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

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

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

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

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

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

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

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

Several hon. Members rose—

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

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

Hon. Members: Short question.

Madam Deputy Speaker: Order. I have asked for brief questions.

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

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

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

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

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

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

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

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