The Minister of State, Department of Health (Mr. John Denham): The Trent regional office and the Nottingham health authority strongly support the scheme for a new breast care unit at Nottingham city hospital. It will replace the 23-year-old prefabricated accommodation with a new purpose-built unit. The local breast team is internationally recognised as being at the forefront of clinical care and research into the diagnosis and treatment of breast cancer. The regional office expects to receive the full business case by September this year, at the latest.
Mr. Coaker: Will my right hon. Friend take a personal interest in the development of the breast cancer unit at Nottingham city hospital? There has been some slippage over the past couple of years, so his intervention would be very welcome. As he said, this is an internationally renowned breast cancer unit, and many people come from abroad to see it. At the moment, it is housed in prefabricated buildings. Will my right hon. Friend take a personal interest in the matter and ensure that if September is the target date for the business plan, September is also the reality for Nottingham city hospital's breast cancer unit?
Mrs. Marion Roe (Broxbourne): As one of the chairmen of the all-party breast cancer group, I welcome any new facilities for the new breast cancer unit at Nottingham city hospital. However, will the Minister tell the House what role clinical need plays in the treatment of patients who present to their general practitioners with suspected cancer? What response would he give to the president of the Royal College of Surgeons, who claims that clinics are being snowed under with inappropriate referrals for breast cancer because of the Government's two-week target?
Mr. Denham: The whole point is to ensure that patients with the highest clinical need are referred urgently to a consultant. The two-week waiting time is for urgent referrals. In support of that, we have published referral guidelines for use by general practitioners that have been drawn up with leading clinicians. The whole point is to enable general practitioners to identify women in need of an urgent referral. I believe that we have a policy that is designed and aimed to give the highest priority to those with the greatest need.
2. Mr. Paul Burstow (Sutton and Cheam): What assessment his Department has made of the number of additional nurses required to meet the requirements of the NHS plan and enable private sector providers to comply with the Care Standards Act 2000 and regulations made thereunder. 
The Secretary of State for Health (Mr. Alan Milburn): The NHS plan contains a commitment for 20,000 more nurses to be provided by 2004. Private sector providers are represented on the new local organisations charged with planning the numbers of nursing staff needed in local communities.
Mr. Burstow: The Secretary of State will know that about one in four nurses is due to retire in the next four to five years. The Royal College of Nursing, in its report last year, said that there would be a shortage of about 57,000 nurses over the next five years. Does the right hon. Gentleman accept, therefore, that increasing the number of posts in the NHS potentially increases the number of vacancies? Will he guarantee that in the effort to recruit more nurses, the international recruitment nursing director will not strip bare developing countries of their valued nurses? Will he also ensure that there will be a dramatic expansion of nurse training places in this country, so that we can grow our own nurses to fill the vacancies?
Mr. Milburn: That is precisely what is happening. It is true that nurse training places have been cut in the past; they were certainly cut under the previous Government in the mid-1990s. The number of nurses was cut in the mid-1990s, too. The national health service is still feeling the effects of that. However, the number of nurses is now consistently rising, the number of training places is up by one third, and the number of UK-based
Mrs. Gwyneth Dunwoody (Crewe and Nantwich): Will my right hon. Friend make it clear to the private sector that before it gets the same input of taxpayers' money that it got last year, it is essential that it complies with care standards? That is a question of the private sector having to come up to those standards not after new nurses have been trained, but before. That is a simple lesson that I would have thought would be in the interests of every patient.
Mr. Milburn: My hon. Friend is right: standards should be high wherever care is provided. That is particularly the case if the resources for that care, whether it is given in the private or the public sector, are provided at NHS expense. Standards are what count, which is why the action that we are taking to raise standards and to expand the number of nurses working in the NHS and the health care system overall is so important.
Mr. Milburn: The difference between this Government and the previous one is that we are paying nurses' pay awards in full, not staging them. Indeed, there is extra pay to address shortages in particular areas, so where need is highest, but where the cost of living is also the highest, we are paying extra money to nurses--up to £1,000 a year extra. There is more money for ward sisters. Last year, there was more money for staff nurses. The year before, there was more money for newly qualified nurses. All the investment that we are making is contributing to the expansion in NHS nursing numbers.
