Today, we publish a White Paper outlining the Government's proposals for further improvements to health and social care services in the community. We are nearly six years through a 10-year programme of NHS improvement that has seen waiting lists dramatically reduced and more people treated faster and better than ever before. At the same time, social care services have been supporting more elderly people than ever before to live at home and maintain their independence.

Our unprecedented investment in the NHS—made possible by strong economic management and our decision to ask people to pay increased national insurance contributions—means that, by 2008, we will have caught up with the historic underfunding of the NHS and caught up with the health care funding of other European countries. What matters is not simply how much we spend, but where we spend it. As a nation, we invest less than comparable countries on preventing people from becoming ill and less on services in the community. For instance, just 2 per cent. of our health care budget is devoted to prevention, half the level in Germany.

I think that all of us know that our health and well-being depend at least as much on what we do ourselves as on what the NHS and social care services do for us. As Sir Derek Wanless said in his landmark report on the future of the NHS, people need to be "fully engaged" in their own health if we are to offset the challenges posed by an ageing population and ensure the sustainability of the NHS and social care, so the views of the public themselves were the starting point for this White Paper.

More than 100,000 people responded to the consultation on last year's Green Paper on adult social care, "Independence, Well-being and Choice". Then we embarked on the innovative, "Your health, your care, your say" public engagement programme, which culminated in a 1,000-strong citizens' summit in Birmingham. I am grateful to everyone who was involved in that, particularly the 10 members of the citizens' panel who worked with us throughout the development of the White Paper.

Four themes emerged clearly from our public consultation: we need more emphasis on prevention, with earlier intervention; we need to give people more choice and more say in the services they receive; we need to provide more support for those who need it most, particularly people with long-term needs; and we need to do much more to tackle inequalities and provide more services conveniently within local communities.

The White Paper makes clear our desire to focus on prevention. It outlines the work that is now being done in the partnerships for older people pilots to help older people to remain independent in their own homes. It sets out our commitment to large-scale pilots covering at least 1 million people in which health and care services will work closely together, with the intensive use of new technologies—including, for instance, the telecare assessment of people's conditions in their own homes that is being trialled in some parts of the country—to improve people's well-being and dramatically reduce emergency hospital admissions. The pilots will provide further evidence of the benefits of new approaches and help the NHS and local councils to spread best practice much faster.

Of all the proposals that came to us from the public themselves, the most popular was the idea of a health MOT. We have responded to that by setting out in the White Paper our proposal for an NHS life check at key points in people's lives. The NHS life check will ask people about their lifestyle and family history, with a follow-up from a health trainer and, if necessary, a nurse or GP, for people in high-risk categories. We will pilot the new health check, starting with parents of very young children and people in their early 50s, and introduce it initially in the areas with the worst health inequalities where we can make the biggest difference. I know that the proposal will be warmly welcomed by the public and by hon. Members, at least on this side of the House.

People also said that they wanted more emphasis on mental well-being. The White Paper sets out how we will improve people's mental well-being through greater use of psychological therapies and a focus on mental well-being in preventive work with older people and by giving people more information and support on how to stay mentally and emotionally well.

By giving people more choice and more say in the services that they use, we will ensure that people themselves become the main drivers of service improvement and that services become increasingly personal and built around the different needs of different individuals and their communities. In theory, people have always been able to choose their GP. We will make that choice a reality for far more people by simplifying the registration system and giving people an entitlement to far more information about the services available in their area. Starting from April this year, the GP contract will link an element of GPs' pay to patients' satisfaction with the practice, including the appointments system, thus providing a real incentive for more convenient opening times.

In social care, we will increase the take-up of direct payments by introducing legislation to extend their availability at the earliest opportunity. We will pilot the introduction of individual budgets and bring together several different income streams from social care, community equipment, independent living funds and other programmes so that individuals can get the services that they need in the way in which they want them.

Those who make the most use of our health and social care services are those with long-term needs: frail elderly people, those with serious disabilities and people with conditions such as asthma and diabetes. Many of those people need the support of several organisations, but are frustrated that, too often, those different agencies seem to work in isolation. We know that it makes sense for everybody if the local NHS and the local authority work more closely together. For instance, if elderly people's homes are adapted to reduce the risk of a fall, they are less likely to end up in hospital, which is far better for them and better, too, for the NHS. If proper rehabilitation occurs after an operation, a patient is less likely to need social care.

By giving local authorities and the NHS stronger incentives to work together, we have already reduced the number of patients who stay in hospital with delayed discharges because no arrangements are in place to support them in the community. Now we will strengthen that joint working by introducing a single assessment of health and care needs and a joint care plan for people with the most complex needs. By 2008, we will expect primary care trusts and local authorities to establish joint health and social care teams. A common budgetary and planning system will support more of those organisations in jointly commissioning services.

Six million people care for relatives or friends with long-term needs. Many of those carers, who are doing a wonderful job in our communities, have to reduce or give up their own work to do so and, often, their own health suffers as a result of the responsibility that they take for others. In future we will ensure that short-term home-based respite support is established for carers, to deal with emergencies. In response to what carers themselves have told us, we will establish an expert carers programme, similar to the enormously popular expert patients programme, to support carers with the skills that they need to look after their own health and that of the people whom they care for.

Despite the fact that we have 4,300 more GPs than we had in 1997, there are still fewest in the poorest areas that need them most. The White Paper will ensure that care is more closely matched to need. We will tackle that inequality in two ways. First, over the next two years, as NHS funding continues to increase by unprecedented amounts, we will ensure that, as every area gets more, those who need most will get the most. Moving traditionally underfunded areas rapidly towards target means that, by 2008, when average NHS funding will be nearly £1,400 per head, primary care trusts in the worst-off areas will receive on average £1,552 per person: fairer funding across the NHS.

Secondly, we will ensure that, where people are dissatisfied with the care that they receive and cannot get a better choice of services, primary care trusts will bring in additional services. Already, in six areas that are short of doctors, including inner-city communities in Barking and Bradford, we are supporting the local NHS to bring in new providers that will offer extended opening hours and a full range of services. Whether services are organised by traditional GPs, by nurse practitioners, by private firms or by social enterprises and the not-for-profit sector, the test will be simple: to get the best services for patients with the best value for money, all free at the point of need in accordance with the founding principles of the NHS.

Modern medical technology is making it possible to deliver in people's homes or neighbourhoods health care that in the past was available only in hospitals. A kidney patient can now receive dialysis in a local health centre, or even in their own home. Minor surgery can be done in a well-equipped GP practice or a modern community hospital. Yet in contrast to what happens in Germany, where most out-patient appointments take place in local health polyclinics, we continue to expect most out-patients to travel to an acute hospital.

As part of our strategy to provide care more conveniently, closer to the patient and with better value for money, we will work with the royal colleges to demonstrate how far more out-patient care and day-case procedures in medical specialties such as ear, nose and throat, and dermatology, can be carried out in the community, while high clinical standards are maintained.

We have already opened or are building 79 new acute hospitals, with more to come. Now we will also develop a new generation of community hospitals—modern facilities, with the latest diagnostic technology, able to provide a full range of out-patient and day-case treatment, and in many cases with intermediate beds as well.

