1. If she will make a statement on waiting times for cancer treatment. [70832]

May I apologise to you,Mr. Speaker, and the House for the fact that my right hon. Friend the Secretary of State for Health cannot be here this afternoon because of a family illness? She was able to speak to the Opposition spokesmen personally yesterday to explain her absence and I am grateful to them for their understanding.

Cancer patients are now being diagnosed and treated more quickly than ever before, with almost 97 per cent. of them receiving their first treatment within a month of diagnosis.

I welcome the fantastic progress in reducing cancer waiting times through the dedication and commitment of health service professionals and the extra investment in the NHS. However, is the Minister aware that cancer waiting times after first treatment remain a problem for all cancers, including prostate and bowel cancer, that the waiting times for endoscopy and colonoscopy have been a problem in the past and that, if the bowel cancer screening programme is to be successful, it is important that sufficient resources are put in place?

I am grateful to my hon. Friend for her remarks about the dedication and commitment of the staff who do such work and about extra investment, with which I absolutely agree. The problems that are due to follow-up treatments often involve radiotherapy. We have done a lot to improve radiotherapy provision. Of course, if it is a first treatment, it counts in the waiting times anyway, but there are unacceptably long waits for the second stage of treatment in certain parts of the country, so we have been increasing the number of radiotherapy staff, both in post and in training. We have been making better use of existing staff and new investment in radiotherapy treatment facilities. For example, the number of linear accelerators has increased by about 50 per cent. There is some way to go, but I can assure my hon. Friend that we take this very seriously. We are doing what we can to improve the situation, but that is against a background of increased improvements over a number of years.

The Minister will be aware of the direct threat to the upper gastro-intestinal cancer unit at Frimley Park hospital in my constituency, not least because I have written to her Department three times to request a meeting on behalf of Surrey, Berkshire and Hampshire MPs, and three times I have been told no. In the last letter that I received from the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), I was told that a review of that decision would not be pre-empted, but I discovered the day after the letter was sent that interviews were taking place and decisions being made that explicitly pre-empted that review. Why cannot we have a meeting to ensure that that vital service, which contributes so much to health in the south-east, does not face imminent dismantling?

We must be absolutely clear about the process that takes place when we consider changing some of the cancer facilities. This is a classic example where cancer networks must look at some of the improving outcomes guidance, which shows that putting some of the cancers together in specialist centres actually saves lives. There is very clear evidence for that, and in a sense to ask for political interference would be wrong in a process that should be looked at very closely by those involved in the networks, which include clinicians, patient groups and representatives of the NHS. It is important that the review proposals are looked at very closely by the networks involved, and that process takes place for very good clinical reasons.

I, too, welcome the decrease in waiting times for cancer care, but may I ask my hon. Friend for her assurance that cancers with lower profiles, such as myeloma, are not forgotten when we allocate resources?

My hon. Friend is right to say that it is important that some of the high-profile cancers are not given more attention than some of the less well known ones. That is why we constantly review things. That can be done through the clinical cancer networks and through the guidance that is issued by the Department in conjunction with the profession to make sure that the very best care is available for patients who suffer in some of those circumstances.

2. If she will make a statement on the national programme for information technology. [70833]

The national programme is an essential part of creating a safer and more modern and efficient national health service. It is delivering integrated IT systems that are critical to the effective functioning of the national health service in ever-increasing numbers right across the country—not least in the hon. Gentleman's constituency.

The Secretary of State has told us that the connecting for health computer project will now cost £6.2 billion, but the chief operating officer of the project predicts costs in excess of £15 billion. Meanwhile, Westmoreland general hospital's coronary care unit in my constituency faces an uncertain future because of deficits that pale in comparison to those overspends. Will the Minister commit today to a full, independent, technical and financial audit of the project to ensure that public money is spent on the public's priorities?

The hon. Gentleman is right to say that this is indeed a major investment in the national health service. However, in contrast to NHS projects of the past, payment will be made only when the project is delivered. When the project is delivered, it will go further in improving patient care in the NHS. It will deliver more benefits to patients. I have looked at the hon. Gentleman's websites, where I read:

"Local MP Tim Farron is leading national calls for an independent review".

If he is to be the self-appointed leader of the national debate on this important issue, may I appeal for less simplistic analysis and more attention to detail? The project will improve patient care and it will not help to make exaggerated and nonsensical claims about it.

Part of that information technology has been NHS Direct. Chorley was the pioneer of NHS Direct, but we found out today that the Chorley centre is about to close, along with Bolton and Preston. Who is in charge of the Department—the Ministers or the chief executive? There is something wrong when people in Preston and Bolton who are being made redundant may be allowed to go to a new site, yet the people of Chorley have not been given the same assurance. Why not?

"Hear, hear."

I hope that Conservative Members are cheering the success of NHS Direct, which is dealing with a huge volume of calls this year—6.8 million. However, I recognise the concerns that my hon. Friend has raised and I understand why he is expressing them, given the news that has been put out today. NHS Direct has to take decisions to make sure that it can offer a sustainable service, given that it is handling an increasing volume of calls and dealing with in excess of 9 million internet inquiries every year. My message to him is that there will be provision in the north-west. There is a possibility that a new service—a new NHS centre—will be located in the region of his constituency. I am happy to meet him and other colleagues who are affected by the changes to discuss those issues.

I am surprised that the Minister did not mention the launch yesterday of another NHS information service at the Royal London Homeopathic hospital—the Complementary and Alternative Medicine Specialist Library. I have no doubt that he will have been fully briefed about that. That new service, which is extremely important and is backed by the Government, has one problem: many of the therapies provided by that one-stop shop are not yet available on the NHS. What is he going to do about that and what is he going to do about the alternative therapies that are available on the health service, such as homeopathy, which Nye Bevan used, but which is not widely understood or known about in parts of the country?

I am well aware of the hon. Gentleman's long-standing interest in these matters. Without a shadow of a doubt, he must have a glass raised to him at the Holland and Barrett annual shareholders meeting each year. I am not trivialising his interest and he raises an important matter, so I will examine it in respect of the IT systems and the other issues that he raises and write to him.

Is the Minister aware that many Labour Members believe that the national programme will be transformatory for the health service, especially due to electronic prescribing and care service records? Will he ensure that IT systems are compatible and, in that context, investigate the Luton and Dunstable hospital and the Royal Free hospital? Electronic records have to be taxied between those two hospitals because of the mismatch of electronic data links. Will he ensure that there is compatibility so that we have a better patient service?

My hon. Friend makes an extremely important point, and perhaps the hon. Member for Westmorland and Lonsdale (Tim Farron) would do well to listen to it. The programme is being procured at a national level exactly to ensure that we get value for money with the systems and so that the systems are compatible. A key benefit of the new system will be that a patient's record will be instantly available to a clinician wherever that patient presents in the NHS. I am sure that my hon. Friend will agree that that will be an enormous step forward that will end some of the paper chase that goes on in the NHS. It is a clear expression of why the system will deliver improvements to patient care and value for money.

I welcome the Minister to his first Health questions.

The Minister got right to the point about the IT system when he said that it was about delivery. The NHS needs an electronic patient record, but can he explain why it is more than two years late? The NHS also needs electronic prescriptions. According to the Government's targets, some 600,000 prescriptions should be transferred electronically each day, but the figure is in fact only about 13,000. The opportunity to make electronic bookings should mean that there are some 250,000 such bookings a month, but in fact there are only 20,000 a week. Can the Minister explain why the delivery about which he talks has so far failed lamentably on the Government's own targets?

I am grateful for both the hon. Gentleman's welcome and his broad recognition that modernising the national health service in such a way is the right thing to do. Rather than claiming that there has been no delivery, I can tell him that more than 1 million prescription messages have been issued via the new system and that 325,000 hospital appointments have been booked electronically. A key aspect of the way in which the programme is working is that the NHS pays only when the service has been delivered. The NHS has thus learned from past IT procurement and is doing the right thing by paying only when benefit is released to the service. I hope that the hon. Gentleman and his colleagues will support that approach.

3. If she will make a statement on the salaries of NHS nurses. [70834]

Investment of £1 billion in pay reform, including for nurses' pay, has delivered a high earnings growth of 2.8 per cent. between October 2004 and October 2005. We have agreed a 2.5 per cent. pay uplift for 2006-07, which will again deliver strong earnings growth this year. This is a good deal for nurses. A newly qualified nurse will earn £19,166, which is a 55 per cent. rise since 1997. I believe that that compares favourably with a newly qualified primary school teacher earning £19,161.

I am delighted that there has been a55 per cent. increase since 1997 and that the salary is just more than £19,000. A specialist nurse gets £23,000, so will the Minister outline whether "Agenda for Change" will give newly qualified nurses the opportunity to go on to that higher salary band?

My hon. Friend raises an important point. "Agenda for Change" is about completely transforming the way in which the pay bands operate to ensure that there is equal pay for equal value and, importantly, to give nurses the opportunity to progress up the scale. A senior specialist nurse can earn up to £31,000 and the salary for a nurse consultant rises up to £60,000. Part of "Agenda for Change" is job evaluation so that the skills and knowledge of individuals are examined and people can acquire skills and knowledge in order to move up the pay band.

