May I say how pleased I am to be in Westminster Hall to debate a report from the Select Committee on Health? The last time that we attempted to have such a debate on the Floor of the House, it was knocked down the pecking order by two statements, and we barely had an hour left for it. At least, we have ample time to debate the report and the Government’s response today.

Hon. Members might be aware that “High Quality Care For All: NHS Next Stage Review Final Report” was published by the Department of Health on 30 June 2008. That was the latest of many reviews of the national health service. The Department stated that the review was different from others because it was led by an eminent surgeon—Lord Darzi—and was the subject of a wide-ranging consultation. For probably the first time, that consultation was not just with NHS managers or senior civil servants, but with clinicians themselves.

I was contacted about the shape of the consultation that took place in my region of Yorkshire and Humber, because people felt that the representatives from the acute sector were too prominent on the original board. That alleged imbalance was put right. Indeed, the Government responded to some people’s concerns that the primary sector of health care was not represented and, for the first time, many clinicians were consulted. Will my hon. Friend the Minister say how many were consulted? I am not sure how many clinicians throughout the country were consulted, but doing so was probably a first for the national health service, and is a good thing.

The report’s main focus is on improving the quality of care provided by the NHS. Variations in quality have been known about for a long time. As Lord Darzi acknowledged, those variations continue despite the doubling of NHS expenditure in real terms since 1997. Lord Darzi also believes that, during the past decade, health policy has rightly focused on access and argues that it is now time to improve quality. I will come to our comment about that, but the focus has been on access. Even five years ago, in my constituency, the wait for things such as orthopaedic surgery on knees and hips was years—not months or weeks, as it is currently. There has been a big move in relation to access, and that is to the credit of the NHS.

The Committee published its report on the review on 13 January this year. We took oral evidence from a wide range of witnesses, including the Royal College of General Practitioners, the Academy of Medical Royal Colleges, the British Medical Association, the chief executives of three strategic health authorities, academics and national health service manager representatives. We also held an evidence session with Professor Lord Darzi himself and David Nicholson, who is the chief executive of the NHS. Many of the review’s key recommendations have been made in previous reports and White Papers, but, nevertheless, we still welcome the extensive consultation undertaken as part of the review and the emphasis that it places on improving quality throughout the system.

The Committee’s main finding was that there are doubts about the capability of primary care trusts to implement Lord Darzi’s recommendations successfully. Despite the Department’s world-class commissioning programme, which aims to improve PCT commissioning, the NHS does not afford PCT commissioning sufficient status. As we said in the report, we found that to be “striking” and “depressing”.

Like most things in the NHS, some aspects of it are good and some are not so good. We cannot sign off any report by saying that commissioning must be present in all aspects of the quality improvements that we would like to see in the NHS. It would have been wrong to come to that conclusion. Some parts of the NHS are quite sensitive about the comments made about the lack of comprehensive commissioning. Indeed, that issue will cost me a couple of hours next Friday morning, when I will meet someone from a national organisation and the chief executive of my local PCT to discuss what they think are some of the report’s implications. That is not part of this inquiry; it is just something I am happy to do.

If the people who I meet in any way think that the evidence that we took was inadequate or we were wrong in our conclusions, I will be more than happy to go along with that. I think that our conclusions on commissioning were well thought through. Perhaps it was a bit emotive to use the words “striking” and “depressing”, but at least we brought the issues forward, so we can further discuss the ability of the NHS overall—or, indeed, of individual PCTs—to commission for quality. I will come on to that in a moment, because it is a different issue.

We are also concerned that the review provides little detail about costs and that it provides many priorities without ranking them. In the NHS, everything is a priority—if someone is ill, what is wrong with them is a priority. We thought that there should have been some prioritisation in the review. However, it was not surprising that that was not the case, because it has happened in many past reviews.

On quality costs, although Lord Darzi argues that improving quality saves money in the long term, that is not always easy to demonstrate. Of course, if we do not know the costs of these things, it is difficult to demonstrate that. An assumption is being made by Lord Darzi that, if quality is improved in the NHS, costs will be saved. That is a difficult assumption to accept without good and reasonable evidence. Certainly, during the years that I have been on the Health Committee, many of our reports have occasionally commented on the woeful omission of good, cost-effective evidence before decision making takes place. There has also sometimes been a lack of effective clinical evidence, which is something that we clearly need to consider.

The review proposes to seek improvements in quality through better measurement and the provision of financial incentives for providing a high quality of care. We strongly support the principle of using financial incentives, but we recommend that the Department should proceed with caution. Schemes such as advancing quality and PROMs—patient-recorded outcome measures—that link the measurement of clinical process and patient outcomes, must be piloted and evaluated rigorously before they are adopted by the wider NHS.

My reading of the NHS, which I truly support as an institution and an organisation that looks after the health of this nation, is that it is equitable in most respects—although not all. Such a situation has been going on for many years, but not much evaluation is done before things are rolled out, which is one of the reasons why many people who work in the NHS—as people have done for 60 years—get somewhat demoralised on occasions, particularly when a missive comes down from Richmond house without much justification other than, “We think that this is a good idea.” It seems that evaluation, knowing what works and piloting good schemes is the way forward in that respect. The evidence should be taken to those parts of the NHS that could do better and we should say, “We’d like you to improve what you’re doing on the basis of this evidence, which we have proven works in similar circumstances.”

The review also reiterated the Department’s plans to create 150 general practitioner-led health centres—one for each PCT in England. We welcome the provision of additional primary care services and acknowledge that there are strong arguments for increasing provision in under-doctored areas. However, the expansion of supply needs careful management and evaluation to determine whether it leads to better evidence-based medical interventions for patients and whether it reduces the disparities in health care access and utilisation between different classes. I do not want to drift off into our report on health inequalities. It has presumably been sitting on a Minister’s desk, but we are expecting the Government’s response to it soon. We believe that there should be better evidence-based medical interventions.

It should also be recognised that investment in primary care might increase demand for hospital care, as deprived people get better access to care and as referrals increase with more diagnostic tests. That is an interesting concept. If one considers the number of people that the NHS has served over the years at GP or another level, notwithstanding that other health professionals such as pharmacists speak to people about their health needs, even in times of plenty, when unemployment was low—before the current recession—there was no lack of attendance at GP surgeries. Just because people are better off financially and perhaps in many other ways, or just feel much better about life, it does not mean that they do not go to the doctor. That is an interesting point. More contact may mean that there will be more referrals to the secondary or hospital sectors.

While my right hon. Friend is on the subject of GP-led health centres, or polyclinics, as they are known—I do not know whether he will refer to this later in his speech—the Committee welcomed in some measure the establishment of what he has just described. However, it also expressed concern at the uniform—some would say doctrinaire— attitude of the Department of Health that every PCT should have such a centre. We felt that that was far too prescriptive and that it would not necessarily be advantageous for every area, even though it would be for some areas.

I shall move on to that. My hon. Friend is absolutely right. This is probably one of the areas about which the Government feel a bit sensitive. Although some PCTs would undoubtedly benefit from more primary care services, particularly those in areas that are under-doctored or that have a high burden of disease, it is less clear how others would benefit. We are not convinced by the Department’s argument that all PCTs should have a GP-led health centre.

Whether a PCT has a centre should be decided locally on a case-by-case basis, as a witness stated, using the best clinical evidence available and a full assessment of the costs and the impact on patient access. PCTs should not make their decisions on a whim. National criteria should be set out to ensure that the benefits and costs of their decisions are known. I and the Committee were disappointed that neither the Government nor the witnesses who appeared before us as representatives of doctors could tell us what criteria should be used to decide whether a PCT needed a GP-led health centre.

I have no doubt that other Members in this Chamber, like me, might have had in their constituency a campaign run by the medical profession when the proposal was introduced. Before the local government elections last year, I had one doctor from a practice of five—not all five doctors—putting out letters saying that people should demonstrate in the ballot box against the proposed changes in primary health care. The letter was about a new primary care health centre in Rotherham that would be open seven days a week for 12 hours a day.

If we look at the disease burden of the three constituencies that cover Rotherham, there is a good case for a centre, in my view—this is anecdotal, to some extent—or we can look at the health profiles of the communities, which are not very good in most circumstances. The only things that make the Rotherham and Sheffield health profiles look good for the region are profiles of places such as Hull and Bradford, but they do not look good when the detail of the problems that we have are studied.

I had a public meeting with that doctor and some members of his association locally. I believe that we agreed that it would probably be a good idea to have the new primary care health centre in Rotherham and that there is a need for it. One of the witnesses who was a representative of one of the professions told us that he worked in a part of East Yorkshire that is, by and large, well off. That does not really mean that everyone is in good health. He said that one centre was going into his PCT, but that there was probably an argument that they ought to have two or three in Hull. Given the profile of the city of Hull and the surrounding area, I think that he was probably right.

It was greatly disappointing that the discussions that we had last year, which have ended now—I am pleased about that—were based on assumptions and not on any agreed criteria about where centres should go. Decisions should be based, by and large, on the health needs of the population, not on the structures of the NHS. All the members of the Committee felt strongly about that.

Another area that we looked at—at this stage, it is a train coming down the track—is the Department’s decision to conduct trials of personal budgets for health care. We welcome those trials if they are done rigorously, and if policy makers wait for the results before beginning any large-scale roll-out of the programme. We would be happy with that.

One or two members of the Committee received briefings prior to the debate. I want to quote from one that I received from Diabetes UK:

“Diabetes UK believes it should be clearly enshrined in legislation that Personal Health Budgets of any kind (notional, third party or direct payments) remain voluntary for pilot schemes and in the event they are rolled out further.”

I do not know whether my hon. Friend the Minister has seen the briefing. Diabetes UK goes on to state:

“Having a personal budget for the entire care package for a complex, changing and progressive condition such as diabetes, could potentially result in individuals receiving suboptimal clinical care if their budgets run out, or a process of self rationing in order to achieve all desired goals within budget.”

I thought I ought to mention that.

I know that my hon. Friend will tell us that the proposals are part of the Health Bill that is in the other place at present—it has not yet reached us. First, I would like to congratulate the Government on piloting the scheme. I hope that the results will be measured and evaluated properly before the scheme is rolled out.

I thought that I ought to mention what some of the major charities that work with people with long-term conditions feel about that prospect. They are not saying no, but it is clear that we must be careful to ensure that it does not disrupt the needs of people with long-term conditions.