Some primary care trusts are planning to close local cottage hospitals. Where these closures are due to facilities that are clinically not viable, or which local people do not want to use, local reorganisation is right. But community facilities that are needed for the long term must not be lost in response to short-term budgetary pressures. So we will expect primary care trusts to reconsider such proposals against the principles of the White Paper.

This White Paper marks a strategic shift in how we provide care, moving services out of acute hospitals into community settings, with more investment in prevention and far better management of long-term conditions. People have talked for decades of a primary care-led NHS. We will now deliver it. Because of our reforms, with stronger primary care trusts, practice-based commissioning, more freedom for GPs and payment by results, more work than ever before will be done locally. As NHS budgets continue to increase, more of that growth money will go into local community services.

The White Paper sets out a vision for health and social care that will give people more choice and more control over their health and well-being and the local services that support them. It is the next stage in creating an NHS that is truly patient led—fair to all, but increasingly personal to each. I commend it to the House.

I am grateful to the Secretary of State for giving me two-hour advance notice of the statement and a copy of the White Paper. I will not be so churlish as to say that it was more useful to read three days of briefing in the newspapers beforehand.

It is clear what Members on both sides of the House want to achieve: more accessible, high-quality health care available to all on the basis of need, not ability to pay and NHS staff and professionals who are increasingly enabled to deliver the care that they want to deliver in response to patient choice and patient voice. I welcome some of the Secretary of State's proposals in the White Paper. In 1996, before the 1997 election, the Conservative party was the first to legislate for direct payments. Today, under a Labour Government, only 2.25 per cent. of people eligible for direct payments have taken them up. The Secretary of State says that such payments should be more accessible and that she will legislate accordingly, which I welcome. She said that there should be more respite care. We all very much agree, but I hope she will be more specific about the entitlements to respite care that will be provided.

In the election, we all promised and intended to deliver increased resources for palliative care. The White Paper makes it clear that that will be delivered through end-of-life care networks, but the Secretary of State has not made it clear how much additional money that palliative care support represents. In particular, she did not say how much of that will go to support children's hospices which, at the moment, must survive with just 5 per cent. of their resources derived from statutory or Government sources. East Anglian Children's Hospices in my own area has recently had to make 25 staff redundant, so it would be very interested to hear the Secretary of State's answer.

I welcome the U-turn on community hospitals. On 15 November last year, my hon. Friends will recall an Opposition debate in which we pressed Ministers to review the closure of community hospitals. Indeed, our motion stated that we should not allow short-term measures to be taken for budgetary reasons, because that would prejudice the delivery of care in the community in the long term. The Secretary of State now says that she will do precisely what Government Members voted against on 15 November.

The statement comes just five days after the Secretary of State sent financial hit squads into 18 NHS trusts. The NHS Confederation threatened "painful decisions" and a £1 billion deficit across the NHS. That is not what we hear from the Secretary of State. Instead, we hear about the sunlit uplands of future health care with happy patients, doctors waiting in supermarkets for patients to drop by and hospitals that are empty for lack of patients. It is rather like "Yes, Minister"—the NHS and hospitals would work perfectly if only patients did not keep turning up and wanting treatment. The Secretary of State must acknowledge reality before she embarks on a Patricia in Wonderland adventure.

Does the Secretary of State understand that primary care trusts have cut the precise services on which her White Paper plans depend? How can palliative care be improved if Macmillan nurses have been transferred to other duties for budgetary reasons? How can consultants offer out-patient clinics in the community or minor operations locally if 90 community hospitals are being closed? How can young people using mental health services be supported as the White Paper promises if those services are being cut, as is the case in my constituency? How can she criticise GPs for lack of access to their surgeries when it is just under two years since the Government contract removed Saturday morning surgeries? It is Government targets that have turned the GP appointment system into chaos.

The Secretary of State has not dared to tell the House what she is proposing to do to hospital services. Last Thursday, her Department published the document that I have in my hand. She did not tell us about it today and she did not make a statement last Thursday, but it makes it clear that, in 2006–07, NHS costs will rise by 6.5 per cent., but the tariff in hospitals will rise by 1.5 per cent. Labour Members should read that document before they read the White Paper. The squeeze on hospitals will continue next year—hospitals that have deficits this year will have larger deficits next year. The Secretary of State is planning a £4 billion shift from hospital care, but she has not told the House which wards and which hospitals will close, and perhaps she will address this point in her reply. NHS staff think it madness to engage with some of the additional proposals in the White Paper while the wards and hospitals that patients need are being closed.

The Secretary of State is taking an immense gamble, because unless patients can be more effectively and comprehensively cared for in the community, the hospital sector will be under-resourced to handle rising demand, and it will be patients who suffer. At least she understands that she must adopt the previous Conservative Government's policies to make progress in community and primary care. Market mechanisms with increased private sector involvement, direct payments in social care and GP fundholding are essential if we are to have success after eight years of failure to reform the service.

The White Paper fails to spell out how the reforms will work. Will the Government legislate to allow direct payments to extend across health and social care, so that patients with long-term conditions can control the management of their care? Will GPs in practice-based commissioning—new Labour-speak for GP fundholding—be given real budgets as Professor Julian Le Grand, the former health adviser at No. 10, has recommended? Will GP budget holders be able to use the savings that they generate to improve their patients' care or will such savings be siphoned off to meet PCT deficits? Will GPs be given the freedom to refer rather than being constrained by PCT decisions? Will the Government actually deliver real patient choice, given that their choose-and-book system is already 15 months late? Finally, will GPs be able to hold and negotiate contracts? If the answer to those questions is yes, then the Opposition will support the White Paper and the legislation to bring back fundholding.

I hope that the Secretary of State makes it clear that no more community hospitals will be shut. If the PCTs must review community hospitals, will she ensure that those PCTs that have deficits and that have nowhere else to go are supported to keep community hospitals open until additional resources are provided? In particular, will she introduce a split tariff to allow patients who are treated in a community hospital as part of a spell of hospital care to obtain part of the tariff for that treatment?

On health MOTs, more screening is, of course, required—for example, ultrasound screening for abdominal aortic aneurisms and bowel cancer screening have not been implemented, although they have been recommended and are needed. We are also 20 per cent. below the target level on diabetic retinopathy.

We need more opportunistic health screening. As the Secretary of State knows, the pharmacy contract permits pharmacies, which are visited by 90 per cent. of the public, to provide cholesterol tests, blood pressure tests, blood sugar level testing and body mass index assessments. Pharmacies can provide such services to GPs, who can follow up on people with certain risk factors. Where will the so-called life checks come from, and why should they take place at 11, 18 and 50? Why did the Secretary of State go down that route rather than the one being developed and piloted in the NHS today?