Macmillan nurses at the Royal Shrewsbury hospital earn £5,000 less although they are on the same pay grade as similar nurses in Wolverhampton, which is just 15 miles away. We are concerned that, within such small regional areas, there is such a large difference in pay, with a possibility of poaching. What can the Minister do to reassure me on that?

I think that the hon. Gentleman raised that point in the Opposition day debate last week. He should understand that, for the first time, there is a pay band that covers both nurses and non-medical staff. Key to that is the job evaluation. He should be asking at local level about the skills and knowledge that are required of Macmillan nurses in one trust as opposed to another. We do not have regional pay scales, but the purpose of "Agenda for Change" was to have that job evaluation. Key to his point is the need to see what is expected of Macmillan nurses in one area and whether that is different from another area, and to take up the issue locally. That is important in defining what pay nurses of different types get in the area.

What we just heard was good news, but is it good news if people looking for jobs do not have access to the benefits of "Agenda for Change"? Has the Minister had any discussions with the unions or the employers about the possibility of setting up a national redeployment, training and relocation scheme? Hopefully, that would address the point raised by my hon. Friend the Member for Chorley (Mr. Hoyle) and mean that no one who wants to stay in the NHS has to leave it.

I thank my hon. Friend for that question. He is absolutely right. I am pleased to say that NHS Jobs, which acts as a billboard for vacancies in the health service—a couple of hundred jobs for nurses are on the board currently—will provide exactly what he says, which is a redeployment service for those who may find themselves without a job as changes take place in hospitals. I reassure him that, where trusts talk about job changes or losses, there might be some compulsory redundancies, but that would be a last resort and kept to a minimum. It will mostly be a case of freezing posts and making less use of agency and temporary staff. I am pleased to say that NHS Jobs will look at redeployment opportunities.

4. What assessment she has made of the impact of financial deficits on budgets for mental health services for 2006-07; and if she will make a statement. [70835]

8. Which mental health trusts are making cuts as a consequence of NHS deficits. [70839]

Planned expenditure for mental health services in 2006-07 is still being negotiated as strategic health authorities finalise their local delivery plans. In 2005-06, 11 out of 84 mental health trusts reduced planned expenditure by £16 million overall, while the complete expenditure increased by £368 million.

I thank the Minister for her response. At the last Health questions, she assured me that mental health services were one of her Department's top three priorities, notwithstanding existing NHS deficits. If that is the case, why is mental health not included on the list of the six key national NHS priorities specified in the Department's operational framework and setting out the key principles for financial management for health trusts for this current year? Does she appreciate that the effect of that is that spending on mental health services by health trusts is likely to be frozen or cut this year as a consequence?

We should be clear about the improvements that have taken place in spending on mental health services—an increase of something like £1.6 billion over the past five years. Also, if we consider what happened last year, again, 11 out of 84 trusts reduced planned expenditure. They were going to spend £384 million more than they spent the year before, but in fact they spent £368 million. That means that overall expenditure on mental health has increased. It is clear, through the targets that have been set and the local delivery plans, that the actions we have adopted contributed towards that increase in mental health spending. Mental health under the previous Administration was a Cinderella service, suffering from years of underinvestment, unlike the situation under this Government.

Berkshire Healthcare Trust faces cuts of £10.2 million in mental health care provision. One area particularly affected by those cuts is early intervention services which, as the Minister knows, are a key Government target in the national strategic framework for mental health. Will she carry out an assessment of the human costs of such cuts?

The hon. Gentleman is right that early intervention teams are important, which is why we introduced them. One of the many changes made under the Government to the delivery of mental health care is the greatly increased emphasis on care in the community. In Berkshire, I believe that the spending figure is about £200,000 less than was going to be spent, so it is not quite the same as what he suggested. I will look into his point, but I understand that the figure is about 0.1 per cent., because the overall budget is £77 million. There have been improvements in his area, and I hope that he welcomes them. I accept the point that he made about early intervention, and I will look at what cuts are proposed for early intervention teams, as I would be concerned about them.

Due to the actions of our Government since 1997, mental health care has recently ceased to be the Cinderella of the NHS, but it is still something of a poor relation. Can the Minister reassure the House that people and patients have not been put at risk by budget reductions, about which Louis Appleby, the national director for mental health, is unhappy?

Given the extra investment in mental health services, we are anxious that primary care trusts and strategic health authorities should maintain a high quality of care. As I have said, when we looked at planned and actual expenditure last year, the difference was £16 million, but that does not mean that overall expenditure did not increase on mental health services. It did, and it has done so consistently in the years since the national service framework was introduced, along with new teams, modernised ways of working and increased investment. That has made a genuine difference to people who use our mental health services, and we certainly want to maintain those improvements.

Last week, Shropshire County PCT announced the closure of Whitcliffe mental health ward in Ludlow community hospital, not because of patient care needs—the patients will be transferred to the only remaining Victorian asylum operating in this country—but entirely as a result of financial deficits. The mental health trust operated at surplus in 2005-06, and it is due to break even in 2006-07, but it has been forced to make cuts and close that ward purely because of the financial deficits that affect the rest of the NHS in Shropshire. Why?

It is difficult for me to comment. As the hon. Gentleman said, the trust will break even this year, so I am not certain why he said that that in-patient ward will be closed. In-patient wards are often closed because services are provided in the community, thus reducing the need for in-patient beds. That may be the case in his constituency, or some of the patients may be transferred elsewhere because that is more appropriate. However, he should accept that in some instances—I will, of course, look at the point that he made—those decisions are made for good reasons, as the fact that there are teams in the community may mean that there is less need for in-patient beds.

On Friday, the Department of Health produced a press release headed, "End of the 'Prozac nation'—more counselling, more therapy". It trumpeted a "ground-breaking initiative", "a major new programme". What we get is a couple of pilot schemes, while in Oxfordshire, Cambridgeshire and other places around the country that we have heard about, front-line mental health services are being cut. Is that not another case of the Department of Health being out of touch with what is happening on the ground?

I am disappointed by the sneering attitude that the hon. Gentleman is taking towards an initiative that has been welcomed by all the mental health charities and by mental health service users, who know the importance of psychological therapies. They know that we need to build up the case for saying that psychological therapies can be a very good alternative to drug therapies. We have always been clear in every White Paper and in our manifesto commitments that we would start a gradual programme of introducing psychological therapies. We need to show—which is why we have set up demonstration sites—the benefits of the approach not just to the individual, but to the local community. The programme is a good way of doing that, and I am sorry that the hon. Gentleman's attitude goes against everything in which we have been supported by service users and mental health charities.

I presume the Minister was disappointed with Rethink when it published a damning catalogue of budget cuts to mental health services around the country: the closure of mental health day hospitals in Suffolk; mental health wards closed at St. George's, Tooting or forced to become mixed sex wards; and 5 per cent. cuts in Hertfordshire mental health services. Was she disappointed with the Mind report yesterday, which highlighted the absence of appropriate services for the one in six women who suffer mental health problems around childbirth, with 25 per cent. of them waiting more than six months for any support? Will she be disappointed tomorrow, when Pulse magazine brings to Parliament general practitioners who are alarmed at its survey showing 93 per cent. of GPs prescribing antidepressants contrary to National Institute for Health and Clinical Excellence guidelines, because of a lack of available alternatives? Does she really think that our mental health services are having their best year ever?

Following the Rethink survey, we carried out a survey of all 84 NHS trusts whose full details we will publish tomorrow. I have been finalising everything that I want included in it. The figures show that, as I said, planned expenditure increased, but not by as much—by about £16 million less than was intended, out of a total expenditure by those trusts of £893 million. On psychological therapies and the Mind survey, the hon. Gentleman is right to say that, for post-natal depression, we need to increase the services available. That is why we have set up the demonstration sites that we announced last Friday. We know that much more can be done—for example, through health visitors to assist with post-natal—

Order. I am reluctant to interrupt the Minister, but we have an Order Paper which we must get through.

5. When she next expects to meet representatives of primary care trusts and hospital trusts from East Anglia to discuss funding issues. [70836]

Primary care trusts determine how best to use the funds allocated to them to plan, develop and improve health services for their local populations. No meetings are arranged with representatives from NHS trusts in East Anglia at present, but as Minister with responsibility for the eastern region, I expect to have meetings with representatives and to visit the region in the course of my work.

Is the Minister aware that the Queen Elizabeth hospital in King's Lynn is facing a £10 million deficit? The staff have my admiration for working tirelessly trying to sort out the crisis. Is it fair on the local community that the hospital is being forced to pay a usage charge of 10 per cent. on its borrowings? Is it fair that the PCT financial uplift for the next two years has been cancelled because of PCT reconfiguration? Does the Minister agree—if he puts his hand on his heart, I am sure he will—that my constituents deserve better from the Government?

I am sure that an hon. Member of his long standing in the House and a member of his party would accept that the NHS must live within its means. The hon. Gentleman must accept that there is a combination of cost pressures on the system this year and that decisions must be taken locally. Before he rides off on his high horse and lectures the Government about NHS funding, no PCT in Norfolk will be more than 3.5 per cent. under target funding. The Norfolk PCTs have experienced a two-year increase of 22.5 per cent. against a national average of 19.5 per cent. He should look at the facts on the money going into his local health service before he dishes out criticism and says that it is all the Government's fault.