The review also makes several proposals for improving work force planning and the quality of leadership in the NHS. The Committee welcomes the Department’s focus on those areas following the severe criticisms in our report, “Workforce Planning”. However, we note concerns that planning will be concentrated in the Department. Strategic health authorities have a key role in work force planning, and we believe that the Department should take steps to ensure that regional NHS employers are given a role in identifying future work force requirements.

When we were doing the work force planning inquiry, we looked at the projections made for the increases in the work force that were very much needed when the Government came to office in 1997. I recall that one of the figures—this was announced in 2000—was that we wanted another 20,000 nurses within five years. Within four years, we had 64,000 more nurses in the system—a 340 per cent. overshoot on what the politicians at the centre predicted.

The Committee tried to investigate why that happened—this is in a different report. By and large, it happened because there was little or no strategic planning for the work force inside the NHS. We think that the Department should use the reconfigured SHAs as one way to improve work force planning, and we hope that that will be taken on board.

We argued that it is unfortunate that the review does not place more emphasis on the importance of recruiting and developing better managers. In many inquiries, the Committee has heard concerns about the quality of management in the NHS, and witnesses to this inquiry echoed those concerns. I am not having a go at management, or saying that managers are not needed. They certainly are needed in our NHS. I know that managers, and the number of them, have often been easy targets for politicians of all parties, but we should be looking at the quality of managers and what they are doing to ensure that patients get better-quality treatment than they have had in the past.

We said:

“Some managers lack the analytical skills or motivation to handle and interpret the wide range of performance and routine administrative data, such as Hospital Episode Statistics, that they have to deal with. With the introduction of PROMs and other quality related measures this issue is becoming ever more important. The Department must address the issue of weak management skills in this area with urgency.”

If we are going to measure the outcome of a patient episode from a quality point of view, as opposed to a quantitative point of view, we need to know how to measure and what we are measuring, and we need to ensure that quality is high on the agenda.

The Government response was published in March 2009. They argued that PCT commissioning would be improved through the Department’s world-class commissioning, saying:

“It is a ground-breaking and ambitious programme that… will help PCTs deliver better services, which are more closely matched to local needs, resulting in better quality of care, improved health and well-being and a reduction in health inequalities across the community.”

We have heard similar claims before in such responses.

If my hon. Friend looks at the Government’s response to the Committee’s inquiry on dental services, he will see that such claims were made at that time, too. The Government also stated that practice-based commissioning would be supported and extended, even though it had not proved popular with many GPs. Is that improving now? I saw some statistics last week that showed that, in respect of the measurement of practice-based commissioning, practices were doing it, but not for everything. There are issues with that.

The Government also accepted our recommendation that incentive schemes for improving quality, such as PROMs and commissioning for quality and innovation, should be properly trialled and evaluated before their widespread implementation. I understand that, strategically speaking, there is a pilot scheme taking place in your constituency, Mrs. Anderson, in respect of the quality up in the north-west of England. I met the chair of the SHA for the north-west at a gathering and said that I might spend one of my days in the recess not lying on a sunbed in a country off the Indian ocean, but going over the Pennines to have a look to see what is happening with that trial. Although this report is now gone, I have no doubt that hon. Members would be interested in how that SHA is measuring quality, how it proposes to do so and the likely effect of that on other parts of the NHS.

The Government reiterated their commitment to extending choice and personalisation in health care and said, again, that this would be piloted. I welcomed that earlier.

Subsequently, since those developments, PROMs for hips, knees, hernias and varicose veins have been rolled out from April 2009. We expect that data in relation to those first roll-outs should begin to emerge in late autumn. Does my hon. Friend have a view on that? Are we likely to see data and what type of data will be useful?

I understand that the Department has put out a tender for PROMs for chronic diseases, so we intend to pilot and roll out further PROM measures for other conditions. When I became a member of the Health Committee in 2005, I had been actively involved in health care as far as my constituents were concerned since I was first elected to the House, and my general assumption was that the NHS spent most of its money on new hospitals, new theatres in hospitals, new innovations or new drugs of the more expensive kind. For example, we are debating the use of end-of-life cancer drugs and how much more expensive they are. In fact, we spend about 80 per cent. of our money in the NHS on none of those things: we spend it on management of chronic conditions.

Some people have two, three or even four chronic conditions. That is where we spend most of our money, from the taxpayer’s point of view. It is right and proper that we should be looking at that area in terms of how PROMs will work. I will welcome the chronic disease pilot when it comes along. If my hon. Friend is still in post—if I am still in post—when it comes along, I shall be more than interested, as an individual, to see exactly how something that I hope will manage and improve the quality of health care for people with chronic conditions is being piloted.

We do not yet know how much PROMs will cost and who will be evaluating the large investment in them. I return to something that I must have mentioned at least three times now: a lot of the time we do not know, although we should know exactly, how much things cost. So, I hope that these pilots will teach us something before there is any general roll-out.

We understand that other quality measures are now published, including hospital mortality rates for certain conditions and GP satisfaction surveys. I do not know how clinically accurate those surveys are. However, they are certainly having some influence in my locality in terms of access to local GP surgeries that are not tied into the new centres that are being built. That is a good thing.

Something hit the press about five weeks ago in my constituency: a surgery was dubbed by regional BBC television the worst surgery in Britain. That surgery is still using 0800 numbers and nobody can ever get through. There was a massive queue, starting at 8 am, for people to see their GP and, until it appeared on television, if it was raining, people had to stand outside in the rain to get in.

The practice’s first reaction was to open the doors at 8 am, which is hardly rocket science. Nevertheless, it has done that, so at least the good people of Dinnington do not have to wait outside in adverse weather conditions. I hope that that practice has put something a bit more practical in place in respect of people phoning and that it is getting rid of a system that makes it difficult for people to get through on the phone when wanting access to their local GP. Out of all the surgeries in my constituency, that is the only one that I have ever had complaints about in terms of access—and I am going back many years.

I understand that we have no plans for evaluating CQUIN, although that is going into many commissioning processes throughout the NHS at the moment. I would like to hear the Minister’s view on that, if he has a view at this stage. I was at a gathering on Monday down here in London, talking about the NSR, and somebody said—I should have kept my notes—“We are collecting the CQUIN data from nine areas. We are not sure what it is intended for at this stage, but we think that if we are collecting data from nine areas, that must be a good thing.” I questioned whether it is a good thing, if the intention in respect of putting CQUIN into current commissioning is not known. Perhaps my hon. Friend will say what the intention is. I do not know what data are being collected, but I was told about this by somebody who works for the NHS in London. It would be useful if we had that information.

Just prior to the debate, I received a little note from Professor Alan Maynard, from York, who often advises the Health Committee. I often say—with some truthfulness—that he tends to appear at Committee sittings more frequently than some Committee members, but that might be a bit unkind. [Interruption.] I see one or two of my hon. Friends smiling. Professor Maynard’s note said:

“There are some indications that improving does not always save money”.

He said that Lord Darzi’s

“contention that improved quality was always cost saving is dodgy”,

because people are likely to grab hold of the low-hanging fruit, which they have had a tendency to do for many years. Once they have got hold of that low-hanging fruit from the lower boughs of the tree, that is taken as evidence that something works. However, the further up the tree they go, the more expensive the fruit might be to get hold of.

Professor Maynard believes that there is no straight read-over and that money might not necessarily be saved. Having said that, that is not the point of the exercise. The point is to put quality rather than quantity on the NHS agenda.

We said in our report that there was no reason why we should not have included quality when we provided quantity during the past decade, but that, by and large, is now a matter for historians to debate. The important point is that what came out of the NSR was an intention to ensure that when our constituents use the NHS, things will not just be done quicker than previously, but the outcome will be clinically better and the quality of that outcome will be measured.

I hope that everyone will understand that, and that those who have a positive view of the NHS and who use it, particularly those who go into hospital, will be able to say in a few years, “It was the best outcome that I could have had,” and not just that it was the quickest outcome or that the nurses and doctors were fine.

It is a huge privilege to speak second after the Committee’s Chairman, Mrs. Anderson, because I do not have to take account of what other hon. Members might have said. I am grateful for that.

My first words are of congratulation for the Department on its response, which is full and in order. I have criticised it previously for fragmenting our reports and making its comments in an order that is amazingly difficult to follow. I have the distinct impression that, unless the word “recommendation” is included, the Department does not respond, but it has responded to these conclusions and recommendations in full, and I am grateful for that.

I welcome the emphasis on quality and leadership, and I shall spend most of my time on those two aspects. The Committee’s Chairman questioned the proof of quality-saving costs. Without proof, it is obvious that, if the quality of care is right, care is likely to be safe, efficient and low cost. Paragraph 36 of the response states:

“High quality and value for money are not competing alternatives; they are one and the same thing. Better care equals better value.”

An obvious example is that cutting down on litigation as a result of better quality saves money.

That quality needs to be addressed is all too obvious. We have recently had examples in mid-Staffordshire, and some time ago, we had examples in Brighton. I fear that poor quality may be more widespread than just two cases. With your permission, Mrs. Anderson, and as time is, thankfully, not tight, I shall read a whole letter that I have received from constituents in the past day or two. It states:

“Dear Dr. Taylor,

A few weeks ago we were devastated by the death of our only son. (We are not saying the standard of care he received wasn’t good in many respects, but there were areas that could have been…improved upon.)

We would arrive to see him, to find him lying in a soaking wet bed, or worse. He was unable to walk at this time so couldn’t get to the bathroom. I offered to take a commode to him, but was told no the nurse would do it. 30 minutes later I asked again but by the time it arrived it was too late. It was made worse by the fact”

that

“when the cleaner was polishing the floor she went only to the first bed, leaving the other two beds not cleaned under.

Our son had an infection under his nails and was unable to pick things up. This the staff knew about, so why were pills left in the little plastic cup. They would be left from the morning and lunch time. Maybe it was because he had no water jug or cup so he had nothing to drink. His Consultant told us he must drink plenty. He was given a warm drink which he had to drink through a straw, but his dad had to fetch water and a mug most days. He would drink 4 or 5 glassfuls which we had to hold for him. We know he wasn’t the only person they had to look after, and it’s said nurses are rushed off their feet. Lots of working people have long stressful days, and I know people who went into nursing as a vocation but sadly those days have gone. When someone is training for this job, I’m sure they must learn what is expected from them, and the meaning of the word nurse means to take care of and hopefully give a person dignity, which sadly our son didn’t have at times.

We hope that if others of us should need to go into hospital in the future, that the cleaners do what they’re supposed to do and our right to dignity is upheld.”