If the Government are confident that Tesco, Boots, companies such as United Healthcare and social enterprises want to provide primary health care, especially in areas that lack GP services, then we will support them. However, the market must be genuinely competitive, and community health services should not be so concentrated in one provider's hands as to represent a monopoly. Of course, there is no reason why PCTs should not continue to provide services, as long as they, too, are subject to competition. However, if they are providers of services, that undermines the case for them to become more distant strategic bodies instead of local providers that are more locally accountable. As the Select Committee on Health made clear, the whole process of PCT reorganisation has been a shambles. Even now, we do not know the future structure of commissioning, and the Government say that it will not be published for some months, yet that is the basis on which reorganisation should proceed. We should know the function of PCTs and then determine what their structure should be, not the other way round.

This White Paper should have been about commissioning. It should have set out how patients can have more choice, more control and a stronger voice. We have had the Government's sham consultations, and many of them, but where is the genuinely accountable patient and public involvement system for the NHS? That has not happened, and there are no proposals in the White Paper to do it. It should have explained how GPs can use real GP budgets to access the whole patient pathway; how we break down the barriers between health and social care, with individual budgets, including for those with long-term conditions; how we break down the barriers between primary care and hospitals instead of institutionalising, as the White Paper does, the idea that money can be shifted between hospitals and primary care rather than devoted to the needs of individual patients; and, most of all, how we can improve the effectiveness of public health and reduce the widening health inequalities in terms of life expectancy.

The Secretary of State said that the White Paper is about a primary care-led NHS. It is not, because GPs are at the heart of primary care, and this does not put them in the driving seat—it puts primary care trusts in the driving seat. A PCT-led NHS is not what we should be looking for. We should have a patient-led NHS that does not try to manipulate from the top down, as the Government have done in the past and are proposing to do again. That approach has failed. There is much that we can applaud in the ideas behind the White Paper, but far too little to applaud in the mechanics of its implementation.

I welcome the hon. Gentleman's support, albeit rather grudging support, for many of our proposals in the White Paper. He mentioned several issues, including palliative care, which we specifically deal with. That is enormously important. As a result of the increased funding over the next few years, including the money that we will shift from reduced administrative costs at a local level into front-line services, more money will go into local networks for palliative care, including better provision at home and in hospices for children who are terminally ill.

The hon. Gentleman referred extensively to GPs, particularly in relation to the target for appointments. I remind him that, when we were first elected, patients were rightly complaining that they often had to wait days, and sometimes weeks, to get an appointment to see their GP. We introduced the target of 48 hours maximum to see a GP and 24 hours to see a nurse practitioner. That has improved the situation for very many patients. The hon. Gentleman still has not told us whether he would scrap that target, along with the other targets that have helped to achieve enormous improvements in NHS services. There are still problems, as I am the first to acknowledge. People sometimes find it difficult to get through to the GP service or to book an advance appointment. That is why we have already negotiated with the British Medical Association, as part of the new GP contract, the agreement that part of GPs' pay in future years will be linked to an independent survey of patient satisfaction. That is part of putting patients in the driving seat. If they are not happy with the appointments system and their ability to get appointments when they need them, that will be reflected accordingly in their GP's pay.

The hon. Gentleman talked extensively about a return to GP fundholding. We are not going to return to fundholding, because it was unfair, created a two-tier system and ended up with hospitals trying to compete on price and undercutting each other to try to persuade GPs to enter into contracts with them, resulting in the most enormous administrative costs and unnecessary bureaucracy. We will do none of that. However, through practice-based commissioning, which will extend to every part of the country and every GP practice by the end of the year, we will give GPs and primary care practices much greater freedom and responsibility for the money that is spent on behalf of their patients in acute hospitals, including, of course, emergency admissions.

The result is an enormous incentive to GPs and primary care practices to deliver much better care closer to home, reduce emergency admissions to hospitals, keep their patients healthier and save money, which will then be available to the practice to reinvest in better services.

The hon. Gentleman mentioned the open contest for services in areas where they are inadequate. I said that, in six disadvantaged areas and many more to come, we are already holding open tenders through primary care trusts for the new primary care services. Applicants may be an existing GP practice that wants to expand, a nurse practitioner who wants to leave the service, a private firm, a not-for-profit organisation or a social enterprise, but the criteria—indeed, the whole process—will be open and transparent. Getting the best services for patients, with the best value for public money, will be the only thing that matters. I hope that the hon. Gentleman supports that.

The hon. Gentleman referred to primary care trusts. Local consultations are currently taking place in many parts of the country where primary care trusts propose to merge and change their boundaries. There is no doubt that, as we get more primary care trusts that are coterminous with a local social services authority, it will make joint working, which people rightly want, between social services and the local NHS much easier to achieve. It will mean stronger commissioning, especially of acute services, from primary care trusts, linked to much more choice for individual patients about health and social care, and a much stronger voice for them. I refer the hon. Gentleman to the chapter in the White Paper that covers the way in which we will strengthen the say of patients and users, including through independent surveys and a much stronger role for overview and scrutiny committees.

The hon. Gentleman mentioned funding. There has been overspending, sometimes for some years, by a minority of organisations, and a small number consequently have serious financial problems. Of course, we must get those under control. Last week, I set out the way in which we shall support those organisations even further to deal with their problems.

I hope that the hon. Gentleman accepts that it makes no sense to force patients to go to an acute hospital for an out-patient appointment, diagnostics or minor procedures if they can be done with good clinical quality safely, effectively and more conveniently for the patient in the local community. That is why the Royal College of Physicians and especially the Royal College of General Practitioners have worked with us closely to identify initially six specialties in which we will redesign the patient pathways to deliver more clinical care in the community. We set that out in some detail.

The hon. Gentleman twice mentioned the extension of direct payments, not only to social care but to health. That sounds like the revival of the patient's passport. It appeared in the Conservative manifesto only nine months ago and was recently dropped, but I fear that it will re-emerge.

The Conservative party voted against increased funding for the NHS. We have heard nothing from the Opposition spokesman about the crucial issue of health inequalities and ensuring fair funding for patients throughout the country. I fear that the hon. Gentleman's responses suggest that his leader's recent changes amount to all words and no substance. The Conservative party has not moved on one bit.

I, too, would like to thank the Secretary of State for giving us advance notice of her statement. I was going to say that we had already seen a lot about it in the press, but a great deal of that was clearly speculation, and much of it has not appeared in the White Paper. It would be churlish not to welcome the broad thrust of the document, and I particularly welcome the proposal to deliver more services closer to people locally, the greater combining of health and social care—although it is not clear that the barriers between the two will be broken down completely; perhaps the Secretary of State could elaborate on that point—and the greater provision for carers. Surely, however, that last proposal would result in an increase in social services funding, which is already stretched. Funding for older people is often one of the first things to be squeezed.

I must question the amount of money that was spent on the consultation. After spending money on gathering 1,000 people together, I am not sure that the Government have come up with anything of which we were not already aware. What new information was gained as a result of that expenditure?

As always, the devil is in the detail, and we have a number of questions to ask the Secretary of State. We strongly support the principle of community-based care, but how will these services be accountable to local people? It is all very well to say that the overview and scrutiny committees will be beefed up, but ultimately they do not have any say over the health services, so where is the greater accountability? Regarding the proposal to expand the use of private profit-making companies in the running of GP services, how will those services be accountable to the taxpayer and the patient? What guarantees can the Secretary of State give that existing GPs will not be poached by private firms offering higher salaries? Will such proposals not mean that we could end up paying more for almost the same level of service?

