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Mrs. Bottomley: I thank my hon. Friend and can certainly confirm the figures that he gives. The private finance initiative is an excellent opportunity for us to extend patient care further and faster. With the great range of projects, we are giving advice and keeping a data bank so that good practice can be developed. The criteria in every case is that projects should be good value for money and lead to good patient care.

Mr. Nicholas Brown: Has the Secretary of State seen the regional private finance initiative referred to in The Independent today? The Worthing district health authority has accepted a bid from an outfit called Westminster Health. Is the Secretary of State absolutely satisfied that those who run it are suitable people to be in charge of the care of our elderly long-term sick? After all, they have been involved in a substantial fraud case in Texas and have had about 150 separate allegations of abuse pending against them since the 1980s. In any event, was not the NHS trust bid cheaper?

Mrs. Bottomley: First, I welcome the hon. Gentleman and the right hon. Member for Derby, South (Mrs. Beckett) to their new jobs. I am pleased, from the point of view of private finance, that it was the hon. Gentleman who said:

"public and private finance working together in transport, in housing, in capital projects, in health and education"

have a part to play. We thank him for that commitment to the initiative. Clearly, he has no objection to the principle but is querying an individual case. I understand that the original proposal was that the district health authority should take on three projects. That did not satisfy the trust. The trust was, however, satisfied that the individual project concerned would lead to the best value for money and high-quality patient care. Those are always the top criteria.

Cheviot And Wansbeck Hospital Trust

4. Mr. Beith: To ask the Secretary of State for Health what representations she has received about redundancies in hospitals run by the Cheviot and Wansbeck hospital trust.

Mr. Sackville: We have received letters from two hon. Members. I also met the right hon. Gentleman and the hon.

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Members for Blyth Valley (Mr. Campbell) and for Wansbeck (Mr. Thompson) on 13 July, to discuss their anxieties about redundancies at the trust.

Mr. Beith: Now that the equivalent of 51 posts have been lost in the Cheviot and Wansbeck group, now that safety standards have been publicly questioned even by a consultant, and now that there is even a threat of the closure of the Rothbury cottage hospital, will the Minister reconsider the situation and answer the question: why do patients have to suffer if the first year of operation of the trust system throws up something that would probably never have happened under the old system?

Mr. Sackville: Let me say how glad I am that the actual number of redundancies has been reduced to 27, the large majority of which are in administrative grades. I do not accept that patients will suffer. I have been given an absolute assurance that those changes will be made without detriment to patient care.

May I remind the right hon. Gentleman of all the good things that are happening at the trust, including the new accident and emergency department, at whose opening ceremony no lesser person than the right hon. Gentleman himself officiated?

Mr. Jack Thompson: Has the Minister seen the letter that I sent some time ago about the case of Charlene Bentley from my constituency, who broke an arm, went to the Wansbeck general hospital, was unable to receive treatment at that hospital because of the lack of beds in the children's ward and had to be transferred to North Tyneside to have treatment? Is that the satisfactory arrangement that he endorses in terms of that hospital and those staffing levels?

Mr. Sackville: I am aware of that case, and it is unfortunate that that little girl had to be transferred to another hospital. Let me remind the hon. Gentleman that the trust works on several different sites and is at a disadvantage in that way. It is not possible to provide all acute services at all sites.

Disabled People

5. Mr. Sheerman: To ask the Secretary of State for Health how many disabled people have been struck off local general practitioner lists in each of the past four years.

The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): Only 1.2 per cent. of patients deregistering from general practitioner lists do so at the request of the GP. Those patients are not categorised in any way.

Mr. Sheerman: If the Minister does not know how many of those people are disabled, perhaps he should speak to Toby Harris, the director of the National Association of Community Health Councils, or even the health service ombudsman, both of whom are extremely worried about the number of patients who are being struck off by GPs. A Manchester report recently said that 1,700 patients, many of whom were disabled people, had been struck off lists by their doctors. Indeed, Mr. Harris said recently that one could be struck off for being too ill.

Mr. Bowis: I have looked carefully at Mr. Harris's press release and the other report to which the hon. Gentleman referred. Neither of them refers specifically to people with disabilities being struck off. That type of evidence has not been presented to us.

