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Health Bill

Perhaps I can help the noble Earl without going through the individual issues again. The noble Earl has referred to a market, but we are in a situation where PCTs are trying to meet the health needs of their communities. That is what their job is with the resources available. Admittedly it involves them making some difficult judgments—I do not dispute that sometimes the judgments may be difficult—but they are under an obligation to try to meet the needs of their local communities; it is not just a straight market issue. The measure will enable primary care trusts to have a greater influence on the provision of services within their areas, including those in some of the vulnerable communities. Certainly the primary care trusts which responded to the consultation on this issue supported the measure, as they felt it would not only improve access to over-the-counter medicines but would improve access in areas where social deprivation was high. They recognise, as do we, that there will be judgments for primary care trusts to make based on the facts of the applications and the circumstances of the neighbourhood to which they relate. If it will help the noble Earl, I can assure him that we will issue guidance to the NHS to support the provisions when we bring them in. However, at this stage, I would expect it to advise PCTs to take into account the overall improvements that applicants offer. It is fair to say that, to some extent, they will be balancing apples and oranges, but that is in the nature of making judgments if you are a commissioning body—as PCTs are—about how best to serve your local community. The primary care trust will need to judge the applicants against its assessment of the requirement in the neighbourhood for the particular types of improvements that it considers necessary or desirable to meet healthcare needs. We are trying to give PCTs some room for manoeuvre when they need it to respond to their local communities.