These proposals constitute an admission that the Government got it badly wrong when negotiating the GP contract. Should not they have predicted that the public would want access to their GPs at weekends and in the evenings? How does the Secretary of State plan to fund and staff the proposed greater access desired by the public? Reliance on the patient satisfaction survey will account for only a small proportion of what is at present in the GP contract. Does this not mean that the GP contract will effectively have to be renegotiated if the Secretary of State is to achieve her aims?

The public clearly liked the idea of health MOTs, and this is where the consultation seems to have been something of a sham. The Liberal Democrats believe that there is some merit in targeted health checks where there is evidence that they could be helpful. The public seem to want a more general health MOT, however, at various times of life. What they will actually get is an online tick-the-box exercise—a sort of "health MOT lite". So, despite these checks being targeted at areas of deprivation, there is no guarantee that they will reach the people who most need them. Will they not be just a sop to the worried well? What incentives will there be to ensure that the people who would most benefit from them will take them up and have their cases followed up?

We welcome the idea of individual budgets, but the present take-up of direct payments is small. For the system to work, it must be sustained by a system of support and advocacy. Will the Secretary of State tell us more about that? She has also announced the introduction of a single assessment of health and care needs. Will she explain how that will differ from the single assessment process that is supposedly already in place but has not been fully implemented across the country?

I echo the comments made about community hospitals. There have been reports that the private finance initiative budget is to be cut. Will the Secretary of State clarify that? Having acknowledged that community hospitals are a good thing and should not close due to budgetary pressures, will she ensure that some of the PFI budget is transferred to community hospitals, so that they can be brought up to date to enable them to deliver the testing and other local services on which she is so keen?

The Secretary of State started by stating that the Government were six years into a 10-year programme of NHS improvement. Some would say, however, that they were six years into a 10-year programme of reorganisation, reorganisation, reorganisation. A primary care-led NHS has been promised before, but not delivered. Combining health and social care has been promised before, but not delivered. And increased health promotion has been promised before, but not delivered. When will the Government stop dithering and start delivering?

I was going to thank the hon. Lady for the welcome she gave to at least some of our proposals. She welcomed in particular the intention much better to integrate health and social care, but rightly said that there are some barriers to that. We acknowledge those very readily in the White Paper, in particular the fact that there are different funding systems for health and social care, with NHS care continuing, as it must, to be free at the point of need.

Social care, of course, is offered on a different basis. We readily acknowledge that that is a problem, but, within that framework, we can still do far more: the single joint assessment of health and social care needs for people with complex conditions; the single health and care plan; far more joint commissioning by primary care trusts and local authority social services departments, in some cases pooling their budgets; and the requirement that, by 2008, local authorities and the local NHS should have joint health and care teams. All that will result in real improvements for some of the most vulnerable people in our community, who depend on those different organisations working together to meet their individual needs.

The hon. Lady raised a number of issues on local accountability. We set out in chapter 7 of the White Paper exactly what we intend to do to strengthen the local accountability of health and social care services. Overview and scrutiny committees, which already play an important part, will have more power, including the ability to institute their own review of a service where they believe, perhaps from their constituents, that a service is not doing well enough. That will be one of the triggers, to which we refer, that lead to a primary care trust needing to put in place an improvement programme or, in some cases, find a different provider for a particular service that is simply not satisfactory. Linked to that are not only independent surveys of patients and users—and not just for GP practices, but for other services—but the possibility of, for instance, user petitions and so on. All that will give people a much stronger say in the services they are getting.

Building on what was a most successful public engagement that helped to bring forward new ideas from the public in the "your say" consultation—I am sorry the hon. Lady dismissed it so readily—we need at local level to achieve far more effective engagement of local people, particularly at an early stage, where there are proposals to reorganise hospital services. In doing that, we need to build on the success of many patient and public involvement forums.

The hon. Lady mentioned the GP contract. It was a major concern of GPs and the British Medical Association that they did not want to be forced to continue to provide out-of-hours services. The new contract gave them that choice, with the responsibility falling back on PCTs if the local GP practice does not want to provide the out-of-hours service. For the first time, that new contract, which was negotiated three years ago, links the pay of GP practices to higher quality and the work they are doing, particularly to manage people with long-term conditions. That is an enormous step forward.

On the health MOT, of course we have looked at the evidence, which makes it clear that we do not want to be screening everyone in the population ever year with all the different tests that can be done. That would not be a sensible use of NHS resources. Our proposal, which we have already discussed with members of our citizens panel and which is undoubtedly welcome, will result in people in high-risk groups getting the additional support and advice, and in some cases further tests, that they need. By piloting it in the most disadvantaged areas in the spearhead PCTs, we will ensure that it reaches the people who are most in need. I regret that the hon. Member for Northavon (Steve Webb), who was busy criticising it in the press this morning, is not here. Perhaps he is also in the Liberal Democrat leadership contest.

The hon. Member for Romsey (Sandra Gidley) ended by criticising the NHS improvement plan. I remind her and others on the other side of the House that we have not only reduced hospital waiting lists to the lowest level since records began, but ensured that nobody has to wait more than six months for operations such as hip replacements, for which people used to wait more than 12 or 18 months, and sometimes more than two years, not so long ago.

As a result of the NHS treating more people better and faster than ever before, death rates from breast cancer and, for men, from lung cancer, are falling faster in our country than anywhere else in the world. We will continue to deliver that kind of improvement.

rose—

Order. I note that the Front-Bench spokesmen have taken more than 40 minutes. I note, too, that many right hon. and hon. Members wish to be called. I ask that all supplementaries are brief, and the answers equally so.

I very much welcome my right hon. Friend's statement in terms of strengthening primary care and particularly ill health prevention. In relation to the action that she proposes to strengthen GP surgeries in areas of high health inequalities, it is about time that that was done. After 50 years, when we consider the national health service—

Short question.

Order. I have asked for brief questions.

Does my right hon. Friend agree that after 50 years of the NHS being seen as just waiting for people to turn up at hospital, it is about time that we introduced the preventive agenda to stop that happening in 50 years' time?

I entirely agree with my right hon. Friend. I am particularly proud that, over the next two years, as we continue to increase massively the funding of the NHS, we will also reduce massively the inequalities in funding in relation to the wealthiest areas, which are usually the healthiest areas, and ensure that the poorest areas, with the greatest health needs, get the funding that they need and deserve.

Members on both sides of the House will commend the Secretary of State's statement that we need to do more to provide more services within local communities. She must know, however, that the gravitational pull of the district general hospital, coupled with budgetary pressures, is leading to those local services leaving local communities. Andover hospital, for example, is about to lose general anaesthetics. Can she now answer the question that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) asked: what will she do to ensure that, in her words, "community facilities that are needed for the long term are not lost in response to short-term budgetary pressures", when those pressures actually come from her Department?

