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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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