We all know the hon. Lady's view of the NHS. She says that she occasionally visits NHS hospitals to see what they are like for those who do not have the privilege of private health insurance. There are two views of the NHS: there are those who use it and those who regard it as a spectator sport.
The Secretary of State for Health (Mr. Alan Milburn): National health service cancer services are receiving more investment and greater priority than ever before. Waiting times are falling, the number of cancer specialists is rising and I can tell the House today that the NHS has the fastest-improving cancer services in Europe.
Mr. Milburn: For a moment or two, I thought that that question would cost me money, so I approach the answer with trepidation. It is right that we invest in our cancer services. Cancer kills well over 100,000 people a year and we know that many of the deaths could have been prevented had earlier action been taken. Although the focus will inevitably and rightly be on improvements in treatment services to get waiting times down, to ensure that more operations are carried out and to provide more scanners and more equipment, the biggest gains in improving cancer care will come from improved prevention.
That is why the action that my hon. Friend the Minister for Public Health and others are taking to improve smoking cessation services, reduce cigarette consumption and ban tobacco advertising is so critical to the future of cancer care in our country. There is a choice: either spend an extra half a billion pounds a year on modernising cancer services, as we are doing, or spend half a billion pounds a year on subsidising those with private health insurance, as the Conservative party proposes.
Sir Peter Emery (East Devon): Will the Secretary of State consider for a moment prostate cancer? The excellent service that I have received from the national health service at Charing Cross hospital only goes to prove what can be done if such services are carried through properly. How much extension work is being done to provide radiotherapy at more hospitals to deal with the problem of prostate cancer?
Mr. Milburn: I am grateful to the right hon. Gentleman; his comments about improvements in prostate cancer services will provide reassurance to many men. Inevitably, when people read newspaper reports about the state of cancer services, they do not always get the most accurate picture. As he knows fine well, by and large NHS cancer care is of a very high standard. We need to expand the range of services available and, most importantly of all, we need to ensure that those services are timely and of the highest possible standard.
That is why more investment is being made, particularly with the new generation of scanners--magnetic resonance imaging scanners, linear accelerators and computerised tomography scanners. Some investment comes through lottery money and some through mainstream NHS money. I can tell the right hon. Gentleman that additional investment is going into research into prostate cancer because treatments are not as good as they should be. However, I hope that, in time, we shall discover new ways to treat a deadly disease that kills far too many men in our country.
Mr. Harry Barnes (North-East Derbyshire): When a patient with suspected cancer visits a GP, often the GP's first question is, "Do you smoke?" That is an important question, but patients are seldom asked where they work or used to work, and in what conditions. The ex-vinatex workers group in my constituency feels that GPs and consultants should ask those questions, so that the position
Mr. Milburn: My hon. Friend makes an important point, although there is a direct correlation between smoking and cancer--and, indeed, between smoking and heart disease. If we succeed in doing what we want to do--improving heart-disease and cancer services, especially on the prevention side, and cutting tobacco consumption--we shall save an awful lot of lives in our country. Finding out where people have worked provides an important clue to the cause of problems, and we are certainly prepared to think about that.
Mr. Philip Hammond (Runnymede and Weybridge): I am sure the Secretary of State agrees that a key part of the Government's strategy is the pledge in the NHS cancer plan that there will be nearly 1,000 extra non-surgical cancer consultants by 2006. Does he deny that that figure is acknowledged in his own Department to be unachievable, that Ministers at the highest level--including the Prime Minister--were advised at the time that it was unachievable, and that it was included in the cancer plan only on the Prime Minister's specific insistence?
The figures that we have announced in both the NHS plan and the cancer plan are based on modelling done in the Department. They show that over the next five years we will increase the number of cancer specialists by 25 per cent. We are having to do that precisely because of the failure to invest in cancer services in the past--a shameful failure, in my view.
When the Government came to power, we found that not a single penny piece had been earmarked for improvements in cancer services. That cash is now being earmarked: there will be hundreds of millions of pounds of extra investment in cancer services next year, rising to £570 million in just two or three years' time.