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Kate Hoey: My hon. Friend must realise just how much anger there is in the communities represented by my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), the hon. Member for North Southwark and Bermondsey (Simon Hughes) and myself. This is a shocking state of affairs and it has gone on for far too long. Does he realise that this is doing the Church no good whatsoever; that, legally, it could sell to a social landlord tomorrow if it wished; and that it seems to all of us who represent those very strong communities in inner-city London that the Church is only interested in profit?
Sir Stuart Bell: On the latter point, the Church, of course, has an obligation to the wider Church, as well as to the people of the Octavia Hill estates, and it recognises that responsibility. The commissioners, however, are unwilling to ignore the statutory duties conferred on them by Parliament to manage their investments in such a way that they provide the maximum sustainable support to the wider Church.
Chris Bryant (Rhondda) (Lab): Does my hon. Friend understand that many hon. Members and many of the wider public find this policy extremely odd, especially when the Church Commissioners are planning to buy a new palace for the Bishop of Oxford for £2.4 million? I mean no disrespect to the Bishop of Oxfordindeed, he is a very fine man, who will retire soonbut do bishops really need so many bedrooms in their palaces?
Sir Stuart Bell:
I had anticipated that the question of princes' palaces would arise, but I would not wish to incur your wrath, Mr. Speaker, thus spoiling your sunny disposition, by widening the question from the Octavia Hill estates to the Bishop of Oxford. Let me simply say
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that we are talking about the sale of the freeholds only of the Octavia Hill estates. Existing tenancy agreements will remain in place after the freeholds are sold.
Sir Stuart Bell: The Inspired campaign is convergent with the Church of England's own work to demonstrate the potential of church buildings and the pressures upon them. The Church Heritage Forum is in regular contact with English Heritage.
Ben Chapman: Given the importance of places of worship in general, and cathedrals and parish churches in particular, at the heart of the community for centuries, will my hon. Friend ensure that English Heritage is given every possible support in its campaign to ensure that action is taken to keep those facilities not just in good order, but alive and thriving?
Sir Stuart Bell: I congratulate my hon. Friend on his continuing interest in this subject. In my forthcoming letter to the Chancellor of the Exchequer, I can draw on his support and that of other right hon. and hon. Members to indicate the need for better state funding arrangements for Churches of different faiths and denominations, and the point that he makes will be taken to the Chancellor in the Treasury.
Miss McIntosh: It seems unfortunate that not only did the Chancellor not negotiate a reduced rate of VAT on church repairs, but that less money is going from the lottery into English Heritage and less money is going from it into church repairs. What representations is the hon. Gentleman making in that regard?
Sir Stuart Bell:
We are aware of the imbalance between the funding of the Church from English Heritage and through the moneys from the lottery. On the back of questions such as those from the hon. Lady and my hon. Friends, we are seeking a fresh partnership that we can enter into with the Government that ensures greater funding in the interests of the Church and of our heritage. According to the latest opinion poll, 86 per cent. of our population actually visit a church each year.
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Peter Viggers (Gosport) : The Electoral Commission's accounts for 2004005, which were laid before the House on 27 October 2005, show that its expenditure in that year in resource terms was £28,824,000.
Is that not a considerable sum of money and probably more than it costs to run the central
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headquarters of the Conservative, Labour and Liberal Democrat parties combined? Does the Electoral Commission not seem to be straying into all sorts of areas way beyond its original remit, and is it not time that we started to look at whether it represents proper value for money?
The Electoral Commission undertakes duties that have been laid upon it by Parliament. Before each financial year, the commission submits to the Speaker's Committee an estimate of the commission's income and expenditure for that year and the Speaker's Committee takes account of the latest report by the Comptroller and Auditor General on the commission and it also consults the Treasury and considers any advice that the Treasury may give before the Speaker's Committee lays the Electoral Commission's estimates before the House.
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The Secretary of State for Health (Ms Patricia Hewitt): Today, we publish a White Paper outlining the Government's proposals for further improvements to health and social care services in the community. We are nearly six years through a 10-year programme of NHS improvement that has seen waiting lists dramatically reduced and more people treated faster and better than ever before. At the same time, social care services have been supporting more elderly people than ever before to live at home and maintain their independence.