As my hon. Friend knows, one of the ways in which the NHS is using its money in East Anglia involves requiring the primary care trusts to allocate a certain amount of money to the private sector to provide services free at the point of delivery for patients, which will provide patients with greater capacity and greater choice. In order that that process should work successfully in my part of the region, will my hon. Friend agree to meet me and my hon. Friend the Member for Great Yarmouth (Mr. Wright) to discuss the way forward in our part of the region?

I am grateful to my hon. Friend for his constructive comments and agree to meet him and my hon. Friend the Member for Great Yarmouth. I am aware that the number of people waiting for an in-patient appointment for more than six months is down to almost nil within his region, and the number of people waiting for an out-patient appointment for more than 13 weeks is also down to a very low level. Huge improvements have been made, but I am ready to listen to him about how we can improve things further.

Is the Minister aware that because of the underfunding of the PCTs in my constituency—we get 90 per cent. of average funding—he is closing one hospital, halving the number of beds in a second, closing beds in a third and has cut to ribbons the money available for mental health? Will he meet me and my PCTs, all of which believe that the situation is a result of underfunding rather than overspending? The health service is now in its worst state for 30 years.

I find it hard to take lessons from a member of the Cabinet which slashed NHS funding. As I said to the hon. Member for North-West Norfolk (Mr. Bellingham), Norfolk PCTs have experienced a 22.5 per cent. increase, and similar increases have occurred across the region. I am ready to listen to the right hon. Gentleman and hear about the pressure on the ground, where difficult decisions are being made in NHS trusts. However, he would be the first to say, "The NHS must live within its means and only spend what it has coming through the door." I am sure that he wants to support us in ensuring that his local NHS has a viable future.

6. If she will make a statement on the progress of the SunSmart campaign. [70837]

The SunSmart campaign, launched today, is the national skin cancer prevention campaign run on behalf of UK health Departments by Cancer Research UK. This year, it will focus on men, in whom the incidence of malignant melanoma has quadrupled in the past 30 years, and also on outdoor workers.

I wonder whether my hon. Friend has read my early-day motion on unstaffed, coin-operated sun-tanning salons, which I tabled last week. She will be aware that under-16s should not use sunbeds and that children are gaining access to unstaffed centres. Will she consider using the SunSmart campaign to raise awareness among children about the dangers of sunbed use?

That is an important issue. More than 100 MPs have signed the early-day motion. I will do more than use the campaign to raise awareness—officials from across the Departments will meet other interested parties to discuss regulation in that area, and in particular coin-operated tanning booths and under-16s.

As part of the campaign, will the Minister ensure that awareness-raising information is targeted at men under 24 and over 64, who are particularly susceptible to not seeking medical advice when symptoms appear?

Part of the SunSmart campaign involves making sure that information goes to doctors and others, who can share it with other health professionals in their surgeries and make sure that leaflets are available. I am pleased that the campaign is focusing on men, because I am sorry to say gentlemen that you are not always very good at coming forward to look after your own health—take advantage of the information and enjoy the sun, but keep it in proportion.

Would my hon. Friend agree that a little bit of sun is really good for you, because it helps to create vitamin D in the body, which prevents a lot of stomach cancer, bowel cancer, osteoporosis and so on? Does she accept the international information that is available, and does she think that Cancer Research may have gone a wee bit too far?

I recently met my hon. Friend and Mr. Oliver Gillie to discuss this issue, and we have had discussions with Cancer Research. I think that my hon. Friend will find that the information does not advise not going out into the sun, but being proportionate. I have asked the Scientific Advisory Committee on Nutrition to consider some of the issues relating to adequate levels of vitamin D and prevention of other serious illnesses. My hon. Friend raises an important point.

7. What estimate she has made of the year-end gross NHS deficit for the 2005-06 financial year. [70838]

As at month six, the NHS is forecasting a net deficit of around £620 million for the financial year 2005-06. My right hon. Friend the Secretary of State intends to publish provisional out-turn figures for 2005-06 in early June.

I, too, welcome the Minister to his post and remember him as a well-respected colleague on the Health Committee, but that is where the pleasantries end. As he will know, the Royal College of Midwives, for instance, will be particularly concerned about this announcement. Is he aware that the decision to merge the three strategic health authorities in the east of England has concerned Southend hospital, which is not running a deficit and has actually saved money? The health professionals there are very worried that they will now be asked to bail out other health authorities that are running a deficit. Will the Minister confirm that that will not happen?

I thank the hon. Gentleman for his generous welcome. I remember our time on the Health Committee. He always had a pleasant word for me then, so I hope that that will continue in this job.

I entirely understand the point that the hon. Gentleman is making on merging strategic health authorities. We made a commitment at the general election to take money out of NHS bureaucracy by slimming the number of NHS organisations and taking £250 million out of the system. I remind him that his party made a much deeper proposal of cuts up to£600 million. One of the systems that we are taking forward is to ensure that those who do run a good ship do not get penalised as they did in the past and that organisations that are helping to recover the position can rightly expect that money to come back into their local health area. That is true for my constituency, too, and for many more represented on the Labour Benches of the House.

May I also welcome my hon. Friend to his new position on the Front Bench? Does he agree that it is vital not only to know what the out-turn deficit is for this particular year and how we are going to deal with that in this financial year and in years to come, but to understand why we have this overspending minority of trusts when we have a Government who have doubled expenditure on the NHS in the past seven years?

I thank my right hon. Friend for his comments and for welcoming me to the Front Bench.

I entirely agree that once we have got through the immediate difficulties, the important thing is to understand how these problems arose and to ensure that there is the strongest possible financial control at trust level. Boards must be given the information that they need in order to make decisions to ensure that the trust lives within its means, balances its books and remains in a strong position. I take on board my right hon. Friend's comments—he is right to make them—but I think that he would join me in saying that despite the problems, there is no trade-off against NHS standards. Within the current difficulties, the NHS continues to improve and is producing record waiting times for patients.

Last week, it was reported in the British Medical Journal that adverse drug reactions are estimated to cost the NHS nearly £500 million a year. In view of the current NHS deficits, is it wise for the Department of Health to terminate the contract for supplying the Drug and Therapeutics Bulletin to prescribers? I, too, welcome the new Minister. I do not think that he was on the Health Committee when we carried out our inquiry into the pharmaceutical industry. The Government response to that recognised the importance of the Drug and Therapeutics Bulletin as one of the very few sources of independent advice to prescribers. Will he therefore reconsider that decision?

I am grateful to the hon. Gentleman for his welcome, and that another of my comrades from the Health Committee is giving me the benefit of his advice at my first Health questions. I always have the highest regard for what he says, and I have listened carefully to the point that he has made. These issues have to be considered in the round against the background of NHS deficits, and there are continual pressures on the national health service. However, I have listened to the hon. Gentleman today, and I will continue to listen carefully to his views.

rose—

I call the hon. Gentleman.

My anonymity knows no bounds— [ Laughter.] I have almost forgotten what I was going to say.

My hon. Friend the Minister referred a moment ago to primary care trusts and health authorities running a good ship. That has been exactly the case in Barnsley, Doncaster and Rotherham in South Yorkshire. Sheffield, however, despite brokerage and borrowings of £20 million, is still £16 million in deficit. Consequently, every health authority in South Yorkshire is now being asked to pay a 2.5 per cent. levy. For Barnsley, that means £6 million being taken out of the PCT's budget before the financial year even begins. Does my hon. Friend think that it is fair that the people who have been running a good ship are being penalised for their success?

My hon. Friend makes an extremely fair point. His PCT is similar to mine in many respects, being in a former mining area. I agree that the money to which he has referred is vital in an area such as Barnsley, just as such funding is needed in my constituency to improve public health and preventive care, so I understand entirely what he is saying. This is about putting in place a fair regime in the NHS, so that those organisations that bail—[Hon. Members: "Bail?"] Those organisations that help those that are having problems should not suffer the consequence of not seeing the money come back into the system. My hon. Friend is right to raise that point. It is not right that organisations that manage their affairs well should compensate those that do not. The incentives in the system must reward those who run a good organisation.

Although we recognise that there has been a huge increase in funding to the national health service, which we welcome, does the Minister recognise that a depressingly familiar pattern is reasserting itself? This afternoon, we have seen the Minister with responsibility for mental health services standing at the Dispatch Box telling the House how important those priority services are, yet PCTs all round the country are cutting the growth budgets available for those services, regarding them as a soft touch for available resources. This is a familiar pattern. What steps is the Department taking to ensure that that is not allowed to continue?

It would be deeply irresponsible, when financial pressures have arisen, not to take steps to get the local health economy back into balance. However, I understand the serious point that the right hon. Gentleman is making about the position of mental health in the overall health economy, and about ensuring that it is not the specialty in which cuts are made and from which funds are taken first. I respect that point. Overall, however, it is up to the local health economies to make a proper judgment on their priorities for mental health services. But, as the right hon. Gentleman says, mental health services are not optional, and it is vital that they are adequately resourced.