Thank you, Mrs. Anderson, for allowing me to read that long letter. What does one say in reply? It is not an official complaint, but I will pass it on to the commissioning and providing trusts. Sadly, I have been passing on such complaints for a long time. If they are formal complaints, there is an investigation, probably an apology and an expression of aims to do better, but I continue to receive such letters.

Today, I received another, much shorter letter. It states:

“1 had an operation November last year to remove a possible…adenoma from my parotid gland. I was extremely unhappy with my treatment…The aftercare was disgraceful—the drain in the wound wasn’t working, but despite me asking numerous times, one was never re attached. I had salivary fistulas and an open wound till mid January, but they just told me to ‘squeeze’ it every day! I was given no guidance on cleanliness, dressing the wound etc. It was appalling.

I asked the surgeon to check my neck in January as I felt that the tumour was still there”.

The surgeon

“refused to listen and explained that the only lump they found was the lymph node, which they removed, so I was wrong, end of story.

I was not satisfied, so I asked my GP…to refer me for another MRI. I received the results of that…and the tumour is still there.”

Why is basic quality lacking? Why are compassion, dignity and communication lacking? Stress and overwork are not an excuse. Demoralised staff are the fault of the leadership. Is there too much emphasis on scientific training for doctors and nurses without adequate training in interpersonal skills, the need for compassion and sympathy, and the importance of dignity to the helpless?

I do not blame the chief executive at the hospital that I am talking about because I have high regard for him, and other chief executives in the area have said that, if anyone could turn things round, he could. Who am I blaming? I am afraid that I am blaming the clinical staff and the clinical leadership, and I will return to that.

Much of the Government’s response is about commissioning, so quality must be written into the contract, and the commissioners must be able to enforce that contract. Will quality observatories in each SHA help? How will they know about the sort of care that constituents do not make formal complaints about because they do not know what to do? If they come to me, I pass those complaints on.

The Government’s response reiterates much that has been said about quality, and paragraph 50—“High Quality Care for All”—sets out the seven aspects of the quality framework, but I am worried that those seven aspects may not pick up the sort of basic lack of quality that I am talking about. One is

“bringing clarity to quality—making it easy to access evidence about best practice by asking NICE to develop and kite-mark quality standards”.

I do not believe that NICE will be able to rule on not leaving patients in wet, soiled beds.

The other aspects include:

“supporting clinicians to measure quality to support improvement…requiring quality information to be published…recognising and rewarding the delivery of high quality care…safeguarding basic standards through a new independent regulator, the Care Quality Commission”.

Patient-reported outcomes will pick some things up, but they are obviously very limited to start with. I am not sure that commissioning for quality and innovation will help, because we need basic quality before innovation. I am also not quite sure how the NHS constitution will help people such as my constituents, but perhaps the Minister can clarify that.

The only answer is inspirational leadership by all groups of clinical staff, and that is covered by recommendations 21 to 24 of the report. Paragraph 107 of the Government response says:

“Far from taking a centralised approach to leadership development, we believe that leadership should happen at every level of the system and that leadership development should start at the level of the individual. All NHS staff have a responsibility to continuously learn, seek development and career opportunities, spot talent and support the development of others.”

My big question is what has happened to the local leaders? Do the ward sister and the consultants on a ward actually talk to one another? Do they do ward rounds together? Does the consultant tell the sister when the nursing standards are low? Does the sister tell the consultant when a junior doctor is hopeless? Sadly, I suspect that the answer to all those questions is no, and that is what we want to look at—we want to bring back basic quality care. The first allegiance of consultants and nurses on the wards must be to the patient and the other staff. I just hope that the review will address the restoration of basic quality care for all, while remembering compassion, dignity and communication.

It is a shame that the House authorities have put the swine flu debate on in the main Chamber, because more hon. Members would have been here if they had not. I do not know whether we can make representations so that we can avoid doubling up in future.

Although there were some reservations about the next stage review, it was well received on the whole. Much of the tribute for that must go to Lord Darzi, because the process was very much driven by him. Initially, I thought that it was a brilliant idea to have him conduct the review. Indeed, one could see the light bulbs popping on over some Ministers’ heads as they thought, “Let’s find a doctor and make him a Lord. If he does the review, it will have much more credibility.”

Call me cynical, but that is the way I felt at the time. I thought that the process would surely get buy-in from the whole health service, but GPs initially said, “Ah, but he is a surgeon,” and even surgeons said, “Ah, but he’s the wrong type of surgeon. He’s a tertiary surgeon. He works on a specific bit of the bowel.” I wondered whether it was ever possible to please anybody, and it is partly a tribute to the man himself that he managed to bring the review off.

Various review streams were being carried out in different strategic health authorities, and it must have been an administrative nightmare to bring them together into some kind of cohesive whole. We sometimes underestimate the sheer hard work that goes into something like the review, and I pay tribute to all involved. Although the Committee found fault with some things, there was a consensus that the review was a good thing.

The hon. Member for Wyre Forest (Dr. Taylor) commented heavily on the issue of clinical leadership. I have been on Committee visits and other visits to countries where hospital boards are led by a strong medical component. That arrangement seems to lead to a more clinically driven process, and one cannot overestimate the importance of that. I am talking not just about doctors, and I am glad that the hon. Gentleman also mentioned nurses. I once visited a local hospital in connection with hygiene, and I was given free rein to go into any ward I wanted, so it was very much a pot-luck visit. What struck me very powerfully was that some wards were run with a rod of iron—the nurse in charge had complete control and authority—but others were not. For the sake of patients, we need to invest heavily in dealing with that.

When I was elected in 2000, people waited at least a couple of years for a hip replacement, and they waited months in a cardiac ward for urgent cardiac surgery, hoping to survive, but we do not see that now. Although we criticise targets, I concede that they might have been necessary at that time to introduce outcome-driven targets, which were probably the only way to focus on what needed to be done. None the less, some targets did skew priorities. Now, however, waiting lists are low, and I hope that budgets will not be affected too much, so we can concentrate on improving clinical care and perhaps have a more clinically driven process.

It was entirely positive that the consultation did not involve just the great and the good and the worthies in their profession—the same old names that we see on every committee. The review went wider and tried to engage health workers in different localities and to involve patients and the public. We could argue about whether it did that as well as it could, but it tried, and that set a useful benchmark for the future. The review’s engagement with the strategic health authorities also meant that the focus could be a little more local. I am not usually a great fan of SHAs, but the engagement with them was useful in this case.

Getting the commissioning right will be crucial to the review’s implementation. It has frequently been noted that people seem to complain about the quality of commissioning wherever one goes in the health service. The Committee’s report highlighted that, saying:

“PCTs lack analytical and planning skills and the quality of their management is very variable.”

We should bear it in mind that the report was published fairly recently.

The Government response was a little weak and a little defensive about commissioning. It acknowledged that the Government were aware of the problem in 2007, but then went on at great length about world-class commissioning. That part of the response is the most disappointing; it is a fine exercise in NHS management speak and makes much of vision, competencies, assurance and status. I do not doubt the Government’s good intentions on commissioning, but the Minister must accept—particularly when he looks at the review of how PCTs were doing on world-class commissioning—that commissioning is patchy.

Services are often commissioned by people who know little about them. I recall speaking to local commissioners about dentistry. They were new in the job and knew little, at the time, about dentistry. They did not even know how many units of dental activity a dentist could get through. They said, “We are going to commission so many thousand units of dental activity,” and when I asked them how many dentists that meant, they sat scratching their heads for a while. If people with so little understanding of what they are doing are commissioning services, we are clearly not going to commission services of any class—let alone world class. There is also a danger that some of the newer, more innovative services that people are trying to develop will not be commissioned.

I want to talk about quality and patient-reported outcome measures. I hope that the Minister will update us on that. The four areas that have been outlined were supposed to have been initiated by April. Niall Dixon, of the King’s Fund, described the implementation timetable as “very challenging”. How far has implementation gone, and what is the sample size? Can we have more information about how the data will be used? The Government response gave as much information as was available at the time, but things will have moved on since then. It would also be helpful, as has been mentioned, if the Minister would outline costs. Lord Darzi estimated £6.50 per person, but other witnesses who came before the Committee gave estimates ranging from £2.50 to £10. It would be useful to have a clear idea of the likely reality.

Another aspect of the NSR report—to do with choice, personalisation and access—was also well-intentioned, but it is unclear how it will pan out. In the interim report it was announced that 100 additional GP surgeries would be developed in under-doctored areas. No one could argue that that was a bad thing. I certainly would not; I might ask why there were to be only 100. More controversial, as has been said, was the new GP-led health centre in every PCT—a one-size-fits-all solution. According to my reading, that was supposed to be a matter of improving access, tackling inequalities and fostering team working; so it might be useful to see whether it has worked out. There is a slightly schizoid tension in Government between the top-down imposition of a centre in each PCT and the mantra that enables responsibility to be abdicated: “Ah, but each PCT will decide where it will go locally.” Well, they did not actually want them locally; and there are some PCTs with huge problems—some of the spearhead PCTs—that could probably have done with a couple more of them. There seems to be no overall planning of the matter; it is neither fish nor fowl. If the Government are serious about tackling inequalities it would be better to concentrate more on the under-doctored areas, because the Committee’s report on inequalities highlighted many problems in those areas.

The desire for access and greater team working was not as well thought through as it might have been. I am not sure whether the consequences were thought through. Very little thought was given to the impact of a polyclinic on the local health economy. If existing doctors and pharmacies were to go out of business, would not the public have less choice? Their only choice would be the new GP-led health centre, which might not be as close for people who had to walk or rely on public transport. A significant proportion of the people affected might be disadvantaged.

There are legitimate concerns, but the campaign that the British Medical Association led on the matter was—I am not allowed to say this about hon. Members, but I think I may about the BMA—dishonest, disingenuous and nothing short of disgraceful.

What a shame that the hon. Lady did not say that at the time.

I think I did, actually. I was vociferous with my local doctors. Every hon. Member was contacted by the GPs in their area who were up in arms about what they all called polyclinics; they did not seem to know what they were—there is great confusion about polyclinics and GP-led health centres. I went to some surgeries in the south of Hampshire, and said, “I think the clinic is going to be in Basingstoke. No one from the locality is going to go there.” There is a good reason for putting it in Basingstoke, because a lot of housing is planned there. A frenzy was whipped up, with no real thought about whether it was realistic. GPs must be careful before they cry wolf, because there will come a time when we do not believe them. This is such a case. I give credit to the surgery in my locality that did not join in the feeding frenzy, taking the attitude: “We know there is no risk to us; we think we are a good surgery and our patients will not want to go to Basingstoke.” There is nothing wrong with Basingstoke, but it is a long journey from Romsey. That campaign by the BMA was unhelpful.

