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Mr. Michael Wills (North Swindon) (Lab): I congratulate my right hon. Friend on what she has said so far. Does she agree that the reconfiguration offers a wonderful opportunity, where there is local support, to adopt new commissioning models that perhaps locate all the services that patients need in one site? In Swindon, there is a great deal of support for integrating caring organisations and social services with primary and hospital care commissioning. Does she agree that there is a good opportunity here to move forward?

Jane Kennedy: I am grateful to my hon. Friend, and I agree with him.

As with PCTs, there are clear and compelling reasons for change in the way in which ambulance services are structured. The range of care they provide is expanding, taking health care to patients who need an emergency response, providing urgent advice or treatment to patients who are less ill and providing care to those whose condition or location prevents them from travelling easily to access health care services.

Spending on ambulance services has increased by over 75 per cent. since 1997, which has helped to bring about improvements to services. Over the past two years, the Government have met, and exceeded, the standard that at least 75 per cent. of 999 calls from patients with immediate, life-threatening conditions should have an ambulance respond to them within eight minutes. This has been achieved in spite of consistently increasing demand for ambulance services.

Mark Pritchard (The Wrekin) (Con): I note the Minister's comments on ambulances, but might I bring her back to superbugs? Is she aware that the isolation ward at the Princess Royal hospital in my constituency closed one month ago? Does that mean that the Government believe that superbugs have gone?

Jane Kennedy: No.

Charlotte Atkins : Will my right hon. Friend ensure that the hon. Member for Eddisbury (Mr. O'Brien) understands that the reason Staffordshire ambulance service is so successful is not because of local knowledge—nowadays we have computer systems that
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deal with that matter—but the unique operating system that means that emergency ambulances are put where they will be needed? That unique system means that a merger of the west midlands ambulance services cannot work unless the Staffordshire ambulance service is allowed to have its operational independence.

Jane Kennedy: My hon. Friend has made a sustained and consistent case for the ambulance trust that she knows so well. I repeat that no decision has yet been taken on the consultations that are taking place on PCTs, ambulance trusts or strategic health authority reform. I have heard my hon. Friend make that point on many occasions and we are listening to the representations that are being made. We know that there is more that ambulance trusts need to achieve if we are to realise our vision for ambulance services and integrated urgent care. To do this, we need organisations that have the capacity and capability to plan for tomorrow as well as to deal with today. That is not achieved through small organisations struggling to deal with huge agendas, or through unnecessary duplication of procurement planning and support services. However, it can be achieved through collaboration and getting best value. This reconfiguration is about delivering for the taxpayer. It is about combining high-quality leadership with retaining the best of what can be delivered locally. It is not about change for change's sake.

In the case of ambulance trusts, there was a clear view from stakeholders that the lack of coterminosity and the small size of some trusts were acting as barriers to improved patient care. This view was reflected in the recommendations of the recent ambulance service review. To achieve the change we are aiming for, we want SHAs to lead the process of reconfiguration locally. We have asked them to work with their local stakeholders, including MPs from both sides of the Chamber, and to put forward proposals for the reconfiguration of ambulance trusts, PCTs and SHAs against a set of national criteria.

Mrs. Eleanor Laing (Epping Forest) (Con): On that very point, will the Minister undertake to listen genuinely to the case being made by some local people and organisations? Some PCTs are very good and the Minister is right to say that services in many areas, such as Epping Forest, have improved. We have an excellent PCT and it would be such a pity if it were to be swallowed up in a large regional organisation and if the opinions of local people were not listened to. I am sure that the Minister would genuinely wish to listen to the people who require and benefit from the services.

Jane Kennedy: The hon. Lady argues strongly that we should listen to local people. I understand that the county council in her area does not share her view. Presumably, it also represents local people. Clearly, it will be a real effort to listen to all sides and to make sure that solutions can be arrived at that achieve the best for the patients, which, in the end, is the objective.

Mr. Brian Jenkins (Tamworth) (Lab): I have listened with interest to what my right hon. Friend has to say, and I ask her please not to take any notice of the county councils on this issue. I do not understand the criteria or
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the figures on which such amalgamation is based. My PCT is one of the most expensive in my area. In terms of management and administration, it costs £27 a head for every man, woman and child in the area—a sum far greater than that applying to other PCTs in the region. I cannot understand why the Department is still pressing ahead with a PCT that will cover nearly three quarters of a million people and all of south Staffordshire, given that the average figure for west midlands PCTs is 230,000. I am not opposed to any amalgamation that improves services, but I want to know what the criteria are and how they have been arrived at, and how we can provide an effective local service for people on this scale. My right hon. Friend has yet to make the case.

Jane Kennedy: Obviously, there are one or two of my hon. Friends whom we need to work more closely with to persuade them of our case. One of the best ways to give patients more of a say in local services is to empower the health care professionals who are closest to the patients. Larger PCTs do not mean more remote PCTs. That is why practice-based commissioning is being rolled out alongside reconfiguration, giving GPs and primary care professionals more freedom to redesign better services for their patients.

Strengthening local commissioning will mean that the money is spent in communities where there is greatest need, rather than being sucked into areas where the demand is more vocal. As was pointed out earlier, our proposed reconfiguring of organisations will strengthen relationships between health care professionals and local authorities through greater coterminosity. London boroughs and PCTs, for example, are bringing about genuine improvements in the delivery of primary and social care in the boroughs. Those improvements have been enabled by the coterminous arrangement of PCT boundaries with social service local boroughs. Currently, just over 40 per cent. of PCTs are coterminous with local government boundaries, and we expect that figure to rise to almost 80 per cent. as a result of the proposed changes in PCT boundaries.

Ambulance trusts and SHAs are likely to see their boundaries much more closely aligned with those of the Government offices for the regions.

Mr. Andrew Lansley (South Cambridgeshire): Why?

Jane Kennedy: These changes will enable organisations to work together more effectively to tackle priorities such as reducing health inequalities. Conservative Members do not like to hear this because they were not interested in achieving reductions in health inequalities when they were in power.

Mr. Lansley rose—

Jane Kennedy: I happily give way to the hon. Gentleman.

Mr. Lansley: Does the Minister recall that Peter Bradley's report said that the number of ambulance trusts should be reduced in line with SHAs, of which there are 28? The report said nothing about regions. Does it not occur to her that ambulance trusts work with
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hospitals, GPs, out-of-hours services and NHS Direct? When do they actually need to work with the regional offices of the Department of Health?

Jane Kennedy: The point that the hon. Gentleman makes is not really very valuable. Benefits will flow from working more closely with other structures. For example, in the event of a very large incident, emergency response is enhanced when services have become used to working together and have developed working policies and protocols. Fewer, larger ambulance trusts will also make it simpler to build the effective relationships with stakeholders that are so important in successfully dealing with major incidents, and in providing the effective delivery of integrated, patient-centred health services.

Our aim is an NHS that is free to all of us and personal to each of us. We are delivering it through high national standards backed by sustained investment, by using new providers where they add capacity or promote innovation and, most importantly, by giving more power to patients over their own treatment and their own health. I ask the House to support the amendment.

7.45 pm

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