Our unprecedented investment in the NHSmade possible by strong economic management and our decision to ask people to pay increased national insurance contributionsmeans that, by 2008, we will have caught up with the historic underfunding of the NHS and caught up with the health care funding of other European countries. What matters is not simply how much we spend, but where we spend it. As a nation, we invest less than comparable countries on preventing people from becoming ill and less on services in the community. For instance, just 2 per cent. of our health care budget is devoted to prevention, half the level in Germany.
I think that all of us know that our health and well-being depend at least as much on what we do ourselves as on what the NHS and social care services do for us. As Sir Derek Wanless said in his landmark report on the future of the NHS, people need to be "fully engaged" in their own health if we are to offset the challenges posed by an ageing population and ensure the sustainability of the NHS and social care, so the views of the public themselves were the starting point for this White Paper.
More than 100,000 people responded to the consultation on last year's Green Paper on adult social care, "Independence, Well-being and Choice". Then we embarked on the innovative, "Your health, your care, your say" public engagement programme, which culminated in a 1,000-strong citizens' summit in Birmingham. I am grateful to everyone who was involved in that, particularly the 10 members of the citizens' panel who worked with us throughout the development of the White Paper.
Four themes emerged clearly from our public consultation: we need more emphasis on prevention, with earlier intervention; we need to give people more choice and more say in the services they receive; we need to provide more support for those who need it most, particularly people with long-term needs; and we need to do much more to tackle inequalities and provide more services conveniently within local communities.
The White Paper makes clear our desire to focus on prevention. It outlines the work that is now being done in the partnerships for older people pilots to help older people to remain independent in their own homes. It sets out our commitment to large-scale pilots covering at least 1 million people in which health and care services will work closely together, with the intensive use of new technologiesincluding, for instance, the telecare assessment of people's conditions in their own homes that is being trialled in some parts of the countryto improve people's well-being and dramatically reduce emergency hospital admissions. The pilots will provide
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further evidence of the benefits of new approaches and help the NHS and local councils to spread best practice much faster.
Of all the proposals that came to us from the public themselves, the most popular was the idea of a health MOT. We have responded to that by setting out in the White Paper our proposal for an NHS life check at key points in people's lives. The NHS life check will ask people about their lifestyle and family history, with a follow-up from a health trainer and, if necessary, a nurse or GP, for people in high-risk categories. We will pilot the new health check, starting with parents of very young children and people in their early 50s, and introduce it initially in the areas with the worst health inequalities where we can make the biggest difference. I know that the proposal will be warmly welcomed by the public and by hon. Members, at least on this side of the House.
People also said that they wanted more emphasis on mental well-being. The White Paper sets out how we will improve people's mental well-being through greater use of psychological therapies and a focus on mental well-being in preventive work with older people and by giving people more information and support on how to stay mentally and emotionally well.
By giving people more choice and more say in the services that they use, we will ensure that people themselves become the main drivers of service improvement and that services become increasingly personal and built around the different needs of different individuals and their communities. In theory, people have always been able to choose their GP. We will make that choice a reality for far more people by simplifying the registration system and giving people an entitlement to far more information about the services available in their area. Starting from April this year, the GP contract will link an element of GPs' pay to patients' satisfaction with the practice, including the appointments system, thus providing a real incentive for more convenient opening times.
In social care, we will increase the take-up of direct payments by introducing legislation to extend their availability at the earliest opportunity. We will pilot the introduction of individual budgets and bring together several different income streams from social care, community equipment, independent living funds and other programmes so that individuals can get the services that they need in the way in which they want them.
Those who make the most use of our health and social care services are those with long-term needs: frail elderly people, those with serious disabilities and people with conditions such as asthma and diabetes. Many of those people need the support of several organisations, but are frustrated that, too often, those different agencies seem to work in isolation. We know that it makes sense for everybody if the local NHS and the local authority work more closely together. For instance, if elderly people's homes are adapted to reduce the risk of a fall, they are less likely to end up in hospital, which is far better for them and better, too, for the NHS. If proper rehabilitation occurs after an operation, a patient is less likely to need social care.