Does my hon. Friend agree that deficits do not necessarily reflect the excellent standard of health care in hospitals such as those at Southport and Ormskirk in my constituency? They are to be congratulated on being placed among the top 40 hospitals in the country, on having attained level 3 in the clinical negligence scheme for trusts, and on having the lowest MRSA rates in the country. My constituents should not be penalised for any errors made in strategic health authorities or in the health economy generally. The people should not pay; the executives should sort themselves out.

My hon. Friend's analysis is absolutely right. Many PCTs in the areas with the highest health needs and the greatest health inequalities have managed to break even and, in some cases, return a surplus. It would be wrong if those PCTs were unable to reap the rewards of that good financial management. The system that we are establishing will ensure that those organisations receive their funds back if they have helped, in-year, to recover the financial position of another health body.

I know that the Minister is new to his post but he had better take care, because this time last year the Secretary of State was 80 per cent. out on the net deficit that the NHS was experiencing. Before he starts quoting a figure of £620 million, he ought to come to the House and tell us the actual unaudited figures at the year-end, rather than speculating on the basis of six-monthly figures. The consequences of that, and of paying off such deficits, are apparent across the country. Job losses were announced at Leeds Teaching Hospitals NHS Trust on Friday, at Nottingham University Hospitals NHS Trust yesterday, and at NHS Direct today, affecting directly the constituents of the hon. Member for Chorley (Mr. Hoyle) and my constituents. The people affected, including nurses who face the prospect of redundancy, deserve better.

The Minister talks about financial control, but will he tell us what is the Government's plan for financial control this year? Is it what the operating framework said in January—that every organisation must plan to recover their deficits from 2005-06 and balance their books this year? Or is it, as the Secretary of State told me in April, that every organisation with an overspend must improve this year, and that by the end of the financial year, monthly expenditure should be covered by monthly income? Those are two completely different financial regimes. Which is it?

As I said in my response to the main question, provisional out-turn figures for the year-end will be published by my right hon. Friend the Secretary of State in early June, so the hon. Gentleman does not have long to wait. While I accept that difficult decisions are being made on the ground in his constituency and others, the purpose of those is to get the NHS into a stable position so that it is living within its means. There are not widespread redundancies across the piece—as I have mentioned, many parliamentary colleagues have a surplus in their health economy. The problem is focused on the 7 per cent. of NHS organisations that are bearing the vast majority of the deficit. On the hon. Gentleman's question about financial control, he knows that we are putting turnaround teams into those trusts specifically to help those organisations bring themselves back to financial balance by the end of this year. The answer could not be clearer: we are taking the difficult decisions necessary to get trusts back into balance.

9. How many general practitioners there were in the NHS in (a) 1997 and (b) 2005; and if she will make a statement. [70840]

In 1997, 28,046 GPs were working in the national health service. In 2004, that figure increased by 4,692, to 32,738, which is an increase of 17 per cent. Those figures do not include retainers and registrars who represent a potential pool of about 3,000 GPs.

I welcome my hon. Friend to his new position. That national picture is reflected in Lewisham, where we have but four vacancies, compared with 20 in 2002, and recruitment is going well thanks to Government support. Will he ensure, however, that the Government monitor the retention of those GPs, giving extra support to PCTs should it prove necessary? Will he also ensure that patients benefit from increased GP numbers by getting better access to out-of-hours services?

I agree entirely with my hon. Friend. The news from Lewisham is good. She is right, however, that it is essential that we maintain the successes made in GP recruitment, especially in disadvantaged and inner-city areas. That is why we have focused and targeted resources on supporting PCTs in those areas, especially with regard to recruitment and retention. We know that it has not always been easy to attract GPs into some of our most disadvantaged communities. I also agree that it is essential to ensure that improvements in primary care facilitate enhanced access to primary care services in every community.

I welcome the Minister to his new duties. The National Audit Office tells us that up to 1 million people in England can no longer rely on out-of-hours services from a GP that they took for granted in 1997, despite the figures quoted by the Minister and a 22 per cent. overspend on out-of-hours services. What is he doing about PCTs such as Harrow, Burntwood, Lichfield and Tamworth, Eastleigh and Test Valley South, North Bradford, New Forest, Richmond and Twickenham and Sutton and Merton, which the NAO says are unable to guarantee patients' access to a GP at night and at weekends?

The transition to the new GP contracts, in terms of out-of-hours services, has on the whole been smooth. That was actually confirmed by the recent National Audit Office report. As for the areas where there are difficulties, we need to examine them with the relevant primary care trusts, and ensure that out-of-hours services are available to patients in those communities where that is appropriate. However, the suggestion that the new contracts have led overall to a deterioration in out-of-hours services is not backed up by the very report to which the hon. Gentleman referred.

10. If she will make a statement on the future of patient and public involvement in health. [70841]

An expert panel was set up to consider the evidence collected in our recent review of patient and public involvement. We are currently considering its recommendations, and will make an announcement shortly.

Does the Minister agree that it is crucial for the public to be involved in decisions relating to health care provision in communities? Does she accept that either abolishing or radically changing the forums only two years after their introduction will be yet another prime example of the Government's permanent revolution of our NHS, which generates a lot of huffing and puffing from Ministers but delivers very little to the public?

The hon. Gentleman is right to say that it is important to have good patient and public involvement in local decisions about health care, especially as some 80 per cent. of the budget is now devolved to local level. The reason we want to change the current system of patients forums is that many people in them felt that not enough resources were going to the front line. They felt that they would be able to do more if they had more control at local level, and if there was more accountability. For example, they wanted to work more closely with overview and scrutiny committees. We shall be presenting a great many ideas that I believe will lead to improvements in this important area.

I believe that public participation is key to ensuring that the NHS delivers the quality services that local people want. The advent of foundation trusts has provided more opportunities for the views of local people to be sought through those new structures, but what consideration has been given to strengthening public involvement in the direction and provision of primary care services at that very local level?

My hon. Friend is right: public participation is certainly one of the keys to ensuring that there is accountability at local level, and that local people are involved in decision making. That is one of the reasons why we wanted to consider the new structures. As there is a stronger role for primary care trusts in commissioning and as there are fewer PCTs, it is important to ensure that there are good local networks involving not only individuals but local organisations and local authorities in some of that local decision making.

I suggest that the Government's record on this issue is very poor. They replaced the system of community health councils with a system that is not working. Patients forums have cost £12 million more to run, and staff turnover is very high. The Commission for Patient and Public Involvement in Health was introduced, only for the Government then to announce its abolition. The total cost of that was £100 million. Last year the Government scrapped their plans for reform, and now there is speculation that patients forums themselves will be abolished.

Given that confusion, will the Minister assure the House that the expertise built up by forum volunteers will not be lost in the latest round of Government changes, and will she do her best to get a grip on the shambles?

The difficulty that we experienced with the CHCs was that they offered services in different ways. Some would offer complaints services, for instance, while others would not. That is why we set up a whole new structure, including the patient advice and liaison service in local trusts, the Independent Complaints Advocacy Services to deal with complaints, and patients forums to consider patient and public involvement at local level.

We will be looking further into how to improve the current system, as people working in patient forums have identified some difficulties, particularly the problem of ensuring that resources are spent at local level. I can assure the hon. Gentleman that that is exactly why we set up the expert panel—to ensure that we improve in future by building on the expertise that already exists in the patient forums.

11. What steps her Department is taking to increase access to child mental health services. [70842]

The Department's recovery and support unit is working closely with strategic health authorities to ensure that comprehensive child and adolescent mental health services, as defined in the national service framework for children, young people and maternity services, are available to all who need them.

In welcoming the Minister to his new post, may I remind him that early in 2004, the then Health Minister, the right hon. Member for Barrow and Furness (Mr. Hutton), told me that an 80-week waiting list for a child to access psychological services was unacceptable? The Cumbria and Lancashire strategic health authority confirmed in March that the waiting time was now 93 weeks, which many would regard as unbearable. I have been told that action has been taken to address that deficit, so will the Minister confirm that he will do everything possible to speed up all the necessary measures to reduce that totally unacceptable waiting period?

I agree with the right hon. Gentleman that that was and is unacceptable and I congratulate him on highlighting those issues. Appropriate action has been taken to deal with the problem, as he has acknowledged. For example, in his locality a number of new posts and services have been created: a clinical child psychologist, a child and adolescent mental health services assistant psychologist, part-time administrative support, an attention deficit disorder nurse, a primary care liaison specialist post and a specialist health worker located in the youth offending team. All that investment should significantly improve the position. I hope that the right hon. Gentleman will keep me informed of developments; we certainly expect to see significant progress in the months ahead.

With permission, Mr. Speaker, and in the unavoidable absence of my right hon. Friend the Secretary of State, I should like to make a statement on primary care trusts and NHS ambulance trusts. Detailed information for each area has, for the convenience of hon. Members, been placed on the Board since 1 pm.