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I remind the hon. Gentleman that under the patients charter, everyone has the right to be on a GP's list, and if anyone has any difficulty, family health services authorities have a role in ensuring that that is possible. I also remind the hon. Gentleman that the General Medical Council, supported by the General Medical Services Committee, has made it clear to doctors that it would be unacceptable if doctors were to remove people from lists because of the cost of their disability.

Mrs. Beckett: Surely the Minister is concerned when, according to a report from the National Association of Community Health Councils, about 30,000 patients are estimated as being struck off and, as he says himself, he has no knowledge of what percentage of those are people with severe long -term illness, disabilities and so on. Does not the Minister also recognise that there is considerable concern that that is happening as a direct result of the Government's policies on GP fundholding; that in Essex, for example, an increase of about 27 per cent. in fundholding practices has been accompanied by an increase of 20 per cent. in patients being struck off? That is a worrying trend. If the Department of Health does not know what is happening and why, perhaps it is time that it did.

Mr. Bowis: There is no evidence to support what the hon. Lady says. Let me first welcome the hon. Lady to her responsibilities. [Hon. Members:-- "Right hon."] I apologise, the right hon. Lady. We look forward to many years of enjoying her position across the Dispatch Boxes.

The right hon. Lady referred to the report of which the hon. Member for Huddersfield (Mr. Sheerman) spoke, which is the one that Mr. Harris produced. That report does not produce that evidence. I am aware, however, that there are some worries about the general issue of registration and deregistration. We are examining that as part of our regular review of registration procedures to discover, first, whether any improvements can be made and, secondly, whether there are any grounds for concern.

Junior Doctors

6. Mrs. Lait: To ask the Secretary of State for Health how many junior doctor posts which entail working more than 83 hours remain in the South Thames region; and if she will make a statement.

8. Mr. Matthew Banks: To ask the Secretary of State for Health how many junior doctor posts entailing more than 83 hours remain in the North West region; and if she will make a statement.

Mrs. Virginia Bottomley: All posts contracted for more than 83 hours a week in the South Thames and North West regions have been eliminated. That is a remarkable achievement as there were more than 3,300 such posts in those two regions in September 1990.

Mrs. Lait: I thank my right hon. Friend for that most encouraging news and I congratulate her on the success of a policy that she initiated when she was Minister for Health. Is she aware that reports are emerging of a significant reduction in the number of applications for doctors' jobs in

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my region? Will she comment on the fact that Conservatives cut junior doctors' hours while the Labour party cut their pay?

Mrs. Bottomley: I take note of my hon. Friend's comments. The way in which juniors are trained--their rotations and accommodation and many other conditions--requires further consideration. I welcome the discussions that we have with the junior doctors to ensure that we continue to train and support some of the best junior doctors so that they can help the health service. Their pay has increased substantially during our term of office. I am pleased, however, that there have been such significant cuts in their hours.

Mr. Matthew Banks: Will my right hon. Friend join me in paying tribute to the Southport and Formby community health service trust which, in March this year, met its important 1994 target of reducing the number of hours worked by junior doctors? Will she give me an assurance that, as the acute trust continues to make progress in that important sector, it will continue to have the support of the regional task force?

Mrs. Bottomley: I certainly pay tribute to the Southport and Formby community health service trust and can assure my hon. Friend that the task force will continue to play a crucial part. I know his region well and have met junior doctors from there. Only three years ago, when I was in Blackpool for a certain purpose, a number of the juniors came to see me and my hon. Friend the Member for Wyre (Mr. Mans). Two years later, we were able to visit them on their night shift at the Blackpool Victoria hospital to talk about the new systems, the way in which shifts have been introduced and the fact that extra resources have been put to good effect and the junior doctors' hours reduced.

Mr. Austin-Walker: Is the Secretary of State aware that one of the arguments advanced for the closure of the Brook hospital in the South Thames region is the requirement to meet the junior doctors' hours? Is she further aware that the future plans of the health authority depend on the acquisition of the Queen Elizabeth military hospital from the Ministry of Defence? Is she aware that the national health service may be gazumped by a private bidder? What steps will she take to ensure that that hospital remains in the public sector?