Those financial pressures come from the fact that in a few areas of the country, there has been over-spending on NHS budgets, even at a time when, year on year, the NHS is receiving more money than ever before, including in north-west Hampshire. As well as publishing the White Paper, I am ensuring that primary care trusts that are considering the closure of community facilities, and particularly community hospitals, review those in the light of the clear strategy that we have spelled out in the White Paper to ensure that they have the facilities that will be needed as more services are moved out of acute hospitals into the community. That is not only better for patients, which must be our No.1 concern, but provides better value for money.

While the general thrust of my right hon. Friend's proposals is extremely welcome and clearly right, does she accept the estimate of the King's Fund care and support inquiry that the extra investment required in care and support services is likely to be at least of the same order as that currently being injected into the NHS—a growth of about half in cash terms, or one third in real terms, in five years? Must that not also include a significant improvement in pay and terms and conditions for care and support workers who are currently in short supply, many of whom are paid even less than those who stack shelves in supermarkets?

My right hon. Friend raises an enormously important point. We are all awaiting with great interest the report on which Sir Derek Wanless is working for the King's Fund. The larger long-term issues that he raises about levels of funding for social care services, however, must await the next comprehensive spending review.

Will the Secretary of State give some attention to a case in point, my constituency, where community hospitals, particularly Malmesbury, as well as those that serve the constituency of my hon. Friend the Member for Westbury (Dr. Murrison)—Bradford-on-Avon, Warminster, Westbury, Melksham and Trowbridge— are under threat? Listening to the Secretary of State's statement, I believe that she is beginning to say that we ought to think again about closing those community hospitals. Since we are one of the 18 primary care trusts into which she has sent the heavy mob, will she tell us how the heavy mob will save money, if we are to believe her that community hospitals will be saved?

The hon. Gentleman rightly reflects the fact that parts of Avon, Gloucestershire and Wiltshire have some of the most serious problems of overspending, and hence of deficits, in the country. That is why I announced last week that they would be helped by a new turnaround director. We, and they, will need to consider in more detail what is the right way to get spending under control. I very much hope that they will involve all NHS staff in identifying the waste and inefficiency that need to be rooted out to secure better value for money. It is in that context that they need to decide whether specific proposals relating to cottage or community hospitals are indeed the answer, or whether those settings represent future paths that need to be extended rather than diminished or closed.

I welcome the key role for social services and social care in the White Paper, but will my right hon. Friend liaise with local authorities which, as she has acknowledged, are under enormous and growing pressure to deliver social care on the ground? They want to be full partners with health representatives in the delivery of the White Paper's proposals. Will my right hon. Friend ensure that that happens?

I certainly will. My hon. Friend has made an extremely important point. We want to avoid the short-term shuffling of responsibilities from one part of the system to another. The system works best when local authorities and social services departments work closely with the NHS, often pooling budgets and commissioning services jointly. More emphasis on prevention and supporting people in their homes and communities can prevent health crises and emergencies that would be much worse for those people, but also far more expensive to treat.

I welcome any further moves to build on the work of this Government and the last Conservative Government by enabling health and social services departments to work more closely together and provide a seamless service. However, given the abandoning of the ring fence in 1997, how can we stop the practice of pilfering money that should be spent on social care to meet statutory requirements for children's care? That happens in the case of too many social services budgets, and has an adverse impact on the elderly.

I think that it was absolutely right to remove the ring fence. Local responsibility and local accountability are important when it comes to decisions about priorities. We are strengthening local area agreements, however, to ensure that local authorities—in partnership with other agencies, including the NHS—achieve the targets to which they have committed themselves, so that their objectives are realised and resources flow to where they are needed.

How will the Secretary of State's proposals affect the voluntary sector, especially services such as the senior citizen link line based in Bilston, in my constituency, which was visited recently by her colleague the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne)? The service, run by volunteers, telephones 1,000 elderly people in Wolverhampton on a weekly basis. It supports patients who come out of hospital, accompanies them to the GP's surgery, and performs a series of other services which enable them to look after themselves in their own homes. What will the Department do to support such services in Wolverhampton and elsewhere?

My hon. Friend has made an important point. I am delighted to congratulate the link line on its excellent work in supporting elderly people in particular.

We have already announced the investment of an additional £80 million in telecare services that will make it even easier for elderly and, indeed, disabled people to be supported in their homes. I believe that there is an increasing role for the voluntary sector and social enterprises in providing services for, in particular, groups in the community to whose needs they may be especially attuned. The social enterprise unit that we are creating in the Department will help to support those third-sector providers.

What steps does the Secretary of State plan to take to end the confusion that exists between NHS and social services departments about what constitutes free care and what constitutes means-tested care, given last week's judicial review judgment that the Department's NHS continuing care guidance was flawed and was resulting in frail and vulnerable people being charged for care that should be free?

As we say in the White Paper, there are two different systems of funding, which can sometimes cause confusion in the agencies themselves and among people receiving care. However, the personal health and social care plans that we shall put in place, starting with the 250,000 or so people with the most complex needs, will help to make much clearer to everybody what services are being provided within the NHS, free at the point of need, and what may need to be charged for within the framework of the local authority assessment. We shall publish a national framework shortly, which will also help to clarify matters.

I welcome my right hon. Friend's statement, particularly her aim to create a primary care-led, prevention-oriented NHS, especially as regards chronic diseases and inequalities. In my area, however, the acute trust employs 611 nurses while the primary care trust, which covers roughly the same area, employs only 176 community nurses and 49 practice nurses. What steps will my right hon. Friend take to address the huge inequality and imbalance between the secondary care and primary sectors so that we can start to make a real difference to primary care?

I very much welcome my hon. Friend's comments. He is, I think, the only general practitioner in the House at the moment, and he makes an important point. As more services are delivered in the community and as resources shift towards prevention and support in the community for people with long-term conditions, we should expect more of our staff, particularly nursing staff, to be employed in the community rather than in acute hospital trusts. Many nurses across the country would welcome that, and both the stronger commissioning role of primary care trusts and practice-based commissioning will help to ensure that that shift in resources takes place.

The Government were elected on a manifesto promising encouragement of community hospitals in our national health service. If the Secretary of State's words today are to mean anything, will she consider the situation in my constituency, where two out of four community hospitals have already closed their in-patient facilities and where the other two are in a parlous predicament? Whatever the arguments are about finance and deficits, that is simply unacceptable to my constituents.

The hon. Gentleman will, I know, welcome the fact that there are more than 1,800 more nurses and more than 1,400 more doctors in Avon, Gloucestershire and Wiltshire than there were eight years ago. On proposals for local service reconfiguration, I can say that the proposals need to be developed locally by the primary care trusts in consultation with local people. They need to be subject to extensive local consultation, and they would come to me if they were referred to me by one of the overview and scrutiny committees. I believe that that is the right process. The important thing is for the primary care trusts to examine their proposals in the light of our White Paper and to ensure that they consult local people on the best way forward.

I, too, welcome the patient-centred approach to health care and the much-needed focus on prevention. May I draw the Secretary of State's attention to the all-party group on breast cancer's report on screening, which recommends increasing flexibility for breast screening services? It found that one in six women who miss an appointment do so because the appointment was not convenient. They never get around to rearranging it. Will the Secretary of State outline what will be done to ensure that breast screening is more patient-centred?

