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The hon. Gentleman is right to say that primary care trusts themselves should eventually have the freedom to take decisions at an operational level, because they are the commissioning bodies. We have emphasised to primary care trusts that they should be free to commission from those that provide the best service. Issues of equity and access will prey heavily on the minds of primary care trusts, and it is right that they should. The national tariff will operate as I have described; not as a barrier to access, but as a way to improve it. Together with the other reforms that we are introducing, the tariff will add into the system a direct incentive for local providers to do more.
A primary care trust may be faced with the difficulty, which is often faced in various parts of the country, that it cannot get a service that provides rapid access to deal with, for example, the problem of long waits because of local shortages. If that is the case, it is important that it is free to commission a service from other parts of the national health service, or from other providers, to ensure that local people get access to NHS-funded care more quickly. That is a separate issue from the one that the hon. Gentleman raised about somehow withdrawing support from local providers. It is not about that; it is about commissioning an additional service. However, it is also about allowing the local provider an opportunity to provide that additional service, since a direct financial incentive is available to them.
I have said previously to the hon. Gentleman that the difference between us is that he represents in this place a set of very deep and conservative attitudes about the national health service that places the interests of producers and providers above the needs and interests of the patients. That is not just my view; it is the view of many of his hon. Friends. I see what is written about him and his Front-Bench performances in ''Focus'' and other magazines, in which he is regularly attacked as being an old-style politician who is not prepared to embrace change. I know that he is trying to learn the language of reform and change, and I will provide some seminars and support for him if he wants to attend. However, he is gradually edging in our direction, which is welcome.
I hope that the right hon. Member for North-West Hampshire—who started this debate by asking about the sourcing of borrowing and capital for NHS foundation trusts—has had some answers. It seems a very long time ago since I started to respond to him, and I have no memory at all of what I said. I will look in Hansard to see whether I answered him. [Interruption.] I see that he wants to have another go at me, so I am happy to give way.