Mrs. Bottomley: I am aware of the facts of that situation, but the hon. Gentleman will understand that the Minister for Health deals with those matters as I have a close personal relationship with one of the hon. Gentleman's neighbouring Members of Parliament--that is in the Register of Members' Interests. I am aware that the effects of the reductions in junior hospital doctors' hours have implications for service delivery. It is extremely costly to provide juniors on duty overnight in a great number of establishments and we have to look carefully at that aspect. We also want to safeguard patient care and the quality of doctors' training. The dialogue that we have established between Ministers, the junior doctors' leaders and the NHS is leading to sensible outcomes, and improvements for juniors and the service.

Mr. Purchase: Is the Secretary of State aware that some of the reductions--which are by no means universal--have been achieved by some grades of nurses having to take on tasks formerly performed by junior doctors? That has led to considerable stress, especially in hospitals in

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Wolverhampton where, I understand, the Minister has imposed a block on further recruitments of junior doctors. Will the Secretary of State respond to that?

Mrs. Bottomley: The hon. Gentleman will understand that the recruitment of junior doctors is connected with a long-standing agreement with the profession over the number of juniors trained for the number of consultant posts available. I hope that we may move towards more flexibility in some of those matters as time goes by, but there has been a steady increase--of 3 per cent. a year--in the number of consultants in the health service and that is a significant achievement in itself. The hon. Gentleman rightly points to the part played by nurses in taking on some of those tasks. Managers, much denigrated by the Labour party, and administrative support staff have also taken on some of the tasks previously done by junior doctors. We need a pragmatic approach that ensures that juniors are well used for the tasks for which they are trained, and that their hours are not excessive. I think that we are making great progress.

Mr. Nicholas Winterton: Does my right hon. Friend remember the case of my constituent, Alan Massie, a talented young junior hospital doctor at Warrington district general hospital who died some months ago? Is she aware that the coroner's report has now found that he died from stress and overwork because of the abnormal number of hours that he was forced to work? Will she therefore keep the matter of junior hospital doctors' hours under continual review, to ensure that young, talented people such as my constituent do not die because of their commitment to the health service?

Mrs. Bottomley: I well understand the case to which my hon. Friend refers. The stress of being a junior doctor is associated with a number of factors, not least rotations. I was interested in a scheme being developed in New Zealand, where there is talk of a mentoring system to give support to junior doctors in training. Reducing the number of hours has been a clear priority. In 1990, 13,000 doctors were working rotations of more than 83 hours: none are now. There has been a fall of one quarter in the number of hard-pressed posts involving more than 72 hours. We want to do very much better than that by the end of the year; it is an important priority for us all.

Mortality Reduction Targets

7. Mr. Rooker: To ask the Secretary of State for Health what progress is being made in respect of the mortality reduction targets set out in "The Health of the Nation", Cm. 1986.

Mrs. Virginia Bottomley: The latest figures show that good progress is being made towards virtually all the mortality targets set out in "The Health of the Nation" White Paper. The targets were deliberately set to be challenging and it is most encouraging that so much has already been achieved.

Mr. Rooker: Speaking between two planted questions, may I ask whether the Minister accepts that poverty is an important factor in determining death rates? That is shown by the fact that deaths from coronary heart disease among poor men and poor women are respectively 44 per cent. and 61 per cent. higher than would otherwise be expected. Does the right hon. Lady appreciate that in the past 15 years in just four regions of the country--the north, the north-west,

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Yorkshire and Merseyside--there have been 125,000 more deaths from coronary heart disease than should otherwise have been expected? That amounts to the Government, by their neglect, killing off two constituencies of Labour voters.

Mrs. Bottomley: I am with the hon. Gentleman to the extent that the Government are committed to wealth creation, job creation and the relief of poverty, and we have been remarkably successful in that. I am also with him to the extent that I am aware of the severe problem of coronary heart disease in his constituency. That is why I hope that he will welcome the £23 million going into primary care in the Birmingham area precisely so that more GPs can deal with those issues and with the multi-factor causation of coronary heart disease and strokes. A great number of factors are involved; the whole point of "The Health of the Nation" strategy is to look into the causes of disease.