My hon. Friend raises an enormously important point that underlines the importance of designing services as much as possible around the needs of the individual. With hospital appointments, for instance, we are already giving people a choice of at least four hospitals or clinics for an acute operation. As choose and book is rolled out, it will be possible to book a convenient appointment for the patient through the electronic system.

As we move of the screening services into the community, it will be much easier for patients to get an appointment at the time they need it, rather than one that they are simply told to turn up for.

I welcome the emphasis on mental well-being and the greater use of psychological therapies, but I am puzzled as to how that can happen. Shortages of clinical psychologists are extreme: in my patch, patients can wait up to a year and I understand that appointments for clinical psychologists are not subject to targets.

The hon. Gentleman raises an important point. Of course we need to do more to train and recruit people, not only at consultant level but at psychotherapist and counsellor level, to support people who need more support in dealing with depression and other forms of mental illness. We will shortly announce the location of two demonstration sites, where we will trial some of the new approaches—in particular, a more extensive use of cognitive behavioural therapy.

I welcome the statement, but does my right hon. Friend agree that the best primary care trusts, such as Staffordshire Moorlands, are already pioneering much preventive work? For instance, the trust has introduced community matrons to work with vulnerable patients to prevent emergency admissions to hospitals, deep vein thrombosis testing, prevention of falls programmes and GPs' surgeries every Saturday and Sunday in the local community hospital.

My hon. Friend is absolutely right. The work that her primary care trust and many others are doing in developing exactly that approach is the foundation on which we have created the White Paper. Many examples of excellent practice are given throughout the White Paper, including the use of community matrons—one of our innovations—to support people who need long-term care. What we now need to do is seize the opportunity that stronger commissioning and practice-based commissioning give us to ensure that the best practice in some parts of the country becomes the norm in every part of the country.

The Secretary of State talked about fully engaging the local community. In my constituency, tens of thousands of people have been fully engaged in opposing the cuts to the acute hospital. Will the statement today mean that those cuts will be reversed or will they go ahead because of the deficits in our trust?

As the hon. Gentleman knows, there are financial problems in Bedfordshire and Hertfordshire. There has been overspending even within a substantially increased NHS budget—a budget against which his party voted. There has been extensive consultation in that area on a reorganisation of services that will make much better use of NHS resources, give people high quality acute and emergency care, and give them better services within the community.

How will my right hon. Friend ensure that the target intentions that she mentioned affect Hastings, which is a very poor area within a rich region? Will the changes to the PCT mean that that will be diluted? How will she ensure that poor areas within rich areas benefit in the way that she intends?

My hon. Friend makes an important point. When we set out the criteria for PCTs that were looking at new boundaries, we said that they needed to satisfy themselves and us that they would be able both to have effective commissioning of acute hospital services and to maintain the focus on local communities, especially the most disadvantaged. Where there is general public support for a proposal to merge several primary care trusts into a much larger area, one of the issues we will consider is how we may sustain that local focus and, in particular, how we may ensure that funding continues to go to the areas that need it most.

Will the Secretary of State confirm that the Government's health checks do not involve checks by doctors or nurses but people filling in self-assessment forms supported by health trainers? Who are those health trainers and will they be clinically qualified?

I am happy to make it clear that in the first instance the NHS life check will not be carried out by GPs or nurses. That would not be the best use of those resources, so the first stage will be the self-assessment process. Then people in the higher risk categories will be offered the help of a health trainer—a proposal that came from the public and was in the "Choosing Health" White Paper—and the first of them are being employed in the most disadvantaged areas, in the spearhead primary care trusts where we shall be piloting the NHS life check. For people in high risk categories who may need more than the support of a health trainer, there would be follow-up by a nurse practitioner, a GP or some other qualified clinician.

On a point of order, Madam Deputy Speaker. Can the Speaker give help and guidance to provide more time for Members who have questions on the Order Paper? During Department for Culture, Media and Sport Question Time only seven Members whose names were on the Order Paper were called, whereas during Church Commissioners questions eight names on the Order Paper were called. Is it possible either that Ministers responding could be asked to give briefer answers or that the time for Church questions could be reduced so that the time for questions to the Department for Culture, Media and Sport could be increased? That would give me an opportunity to mention Colchester's success in the FA cup.

As hon. Members know, Mr. Speaker is always keen to have contributions from as many Back Benchers as possible. Although we only got to Question 8 on the Order Paper, in fact 30 questions were asked and answered in total. However, it is always helpful if supplementaries are kept short and answers from Ministers are equally short.

On a point of order, Madam Deputy Speaker. In a sense, I am the wrong Member to raise this point of order, as you were kind enough to call me during the statement, but I noticed that Front Benchers' questions and answers took almost three quarters of an hour of the hour and five minutes for the statement, which is unprecedented in my 14 years as a Member of Parliament. Will you, Madam Deputy Speaker, be kind enough to draw that to Mr. Speaker's attention to see whether discussions between the usual channels could take place so that ministerial statements and questions could be kept a little shorter to give the large number of Back Benchers who could not get in today the chance to speak in future on important subjects such as the statement that we heard today?

The hon. Gentleman will no doubt recall the statement that I made immediately the Front Benchers sat down. I have noted the matter; it is on the record and it will be brought to Mr. Speaker's attention. Despite that and the programme motion, I allowed the debate to continue for some considerable time. I have every sympathy.

Further to that point of order, Madam Deputy Speaker. If Front Benchers have long statements to make on serious subjects, would it be possible to agree with them that Back Benchers could have longer for questions, so that, for example, I could raise important issues about the possible closure of the accident and emergency department at Chase Farm hospital?

The point has been well made. I have noted it, as have many Back Benchers.

On a separate point of order, Madam Deputy Speaker. I have no criticism of the Lobby—I sat upstairs with my friends in the Lobby for many years—but it received copies of the statement long before Members, so we had no opportunity to appraise what was being said. The Lobby receives the statement immediately the Minister stands up, yet we do not receive it in the Chamber. Can you look into that matter, Madam Deputy Speaker?

I understand that members of the Lobby receive the statement when the Secretary of State stands up. As the hon. Gentleman will be aware, the statement is brought into the Chamber fairly soon afterwards. That is a comparatively recent practice that has been adopted.

Order. Somebody clearly has a mechanical instrument of some kind. Perhaps they could immediately leave the Chamber and switch the instrument off. If it is a microphone, my apologies to hon. Members present.

Six days ago, I was stopped mid-sentence when referring to Splott market, and hon. Members may or may not recall that the purpose of my mentioning the market in Splott or any other marketplace in Wales was to try to bring to the House's attention the fact that constitutional matters, such as those that we are discussing, may be of enormous interest to us, as politicians, and perhaps to academics, but the Bill and any legislation passed by the House of Commons and the House of Lords refers to people's lives. Hon. Members will recall that, over the past one and a quarter hours, the House has been dealing with an extremely important matter regarding the health service. So I make no apology to the House for saying that the basis for every Bill that we consider must be an improvement in the services that our people receive in Wales. However, we must understand that the way in which the Assembly Members are held to account by the people of Wales through the ballot box is also of great interest to our constituents. The amendment refers to the need to have proper consultation in the months ahead on the nature of the electoral system—in particular, the so-called top-up system—under which the National Assembly for Wales is elected.

