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Primary Care Trusts and Ambulance Trusts

Thank you, Mr. Speaker, and in that long speech, I will seek to pick out the points of substance that there were. There is no confusion. Our aim overall is to improve patient care. That is what we are in business to do, and I can tell the hon. Gentleman without fear of contradiction that patient care is improving. Patients are not waiting for more than six months for in-patient treatment. On the whole, they wait a maximum of 13 weeks for an out-patient appointment. There is clear evidence of progress. That is what guides our changes; it is what guides these changes, so I can assure him that there is no confusion on our part at least. The hon. Gentleman says that this is change for change’s sake. I point out to him that the NHS changes; it is different from what it was in 2000. We have an ambitious programme of reform to drive through in the NHS. We want to ensure that people can choose where they are treated and that the wait for that treatment is short, once the full reform programme is introduced. That will require strong commissioning throughout the NHS. It will require people cleverly commissioning services and using their organisational strength. That is why we are making these changes. He will know that some changes have begun, and some of the changes that we have formalised today have already begun to take shape. On ambulance trusts, the hon. Gentleman claims that we have an obsession with the regions—far from it. He asks what the connection is with other emergency services. Surely, it makes sense to ensure that, at regional level, there is the contingency capacity to deal with major events and that capacity is planned regionally. I hope that he agrees that there is some logic in doing that. He claims that there is no support, but Peter Bradley’s proposals commanded strong support from within the ambulance service, particularly because they clearly focused on the professional development of those who work in the service, thus giving them the ability to shape ambulance services in future. The hon. Gentleman claims that we have not listened. Clearly, if he looks at the proposals for PCTs that we are publishing today, he will see that precisely the opposite is the case. We have indeed listened hon. Members—not just Labour Members, but Opposition Members, too—and we have taken on board those concerns. He asks where the proposals differ and whether we will put the evidence in the Library. I would be happy to do that, but the reason why we have taken those decisions and listened to those representations from hon. Members on both sides of the House is that we want a consensus of support for the new organisation, because it is our judgment that the organisation will have the best chance of success if it is underpinned by strong community support. That is exactly why we have done that. The hon. Gentleman asks me whether we will detail where the cost savings can be made. There will be one-off costs in relation to the exercise, but the savings will come year on year. As for the timetable, we expect that the savings from the exercise—some £250 million a year—will be realised by 2008. That, of course, will be a recurrent saving for front-line services. There is a logic and coherence to our proposals, and the hon. Gentleman talks of incoherence and confusion among Government Members. I put it to him that the Conservative party’s policy at the last general election was to take about £650 million from so-called NHS bureaucracy, as defined by the James review; coupled with that was the patient’s passport, which would have taken money from the health service. What kind of organisational chaos would the combination of those policies have created?