By giving local authorities and the NHS stronger incentives to work together, we have already reduced the number of patients who stay in hospital with delayed
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discharges because no arrangements are in place to support them in the community. Now we will strengthen that joint working by introducing a single assessment of health and care needs and a joint care plan for people with the most complex needs. By 2008, we will expect primary care trusts and local authorities to establish joint health and social care teams. A common budgetary and planning system will support more of those organisations in jointly commissioning services.
Six million people care for relatives or friends with long-term needs. Many of those carers, who are doing a wonderful job in our communities, have to reduce or give up their own work to do so and, often, their own health suffers as a result of the responsibility that they take for others. In future we will ensure that short-term home-based respite support is established for carers, to deal with emergencies. In response to what carers themselves have told us, we will establish an expert carers programme, similar to the enormously popular expert patients programme, to support carers with the skills that they need to look after their own health and that of the people whom they care for.
Despite the fact that we have 4,300 more GPs than we had in 1997, there are still fewest in the poorest areas that need them most. The White Paper will ensure that care is more closely matched to need. We will tackle that inequality in two ways. First, over the next two years, as NHS funding continues to increase by unprecedented amounts, we will ensure that, as every area gets more, those who need most will get the most. Moving traditionally underfunded areas rapidly towards target means that, by 2008, when average NHS funding will be nearly £1,400 per head, primary care trusts in the worst-off areas will receive on average £1,552 per person: fairer funding across the NHS.
Secondly, we will ensure that, where people are dissatisfied with the care that they receive and cannot get a better choice of services, primary care trusts will bring in additional services. Already, in six areas that are short of doctors, including inner-city communities in Barking and Bradford, we are supporting the local NHS to bring in new providers that will offer extended opening hours and a full range of services. Whether services are organised by traditional GPs, by nurse practitioners, by private firms or by social enterprises and the not-for-profit sector, the test will be simple: to get the best services for patients with the best value for money, all free at the point of need in accordance with the founding principles of the NHS.
Modern medical technology is making it possible to deliver in people's homes or neighbourhoods health care that in the past was available only in hospitals. A kidney patient can now receive dialysis in a local health centre, or even in their own home. Minor surgery can be done in a well-equipped GP practice or a modern community hospital. Yet in contrast to what happens in Germany, where most out-patient appointments take place in local health polyclinics, we continue to expect most out-patients to travel to an acute hospital.
As part of our strategy to provide care more conveniently, closer to the patient and with better value for money, we will work with the royal colleges to demonstrate how far more out-patient care and day-case procedures in medical specialties such as ear, nose
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and throat, and dermatology, can be carried out in the community, while high clinical standards are maintained.
We have already opened or are building 79 new acute hospitals, with more to come. Now we will also develop a new generation of community hospitalsmodern facilities, with the latest diagnostic technology, able to provide a full range of out-patient and day-case treatment, and in many cases with intermediate beds as well.
Some primary care trusts are planning to close local cottage hospitals. Where these closures are due to facilities that are clinically not viable, or which local people do not want to use, local reorganisation is right. But community facilities that are needed for the long term must not be lost in response to short-term budgetary pressures. So we will expect primary care trusts to reconsider such proposals against the principles of the White Paper.
This White Paper marks a strategic shift in how we provide care, moving services out of acute hospitals into community settings, with more investment in prevention and far better management of long-term conditions. People have talked for decades of a primary care-led NHS. We will now deliver it. Because of our reforms, with stronger primary care trusts, practice-based commissioning, more freedom for GPs and payment by results, more work than ever before will be done locally. As NHS budgets continue to increase, more of that growth money will go into local community services.
The White Paper sets out a vision for health and social care that will give people more choice and more control over their health and well-being and the local services that support them. It is the next stage in creating an NHS that is truly patient ledfair to all, but increasingly personal to each. I commend it to the House.
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