As to team working, I concede that there are advantages in a variety of health practitioners working together in one location, but that is another approach that ignores the wider health economy. There will be a feeling that there is no mechanism to enable people outside the loop, who could work with the GP health centre and build up links, to do that. The way to get health professionals working together is to start when they are at university. Many schools of nursing at universities are trying, with varying degrees of success, to do that. Students regard aspects of such courses as tokenistic. I took part in a BMA-organised debate in Southampton, which was well attended by medical students. It was good to see that they were interested and engaged enough to come out on a Thursday night. They were quite scathing about the joint working. It was not that they already had an arrogant attitude towards working with other partners. They just felt that it had not been well thought through. When the Committee was in New Zealand we made a visit to someone—I think it was a doctor—who had tried such an approach. I think that a little more thought had gone into what he did. He had not mixed everyone together at the beginning of their training, but had put doctors at the beginning of their training with nurses and pharmacists who had been training for longer, and set exercises that meant that the student doctors had actively to engage with those pharmacists and nurses, and appreciate their expertise. Such approaches should be considered more closely.

The other concern about polyclinics and GP-led health centres is that they are being introduced with no pilots or evaluation. I have never quite understood why some initiatives are introduced with pilot after pilot—and when it is clear that they are doing quite well there is another pilot, so that it takes years to introduce them—whereas other, untried, initiatives are introduced wholesale. It would be helpful if the Minister clarified how the Government decide what will be piloted and what will appear everywhere. The Committee’s report raised concerns that

“roll out will precede the results of the evaluation, which has the potential to waste taxpayers’ money and be grossly inefficient.”

Obviously, in the current financial climate, we cannot afford to do that.

The Government response in paragraphs 77 to 79 was a little disappointing. Those paragraphs only defended the Government’s position. There was no mention of a review. The Government did not even say, “Well, we’re not going to do one, so tough.” It would therefore be helpful if the Minister elaborated on whether there will be any evaluation and, if early health centres are shown not to work, what will be done.

I shall briefly mention personal health budgets. Despite what I have said about piloting, I think that it is absolutely right to pilot those. I have been a great fan of individual budgets in social care, but they are not for everyone. Some people would rather have the responsibility taken off them. For those who like individual budgets, they are brilliant and they have made a huge difference to people’s lives. Hampshire has been at the forefront of piloting them. However, the lessons from social care cannot necessarily be transferred wholesale to health care, for a number of reasons. People live with a range of long-term conditions. We do not all neatly fit into a box, so it is not easy to decide what the budget should be. If someone has three or four conditions, are there economies of scale; can some of them be managed together? Is it the case that someone’s situation is more complex and they need more funding? Also, the budgets could be a back-door route to rationing if there was not careful monitoring.

Despite my criticism of the BMA, I think it only fair to say that it is asking sensible questions about the budgets. What happens if the budget runs out? Who is responsible? Who will have access and how will they have access? Will they be able to access the budget for the next year, in advance? If they spend less, what will happen to the money? Will the patient get a pat on the back and be able to keep it, or will they have to return it to the NHS pot? How will all that be administered? The BMA also raises the point that I have raised. How will the calculations be made? Will there be a consistent methodology between PCTs? We have all seen the differences in the commissioning of various services by PCTs. How can we price health? Not everything can be easily put into a one-size-fits-all tariff. There are realistic and genuine concerns in that regard.

I shall finish with a few words about the NHS constitution. No one could argue with the general idea, but it does seem a bit motherhood and apple pie. It is all very well having a nice document and handbook, but if we are trying to improve the patient experience, we really need to be concentrating even more on clinical leadership, which has been mentioned. Just producing the book will do no good at all if it is not linked with clearly defined ways of inculcating that leadership and ensuring that the thinking behind the constitution, which is well meant, is part of everyday thinking. Otherwise, sadly, we will be sitting here in debates in years to come and the hon. Member for Wyre Forest or his successor will be reading out letters similar to those that he read out today. We would all wish to avoid that.

As no other hon. Members had previously indicated a wish to speak, I moved on to the winding-up speeches by calling the hon. Member for Romsey (Sandra Gidley) in her capacity as spokesperson for the Liberal Democrats. However, I think that her dual role—she is also a member of the Health Committee—has caused some confusion, and the hon. Member for Lewisham, West (Jim Dowd) has now indicated a wish to speak. Therefore, exceptionally, I call Mr. Jim Dowd.

Your generosity and understanding are legendary, Mrs. Anderson, and I apologise to hon. Members—I was misled. The hon. Member for Wyre Forest (Dr. Taylor) is not only the health spokesman for his party, but the leader of his party. He is with us today, as is the hon. Member for Romsey (Sandra Gidley). I thought that you were just calling members of the Committee and, in my naturally deferential way, I deferred to them before attempting to speak. I will be brief, even though we are not short of time.

To go off on a slight tangent, we have had a next stage review in Lewisham, south-east London, recently. It was principally about the future of acute hospital services. The independent reconfiguration panel reported just last week, and there are difficult choices for some of the hospitals in what was called outer south-east London, although as a native south-east Londoner, I had never heard of such a place before.

Queen Mary’s hospital, Sidcup; the Queen Elizabeth, Woolwich; and the Princess Royal hospital at Farnborough in Kent will have difficulties, but the report was excellent news for Lewisham and for the future of University Hospital Lewisham. The critical services that it provides to my constituents and people across a much larger area have been secured, and I thank the Department and everyone involved for reaching such a conclusion.

Lewisham hospital can now engineer an ever closer collaboration with what will become, I think, the largest academic health sciences centre in the country. It will involve King’s College hospital, King’s college itself, Guy’s and St. Thomas’s hospitals, and the South London and Maudsley NHS Foundation Trust. University Hospital Lewisham looks forward to an increasingly beneficial partnership with them.

As ever, it was a pleasure to serve on the Health Committee and to be part of the preparation of the report. I want to highlight the one area that I mentioned in my intervention on my right hon. Friend the Member for Rother Valley (Mr. Barron). I am referring to the concerns about GP-led health centres, or polyclinics.

I want to echo much of what the hon. Member for Romsey said about the issue. I have to say initially that I notice that the Government response states:

“GP-led health centres as a model of provision are distinct from the ‘polyclinic’ programme that has been developed by the NHS in London”.

The previous, Conservative Government lost the battle over calling the community charge the community charge, because the rest of the world called it the poll tax, and the current Government are in a similar position over GP-led health centres and polyclinics. The whole world out there believes them to be polyclinics—not that they necessarily understand what a polyclinic is, but even on the title, the Government have lost ground.

I received a delegation at my advice surgery in Forest Hill last Saturday from the Lewisham pensioners forum. It is always a pleasure to meet and discuss issues with them. I think that at the outset of the meeting they did not realise that we were discussing this issue today, but they came with a copy of the Select Committee report to say how much they supported it, particularly the less than ringing endorsement that the Committee has given. Perhaps that overstates it, but certainly we have serious reservations about why the Government are proceeding as they are on GP-led health centres. I am referring to the instruction that every PCT has to have one.

The fact that there has to be a private sector bidder is, in particular, causing considerable disquiet among not only the Lewisham pensioners forum, but people far more widely. The fear is that the centres will undermine local GP services and that if they are proved not to work—to have failed, in the absence any evaluation—they might so seriously undermine current provision of GP services that people will have no alternative other than to suffer a degradation in services.

I would contrast that with the Government’s approach on personal budgets, which the hon. Member for Romsey described. There, they are happily, and in my view wisely, proceeding with great caution, because although personal budgets do not necessarily worry people, they are not quite sure what the term means. It may well mean caps on personal budgets, as there are on all other budgets, but what will that mean for the provision of health care needed by the individual?

I believe that the Government are being wisely cautious in preparing for the introduction of personal budgets, if they go ahead, yet that stands in stark contrast to their approach on GP-led health centres—that everyone must have one, and that every PCT should provide one. The Government response suggests that it is up to the PCT to decide what mix of services should be provided. Paragraph 79 states:

“Although we have encouraged PCTs to consider including other community-based services in GP-led health centres, where this meets local needs, it is up to local PCTs to decide whether and, if so, on what scale to do so.”

That is fair enough, but taking it back one step, it is not up to the PCT to decide whether to have one at all. The Committee found that something of a contradiction, one that at least needs clarification.

The proposals may be beneficial. The PCT in Lewisham is looking to provide a GP-led health centre at the Waldron health centre in New Cross, which is in the constituency next door to mine—that of the Under-Secretary of State for Energy and Climate Change, my hon. Friend the Member for Lewisham, Deptford (Joan Ruddock). There has been little or no enthusiasm for it from the practice already based there and no demand for it from patients in Lewisham; the pressure is coming entirely from the centre, from the Department of Health. The danger is that something will be foisted upon us that we may not need.

I am genuinely optimistic about the programme, but the Government need to show more direction, more clarity and, in particular, more flexibility in introducing it. There is one element that we should never underestimate. The Government have an excellent record with the NHS over the past 12 years, and particularly the last eight. We have made huge, tangible and sustainable progress. I am a great supporter of what the Government have done, but on this matter they need to tread more cautiously and more carefully.

My right hon. Friend the Member for Rother Valley mentioned the campaign mounted by the British Medical Association. Incidentally, my GP was leading the campaign locally. I have been trying for the past month to get an appointment with him for a medication review; I must say, in all modesty, that he found it a damned sight easier to get hold of me than I found it to get hold of him.

When giving evidence to the Committee, Dr. Hamish Meldrum, chairman of the BMA council, disowned the activities of the GP in the constituency of my right hon. Friend. My right hon. Friend was too modest to mention it, but Dr. Meldrum went on to say that the BMA does not support one-size-fits-all health provision, to which my right hon. Friend rightly pointed out that the BMA supports one-size-fits-all political campaigning when it suits.

Is my hon. Friend aware that Dr. Meldrum was successful in his bid to run one of the centres?

Of course—if you can’t beat ’em, join ’em!

The Government need to demonstrate more openness and flexibility. The one crucial element to the changes engineered in the health service was taking the public with us. Public confidence can be established, but I am pretty certain that there is none at the moment.