In my right hon. Friend the Secretary of State's written statement of 18 October 2005, she explained that strategic health authorities had been invited to submit proposals to the Department of Health on how to streamline SHAs and strengthen primary care trusts. Four clear criteria underpinned that exercise: the need to improve health and reduce inequalities; to strengthen the PCTs' commissioning function; to improve co-ordination with social services through greater coterminosity between PCT and local authority boundaries; and to deliver at least a 15 per cent. reduction in management and administrative costs.

In the intervening period, SHAs have consulted local people, staff and clinicians, partners in local government and a range of other local stakeholders on the proposals for SHAs, PCTs and ambulance trusts. Many right hon. and hon. Members on both sides of the House have offered their views and I am very grateful to them. After local consultations, SHAs submitted their reports and recommendations to the Department. An external panel, established to advise Ministers on the proposals, has since met to consider in detail each proposal for PCTs and SHAs. After receiving its advice, we announced on 12 April that the numbers of SHAs would reduce from 28 to 10.

Ministers have now considered the recommendations and the panel's advice on PCTs. I can now inform the House that the number of PCTs will fall from 303 to 152, and that the new organisations will be established on 1 October 2006. The population covered by each PCT will rise from an average of around 165,000 at present to an average of just below 330,000. About70 per cent. of the new PCTs will be coterminous with the boundaries of local authorities with social services responsibilities, which compares with about 44 per cent. of PCTs that are currently coterminous with their local authorities.

In some areas, concerns have been expressed that larger PCTs could lose a locality focus and divert resources away from deprived areas or that smaller PCTs could lack commissioning power. We acknowledge those concerns and have sought to strike a careful balance between those conflicting demands. In response, we propose that four general conditions be applied: first, that all PCTs retain and build on partnership arrangements; secondly, that a strong locality focus must be retained and, where necessary, that local structures should be put in place; thirdly, that all PCTs must deliver their share of the 15 per cent. management cost saving, strengthen commissioning and ensure robust management of financial balance and risk; and fourthly, that the new PCTs and SHAs should consider how any further conditions relating to issues that arose during the consultation could be applied.

In some areas, the new proposals differ from those suggested by the SHA and the external panel. Having taken into account all the evidence and sought local consensus wherever possible, we have judged that in those circumstances, the alternatives could better satisfy the "Commissioning a Patient-led NHS" criteria and have the best possible chance of success.

On PCTs as providers of services, let me restate the Secretary of State's clear commitment to the House on 25 October 2005. She said that

"district nurses, health visitors and other staff"

delivering clinical services

"will continue to be employed by the PCT unless and until it decides otherwise."—[Official Report, 25 October 2005; Vol. 438, c. 152.]

Our aim in making these changes is to benefit both patients and taxpayers. Fewer, more strategic PCTs will be better placed to ensure effective commissioning of services for patients, and to support the development of practice-based commissioning among GPs and other primary care staff. Patients will receive the right care and treatment in the right place, and at the right time. The taxpayer will see the release of £250 million worth of savings annually, through the merging of back-office functions and a reduction in administrative costs, for reinvestment in front-line services from 2008-09. That could pay, for example, for roughly 50,000 heart operations or major improvements in services for people with long-term conditions, especially older people. The changes will also build stronger partnerships between the NHS and local government.

The reconfiguration of PCTs is the first stage in strengthening the commissioning function. The next stage is a development programme for all PCTs, which will ensure that they are strong, confident organisations fit for driving forward the NHS reforms that we are implementing.

On ambulance trust reorganisation, in June 2005 the Government accepted the recommendations set out by Peter Bradley, our national ambulance adviser, in the review entitled "Taking Healthcare to the Patient: Transforming NHS Ambulance Services", which set out a vision for ambulance services. In future, they will provide more care in the home and more treatment at the scene, give better advice to patients over the telephone and ensure faster response times to save more lives. The review made it clear that in order to ensure that ambulance trusts have the right strategic capacity, infrastructure and staff to deliver these improvements in patient care, there should in future be fewer, larger ambulance trusts. These changes will enable standards within the new trusts to be levelled up to those of the best.

In her written statement of 14 December 2005, my right hon. Friend the Secretary of State set out our intention to consult and to ensure that the benefits outlined in the ambulance review can be fully realised. Following this consultation, the Secretary of State has now decided that from 1 July 2006, most of the existing 29 NHS ambulance trusts will merge into 12, with separate management arrangements for the Isle of Wight. For now, Staffordshire ambulance service will remain a separate trust, working in partnership with the new West Midlands ambulance service, but will eventually merge at a later date.

Feedback from most areas was supportive of our proposals. However, we have decided to address the public's concern that local responsiveness and flexibility could be lost through having larger trusts by requiring ambulance trusts to ensure that their services are meeting the needs of all localities and populations within their boundaries. Those changes should mean more investment in front-line services as trusts identify savings in back-room functions; improved patient care through providing an opportunity to raise the standard of the service provided by all trusts to the level of the best; better emergency planning, with greater capacity and the capability to respond to major incidents of all kinds; more integrated services; and better career opportunities for staff.

Changes of this kind are inevitably difficult. We have not sought to impose a single blueprint on the NHS; instead, we have listened carefully to representations from all Members and from local communities and organisations. Wherever possible, we have responded positively to them. We have one aim above all: to deliver better health care to patients. I commend this statement to the House.

I thank the Minister for providing me with a copy of his statement in advance, and for putting local information on the Board for the use of hon. Members.

Since Labour came to office, there have been seven reorganisations of the NHS already, and today's pair are the eighth and ninth. Under the cloak of words such as "modernisation" or "reform", this is change for change's sake. Has the Minister any idea of the effect that the reorganisation has on staff morale, and on the ability to retain the good? It means that underperformers inevitably will be recycled into similar jobs in the new organisations. It causes instability among clinical staff—doctors, nurses and allied professions—and inflicts uncertainty and inefficiency in the NHS supply chain. Above all, is he aware that it leaves patients wondering where they feature in it all?

The Government have form, however. They never allow anything to settle and bed down—much to the consternation of the hard-working people trying to deliver the front-line patient services. In Government, as in all walks of life, the addiction to constant structural change is a well known technique deployed by those who did not get it right the first time—or the second, third, fourth, fifth or sixth times. Imposing another restructuring and a further reorganisation is a great wheeze to put through changes in a bid to avoid accountability and to keep running ahead of mistakes.

The mounting job losses in the NHS show that the Government are no longer lulling the public, whose trust in the Government, not least in respect of the NHS, has plummeted. Let us look at why the Government have felt impelled to announce yet more changes to the NHS—

It says here.

Indeed, it does say it here, because that is what I wrote.

First, let us look at ambulance trusts. Peter Bradley's review concluded that there should be fewer of them, but that they should be larger, yet no evidence for that major change was contained in the report, or made available since. Ministers then decided to reduce the number of strategic health authorities to align with their obsession with regions, notwithstanding the electorate's rejection of the idea in the north-east. With sleight of hand, Ministers have used the reorganisation as an excuse to reduce the number of trusts to 12, and then they have ducked the flak by suggesting that that was Peter Bradley's idea and recommendation all along. Will the Minister therefore undertake to place in the Library of the House any evidence that relates specifically to claims that creating large trusts will lead to improvements in patient care?

How does the reorganisation achieve closer integration of all the emergency services? Will the Minister explain how a north-west regional ambulance service will integrate better with the newly merged Merseyside and Cheshire police force—a merger that will be carried out in the teeth of maximum hostility and objection? How will it integrate better with contingency planning in Cheshire, or with the Cheshire fire service's move to sub-regional control rooms?

Will the Minister comment on proposals to reduce control room numbers by co-aligning them with the police and fire services? The House should bear it in mind that in Warwickshire, for example, the fire service responds to some 3,000 emergency calls a year, whereas the ambulance services respond to some 100,000.

Who is co-ordinating the reorganisation across Government? Co-ordinated is the last thing that it is—perhaps the Deputy Prime Minister has been devoting his time to this matter recently. It is shambolic, inconsistent centralising by an arrogant Government who claim to listen but who choose not to hear the views of those who work on the front line and who know best.

The official consultation on ambulance trusts lasted from the middle of September last year to near the end of March this year, yet the NHS appointments commission sent out letters on 30 January—in the middle of the consultation period—asking for nominations for men and women to chair the new NHS ambulance trusts. The question arises—was not the decision therefore a foregone conclusion?

I have had a letter from Roger Moore, the chief executive of the appointments commission, in which he stated that the recruitment began

"at the request of the Department of Health".

I am pleased that concerted work by MPs across Staffordshire and by the shadow health team, supported by huge amounts of work by the people of the county, has caused Ministers to backtrack on axing Staffordshire ambulance service for up to two years. That 24-month period was set out in the handout on the Board in the Members' Lobby, but not in the statement. That is a classic fudge, as it puts Staffordshire ambulance trust in the departure lounge. However, will the Minister give the House an assurance that unless the west midlands service is brought up to the standard of Staffordshire there will be no hint of a merger, whether in two years or beyond?

Given today's statement, any right-thinking person is entitled to regard the Government's consultation as a sham. Constant change will undermine what has already been achieved; for example, by turning round the East Anglian ambulance trust. The Buckinghamshire and Northamptonshire service is about to complete the process of splitting; now they will have to go through the upheaval of being merged again.

