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I do not think that we are in any disagreement. I absolutely agree about the importance of choice— [ Interruption. ] This argument is not going anywhere. The hon. Gentleman and I agree on the importance of choice in maternity services.
On access to GPs, there are clearly problems with out-of-hours services and with the straitjacket that the Government have placed on GPs' hours through the contract. There is an urgent need for that to be reviewed. I would be grateful if the Minister would also respond to a concern about independent sector treatment centres. There was a report in the press last week that two proposed new independent sector treatment centres had been cancelled. I would be interested to find out whether that suggests a change of approach, or whether the Government have at last recognised that it is not sensible to impose these private sector treatment centres from the centre. Such decisions should be made locally.
The NHS chief executive's annual report described
"the biggest reform programme for the largest publicly funded health care system in the world".
He went on to ask:
"How can you drive this degree and nature of change from the centre? The simple answer is you can't."
The former Secretary of State, learning from bitter experience, drew attention to the fact that if the NHS were a country, it would be the 33rd biggest economy in the world. It would be larger, for example, than Romania or Bulgaria, and four times larger than Cuba—and, as she pointed out, "more centralised" than Cuba. It is the fourth largest employer in the world after the Chinese army, Indian Railways and Wal-mart. It is a remarkable organisation, but it cannot continue to exist as such a centrally driven institution.
The former Secretary of State admitted that there was a democratic deficit in health services and, as I mentioned earlier, she floated the idea of locally elected boards. Local accountability and local responsibility are absolutely crucial and provide the best way to secure services that are relevant to the local area, combined with national entitlements for citizens so that they know what to expect from their health service. In his statement today, the Prime Minister talked about devolving power in the delivery of public services. Will that be a reality in the health service? It is badly needed.