May I say how pleased I am to see you in the Chair, Mrs. Anderson?

I congratulate the right hon. Member for Rother Valley (Mr. Barron) and his Committee on putting together a thorough, pithy and succinct report. It clearly sets out the issues raised by the next stage review. I thank him for his comprehensive and detailed introduction to the key points in the report.

The right hon. Gentleman was correct to highlight the concerns of the primary sector. I would go further; it was not only the primary sector and GPs that did not feel that they were involved in the process, but the nursing profession. It would be helpful if the Minister said how many of the 2,000 consulted were GPs and nurses. The right hon. Gentleman also mentioned costs. The primary care sector was supposed to have set out the costs in detail by spring 2009. Will the Minister say how many PCTs met that time scale, and what he and the Department are doing to chase those that have not and to ensure that they do so shortly?

Another issue mentioned by the right hon. Member for Rother Valley and the hon. Members for Lewisham, West (Jim Dowd) and for Romsey (Sandra Gidley) was one that I had intended to refer to without being prompted—the question of pilots. The Minister will not be surprised to hear that I shall return to the subject of polyclinics and GP-led health centres. However, when the right hon. Gentleman was talking about the significance of pilots, I noticed that the Minister was nodding vigorously. If pilots are right in some cases, why were they not right for rolling out GP-led health centres? They were introduced without adequate criteria or clinical evidence and so on. I may go into that in more detail later.

The right hon. Gentleman highlighted the importance of leadership and improving the work force. On that, the Government response to the Committee’s report was good, and we agree with much of it. It is essential to have incentives and standards, and to advocate improvement at all levels within the health service. The Government dealt with that point properly.

The hon. Member for Wyre Forest (Dr. Taylor) always makes extremely informed contributions to our health debates. He is right that, for once—I do not know whether he was criticising only the Department of Health—the Department’s response to a report is extremely logical and easy to comprehend and digest. That is not always the case, and is certainly not the case with other Departments.

However, I am sorry to have to tell the hon. Gentleman that the examples that he gave and the moving letters that he read out are not unique to his constituency. We could all do that, and I receive similar letters at my office relating to my constituency in rural Lincolnshire. Although there are centres of excellence and good hospitals, examples of poor practice can often be found. We need to deal with that collectively. However, he is right to highlight the concerns set out in the quality framework.

The hon. Member for Romsey is right in what she said about commissioning, and about the problems and patchiness that exist. Even if we could define what is meant by world-class commissioning, it is clear that many PCTs are struggling to implement it. Indeed, many are struggling to separate the conflicts that arise in their commissioning and provider arms. Indeed, the Minister will be aware that some PCTs are struggling to commission efficiently and effectively, and that the independent sector has been sent in to assist, but if PCTs cannot commission as they should, innovation can be harmed. Given the time, that is another theme to which I shall return.

I join the hon. Lady in thanking Lord Darzi for the tireless work that he put into the NSR. Like her and others, I picked up on the fact that he was bring criticised for not understanding primary care, but the NSR summarised many of the problems prevalent in the health service. However, the Select Committee report says that many of the key recommendations had been made before. Indeed, many were set out two years previously in the Department of Health White Paper “Our health, our care, our say”, and some themes are replicated in Lord Darzi’s report. The NSR is nevertheless a significant report, the difference being the wide range of consultation involved and the fact that people throughout the NHS participated.

The White Paper was the sixth on health since 1997. I would argue that few of the aspirations set out in them have been achieved. However, we do not need more reviews and more reorganisations. We need to focus on delivery and better patient outcomes through the NHS.

If I have a generic criticism of the NSR, it is that the responses to the issues highlighted in it are inevitably bureaucratic. They are centralised and do not focus on patient care. I give the Minister an example: out of the NSR and the regional reports that emerged from it, in the east of England alone, 12 new permanent bodies have been set up. That is a bureaucratic response, not a delivery-based and outcome-based response.

I want to turn to some of the specific issues highlighted in the Select Committee report and the Government response. Of course it is vital that the NHS focus on quality, but quality and standards should always have been right at the top of the priority list for the NHS. If one key issue is highlighted in the Select Committee report, it is the feeling that building capacity and access has been the significant priority, rather than improving quality. I would certainly argue that the two things are not mutually exclusive and should not have been treated as if they were.

Lord Darzi quite clearly sets it out that each trust should produce a quality report, and he hopes that the quality account will soon be as important to trusts as meeting their financial targets. However, I am concerned when I look at the draft produced by the Department of Health. I have it here. It is entitled “Sunnyview University Hospital Trust quality report 2008-09”. I do not know whether the Minister has had a chance to look through it, or even whether he has seen it in his ministerial box. If not, it is well worth looking at, because what it says to me is that quality equals targets, and as far as I am concerned that is not the perspective of the original Darzi review, or indeed the Select Committee report published afterwards.

There is a danger that many trusts will look at the draft produced by the Department and merely replicate it for their own use, inserting what is relevant to them. I suggest that the Minister and his team need to have a fundamental look at that issue.

Lord Darzi was absolutely right to say that quality can be achieved only by having much more accessible and comparable information; I believe that patient outcomes can be bettered only by having such information. Indeed, the Conservative party has produced a skeleton outline for an information strategy, which we will be fleshing out in the coming months.

However, I am not convinced that information should merely be disseminated through NHS Choices. There must be other avenues. We must ensure that we take information to patients, not just wait for patients to come and access that information.

I want to say a few words about outcomes. We in the Conservative party have been talking about an outcome-focused NHS for a long time, so I am pleased that there seems to be a drift in the original Darzi document towards that sort of conclusion. I am afraid that we still have some of the worst health outcomes in the whole of Europe, whether it be cancer survival rates, stroke and lung disease rates or cardiovascular mortality rates.

As the hon. Member for Wyre Forest mentioned, we need to say that tragedies such as Stafford demonstrate that there are still significant issues to be addressed in the system. I must say that the Stafford trust was criticised for focusing on a target culture and on financial savings, rather than on patient safety and outcomes. If there is one common theme that I hear as I travel around England talking to people who work in the NHS, it is that they agree with that comment. They agree that there is too much focus on process-driven targets and not enough focus on patient outcomes. We certainly want to change that perception.

Lord Darzi’s report clearly says:

“There will be no additional top-down targets beyond the minimum standards.”

Perhaps the Minister can clarify whether that means that there will be no more targets set centrally, or whether there are some targets hidden in the term “minimum standards”. Also, if the Department of Health accepts that there are some clinically distorting targets, why has there been no reduction in the top-down targets mentioned in Lord Darzi’s report?

I want to discuss GP-led health centres, or polyclinics. Other hon. Members have made the key points. The Select Committee report agrees with the position of the Conservative party, and I am pleased that the Liberal Democrat party now seems to agree with our position too. We were never against GP-led health centres. If they are based on clinical evidence, supported by patients and GPs, and of benefit to patients and the local NHS structures, we would be supportive of them.

However, it is imposition from the centre that we oppose. I was a little uncomfortable with how some campaigns on this issue developed, and I take the point that other hon. Members have made about that. Also, whatever the Minister says, we do not always agree with the British Medical Association. None the less, there was genuine concern expressed by patients, particularly in rural areas, that their GP surgery would not exist for much longer. Clearly, however, that will not be the case.

I suspect that the drive from the centre came from No. 10 Downing street and had much more to do with political outcomes than with health outcomes. I think that there were one or two chief executives of primary care trusts who said publicly—many more did so privately—that they did not want an imposed GP-led health centre and they thought that they could use those resources far more effectively by building services through existing GP practices.

I agree with the hon. Member for Romsey that we need to do more to reduce health inequalities. A major factor behind increasing health inequalities is lack of access to primary care, and we need to increase the accessibility of primary care in areas with socio-economic deprivation, including those with large ethnic minority communities, to enable the people there to access services that they currently find challenging to access.

The sentence in the Select Committee report that says it all is the one that has been mentioned before, but I will repeat it to put it on the record. The report says that there is

“the potential to waste taxpayers’ money and be grossly inefficient.”

The Department will need to look very carefully at that particular area.

I will not repeat what has been said before about piloting personal health budgets. We agree with piloting personal health budgets. It is essential that there is proper analysis and evaluation of the pilots. The complexities of that process have been set out before and the detail of delivering those personal budgets is very challenging indeed. However, it is certainly worth running these pilots. Again, the House will be aware that the Conservatives have been saying that for some considerable time. We are also pleased that Lord Darzi set out—again, we have been saying it for some time—the fact that we need to provide much greater choice of GP practice for people to register with.

I want to make a few comments on commissioning. The Select Committee report clearly acknowledges the fact that one of the largest barriers to implementing many of the recommendations is the weaknesses that exist in many PCTs. That issue needs to be looked at extremely carefully. It is not just the lack of expertise and experience that matters; a careful look needs to be taken at the qualifications of some of the staff who are dealing with some of these complex commissioning issues. We think that the commissioning process needs to be reformed. As the House will know, we have set out proposals to remove some commissioning, or to put it down closer to the patients and allow GPs to work together in commissioning consortiums.

The Minister may respond to that by saying, “Well, it is already happening through practice-based commissioning,” but I am not sure that it is. Certainly, as I travel around, the response from GPs to practice-based commissioning is, to put it politely, extremely patchy. Practice-based commissioning has run into the sand; it does not involve real money or hard budgets. Indeed, the Select Committee report clearly states that

“practice based commissioning had failed to engage doctors”.

It went on:

“We are not convinced that the Next Stage Review will succeed in reinvigorating the scheme.”

I think that there is real reluctance to engage with practice-based commissioning. Having said that, where I agree with the Government response to the Select Committee report is that we must build incentives into the system to encourage quality and to deliver better patient outcomes.

I want to mention public health very quickly. Clearly, the Conservative party has detailed proposals on how to change public health, including ring-fencing budgets and so on. One of the strange things that happened while Lord Darzi was undertaking his “once in a lifetime” review was that in January 2008 the Prime Minister came out with a speech in which he talked about “whole population screening”, without having talked or referred to the National Screening Committee or, as far as I could see, to many other people.

Of course, the Government have now resiled from that position and said, quite rightly, that they will have screening for diabetes, heart disease, stroke and kidney disease only for everyone between 40 and 74. It would be helpful if the Minister, if he has time, said how those health checks are going. I believe that they started earlier this month. It would also be useful if he said what the proposals are to roll that scheme out, and when information will be available to assess how effective the scheme is and how many people are using the facilities available to them through the scheme.