The hon. Gentleman may like to know that the health of the nation has improved for all income groups and all social classes, and perinatal mortality has decreased, as a result of the success of the health reforms and the work that we have been undertaking.

Mrs. Roe: Does my right hon. Friend agree that the highly successful programme of childhood immunisation has made a major contribution to reducing the numbers of untimely deaths and improving the health and well- being of children? Will she take this opportunity to reinforce the message that, with the threat of a measles epidemic, it is vital that parents ensure that their children are vaccinated?

Mrs. Bottomley: I thank my hon. Friend. I can confirm the great success of the immunisation campaign. It is bizarre that the Labour party so stubbornly resisted the new GP contract, which has resulted in well over 90 per cent. of children being immunised against avoidable childhood diseases.

That is just one of many ways in which we set a target that we not only met but beat.

The introduction of the hib meningitis vaccine has resulted in an 80 per cent. fall in those cases in only a year. This country now has its largest ever immunisation programme. Some 7 million schoolchildren are to be immunised in November. We hope that the scheme will be widely supported because it is the effectiveness and success of the national health service that enables us to implement that important policy.

Mrs. Wise: What account is the Secretary of State taking of the clear links that have been established between unemployment and mortality and ill health? What is the right hon. Lady doing about that, and will she restrain her hon. Friends from hounding the unemployed and persuade her Government to act to provide more real jobs?

Mrs. Bottomley: I am vigorously championing the success of the Prime Minister and other members of the Government in reducing the number of unemployed. A reduction of 400,000 in the number of unemployed since the end of 1992 is a remarkable achievement. I am certainly not pursuing populist gimmicks such as compulsory paternity leave which would be imposed by Brussels and would drive jobs out. A minimum wage would also be counter- productive in terms of providing

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real jobs for our people. I want to make sure not only that we have people in employment but that we have healthy people in employment.

Mr. Sims: Is not the progress towards meeting the targets in "The Health of the Nation" extremely encouraging? But does my right hon. Friend share my disappointment at the poor figures in relation to reducing the incidence of smoking among young people and especially girls? What are her plans to reduce the largest avoidable cause of premature death?

Mrs. Bottomley: My hon. Friend is a persistent and wise champion of the cause of reducing the extent of smoking. As he will know, in that respect we have been more successful than any other European country apart from the Netherlands. That is largely because we believe that price is a crucial variable. Every 10 per cent. increase in price leads to a 3 to 6 per cent. fall in consumption. We are meeting the target for adults and pregnant women. The problem is in meeting the target for young people. The most important factors are parental disapproval and education in schools. I am pleased that through our "Health of the Nation" strategy we are reinforcing our messages to parents and to those in control of young people and are increasing the extent of anti-smoking education.

Private Children's Homes

9. Ms Coffey: To ask the Secretary of State for Health what monitoring her Department is undertaking of the placement of children by local authorities in private children's homes unregistrable under the Children Act 1989.

Mr. Bowis: The social services inspectorate is currently undertaking a study of children's small homes in England.

Ms Coffey: How can the Minister undertake adequate monitoring when his Department has absolutely no idea how many children are placed in children's small homes? His Department does not specifically request that information from local authorities. As he knows, a lot of nonsense is coming from his Department about such homes. When will he introduce legislation that will require those homes to register and enable them to be inspected so that the same standards can apply to all children's homes irrespective of size?

Mr. Bowis: That is precisely what the current study is doing. It is establishing a database of small homes and considering whether the regulations that apply to them are adequately understood and applied. As the hon. Lady knows, unlike homes for adults, small homes for children are covered either by foster home regulations or placement regulations, and that is in addition to the welfare responsibilities of the authority in whose area the home is located.

Dame Jill Knight: As most of the worst cases of bad treatment of children in homes--for example, pin-down--occur in local authority-run homes, why are we being asked to monitor only the private homes?

Mr. Bowis: My hon. Friend is right. Sadly, the cases of abuse that we have had to investigate occurred in homes run by or under the auspices of local authorities. The homes that we are discussing here are for four

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children or fewer. Except in my discussions with the hon. Lady about her concerns and with the hon. Member for Streatham (Mr. Hill) about the impact on the community of children from such homes, I have not heard anyone say that children in such homes are at risk.