We are not against the restructuring of PCTs per se—[Hon. Members: "Ah."] The Under-Secretary of State for Health, the hon. Member for Bury, SouthMr. Lewis suggests that the whole statement was about PCTs; clearly he was not listening, as much of it dealt with ambulance trusts. On PCTs, as distinct from ambulance trusts, we are not opposed to restructuring, but we have always said that future functions need to be defined before such restructuring takes place.

In 2002, the Department of Health abolished the 11 regional offices of the former NHS executive and about 100 health authorities. Today, the Government are bringing back that map. Has the Minister estimated the cost of that U-turn, which takes us back to the position four years ago? He may talk of the Secretary of State's clear commitment in October 2005 about the functions of PCTs, yet three months before that the DOH was equally clear, in "Commissioning a patient-led NHS", when it called for PCTs to become

"patient-led and commissioning-led organisations with their role in provision reduced to a minimum"

by 2008. The Secretary of State backtracked on that commitment, without reassessing whether the proposed structures would be fit for purpose. Now, no one is clear.

As the Health Committee said in January, when it attacked the Government's indecision,

"we are appalled at the continuing lack of clarity about whether or not PCTs will eventually divest themselves of provider functions."

The Department of Health's NHS operating framework for 2006-07, published on 26 January, offered little further clarity, stating:

"Where PCTs do continue to provide services, they will need to put in place clear governance procedures that ensure that there is no undue influence from the provider side on commissioning decisions."

Will the Minister detail how 15 per cent. management cost savings can be made when the Government are calling for each PCT to have two sets of managers—one for commissioning and one for direct services?

The problem for the Minister is that all this restructuring has gone on without putting in place the necessary precondition for its having a realistic chance of success: defining the future functions of PCTs. Will the Minister tell us how many PCTs are predicted to be direct providers of services in two years' time? New organisations can hardly be expected to deliver unless and until they have clarity of purpose.

In his statement the Minister said that in some cases the new proposals differ from those suggested by the strategic health authorities and the external panel. Will he tell the House how many PCTs the expert panel proposed should be created overall; and will he publish in full the panel's advice so that we can see to what extent the Government arrived at different decisions and the implications of the variations?

The Government seem only now to be waking up to the cost of the reconfiguration and the redundancies that go with it. Can the Minister confirm that the estimated cost of this latest round of NHS reconfiguration, which will merely take us back to where we were four years ago, will be £320 million? Will he also confirm that at £250 million—the figure he gave in his statement—the savings will be less than the cost? Is he confident even of that amount, or was the Health Committee right when it said that savings of between £60 million and £135 million were nearer the mark? Are those estimates gross or net, given the cost of the redundancies that will be inevitable to deliver on that Government promise?

What is the time scale? The House is entitled to have that crucial information in a year when the Government's financial control of, and credibility with, the NHS is shot to pieces and the NHS is in confusion and plunged into at least 10 months of uncertainty and chaos at PCT level. This is no way to run an NHS.

rose—

Order. The Opposition spokesman took longer than the Minister. I do not want to see that practice continued.

Thank you, Mr. Speaker, and in that long speech, I will seek to pick out the points of substance that there were.

There is no confusion. Our aim overall is to improve patient care. That is what we are in business to do, and I can tell the hon. Gentleman without fear of contradiction that patient care is improving. Patients are not waiting for more than six months for in-patient treatment. On the whole, they wait a maximum of 13 weeks for an out-patient appointment. There is clear evidence of progress. That is what guides our changes; it is what guides these changes, so I can assure him that there is no confusion on our part at least.

The hon. Gentleman says that this is change for change's sake. I point out to him that the NHS changes; it is different from what it was in 2000. We have an ambitious programme of reform to drive through in the NHS. We want to ensure that people can choose where they are treated and that the wait for that treatment is short, once the full reform programme is introduced. That will require strong commissioning throughout the NHS. It will require people cleverly commissioning services and using their organisational strength. That is why we are making these changes. He will know that some changes have begun, and some of the changes that we have formalised today have already begun to take shape.

On ambulance trusts, the hon. Gentleman claims that we have an obsession with the regions—far from it. He asks what the connection is with other emergency services. Surely, it makes sense to ensure that, at regional level, there is the contingency capacity to deal with major events and that capacity is planned regionally. I hope that he agrees that there is some logic in doing that. He claims that there is no support, but Peter Bradley's proposals commanded strong support from within the ambulance service, particularly because they clearly focused on the professional development of those who work in the service, thus giving them the ability to shape ambulance services in future.

The hon. Gentleman claims that we have not listened. Clearly, if he looks at the proposals for PCTs that we are publishing today, he will see that precisely the opposite is the case. We have indeed listened to hon. Members—not just Labour Members, but Opposition Members, too—and we have taken on board those concerns. He asks where the proposals differ and whether we will put the evidence in the Library. I would be happy to do that, but the reason why we have taken those decisions and listened to those representations from hon. Members on both sides of the House is that we want a consensus of support for the new organisation, because it is our judgment that the organisation will have the best chance of success if it is underpinned by strong community support. That is exactly why we have done that.

The hon. Gentleman asks me whether we will detail where the cost savings can be made. There will be one-off costs in relation to the exercise, but the savings will come year on year. As for the timetable, we expect that the savings from the exercise—some £250 million a year—will be realised by 2008. That, of course, will be a recurrent saving for front-line services.

There is a logic and coherence to our proposals, and the hon. Gentleman talks of incoherence and confusion among Government Members. I put it to him that the Conservative party's policy at the last general election was to take about £650 million from so-called NHS bureaucracy, as defined by the James review; coupled with that was the patient's passport, which would have taken money from the health service. What kind of organisational chaos would the combination of those policies have created?

I thank the Minister for advance sight of his statement.

The Government abolished health authorities four years ago and created primary care groups and primary care trusts, and they are now merging them back together to create health authorities. Were the Government right to abolish health authorities, and are they right to recreate them? Is that what the Minister is telling the House? Or did they make a mistake four years ago, and will he admit that to the House?

Can the Minister provide evidence of where the£250 million cost saving will come from, given that the Select Committee on Health was very sceptical that savings on that scale could be achieved? He did not answer the Conservative Front-Bench spokesman's question about the number of redundancies that are implied by a £250 million annual saving. How many people will lose their jobs?

On responding to local consultation, I thank the Minister for listening to some very effective lobbying from the west of England, which has resulted in keeping PCTs coterminous with social service authorities. I welcome that fact, because I was sceptical that the Government would listen on that point. I assume that he already knows that I was pressing for that. I also welcome the fact that, following recent political trends, the south-west of England has turned from blue to orange.

On coterminosity, the Minister said in his statement that about 70 per cent. of PCTs will be coterminous. Is there a limit to that, or will he go further? What is the restriction on having 100 per cent. coterminosity and having real integration of health and social services? How far will the Government go?

What are the promises of PCTs that have been abolished worth? Many of my colleagues are worried that, although they have been promised things by existing PCTs about new community services, the successor bodies may well say that they are not bound by the promises of the predecessor bodies. Can the Minister give us an assurance that, when an existing PCT has made a promise, the successor bodies will honour that promise?

Finally, on the ambulance trust mergers, what confidence can people living in rural areas have that the very large ambulance trusts will not inevitably concentrate on urban centres? Whereas small trusts could respond to local circumstances, larger ones may neglect rural areas to hit their performance targets.

I thank the hon. Gentleman for his constructive response. In the course of his remarks, he made the point that we have listened. The hon. Member for Eddisbury (Mr. O'Brien) would have done well to take that point on board. We are not recreating health authorities; the building blocks are the same. The exercise has shown a range of interest in and commitment to primary care trusts around the country. People seem to be attached to them. The changes are not happening everywhere. In my area, in Greater Manchester, the building blocks will largely remain the same—as they will in London. Experience has shown that there is a PCT size that is more effective in commissioning good quality patient care. We are making the changes in that respect and ensuring that the NHS is able to use its strength at local level to drive up quality for patients.

The hon. Member for Northavon (Steve Webb) mentioned coterminosity. I am in full agreement with him on that point. I have long believed that there needs to be much closer working between the national health service and social services at a local level. I fully support such moves, including even pooled budgets—that kind of approach. I hope that the proposals will pave the way for much greater joint working. There are examples around the country where that working is close. The greater level of coterminosity allows those partnerships to be built. The level is around the mid-70 per cent. mark. We have to strike a balance between representations from local Members and not creating bodies that are too big to do the job. We have sought to manage those tensions. We have produced a significant increase in the number of PCTs that are coterminous with their social services departments. That will be a positive step forward for patients and particularly for older people in those regions.

There will, of course, be redundancies as a result of the exercise, but we made it clear at the election that we would be clear about reducing unnecessary NHS bureaucracy. There should be savings made in merging back-room functions, where that can be done, but at the same time we do not want to diminish the power of PCTs to be effective commissioners for their communities. Today's proposals strike that balance.