There are also big challenges in this area. I know that the take-up is slow in commissioning these screening services and that PCTs are finding that challenging. Most of those services are being delivered through existing GP practices. However, I feel that there is significant scope to use other providers; pharmacies are just one example. Pharmacists are extremely nervous because they feel that they are not being used and that their skills set is not being maximised for the benefit of patients.

Promoting and encouraging innovation, which are at the heart of the NHS, are fundamental if we are to see an improvement in patient care. The NSR recognises that, but again, the response is rather bureaucratic: the establishment of the Health Innovation Council, giving strategic health authorities legal duties to promote innovation and regional funds to deliver prizes for innovation. Prizes are not needed to create innovation; instead, we need to set clinicians free. That might need to be incentivised.

What has happened to the Health Innovation Council? What has it achieved? What are the costs associated with establishing the organisation? I understand that the Wellcome Trust was supposed to make a significant contribution. Has that happened? If so, how is that money being used? Will the Minister also talk about the regional prizes being presented? What is the relationship between prizes and innovation?

We must set clinicians free to innovate, rather than insist on innovation being imposed from the top. We are determined to have a more patient-centred NHS, driven by outcomes, not central process targets, because this is the best way to achieve innovation, cost-effectiveness, accountability and, most importantly, high standards of patient care.

I am extremely grateful to the hon. Members on the Liaison Committee for giving the Chamber the opportunity to debate the NHS next stage review and, more generally, health policy. This debate has given all hon. Members time to breathe—often we have to rush through our points. I also apologise, on behalf—I guess—of business managers, for the unfortunate clash with the swine flu debate on the Floor of the House. It is just one of those unfortunate coincidences, I am afraid, and I do not think that anything could have been done to help.

Before I address hon. Members’ specific concerns, it is worth putting on the record—as I always try to do—the fantastic work done by NHS staff throughout the country in delivering a better than ever quality of health service, benefiting all our constituents. I am confident that they will continue to deliver an improving service in the years to come. In 1997, when this Government came to power, the NHS was in crisis; it was chronically underfunded, woefully understaffed and failing to provide a decent service to patients. In many cases, the quality of service was unacceptable.

The immediate answer had to be sustained and substantial investment, combined with a strong direction from the centre—emergency treatment to bring the patient back to life. There are now thousands more—and properly paid—doctors and nurses; hundreds of new or refurbished hospitals and GP practices; and, from a patient’s perspective, a radically improved NHS in every way. Waiting times are down from 18 months to an average of just eight weeks. Cancer treatment is better, faster and more effective, with survival rates rising every year. I accept that, as the hon. Member for Boston and Skegness (Mark Simmonds) mentioned, we remain, in some cases, behind the EU average, but some of the data often referred to have a time lag of one, two or even three years. I am confident that we are catching up rapidly and even, in some cases, overtaking others.

When a patient starts to recover—as the NHS has—their treatment is changed. They are not kept in intensive care. What was right for the NHS in the 1990s is not necessarily the most appropriate treatment today. That is why we published “High Quality Care for All”, through the next stage review, under my noble Friend Lord Darzi. I would like to express my gratitude to hon. Members, especially the hon. Members for Boston and Skegness and for Romsey (Sandra Gidley), for their kind, personal words about my noble Friend. He has been an excellent addition to the Government. In my view, he is the most successful GOAT—Government of all the talents—and long may he stay in his role. He is a very good example of how we can improve the performance of government—not just the health service—by bringing in people with that level of expertise. He did a fantastic job of setting out a vision that should deliver high-quality care for everyone in everything that the health service does—an NHS that now provides greater choice and easier access for patients; is more innovative and responsive; is helping people to stay healthy; empowers front-line staff, and works in partnership with patients.

The hon. Member for Boston and Skegness asked how many nurses—I think—were consulted during the consultation. I cannot give him an exact figure on nurses, but I can tell him that, at the SHA level, 2,000 clinicians were involved, and many more were involved locally. Sixteen thousand people in total took part in deliberative events. It was the single biggest consultation that has ever taken place in the NHS. The resulting vision is founded on unprecedented engagement with staff, patients and communities.

What do I mean by high quality? Quality means protecting patient safety by eradicating things such as health care associated infections and avoidable accidents. It is about the effectiveness of care: from the clinical procedures that patients receive to their quality of life after treatment. It is about the patient’s entire experience of the NHS and about ensuring that they are treated with compassion, dignity and respect, in a clean, safe and well-managed environment.

During the debate, there was much discussion about quality, how we measure it and whether it is necessarily cheaper. The hon. Member for Wyre Forest (Dr. Taylor) asked how we will ensure that quality is achieved in the health service. We have a number of ways of doing that, and I shall deal with one of the most important now. He referred to our response to the two reports on the Mid Staffordshire hospital inquiry. The inquiry benefited from much greater patient and public involvement in decision making and much more accountable and open NHS boards. The inquiry supported the excellent work of the independent regulatory system, which was established under this Government, and led previously by the Healthcare Commission, and now by the Care Quality Commission.

The regulatory system helps to ensure that people make complaints. If the hon. Gentleman wants to pass on the terrible individual cases that he cited during the debate, I shall be very happy to look into them. I try to encourage anyone who writes to me, and encourage other hon. Members to do the same. It is desperately important that people complain, through the official complaints process, not only because, otherwise, no one will know about it, but because hospitals are now measured on the number of complaints that they receive, on how well they deal with them, on how well they learn the lessons, on the number of complaints passed on to the independent regulator and on the number upheld.

A very strong and robust complaints system is now in place; and it is really important that people use it. We need to change the culture in which the patient feels that they are a passive recipient of health care and that the doctor, manager or bureaucrat knows best. Everyone in this country needs to get into a mindset where they behave more like a consumer—after all, they are paying for the service, and they need to demand their rights to ensure that the care that they are getting is good. If it is not up to scratch, they should make a heck of a noise.

Another recommendation in the NSR was for a new quality board, which met for the first time at the end of March. It brings together all those with an interest in improving quality across the NHS and will align and agree the NHS’s quality goals, while respecting the independent status of participating organisations. However, we will never attain the high levels of quality that the public demand without strong leadership, which was a point also raised in the Health Select Committee’s report. The National Leadership Council, under the chairmanship of the chief executive of the NHS, David Nicholson, was launched in April and will champion the transformation of leadership across the NHS. It will not only deal with senior management, but develop leaders at all levels of the system—from chief executives to porters. It is about developing and supporting leadership potential wherever it exists.

GP-led health centres were mentioned not only in the Select Committee’s report, but by all hon. Members here today. I hope that we all agree that people want better access to their GP and health care that is more personalised and convenient. According to our annual surveys, the single biggest cause of dissatisfaction among the public is their inability to see a GP at a time and place convenient to them. That was the basis of the programme that we announced. We are investing an additional £250 million every year specifically to improve access to primary care. Every PCT should develop a new GP-led health centre, open from 8am until 8pm, seven days a week, 365 days a year, offering both booked appointments and a walk-in service for any member of the public, who could remain registered with their own GP, but still use this new service.

We will also address the point about under-doctored areas by establishing 112 new GP practices in those areas. Such practices will provide greater access to a wider range of services and offer more choices for patients as to where and when they can see a GP or other health care professional. Moreover, they will help to address inequalities in health care in those areas.

The Select Committee took us to task for our insistence that everyone in England, wherever they live, should have access to one of the new seven-days-a-week, 12-hours-a-day health centres. It argued, and a number of other hon. Members have argued again today, that we should have left it up to PCTs to decide whether or not to have one. The problem that I have with that is that some PCTs are not universally good at standing up to pressure. I am talking here about the pressure that can be exerted by local GPs, who can be an effective and powerful lobby group. As hon. Members have reminded us, there was a massive and—as some hon. Members have belatedly acknowledged—highly misleading campaign against the new centres. I suspect that if we had left the decision up to the PCTs, they would have buckled under the pressure, and said, “This is too much grief.” That would have meant that people in their area would not have been able to enjoy the new service that was available in neighbouring areas.

I am sorry, but I do not believe that there is anywhere in England where people would not appreciate the ability to visit a GP in the evenings, at the weekends or to drop in on spec. I invite the Health Committee to visit some GP-led health centres that are already open and see how incredibly popular they are. In fact, I detect a rewriting of history going on. I remember seeing a Conservative website that encouraged people to support the BMA campaign and sign the petition. The Liberal Democrats were equally critical of the programme of new health centres. However, once the BMA stopped its campaign, so did the Opposition. I have opened a number of centres and I have not been subjected to angry demonstrations, either by local GPs or by local Conservative and Liberal Democrat politicians. On the contrary, I have had local politicians of all political parties coming along to celebrate them and how popular they are.

I admire the Minister’s robust defence, but could he explain how, in a county as large as Hampshire where it can take three hours to travel from one end to the other, sticking one centre in the middle helps the vast majority of the population? It does not. One of the side effects—I do not know whether the two are related—is that the local walk-in centres have now reduced their hours, which is reducing availability. If access is so important, will the Government consider the reduced hours of walk-in centres?

The hon. Lady seems to be suggesting that we should force PCTs to open even more GP-led health centres in areas as big as Hampshire. A number of PCTs have, off their own bat, introduced more than one centre. However, we felt that it was reasonable for the public, in whichever PCT area they live, to have at least one such centre. On the one hand we are criticised for doing that, yet on the other, we seem to be criticised for leaving it up to Hampshire PCT to decide where it should go. It may not have been our choice to place it in Basingstoke. Oxfordshire decided to put its centre in Banbury. I had a robust conversation with Oxfordshire PCT in which I said, “Wouldn’t Oxford be better because you have people who commute to Oxford, and a big student population?” We know that access to primary care by students can sometimes be very difficult—incidentally, the centres are incredibly popular with students for that very reason. Therefore, I do not accept the argument.

The parallel development over the last year has been a massive expansion in extended opening hours for GPs. I am not sure how many surgeries in Hampshire are offering such a service, but it is probably around the 80 per cent. mark. Again, that is a result of the Government deliberately ensuring that surgeries open either in the evenings or at the weekends. If any of the hon. Lady’s constituents find it inconvenient to go to Basingstoke, they should be enjoying the benefits of extended hours in GP surgeries.