Mr. Kirkwood: Will the Minister acknowledge the importance of professional training for officers in charge of residential homes for children? Will he confirm that the Utting report found that 21 per cent. of officers in charge do not have relevant professional qualifications, and can he give the House an assurance that the Government are on target to achieve the Utting recommendation of having all officers in charge of residential children's homes fully qualified by 1995?

Mr. Bowis: The hon. Gentleman is right. The Warner and Utting reports both contributed to our policy making. As he will know, we have set up the support force, which is doing excellent work around the country. He will also know that we have a budget of some £70 million for training and that there are now 5,000 more qualified social workers every year. We are seeking to meet the targets to which he refers. The proof of that is that, 20 years ago, 38 per cent. of field social workers were trained, whereas the figure is now more than 90 per cent.

Mr. Hinchliffe: Only this morning, I was speaking to the owner of a private unregistered children's home in my constituency who stressed that such owners want to be registered and distinguished from what he termed "the cowboys" involved in private care. I met the Minister's predecessor--

Madam Speaker: Order I am waiting for a question from the hon. Gentleman.

Mr. Hinchliffe: Bearing in mind the fact that it is now nearly two years since my hon. Friend the Member for Stockport (Ms Coffey) and I met the Minister's predecessor at the Department of Health to discuss this matter, why has it taken so long to plug what is, frankly, a dangerous loophole in our child protection legislation?

Mr. Bowis: There is no way that I would be satisfied if I thought that regulations were inadequate to protect children in those homes. That is why we have issued a circular reminding local authorities of their very real powers in such matters. That is why, from now and in future years, the annual gazetteer of children's homes will include the numbers of children placed in such homes so that we know what the position is and can continue to protect children in small homes as well as in the larger ones.

Mr. Rowe: My hon. Friend will know that one of the great difficulties in the care of children, whether in small or in large homes, is that there is such a rapid turnover in the people who look after them. Will he take steps to give much more robust guidance to the statutory services, to encourage caring volunteers to act as long-term mentors for those children and keep an eye on the way in which they are being looked after by the statutory services?

Mr. Bowis: My hon. Friend makes an excellent point. So much can be done by statutory services--by inspection, regulation and visits-- irrespective of the size of the home. What is needed are friends for children--key workers looking after children and making sure that they are in touch with those individual children's lives,

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ambitions and hopes so that if they get into difficulties, somebody is there to take note and alert the proper authorities.

Dental Services

11. Mr. Canavan: To ask the Secretary of State for Health what response she has received on the Government's proposals for NHS dental services and charges.

Mr. Malone: We expect the dental profession's representatives and those others consulted to respond to Green Paper "Improving NHS Dentistry" when the consultation period ends on 1 November.

Mr. Canavan: Does the Minister realise that a 25 per cent. increase in dental charges would further increase the number of patient deregistrations because many people would no longer be able to afford to visit the dentist? In view of the recent Denplan survey, which revealed that more than three quarters of dentists would be more likely to leave the national health service if the Government's Green Paper proposals ever became a reality, and forecast that 69 per cent. of patients would be private by 1999, will the Government scrap the Green Paper and instead take steps to ensure an adequately funded dental care system within the national health service?

Mr. Malone: Certainly not. The hon. Gentleman should remember that Denplan is a private organisation. Its headquarters happen to be in my constituency, so I know the company extremely well. It is hardly surprising that a limited survey carried out by an organisation with such an interest has come up with such a finding.

I remind the hon. Gentleman that recruitment of NHS dentists is extremely good, with 578 additional dentists being recruited in two years. Also, 378,000 more patients have been added to NHS lists during that time. Spending on general dental services under this Government has increased by 56 per cent. since 1979 in real terms. That is the real level of this Government's commitment to NHS dentistry, which will continue.

Cancer Research

12. Mr. Chisholm: To ask the Secretary of State for Health how much money was spent last year on cancer research; and what percentage of that was provided by charities.

Mr. Bowis: The latest figures are for 1992. They are £250 million and 45.9 per cent. respectively.

Mr. Chisholm: Why is much less money spent on cancer research per million of population in the United Kingdom than in other countries? Why is it that in this country, uniquely, most of the money comes from charities? That makes long-term research difficult. Will the Minister undertake today to give more Government support to research into breast cancer--the biggest single killer of women between 35 and 50--as part of a much-needed national action plan on breast cancer?

