Let me go directly to the important question about the reforms, the status quo once they are in place and how that will help deliver what Francis talks about. As I said in answer to the Leader of the Opposition, Francis says he is content this can be delivered:
“it requires changes which can largely be implemented within the system that has now been created by the new reforms.”
I hope the reforms will help in a number of ways. I hope HealthWatch can be created as a robust independent organisation that is taken seriously by those in the health service and more widely. I hope that having clinical leadership of the clinical commissioning groups, with local GPs and others in charge, will mean they will reach further into their hospital and perhaps ask better questions than the primary care trust put. As I said at Prime Minister’s questions, I also hope that the Department of Health sets a mandate for the national Commissioning Board and that we put quality and care for patients at the heart of it. While I accept that we need some process targets because things such as waits in A and E matter, I hope that the move towards judging outcomes rather than processes will reinforce the importance of quality, because if we do not get quality care, we will not get quality outcomes.