I thank my hon. Friend for his statement, which will be widely welcomed. It is good news in my constituency of Darlington, in particular. I also thank Ministers for listening to the views of the many local people who campaigned in large numbers to retain Darlington's primary care trust. Does he agree that his statement is a sure sign that, in the future, we will need to strengthen still further the working arrangements between not just health and social services, but housing services, so that more people—particularly old people—get access to the locally delivered, locally commissioned seamless services that they surely deserve?

I thank my right hon. Friend for his comments. He has done more than anybody in the House to bring about the improving NHS that we have. The PCT structure on the ground is largely due to the changes that he made as Secretary of State for Health. I am grateful for his comments about listening. We have indeed listened. I know that strong representations were made by him and others in the north-east region. As I said to the hon. Member for Eddisbury a moment ago, it was right that we listened to those representations because we want the organisations to command solid local support. I am pleased that we have achieved some success in my right hon. Friend's area.

My right hon. Friend made a point about housing. When we consider coterminosity, we all think about social services, but he is absolutely right to say that we can think more widely about links with councils and consider the provision of adequate housing and leisure and cultural services to local populations so that we can really begin to understand how to make people more active. All those possibilities are opened up by greater coterminosity and I am grateful for the welcome given by my right hon. Friend.

When we in Hertfordshire were faced with the prospect of one PCT, we campaigned for two, so we are delighted that we have got two. The east and north Hertfordshire PCT will serve my constituency. What safeguards will be in place to ensure that that new PCT serves the less-well-off parts of my constituency, such as Waltham Cross and Cheshunt, and does not focus too much of its time on—how can I put this delicately?—the posh parts in the north of Hertfordshire?

That is proof that we listened to the hon. Gentleman's representations. It is obviously for the champion of the underprivileged on the Conservative Benches to ensure that his local PCT pays adequate regard to the parts of his constituency in which the health needs are greatest, although, of course, that is something that local responsiveness should pick up.

I thank my hon. Friend for his statement. He will be aware that the strategic health authority recommended that the new merged primary care trust that will serve my community and Rochdale be called Rochdale PCT. I welcome the Minister's decision to call it Heywood, Middleton and Rochdale PCT because I think that that is the right order for the name, which is important to my local community. Will he ensure that membership of the new board is representative of the two constituencies and two primary care trusts and, especially, that the resources are evenly spread across both areas?

I thank my hon. Friend for his comments. I am pleased that my primary care trust will still be called the Ashton, Leigh and Wigan PCT because I would be in great trouble indeed if it was called something else. I understand that such local connections and ties are extremely important and am pleased that Heywood has been recognised in the name of my hon. Friend's PCT. As I said in reply to the hon. Member for Broxbourne (Mr. Walker), it is crucial that the new organisations serve all parts of the areas that they cover and, especially, that they pick out the health needs in those areas and bear down on the health inequalities that are important to him, me and Greater Manchester in particular.

I warmly thank the Minister, his predecessor and the Department of Health for listening to the overwhelming view of the people of Cheshire and establishing not one but two PCTs to ensure that the different cultures of east and west Cheshire are properly reflected in the provision.

Posh.

And Becks.

I am grateful to my hon. Friends and am sure that the Minister got the gist of what I was saying.

It is important that the interests of both sides of Cheshire are properly catered for in the provision of health services. Does the Minister accept that there is concern that the target arrival times are not being met by the existing ambulance service? Will he give an assurance that those target times will be met under the merged ambulance service in the north-west?

I am grateful for the hon. Gentleman's warm welcome for the proposal. I hope that we will not see the emergence of an east-west Cheshire split and an explanation of the different cultures between the two. I am grateful for his recognition that we have listened and created a structure with which he is comfortable. Under the new North West ambulance service, which will serve my constituency, too, it will obviously be crucial that performance is improved across the piece. When improvements need to be made to services, it is important that the body takes particular care to bear down on the problems and ensures that all residents of the north-west can look forward to and enjoy the same standards of service. I am sure that the new service will be focused on those matters.

I welcome the statement and am pleased that the Government have taken notice of local consultation. What we have in front of us is not the top-down method that the exercise was accused of pursuing late last year.

In relation to moving PCTs to be coterminous with local authority social services, what plans does the Minister have to ensure that there will be joint working where the changes took place in this round? It is not always easy to achieve that between local authorities and local health communities, as many of us have experienced. What plans does he have across government to ensure that local social services, health and, probably, housing work well together from day one, as opposed to waiting for that to evolve at a local level over the years?

I thank my right hon. Friend for his comments and am grateful to him for making an important point. I think hon. Members on both sides of the House realise that the NHS has perhaps not run the best consultation exercises and has not been as good at listening to local communities as it should be for the fine organisation that it is. The exercise, for all its difficulties—I recognise that there have been difficulties along the way—has produced a good outcome. The NHS has shown that it can listen to local opinion and come up with structures that respond to concerns expressed on the ground.

My right hon. Friend is right. There is a lot of talk about the need to have joint working between health and social services, but often that talk runs ahead of the reality. His predecessor as Chairman of the Select Committee on Health, David Hinchliffe, the former hon. Member for Wakefield, was passionate about that. He often made that point when I served under him on the Select Committee. I, too, am convinced that we will see real improvements when we have much greater integration of health and social services in my right hon. Friend's constituency and mine.

I thank the Minister for recognising the special qualities of the Staffordshire ambulance service. Will he give me the assurance, which he was not able to give my hon. Friend the Member for Eddisbury (Mr. O'Brien), that there will be no question of merger unless the neighbouring merged ambulance service has reached at least the standard of Staffordshire in two years' time?

The hon. Gentleman makes an extremely important point. He can see from the proposals that we have recognised the strong concerns expressed by him and some of my hon. Friends. The public in Staffordshire clearly feel a strong attachment to their ambulance service, and rightly so. We have stated clearly that merger is expected within a period of time. I am not going to lay a time frame on that today, but he makes the legitimate point that we would not want Staffordshire ambulance service's standards to be eroded in any way.

I, too, welcome my hon. Friend's statement. The people of Staffordshire will be pleased that Ministers have listened and that there has been a true consultation. Up to two years will certainly allow time for the West Midlands ambulance service and the Staffordshire ambulance service to be aligned and for protocols to be developed, which I hope will maintain the excellent service. However, if a little more time is needed, I hope that Ministers will consider extending it. Ministers have truly listened, so thank you.

I am grateful for those comments—more like it would be much appreciated—and for my hon. Friend's measured words. I am happy to give her the assurance that although we expect merger to be right in due course, I hear what she says. I will relay her words to Lord Warner, who has done a great deal of work to bring about the proposals.

Not long ago I was a customer of Staffordshire ambulance service following a crash on the M6. The standard of care was exceptional and the standard of support provided by the paramedics on site was fantastic. I have good personal reason to endorse fully what my hon. Friend says.

North Yorkshire PCT will be the third largest in the country with a population at 765,000, behind only Hampshire and Surrey, yet it covers a huge county of scattered communities. Will the Minister ensure that it is gospel with the new PCT that it should do everything it can to reinforce its working relationships at the local level? If it does not, my constituents will conclude that the Government's only intention is to drain services to a larger regional level, as they have done with the police, with the loss of accountability and of sheer local personality that make public services so valued.

The right hon. Gentleman makes an important point. May I refer him to my statement, in which I gave a clear commitment to ensure that structures are in place in the new organisations so that local concerns can be aired or voiced? I therefore agree with him on that point. The new PCT is one of the larger PCTs that have been created today, with the benefit that it has a significant ability to drive up standards for residents. The important thing is to get the balance right, and we believe that, bearing in mind the points that he has made, we have done so.

I accept the logic of coterminosity between social and health services, but I congratulate my hon. Friend on acknowledging that in some circumstances common sense dictates a different solution—hence the retention of Tameside and Glossop PCT, which has the support of 99 per cent. of respondents to the consultation. Does he agree that such modifications of coterminosity will test the principle of local area agreements—it is none the worse for that—and that areas such as Glossop should not be disadvantaged by the emphasis on local area agreements and local commissioning?

May I pay tribute to my hon. Friend's efforts to ensure that the voice of people in his constituency, particularly in Glossop, is heard? He is quite right that there are occasional exceptions for people with health ties that do not fit the local government structure. Knowing the area well, I can say that Glossop is one such location. Traditionally, people have travelled north-west into Manchester for hospital care, but technically they are not within the region's local government boundaries. We have listened to my hon. Friend's concerns, and we have made an exception, as we recognise that people in the area lean towards the north-west for health care. However, he is right that that exception does not challenge the other structures that have been put in place to improve services on the ground.

In addition to their local commissioning and partnership functions, how many national targets will the PCTs still have to monitor and report on? In the new, reorganised NHS, approximately how many staff will be deployed in that role?

I would make a staunch defence of targets. By providing clarity from the centre, we have been able to deliver improvements to the NHS in recent years, so I make no apology for them. However, the hon. Gentleman will know that we have reduced the number of targets and have set fewer priorities, as we need to focus on our true priorities. It is the new PCTs' job to ensure delivery of standards. Throughout the process, I am pleased that there has been continued improvement in NHS patient care, and I fully expect the new organisational structure to continue to drive change for patients' benefit.