Mr. Bowis: That is a collection of questions. Of course, it makes sense to combine with our counterparts abroad to ensure that the resources of the world are devoted to combating cancer. According to the Office of Population Censuses and Surveys, Britain is spending 7 per cent. of the NHS budget on cancer--that is some £2.8 billion. The

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hon. Gentleman must be aware that this country leads Europe in its breast cancer screening programme and on investment in that. The hon. Gentleman referred to the mixture of funding for investment. We very much welcome, and work alongside, the resources invested by charitable organisations and also by the pharmaceutical companies.

Sir Donald Thompson: Does my hon. Friend agree that charities give all sorts of people the opportunity to contribute directly to the extension of knowledge, to the fight against cancer and, very often, to mutual support groups?

Mr. Bowis: My hon. Friend is absolutely right. The work of charities and their ability to attract resources from individuals is a great asset and one which we should nurture. They are especially good at attracting resources from individuals for the fight against cancer.

NHS Employees

13. Ms Eagle: To ask the Secretary of State for Health what representations she has received from employees afraid to speak publicly on NHS matters.

Mr. Malone: None.

Ms Eagle: Does the Minister agree that there is growing concern about the increasing number of dedicated health care professionals who are being disciplined or even dismissed by their health trusts for speaking out about the decline in standards? What will he do now to put a stop to draconian gagging clauses?

Mr. Malone: There are no draconian gagging clauses. The procedure is set out clearly in the guidelines that have been issued, which emphasise not only that there is a right to speak out and go through the proper procedures but that there is a duty to raise such matters in the proper way and to have them dealt with thoroughly and properly.

Mrs. Gorman: What representations has my hon. Friend received from the proprietors of private nurseries who are being harassed--

Madam Speaker: Order. [Interruption.] Order. I am on my feet. If the hon. Lady will relate her question to the question on the Order Paper, I will hear it.

Mrs. Gorman: What representations has my hon. Friend the Minister received on health matters from the proprietors of private nurseries, who are afraid of speaking out publicly for fear of their being closed for the most minor infringements?

Mr. Malone: None, to my knowledge.

Mr. Pike: Is the Minister aware of the concern at Burnley health trust, where many of the employees are not able to speak about what is happening? Is he further aware that one consultant was dismissed last month with three hours' notice and that the chief executive was asked to resign yesterday? Should not there be an inquiry into what is happening at that health trust?

Mr. Malone: The guidelines are precise. They state that fair procedures should be set out which allow openness and that a climate should be established between those who manage the institutions and those who are employed in them so that such matters can be properly

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investigated. The hon. Gentleman should refer to the guidelines. If it is the case that the institution to which he refers is not living up to them, that is a matter which needs to be looked into.

Junior Doctors

14. Mr. Congdon: To ask the Secretary of State for Health when she last met representatives of junior doctors to discuss the implementation of the new deal.

Mr. Malone: I last met the junior doctors' committee chairman to discuss the new deal on 29 September, and before that on 28 July. Ministers have met the representatives of the junior doctors on numerous occasions since we launched the new deal.

Mr. Congdon: Given the success in reducing junior hospital doctors' hours, does my hon. Friend agree that it is now important to do what we can to ensure that all accident and emergency departments have the appropriate level of junior and senior doctors on duty at the most critical times?

Mr. Malone: It is always extremely important that all accident and emergency units have a proper mixture of staff. However, those patterns are changing and, in many cases, it is possible to break down boundaries between the nursing profession, junior doctors and consultants. Where that happens, a far better mix of patient care is available for those who need it.



Q1. Mr. Berry: To ask the Prime Minister if he will list his official engagements for Tuesday 25 October.

The Prime Minister (Mr. John Major): This morning, I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.

Mr. Berry: Does the Minister for business probity still command the full support of the Prime Minister?

The Prime Minister: I shall be making a statement immediately after Question Time and the hon. Gentleman should contain himself.

Q2. Dr. Michael Clark: To ask the Prime Minister if he will list his official engagements for Tuesday 25 October.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

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