If hon. Members look at clauses 8 and 9 or paragraph 57 of the explanatory notes, they will see a rather convoluted and complicated description of how the so-called top-up Members are elected. That is for us to consider, but I recall that when I left the polling station after voting during the first election to the Assembly, a little old lady came out with me, clutching what she thought was a manifesto or an election address from a political party. As it turned out, it was the second ballot paper for the top-up Members. She asked me what to do with it, and I suggested that she should go back into the polling station and vote according to her conscience. But she did not know what that paper represented, and there had been plenty of publicity about the nature of the second electoral system.

The figures speak for themselves about how it is that our constituents do not understand what it is that they do when they go into the polling station to vote in the second ballot. For example, my constituency is in the South Wales East region, which has almost 500,000 electors. At the last election—this applies to all parties other than mine—the Liberal Democrat, Mr. Michael German, won. He gained 17,661 second votes out of 500,000—3.76 per cent. of the people in South Wales East. At the same time, he stood for my constituency—Torfaen—and received 2,746 votes. Of course, he did not win, but he did win in the ballot for the top-up seats. It is virtually impossible for people in our constituencies to understand how it is that they pile up their votes—for example, in South Wales East, for Labour—yet none of them count in determining the second group of people who are elected to the National Assembly for Wales. Therefore, we need to take a very serious look at that system. Proportionality seems to be the answer for the second ballot. Why do people who elect Assembly Members not have them elected on the basis of proportionality and according to the votes that they cast?

I have had the same experience as my right hon. Friend. People at the count have asked me how many candidates we have had elected only to find out that, despite topping the poll, we have had none. That is the same for any political party. Clearly the longer this flawed system goes on, the more it will act as a disincentive for people to take part in the second vote. They think that a vote for whatever party will not deliver them anything.

There is complete confusion among the electors of south Wales, north Wales and middle Wales about the whole question of how votes are distributed.

How does the right hon. Gentleman reconcile the statement that he has just made with the evidence provided by the Electoral Commission to the Welsh Affairs Committee that this was not a contentious issue? Certainly it was not a topic of conversation on the bus in Dowlais.

I disagree with the Electoral Commission, and I do so on the basis that I have been elected to various bodies in Wales for the past 40 years. The people in this Chamber have been elected by the people who send them here and we talk to our constituents. The Electoral Commission is absolutely wrong and it is about time that it started listening to the people whom we represent.

I appreciate that the right hon. Gentleman is making the point that there is widespread and large concern among his constituents and, indeed, throughout Wales. However, would he care to share with the Committee all the letters and e-mails that he has had about this system over the years that the Assembly has been in existence? I would like that large body of evidence to be made available to everybody. If he has such a large body of evidence, we will all be able to understand it. However, the Electoral Commission says that there is no such body of evidence.

If the hon. Lady came to Wales and asked people—whether in Pontypool market, Splott market or anywhere else—what they thought about the second system of electing Members of the Assembly, I have not the slightest doubt that they would show confusion and a complete lack of understanding.

Obviously, democracy depends upon understanding, so can my right hon. Friend tell us what percentage of the population understand the d'Hondt system?

I suppose that I am one of the few people in the world who does because, as my hon. Friend knows, the d'Hondt system has been used in Northern Ireland after the Good Friday agreement.

I must admit that the d'Hondt system is enough to confuse anybody; I am not necessarily supporting a system. However, surely the right hon. Gentleman would not expect me to rely on prompted questions to his constituents or people in Wales. If the concern is widespread, there must be some spontaneous evidence of that in the form of letters and e-mails to all the hon. Members in Wales. I can assure him that my hon. Friends who represent Wales have not received enormous postbags containing concerns about this issue, so we would very much like to see his evidence.

Those Members did not receive such postbags because only one of them was elected to the Assembly under the first-past-the-post system. [Interruption.] We do not need e-mails and letters. Let us walk around the streets and go to the markets in our constituencies to talk to the people whom we represent and who know about politics. Despite what the Electoral Commission, academics and e-mails say, those people will say that the system is flawed and discredited. They will certainly say that it is unloved.

Much against my better judgment, I supported the system when I was a member of the Government. In the early days when we discussed the best system for the National Assembly, my personal preference would have been for first past the post. There is no better system than one that has a direct link between the Member in the Assembly or Parliament and those who elected him. If we are to have a different system—I accept that there is a case for having a slightly different system for the devolved institutions—it is right to consider the alternatives. However, I simply think that the one that has been chosen is the worst of the lot.

I have been to Splott market, as a matter of fact, because my daughter lived in Splott until very recently, but I have not heard anyone in Splott showing any concern about the subject, and much less in the part of north Wales that I represent. May I take the right hon. Gentleman back briefly to the point about the d'Hondt system made by the hon. Member for Caerphilly (Mr. David)? The right hon. Gentleman says that the existing system is complicated, outmoded and flawed. Would he thus support our amendment to clause 29 that would stop the use of that system for determining the composition of Committees?

I will have a look at the amendment when it comes up, but we are dealing with something totally different at the moment. The hon. Gentleman will recall that I referred to the markets when talking about the way in which the Assembly relates to people in Wales and their lives, whether that is due to its impact on the health service, education or any other matter. An electoral system that cannot be, and is not, understood by people is flawed. The problem is that the second system that we are using does not produce a result that is proportionate to the votes cast for the second group of Assembly Members. I could live with it if the system was properly proportionate, but those Members are added to first-past-the-post Members and people simply do not understand how their votes can pile up, yet be useless.

I am listening to the debate with great interest, although I suggest that we might be pre-empting a later group of amendments about the process. As we are having such a discussion, may I ask the right hon. Gentleman a question? If he thinks that the public are so dissatisfied because people who do not win an election in a constituency can nevertheless be elected, will he explain why he does not feel ashamed of being a member of a party that refuses to change an electoral system that is such that his party can become the Government of the United Kingdom with one third of the vote? Two thirds of the electorate voted against Labour, yet it formed the Government. The logical consequence of what he says is presumably that he would also like to change—

Order. The hon. Gentleman's comments are very wide of the amendment.

As tempted as I am to comment on the hon. Gentleman's points, I shall leave that for another debate.

Amendment No. 110 is precisely about consultation. I am expressing my personal views to the Committee. The hon. Member for Chesham and Amersham (Mrs. Gillan) talks about e-mails and other hon. Members mention letters and a lack of consultation, but the amendment would allow us to find out people's opinions. I am not prepared to listen to the Electoral Commission so that it can make up my mind on what the people of Wales think. There should be a properly co-ordinated and constituted consultation on the nature of our electoral system. That might result in agreement with the system that we have. I simply say that if a system is not understood, it is not a good system.

