schools by the previous Government and a second is their introduction of a contract in 1992, although they were warned at the time that it would lead to the sort of problems that we now face.