I firmly believe that the development of primary care trusts has developed a system for GPs that promotes innovation and exciting programmes to improve people's health in our constituencies, and I congratulate Crawley PCT on its work. How can we ensure that GPs who are determined to drive up standards in a larger PCT can do so and can continue to work with local authorities so that everyone benefits from the new PCT?

My hon. Friend makes an extremely important point. General practitioners in her area are at the forefront of leading practice to develop good services at community level. It is a priority for everyone, wherever possible, to deliver services away from the hospital setting and closer to the patient's home. I fully endorse that as the way forward, and I applaud the work on the ground in her area. Within the new structure, we are introducing practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area, so it should give more power to their elbow than they have at present. That is what I would like to see as a result of these changes.

Given that half the beds at Sevenoaks hospital that were temporarily closed in February for financial reasons have now shamefully been removed altogether, what reassurance can the Minister give me that good local hospitals will be any safer inside larger PCTs?

The point of the changes is to ensure that PCTs can take a balanced view across a broad area to ensure that patient services are most effectively provided. He would be the first to complain if local priorities were overridden from the centre by targets or central diktat. It is right that at local level people should be able to create the kind of health service they want. Through foundation trusts we want to give local people much greater ownership, control and say over how their hospitals provide services. Ultimately, that is the way in which local people and local communities will have their say over the configuration of hospital services.

Great concern has been expressed in Leeds about the continued development of the strong local focus of the five PCTs. Will my hon. Friend ensure that any savings realised as part of the reconfiguration in Leeds are re-invested in Leeds to develop that local focus still further?

As my hon. Friend knows, the changes will lead to a Leeds PCT that could provide a powerful voice for local communities across the Leeds area. I am happy to confirm that the savings that will be made as a result of the changes will be directly released for patient care. That is the very reason we are making the changes. We must achieve a balance so that an organisational structure is the right size and is not unnecessarily duplicating back-office functions. Where savings are released, they will be ploughed back into patient care at the front line.

Blackwater Valley and Hart PCT and North Hampshire PCT have just gone through a painful reorganisation. They already cover a population of 385,000—50,000 higher than the average PCT that the Minister is creating. Now he wants to foist on Hampshire yet another period of turbulence. Can he explain in practical terms how he will deliver the local focus of which he speaks? In particular, how will he ensure that the PCT covering 800,000 people in Hampshire specifically looks after the interests of my constituents, who are served by a hospital in Surrey, next door? That is the question to which they will need the answer tonight, please.

The hon. Gentleman raises an important point. Competing demands must be balanced in reaching the right judgment. Those demands are local focus, responsiveness to local need, a commissioner who has the weight and the power to drive a good bargain and get good commissioning for local people, and together with all those things, coterminosity with social service providers so that we can get joined services at local level. Some of those pressures are pulling in opposite directions and it is difficult to get them into balance. That is why we have no blueprint specifying that a PCT must be a particular size and shape in a particular locality. We have sought to do the best we can to manage the competing priorities. I am pleased to say that in the hon. Gentleman's area there was strong support for a Hampshire PCT coterminous with the local authority boundaries.

I thank my hon. Friend for his statement. I join the growing number of hon. Members in all parts of the House thanking him for its content in relation to the reconfiguration of primary care trusts. I specifically thank him for rejecting the proposal from the Avon, Gloucestershire and Wiltshire strategic health authority to remove existing coterminosity and create even less, and for listening to the opinion of every local council, every local trust, their staff, Members of Parliament, voluntary community organisations, GPs and just about everybody who thought that that proposal was unwise. I thank the Government for making a sound decision.

I thank my hon. Friend for his kind words. People have long complained about a democratic deficit within the NHS, and I hope that some of the proposals that we have announced today and campaigns run on the ground by elected representatives throughout the country will show that the NHS can respond to local concerns and put in place a structure in local communities in which people feel confident and with which people identify.

The Minister has talked about the need for strong community support and coterminosity. Perhaps he will explain which organising genius at the centre of Government has produced a PCT for Surrey, which is welcome, but managed to remove the police, fire and ambulance services from boundaries within Surrey in the same period.

This is my second week in the job, and I have just discovered that I am not responsible for police, fire or other emergency services. However, I am pleased that the hon. Gentleman recognises that our NHS structure is the right way to go in Surrey.

My hon. Friend has given the House absolutely brilliant news on Staffordshire ambulance service, and I am grateful to him and the rest of the ministerial team for listening to the people of Staffordshire. Will he confirm that Staffordshire ambulance service will remain operationally independent and that it will have its own trust board and its own chief officer, so that it can continue to run its system, which is completely different from those used by other ambulance services in the country? Will he also confirm that no merger will take place unless Staffordshire ambulance service agrees to it and unless the west midlands service comes up to the standard of the Staffordshire service, which delivers the fastest response times in the country?

I am grateful for another bouquet from the Back Benches, but, before I am accused of being a fraud for accepting them, I must point out that many people in my Department have been working on the proposals. I know that my hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) has been in close discussions with people in the Department—I am, perhaps, the only person who has not been in detailed discussions with her, so it is not right for me to accept all the congratulations, which I shall relay to the rest of the Department. She knows health issues in detail—I have worked with her on other matters—and I know how passionately she believes in the health service in her area. She has run a good campaign and has expressed her concerns extremely well. We have said that a merger should be the eventual goal, and I am happy to give her the assurances that she seeks on the operating structures of the two services. My noble Friend Lord Warner will judge those issues, but it makes sense to have agreement in the region when any further change is made to the structure.

The consultation document on the creation of the North West ambulance service did not contain a business case with real numbers to justify the assertion that resources will be available for the service improvements that the Minister mentioned in his statement. When I asked the excellent Lancashire ambulance service for details on that point, it could not help either. The Minister must have seen a business case to convince him that his decision is right. Will he assure the House that the details will be placed in the Library, so we can all understand where the resources will come from and be sure that good services, such as Lancashire ambulance service, will not be drained of resources to prop up those that are not so good?

I assure the right hon. Gentleman that we will put into the public domain any information that we can to show the basis on which those decisions were taken, but he knows that the structure proposed by Peter Bradley commanded strong support within the ambulance service. People want to be part of a service that can invest its resources in front-line services and in improving the professional development of its staff. A unified ambulance service in the north-west will lead to an improved level of service for his constituents and for mine. I hope that we can share that information, but, as I have said, it is vital that residents across the north-west can look forward to service improvements as a result of the changes. However, the right hon. Gentleman must accept that savings can be made by merging the back-office functions of existing ambulance services.

May I give two cheers for my hon. Friend's announcement about Staffordshire ambulance service? It is the best performing ambulance service in the country, and it would have been inexplicable to have merged it. The Government deserve great credit for not forcing such a merger. Will my hon. Friend get a third cheer by giving the assurance for which he has been asked on several occasions—that no merger in future, whether in 2008 or at any other time, will take place until the standard of the service with which it is intended to merge has reached the standards, including the response time standards, of the Staffordshire service? That is the crucial guarantee that my hon. Friend has to give.

I thank my hon. Friend for his two cheers. Again, I will pass them on to others who have worked on this. The crucial test in judging changes to an ambulance service is, first, that the service is viable and, secondly, that it is providing a safe service to all the residents in the area. Those are the guiding principles on which any further changes will be made. As I said to the hon. Member for South Staffordshire (Sir Patrick Cormack), any further change would be about ensuring that service standards could be further improved. We recognise the improvements in service standards that Staffordshire has reached; that is why we are happy to make the decisions that we announced. I hear what my hon. Friend has said. In going forward with any further change, we must be clear that it is about improving service standards to all the residents of Staffordshire and the west midlands.

Can the Minister confirm that the effect of his announcement is that, in future, commissioning in the health service will be the responsibility of roughly the same number of regional health authorities that the Government inherited in 1997 and renamed strategic health authorities, of roughly the same number of health authorities that the Government inherited in 1997 and renamed primary care trusts, or importantly—in this I agree with the Government—when in the hands of GP fundholders renamed primary care commissioners? Does this mean that we got it roughly right?

I am intrigued by the right hon. Gentleman's line of questioning. There are very important differences, as we said in exchanges across the Floor of the House last week, between GP fundholding and the Conservative model— whereby, for completely arbitrary reasons, people had differential access to hospital treatment—and the practice-based commissioning model that we are introducing through these new reforms. Under the right hon. Gentleman's leadership, the NHS had a bizarre paper chase involving a whole process of red tape and people chasing invoices around the system. I am happy and proud to say that we will certainly not replicate that in our NHS.

I congratulate the Secretary of State on rejecting Trent strategic health authority's aggressive campaign for a single Nottinghamshire-wide PCT and instead listening to the many thousands of my constituents who queued up to sign my petition for our PCT to remain on its own. Can the Minister assure the House that that practice of listening to the people will underpin the way in which we run the health service in future?

I know that my hon. Friend has run a characteristically dogged and tenacious campaign on this issue and that he did indeed present a very large petition to the Department. As I said, that shows that the new PCTs have commanded a great deal of support and that people are identifying with those organisations as providers of health care. I will of course pass on to the Secretary of State the points that he raised. He is absolutely right to say that as the NHS goes forwards, it needs to show that it can listen and, where possible, make changes to respond to local communities.