Does it follow that the right hon. Gentleman will support our amendments to the provisions in clause 7 that will bring about changes to the electoral system with absolutely no consultation of the people of Wales whatsoever?

I assume that the hon. Lady is referring to the proposed changes regarding dual candidacy. One of the bad effects of the present system is that it creates problems of dual candidacy, which I shall not discuss now because that is for another time this afternoon. Such problems result directly from the existing system. That is why I think that it should go, but that is not the purpose of the amendment. The amendment would establish consultation. We should ask the people of Wales what they think about the system.

There are a number of alternatives. Some years ago, several of us suggested that there should be 80 Assembly Members, with two elected for each constituency. That would have solved the problem of gender balance in my party. We would have been able to elect those Members by the alternative vote, which would have been a different method from the first-past-the-post system. Lord Richard recommended using the single transferable vote. I am not too keen on that, but it would produce something that was more understandable than the existing system. I would not support it, but at least I can see the sense behind it, which is not the case for the existing system.That is why I support the amendment. I hope that the Secretary of State and the Minister will consider it carefully and reflect on the need to ask people in Wales what they think about the current system. There is a risk to the legitimacy of the Assembly and to solid, firm, sound and strong government because of the results that the current system produces. Worst of all is the fact that the system is not easily understood by the people. That makes it a bad system.

There are many ways of reforming the arrangements—a single vote, a single constituency for the top-up Members from the whole of Wales, or some other system— but the present system is not doing the job. In my view it should go, but at least we should examine it.

I too shall speak in favour of the amendment in the name of my hon. Friend the Member for Wrexham (Ian Lucas), and I shall take up a couple of the points made by my right hon. Friend the Member for Torfaen (Mr. Murphy) about the confusion in the current system. The amendment is sensible because, as we are asking for a referendum about more powers, and the Assembly creating Acts, it is only right and proper that we should consider how Members are elected to carry out that new responsibility, and also how many Members are needed to conduct proper scrutiny of the additional responsibilities and powers that will be bestowed if the referendum supports them.

One concern about the amendment is that it curtails the consultation to 120 days. That is a little ambitious. However, if the Assembly and the two Houses of Parliament allow additional powers, I presume that the debate will already have begun, and people will be finding out how the scrutiny works, and whether additional Members are needed.

In my opinion, additional powers and responsibilities will mean additional Members. The part of the Bill that will come into force is about enhanced powers, and I believe that there is flexibility within the current arrangements for the National Assembly to deal with those powers. However, for full primary legislation we need to examine the number of Assembly Members who will undertake that work, so I am grateful that the amendment was tabled.

The present electoral system is flawed and confusing to members of the public. In 1999 I was a candidate in the Ynys Môn constituency. I was the runner-up, I have no complaint about the fact that the people voted for their candidate. That time was the high-water mark for nationalism in Wales, and the nationalists had a runaway success; ever since then they have been in continuous decline, and I think that that will go on into the next Assembly elections. The winner won, and the first-past-the-post system clearly identified who the people of Ynys Môn wanted as their Assembly Member. I was the runner-up, yet through the list system the Conservative, who came third, was elected as an Assembly Member. The runner-up was out of the game, but the candidate who came third was elected. If that is not confusing for people, I do not know what is.

I apologise for being out of order before, Mrs. Heal, but given the nature of the hon. Gentleman's argument, I am sure that I will be in order if I now ask him to explain how he justifies to people who are confused the fact that a party that two thirds of the electorate voted against formed the Government. How would he justify that, according to the democratic principles that he is now supporting?

You said that the hon. Gentleman was wide of the mark when he first asked that question, Mrs. Heal, so I presume that you would be consistent and say that if were to stray into that area, I would be wide of the mark as well. However, the honest response is that we are talking about proportionality. When people vote for the National Assembly for Wales on a second ballot, they are voting for a party to represent them in that region, so many thousands of people are disfranchised because of the current d'Hondt system, which is there to help the minority parties and other parties that do not win constituency seats. That is a serious flaw.

Is my hon. Friend aware that at the most recent Assembly elections in north Wales, the Liberal Democrats put out a leaflet telling people not to waste their second vote by voting Labour, because the person for whom they would be voting would never be elected? They were absolutely right, because despite topping the poll in north Wales, no Labour top-up Members were elected.

My hon. Friend, who has raised this matter before, is right. The inconsistency in the Liberal Democrats' argument does not surprise me in the least. What does shock me, however, is the fact that many people are disfranchised, and we need to address that. The consultation can be used to demonstrate the arguments and allow people to have their say, which would lead to greater clarity.

Is the hon. Gentleman arguing against proportionality as expressed in the d'Hondt system, or against proportionality in general? If he is in favour of proportionality, which system would he like?

I was coming to my preference, but I am against the d'Hondt system, because it is confusing and people do not get what they want. When electors vote in a region for a particular party which is identified as a second vote, distinct from the first vote, they should get proportionately what they voted for. I would prefer the additional Member system to be one of strict proportionality if the single transferable vote is used.

On a point of order, Mrs. Heal. I do not wish to interrupt the hon. Gentleman's argument, but I am desperately concerned that we are deep in a debate which, in fact, relates to the group of amendments on the way in which we elect Assembly Members. I therefore seek your guidance, as there is a danger that if we conduct such debates on each group of amendments we will never reach that particular group.

I thought I made it clear that hon. Members must confine their remarks to the amendment under discussion. Despite the temptation, they should not go far beyond that.

I accept your guidance, Mrs. Heal, but I am referring to the amendment, which talks about changing the voting system and the number of Assembly Members. In response to the hon. Member for Caernarfon (Hywel Williams), my preference is for 80 additional Members, with two for each constituency, in an alternative vote system, as that would give people a choice. If we increased the number of additional Members and kept the constituencies, I would prefer to have a straight STV, because that would be a simpler and quicker method and people would understand the proportionality involved. That is the way forward. The current system is flawed, and I do not understand why hon. Members are afraid to consult the people of Wales. If we accept, as the result of a referendum, that people want additional powers we should consider how we will elect Assembly Members.

The hon. Gentleman is rightly talking about consultation on the powers, the method of election and the number of Assembly Members. Does he not agree, however, that there was such a consultation recently under the cross-party commission chaired by Lord Richard? What weight does he give its recommendations?

I certainly give greater weight to the general election that has just taken place. The manifesto of the party that received the greatest number of votes in Wales made provision for the Bill. That is democracy. At the top of the agenda of Plaid Cymru, the nationalist party, were full law-making powers equivalent to those in Scotland. That was rejected in my constituency and many other constituencies, so I give a great deal of weight to what the people of Wales say. When the time is appropriate, we should conduct a consultation.

As I recall, the Welsh Labour manifesto did not say that the party would gerrymander the voting system at all, but that is what the proposal amounts to. More importantly, on the question of consultation, I remind the hon. Gentleman that the Electoral Commission was consulted, but its view was thrown away. The Arbuthnot commission in Scotland has been consulted, but its advice has been rejected out of hand. The thousands of people, including myself, who gave evidence to the Richard commission count for nothing in the eyes of the Government—again, our views are just thrown away.