If she will make a statement on the future of primary care trusts.

The national health service has made excellent progress in improving hospitals. We now need to focus on community services and ensure that primary care trusts deliver the community health care services that patients want and need. We have therefore asked health authorities and PCTs to review their structure and come forward with proposals for change where that is needed.

Can the Secretary of State explain why a major NHS reform that was politically contentious was launched not by her in Parliament but by an official in the recess? Can she nevertheless give us an assurance that PCTs that are working well through joint working with local councils and running good community hospitals will be left to continue their work rather than being subject to the Maoist process of constant reorganisation and revolutionary upheaval?

I was not aware that the hon. Gentleman was an expert on permanent revolution or Chairman Mao. I agree that it would have been preferable if the statement made by Sir Nigel Crisp at the end of July had been available earlier to hon. Members. However, that statement set out the criteria that we want strategic health authorities and PCTs to take into account. Crucially, that includes ensuring that PCTs work closely with social services authorities, particularly to ensure better integration of health and social care.

When my right hon. Friend looks at structural change and the provision of services, will she ensure that Leeds, which has five PCTs, is carefully considered? Its PCTs provide commissioning as well as service provision on a localised basis. The West Leeds plus scheme, for example, provides services to prevent the unnecessary admission of old people to hospital.

I can certainly give my hon. Friend that assurance. Far from trying to impose a one-size-fits-all change from the centre, we are asking strategic health authorities and PCTs to look at what is working well in their area to see whether change is needed and, if so, to introduce proposals. When we look at the proposals for Leeds, I shall certainly bear in mind his points. I hope that I have an early opportunity to visit the scheme to which he referred.

Does the Secretary of State accept that, while the four Cheshire PCTs, in accordance with the Government request, are prepared to merge and restructure into one, all informed people in east Cheshire—an area that my hon. Friend Ann Winterton and I have the pleasure to represent in the House—including doctors, nurses and patients believe that there should be two PCTs? An east Cheshire PCT and a west Cheshire PCT would be appropriate, because the interests and needs of west Cheshire are very different from those of east Cheshire, which also serves west Derbyshire and north Staffordshire.

The hon. Gentleman makes an important point. We asked health authorities and PCTs to consult local government and other key individuals, including hon. Members representing the district. Although I have not yet had an opportunity to see the proposals for Cheshire east or west, I will look at them with particular interest in the light of his comments.

Will my right hon. Friend guarantee that she will not authorise any changes to PCTs unless there is a clear and demonstrable health benefit from the change that will not be achieved on the back of years of uncertainty for PCT staff?

All the changes that are being made in the NHS are designed to achieve even better services for patients and users. That is the goal and the test of everything that we do. I assure my hon. Friend that district nurses, health visitors and other staff who deliver services in the community will continue to be employed by the PCT unless and until it decides otherwise. Any such decision would be made locally in light of the forthcoming white paper on community health and care services and, of course, with full consultation with patients, users and staff.

Will my right hon. Friend assure the House that all the changes that are to take place, whether reconfiguration or changes in the provision of services and commissioning, will be subject to full consultation, including with hon. Members, and not during the long summer recess?

I can readily give my right hon. Friend that assurance. The proposals that are coming forward are proposals for consultation. We will examine them in the light of the criteria that we published. If we are satisfied that a particular proposal is based on those criteria and on proper initial consultation, it will go forward for full consultation in line with statutory procedures—three months' consultation with local people, including of course hon. Members. That is the process. If the proposals that come forward have not been based on initial proper consultation and do not fit the criteria, they will not even proceed to consultation.

Does the Secretary of State accept that one of the problems with amalgamations of PCTs is that many PCTs suffer historic financial deficits, making them unattractive partners for other PCTs? Will she undertake to stabilise the financial situation of any PCT that is proposed to be amalgamated?

The hon. Gentleman raises an important point. There is a minority of PCTs that are in deficit according to last year's accounts and having to manage a financial recovery plan now. That is not in itself a bar to a merger if there are good reasons for PCTs to merge, and many of them have been discussing mergers for many months, but it is an issue that not only the PCTs but the strategic health authority will need to look at closely and it underlines the importance of PCTs and other parts of the NHS that have deficits meeting their commitment to getting those deficits under control and achieving their financial recovery targets in the current financial year.

Will PCTs be required to split the commissioning role from the provider role, regardless of how well a particular PCT is performing?

Decisions on services will be made locally in the light of the forthcoming white paper on community health and care services, and subject to full public consultation with staff, patients and users. This is about getting the best services for patients and users in each local area. It is not about a top-down, one-size-fits-all model.

Does the Secretary of State accept that, before structures are changed, there must be a clear definition of the role of any new body? May I press her, following the question from Mr. Illsley? There is considerable confusion. Will the reorganised PCTs be responsible for providing services, and if not, who will be?

As we stated in "Commissioning a patient-led NHS", the commissioning role of PCTs in the NHS of the future will be increasingly important. We need strong, effective, expert primary care trusts that can, where necessary, challenge and hold to account general practitioners and hospitals, and which can ensure that they have in their area the best possible services for patients and a much closer integration of health and social care services. We must get the commissioning right and that is why reorganisation is needed in some cases. As I have just said, community staff employed by PCTs will continue to be employed by PCTs unless and until the PCT decides otherwise, following full public consultation.