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Primary Care Trusts and Ambulance Trusts

I thank the hon. Gentleman for his constructive response. In the course of his remarks, he made the point that we have listened. The hon. Member for Eddisbury (Mr. O'Brien) would have done well to take that point on board. We are not recreating health authorities; the building blocks are the same. The exercise has shown a range of interest in and commitment to primary care trusts around the country. People seem to be attached to them. The changes are not happening everywhere. In my area, in Greater Manchester, the building blocks will largely remain the same—as they will in London. Experience has shown that there is a PCT size that is more effective in commissioning good quality patient care. We are making the changes in that respect and ensuring that the NHS is able to use its strength at local level to drive up quality for patients. The hon. Member for Northavon (Steve Webb) mentioned coterminosity. I am in full agreement with him on that point. I have long believed that there needs to be much closer working between the national health service and social services at a local level. I fully support such moves, including even pooled budgets—that kind of approach. I hope that the proposals will pave the way for much greater joint working. There are examples around the country where that working is close. The greater level of coterminosity allows those partnerships to be built. The level is around the mid-70 per cent. mark. We have to strike a balance between representations from local Members and not creating bodies that are too big to do the job. We have sought to manage those tensions. We have produced a significant increase in the number of PCTs that are coterminous with their social services departments. That will be a positive step forward for patients and particularly for older people in those regions. There will, of course, be redundancies as a result of the exercise, but we made it clear at the election that we would be clear about reducing unnecessary NHS bureaucracy. There should be savings made in merging back-room functions, where that can be done, but at the same time we do not want to diminish the power of PCTs to be effective commissioners for their communities. Today’s proposals strike that balance.