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

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

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

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

Ms Hewitt: I think that it was absolutely right to remove the ring fence. Local responsibility and local accountability are important when it comes to decisions about priorities. We are strengthening local area agreements, however, to ensure that local authorities—in partnership with other agencies, including the NHS—achieve the targets to which they have committed themselves, so that their objectives are realised and resources flow to where they are needed.
 
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Mr. Pat McFadden (Wolverhampton, South-East) (Lab): How will the Secretary of State's proposals affect the voluntary sector, especially services such as the senior citizen link line based in Bilston, in my constituency, which was visited recently by her colleague the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne)? The service, run by volunteers, telephones 1,000 elderly people in Wolverhampton on a weekly basis. It supports patients who come out of hospital, accompanies them to the GP's surgery, and performs a series of other services which enable them to look after themselves in their own homes. What will the Department do to support such services in Wolverhampton and elsewhere?

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

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

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

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

Dr. Howard Stoate (Dartford) (Lab): I welcome my right hon. Friend's statement, particularly her aim to create a primary care-led, prevention-oriented NHS, especially as regards chronic diseases and inequalities. In my area, however, the acute trust employs 611 nurses while the primary care trust, which covers roughly the same area, employs only 176 community nurses and 49 practice nurses. What steps will my right hon. Friend take to address the huge inequality and imbalance between the secondary care and primary sectors so that we can start to make a real difference to primary care?
 
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Ms Hewitt: I very much welcome my hon. Friend's comments. He is, I think, the only general practitioner in the House at the moment, and he makes an important point. As more services are delivered in the community and as resources shift towards prevention and support in the community for people with long-term conditions, we should expect more of our staff, particularly nursing staff, to be employed in the community rather than in acute hospital trusts. Many nurses across the country would welcome that, and both the stronger commissioning role of primary care trusts and practice-based commissioning will help to ensure that that shift in resources takes place.

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

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

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

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

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