I was interested to hear what my hon. Friend the Minister said about MPs turning up to the opening of new centres. Presumably they are there to be photographed. Perhaps they could get on a website that has as high a profile as the campaign did. I agree with what my hon. Friend said about local health communities and local GPs lobbying PCTs, but does he not think that if we had had some good criteria as to why the centres had to be put in areas, such as disease burdens or lack of access, it would have helped? I take what he said about doing other things as well. Rotherham has a new centre and a new GP practice, which is very good. However, if the Government and the professional representative bodies had agreed on a good set of criteria, it would have been a lot easier to put the centres where they should have been, as opposed just to saying, “You shall have one.”

To a certain extent, I agree with my right hon. Friend. He is right to highlight the fact that many parts of the country, because they have been either spearhead or under-doctored areas, have received not just a new GP-led health centre, but one, two, three or even four new GP surgeries. The criteria for that have been based on the level of deprivation, disease and the ratio of GPs per head of population. The criteria and the driver for the new GP-led health centres was a real feeling on the part of the Government and the public—it was borne out not just by the annual GP surveys but by MORI and the deliberative events that we did in the context of the next stage review that having tackled waiting times and some of those really big quality and capacity challenges that the NHS used to face in the past what the public most wanted was the ability to see a GP at a time that was more convenient to them.

We had a twin-track approach. Part of that was getting as many GPs as possible to open in the evenings and at weekends, which we have done through the extended hours programme. We had a bit of an argy-bargy with the BMA over that, but in the end it agreed to sign up. I think there is only one PCT in the whole country—it may be in Worcestershire, but do not quote me because I may be wrong—that is not up to 50 per cent. of GP surgeries offering extended hours. The average now is 75 per cent. For those people who live in an area in which they do not have 100 per cent. of GPs offering evening and weekend openings but who want to stay with their own GP, why should they not have the ability to visit a GP in the evenings and at weekends as well? Similarly, a lot of people who commute face difficulties. Hon. Members will be aware from their postbags that a lot of people say, “Why can I not register with a GP where I work rather than where I live?” Of course there is a problem with that because of practice boundaries and the cost of double registration and so on. The new GP-led health centres will provide a useful service for those people who may commute to the nearest local town, be it Banbury, Oxford or wherever, and will be able to visit a GP-led health centre there as well as one at home if that is more convenient.

There is a good story to be told about GP-led health centres. I have seen, as I am sure other hon. Members have, that where they have been established, the increase in availability of other GPs has acted almost as a competitive spur. Part of the problem is that the evaluation of the five original centres in London has not even been designed yet. The Government are being a bit tardy. They should insist on an early evaluation, which will then go out to convince all those with reservations that the centres will be an adjunct and an improvement and not a deterioration in services. Will my hon. Friend say why the Government insist on the presence of a private sector bidder because it is causing considerable disquiet?

The simple answer to that is we are not. All we insist on is an open and fair procurement process. I invite my hon. Friend, or the Select Committee as a whole, to do a follow-up report. One of the BMA scares was that the centres were the start of the privatisation of the health service, the end of primary care and family doctors. In fact, only a small minority of the contracts are going to the private or independent sector. The vast majority are going to local GPs, local GP consortiums and local GP co-operatives, and those decisions are quite rightly being made by the PCTs on the ground.

Let me deal with my hon. Friend’s other point. There has been a bit of confusion between the new GP-led health centres in every PCT—one in each—and the extra investment going into the more deprived areas to increase the overall capacity in primary care, which has been universally welcomed. There has been particular confusion in London, and outside London, because of this word “polyclinic”. The BMA campaign deliberately tried to conflate the polyclinic model with GP-led health centres. Many people call them Darzi centres. I am sure that my noble friend will leave a significant legacy, but if he does not, there will still be Darzi centres up and down the country.

London is different because it already had a programme to develop a series of polyclinics that was agreed by the London health economy. Those polyclinics are much bigger than the GP-led health centres in other parts of the country and bring in far more GPs and other services. Perhaps my hon. Friend the Member for Lewisham, West (Jim Dowd) is referring to such a polyclinic, rather than to the national programme under which there will be a new GP-led health centre in every PCT area. Confusion over the terminology has sown confusion about the programme up and down the country. People say that they do not want a huge polyclinic, but they are fine about it when they see the kind of little GP-led health centre that they are used to.

I cannot let the Minister rewrite history. The Government backed away from the word polyclinic because of the noise that was created. They changed the terminology to GP-led health centres for those outside London. As the Minister will recall, the reason that so few GP surgeries opened in the evenings, early in the mornings and at weekends was that the Government were outmanoeuvred when negotiating the 2004 GP contracts. The enforcement of extended hours merely replaced what had been taken away in 2004.

I do not want to engage in argy-bargy over this. He might not do it now, but I invite the hon. Gentleman to change his party’s official policy of allowing GPs to decide their own opening hours. That would be a massive step backwards. We have achieved a lot in the last 18 months to improve access to primary care. We do not want to go backwards.

Before I leave the issue of London, if he has studied the GP patient survey, my hon. Friend the Member for Lewisham, West will be aware that Lewisham has one of the highest levels in the country of dissatisfaction over access to primary care services. The average level was 18 per cent., but in Lewisham it was 23 per cent. Nearly a quarter of his constituents are not happy. The survey was carried out before the introduction of the programme of extended hours and GP-led health centres so I hope that the figure will improve next year.

The NSR marks a dramatic development in the relationship between the centre, PCTs and local service providers. It is a move away from the central direction that was needed to successfully tackle historical issues such as waiting lists, to an empowering of local leaders and a devolution of power and decision-making to as close to the patient as possible. The Select Committee report is right to highlight how important effective commissioning is in achieving the goals of the NSR. It is for PCTs to make the decisions that are in the best interests of their patients. However, the system relies on PCTs having the necessary people and skills to use that power effectively. The Select Committee was right to highlight how many PCTs are not as strong as they could be.

The world-class commissioning programme is aimed at raising the standard of commissioning in PCTs across the country. A year in, it has helped PCTs to plot a clear path towards the high standards of commissioning that we all expect. The next two to three years will see better commissioning skills within PCTs and improvements to local health outcomes and to outcomes overall.

The Department is working with strategic health authorities to provide PCTs with a range of world-class commissioning tools, such as improved data, guidance on strategic planning and topic-specific commissioning guidance for areas such as stroke, cancer and primary care. Most PCTs now have a board development programme and each region runs commissioner training programmes. Many PCTs are also working together to improve their analytical and commercial capacity, to better commission services from a single provider or for a particular care pathway.

The hon. Member for Romsey asked how we will evaluate the role of local government. In our surveys of local government and NHS organisations that are involved in the process, 90 per cent. of respondents agreed that world-class commissioning will help them to become better commissioners of services and that it will improve the governance of their systems.

The hon. Member for Boston and Skegness spoke about practice-based commissioning. I accept that that is a vital part of world-class commissioning. As he is aware, in March we published “Clinical commissioning: our vision for practice-based commissioning”, which sets out the role of practice-based commissioning in world-class commissioning. That has been well received by the NHS and by independent commentators. The NHS Alliance commented:

“This confirmation and reinforcement should dispel any doubts about whether PBC is here to stay—it is. This must now mark the end of discussions of the role of PBC, and the start of the real action throughout the English NHS.”

Nick Goodwin, the senior fellow at the King’s Fund, stated:

“The vision outlined by the government…confirms its commitment to PBC”

and

“its strategic importance within the wider commissioning agenda…The guidance helpfully places PBC as a key tool for PCTs to influence and lead strategic service change through commissioning.”

Practice-based commissioning is a firm and popular foundation from which to build. A recent independent survey of almost 1,900 practices by MORI showed that 64 per cent. supported PBC, with just 16 per cent. opposing it. It showed that clinicians are becoming more involved in commissioning, with 61 per cent. of GP practices commissioning a service through PBC as of February this year, compared to 56 per cent. in the previous quarter.

The PBC development framework and a national PBC improvement team are in place to help PCTs develop practice-based commissioning. We will be holding them to account through the world-class commissioning assurance process, which will ensure that PCTs provide practices with the support and resources they need.

Hon. Members have raised the cost of the NSR, as did the Select Committee report. In our view, the NHS cannot afford not to take the recommendations forward. The national and local visions that were developed as part of the NSR process focused the NHS on prevention, constantly improving quality and innovation. That will enable the NHS to better deliver value for taxpayers’ money. I am sure we all agree that that is necessary to meet the challenges facing the health service and the economy.

Implementing the 10 regional visions of “High Quality Care for All” is now the core business of the NHS. The NHS budget for England will increase to over £100 billion by the end of the year. All the NSR proposals will be funded from within that budget. Prioritising the most effective treatments, reducing errors and waste, and keeping people healthy and independent for as long as possible all contribute to quality care, and to a more efficient and productive health service. High quality and value for money are not competing alternatives; they are often one and the same thing. That is increasingly important in an economic downturn.

There has been discussion about whether high quality always means saving money. I agree with the point the Select Committee Chairman made when he quoted Alan Maynard. He said that high quality is not always cheaper than poor quality. As the hon. Member for Wyre Forest said, although quality sometimes costs more, there are big overall savings to be made through better quality.

Savings can be made if the right treatment is given in the right setting first time round, if the length of stay is reduced by the right support being provided and if the rates of prescribing generic drugs are increased. Care can be organised to ensure it is of a high quality. Simple things can be done such as having protected meal times and freeing up staff time through the productive ward programme. Those are just a few examples of how high-quality productivity, good outcomes and less wastage of resources go together.

The hon. Member for Wyre Forest is right that prioritisation will be critical. We do not just have priorities at local level. Although there are now fewer of them, we still have national targets for waiting times. We also have the annual operating framework, which states what we believe are the top priorities that should guide the service.

Hon. Members mentioned the patient reported outcome measures. That scheme is currently limited to four elective procedures: hip and knee replacements, and groin hernia and varicose vein surgery. There are no commitments to extend the scheme but the Department is actively exploring the potential for PROMs in other areas such as long-term conditions. Any decision to extend the scheme will be evidence-based.

The cost of implementing PROMs is expected to represent less than 0.5 per cent. of the total spend on the four elective procedures that they cover. The national scheme started in April 2009. Indications are that implementation is going well, and the scheme should be fully embedded by April next year. It will be subject to ongoing review. Incidentally, I forgot to say that GP-led health centres will also be evaluated; a number of hon. Members asked about that. The PROMs scheme will also be evaluated to test and demonstrate its value for money.

Implementation is already under way. All but a handful of providers began collecting PROMs data on schedule in April. The data can be incorporated into quality improvements, such as the commissioning for quality and innovation incentive scheme, in the same way as other quality data.

My right hon. Friend the Chairman of the Select Committee highlighted the importance of leadership in the NHS. We believe that leadership is central to fulfilling the vision of the NSR. I accept that past initiatives to improve the quality of leadership in the NHS have not always succeeded. They have often failed because they have focused on too small a group of people over too short a period. However, I believe that we are better placed than before to drive the leadership agenda forward. We have a clear 10-year plan based on the regional clinical visions and a new emphasis on quality that makes it much more attractive for clinicians to become involved in leadership.

The NSR will ensure that clinicians are fully prepared to take on senior leadership roles within the NHS. It will embed leadership in undergraduate and postgraduate degrees and development programmes at different stages of clinicians’ careers. The NSR is designed to support local health organisations in identifying, developing and recruiting the best leadership talent across their regions. The national leadership council, to which I have referred, will intervene only where it can add value. Its role is to ensure that the system supports high-quality leadership and to challenge it where it does not.

As I said, the NSR supports local health organisations in identifying, developing and recruiting the best leadership talent across their regions. At its core, the guidance is about creating a deep and diverse talent pool from which we will draw our next generation of NHS leaders. All responsibility is devolved to the NHS locally, and managers will face much greater local scrutiny.

I was glad to hear someone—it was either the hon. Member for Wyre Forest or my right hon. Friend the Chair of the Select Committee—speak up in defence of managers. We need good managers in the NHS, and they often get a lot of stick. Although the vast majority of managers meet high professional standards, I am afraid that a minority sometimes suffer lapses in performance or conduct that threaten to undermine the confidence of their staff, their organisations and patients. An advisory group chaired by Ian Dalton, chief executive of the NHS north-east strategic health authority, will consider how senior NHS managers can demonstrate publicly that they have reached and are maintaining high professional standards, in order to ensure and enhance confidence in the profession.

The clinical excellence awards scheme is currently under review. We will examine how leadership skills can best be reflected in the criteria for awarding CEAs. The national management training schemes recruit and develop talented individuals who have the potential to become directors or chief executives within the NHS. The scheme has already produced some of our most outstanding leaders—the current NHS chief executive, David Nicholson, is an alumnus—and the scheme came fifth in The Times top 100 graduate employers in 2008 as voted by graduates, up from sixth in 2007. I would not be surprised, given the current economic climate, if it continued to rise up the league table. It is a very reputable and high-quality scheme.

The hon. Member for Boston and Skegness asked about innovation. He is absolutely right: creating an environment in which innovation can flourish is vital to improving quality. We announced the creation of five new academic health science centres in March. Last month, the Government launched a range of measures to drive innovation and ensure that innovative ideas and practices are disseminated across the service. They include a new £220 million innovation fund to support faster innovation and the universal spread of best practice; a new legal duty for SHAs to promote innovation, which will be important in driving innovation through the system; and a series of challenge prizes to reward those who have excelled in creating and diffusing innovative ideas and encourage others to do likewise.

I saw the challenge prizes rubbished in the press when they were announced, but the idea is an exciting and interesting one. We are not giving people lots of money for doing things that they should be doing anyway; we are encouraging innovation and imagination at the local level, so that ideas can come up from the bottom, as the hon. Member for Boston and Skegness himself highlighted.

We are also introducing a new IT system, NHS Evidence, to improve access to information and support for better clinical and commissioning decisions. Medical Education England provides independent, expert advice on training and education for doctors, dentists, health care scientists and pharmacists. MEE is supported by professionals and has developed as a result of extensive consultation with stakeholders. We are developing similar bodies for the other professions that will be in place by September 2009.

I am incredibly grateful not only for the Select Committee report but for the contributions and comments made today. This has been a constructive discussion. I expect that we will continue to have a robust debate about GP-led health centres for a while, at least until they are up and running everywhere in the country, and then I hope that people will make a different judgment on them. I invite the Health Committee to revisit the issue when it feels that it has something interesting to say.

The quality of today’s debate reinforces how important the future of the NHS is to us all. I have been heartened by the strong support for how the NSR was conducted and the vision that it sets out. This debate and the Health Committee report will help us considerably in getting the implementation right. That is the most important thing about all reviews and reports: not that we publish them, but that we get the implementation right and see it through.

There will, of course, be challenges ahead, but I am confident that because the review has generated a deep feeling of local ownership and genuine enthusiasm, we will deliver its vision for the NHS. By placing power in the hands of local PCTs and patients, we will make high-quality care for all more than the title of a report. It will be exactly what we will achieve.

I will not keep hon. Members for too long; I would just like to respond to one or two things that my hon. Friend the Minister and the Opposition spokesman said. First, though, I must comment on the remarks made by the hon. Member for Wyre Forest (Dr. Taylor)—not just on the letters that he read out, but on his experienced view of how important interpersonal skills are in health care. He has brought his wisdom to the Select Committee. I am pleased that my hon. Friend has decided to take away those letters and look at how the patients were treated. Quality is not just about clinical outcomes, although we all want the best clinical outcomes; quality goes a lot more widely, and the hon. Gentleman gave us all a lesson on exactly how things should be for the patient. I am grateful to him for what he said.

The hon. Member for Romsey (Sandra Gidley) and my hon. Friend the Member for Lewisham, West (Jim Dowd) commented on primary care centres, or polyclinics. I must say to the hon. Member for Boston and Skegness (Mark Simmonds) that it is a bit of a stretch to say that the Select Committee agrees with Conservative policy on polyclinics. I am tempted to ask my hon. Friend the Member for Lewisham, West whether he agreed with the Conservative press release last year on polyclinics in London in which the word was spelled “polly”.

It might be of assistance to my right hon. Friend to remind him that the shadow Health Secretary said in June 2008:

“Patients and family doctors are right to be worried about losing a valued local service. It’s time Labour faced up to their concerns and called a halt to their unpopular polyclinics scheme.”

When asked in April 2008 whether he would scrap our extended GP opening hours target, he said, “Yes, we would.” The Leader of the Opposition also said in April last year, on the GP-led health centre scheme,

“Now they are trying to abolish the family doctor service.”

If there has been any rewriting of history, as the hon. Member for Boston and Skegness accuses me of doing, it has been on the other side.

As the non-party political Chairman of the Health Committee—inasmuch as I can be—I will not be drawn into that debate. I just thought that I ought to mention it.

Before my right hon. Friend gets too far away from the spelling of polyclinic, I am sure that he will recall that, when we were looking for a definition of polyclinic during our inquiry, someone offered the idea that it is where one goes when one is as sick as a parrot.

Yes, and we have some twitchers on the Committee, in the form of the hon. Member for Wyre Forest and myself.

Overall, I would not say that we go along with the Opposition, but we want more primary care. Yes, it does disturb the balance, and, yes, it might disturb capitation fees, but my argument and the Committee’s argument is that, if it based on the need of the local population, it is time that things moved on. We cannot have things set in aspic. The way that GP practices are formed has not changed a lot since 1948. New ones come along now and again, but someone usually takes over a business that someone else has been running, so there is a need for more. Although last year was a bit disruptive given what was said on either side of the debate, I am pleased that we will get people more access to primary care, which can be no bad thing.

I completely agree with the hon. Member for Boston and Skegness about quality in standards and outcomes. I hesitate to agree that we should get rid of all centrally set, top-down targets, because smoking cessation targets, for example, will prove very beneficial in years to come to the health care of the nation. That issue cost my PCT a star a few years ago, which it was upset about, but if we look at the incidence of smoking and the incidence of ill health from smoking in my constituency and the borough that I represent a third of, it is right and proper to keep some of those targets in place. It would be too easy to get away from those targets, which are rightly challenging.

Let me clarify this point. I agree with the right hon. Gentleman, and we have clearly said that we will retain targets in the public health sphere, such as the smoking example that he has given, for the very reason that he is explaining.

Another example to consider is the 18-week wait. We talk about choice in the NHS, but, five years ago, in one or two hospitals in my part of South Yorkshire, if someone had wanted orthopaedic surgery, some consultants, but not all, would have said that there was a two-year wait for a new knee, or that “You could have it next week if you want to go to a hospital in Sheffield, and I’ll do it for you.” Getting rid of that kind of choice has been a good thing. Such targets have been designed to do things that may not be obvious, and they have worked. The 18-week target may not have worked very well for some consultants’ bank accounts, but it has worked very well for my constituents. People have been able to get things done far more quickly and cheaply—other than the general tax that they pay—as a result of those targets being set and the local health service being asked to look at them.

I agree entirely with the hon. Member for Boston and Skegness that innovation must remain at the heart of the health service, as that is how we have improved it. We all accept that it could be better still, but it has improved in the past six years because people have been allowed to innovate. There are many places of excellence in areas such as spinal injury, because there has been innovation by individuals in those areas. Those places are not always where we would want them to be geographically, but they have come about because the health service has allowed individual practitioners to work to improve the service and to specialise in those areas.

We must be the envy of large parts of the world, even developed economies—so we need innovation. The one hesitation I have in agreeing with the hon. Gentleman is to say that that approach applies across the piece, including with information technology, and we might have a debate on that at another time. Health professionals and others would be helped in improving health care in the 21st century by having good, competent systems in which people have confidence.

I want to pick up on three issues that my hon. Friend the Minister discussed. He talked about the new quality board not being top-down and about the national leadership council. I hope that he and other Ministers will make sure that those measures are working, so that we get the right leadership in the right place and the right managers with the right experience. I do not blame managers who find it difficult to do a job if it is something that they have never trained for and that has been put on them from above, or wherever. The essence of this is to make sure that they have the support to do the job and that they are not simply dismissed on the ground with, “We don’t think you’re up to it, so we’re going to bring someone else in.” There are issues about developing the whole work force, and management is clearly a major part of that.

My hon. Friend talked about effective commissioning. World-class commissioning came in just a few years ago, after the weakness of commissioning in our system was recognised, and I wish him well with that. He talked about bringing something forward next April on what we are learning about the four areas in which PROMs are being measured. I would be very happy if he shared that information with the Committee—if we are still around next April, which I suspect we will be—as soon as he gets it. I think that it will be crucial to bringing the NSR into being and really bringing quality into the workplace as far as patients are concerned.

In conclusion, I am very pleased with the intent of the report, and I add my name to those who have complimented Lord Darzi on his work. Like the Minister, I hope that we will all see major aspects of the review being put into action.

Question put and agreed to.