Clause 1 - English health authorities: change of name
NHS Reform and Health Care Professions Bill
11:15 am
Mr John Baron (Billericay, Conservative)
My point is that there has not been enough clear and joined-up thinking about the responsibilities of SHAs in terms of their communication and relationship with PCTs. That leaves open many questions that people in the medical profession cannot answer: for example, how will conflicts be resolved? The BMA has noted that PCTs will be accountable for their performance to SHAs through individual performance agreements. That is fairly straightforward. However, SHAs will also be expected to manage the performance of PCTs across organisational boundaries and to broker solutions if necessary. The BMA has questioned how conflicts between SHAs will be resolved—although they will be accountable to the Secretary of State.
The BMA is concerned, as are we, that neither the Bill nor the document on shifting the balance of power within the NHS allocates responsibility for safeguarding or fostering academic activity. Unless such provision is made, benefits to the health service, including clinical service and education, will be lost. Moreover, the decline in recruitment and retention in academic medicine will continue.
The BMA has pointed out that it is unclear whether the responsibility for co-ordinating and collaborating on the provision of tertiary services will lie with SHAs or with the new regional directors of health and social care. I hope that that will be made clear in the course of the Committee's proceedings. The Bill does not make it clear to those who have to operate at the coalface how such issues are to be resolved. We need to give it more careful consideration and delay its implementation until it is suitably amended.
I have another concern, which has already been touched on by other hon. Members. Although PCTs are not directly linked to SHAs, there is a strong connection with the operation of the NHS at the coalface. My concern is that PCTs are not ready for the responsibilities that they will be taking on from next April. From visits to the two PCTs covered by my constituency, I know that they feel that, organisationally, they are a little behind the curve. I know that some PCTs are already up and running, but the fact remains that there will be quite a rush into mergers between PCTs and PCGs, whether that is wanted or not.
PCTs are taking on responsibilities for which some of them—not all, but a good number—are not fully prepared. I think that I am right in saying that one in seven of existing PCTs do not have a finance director. That is crucially important because there will be a major shift of resources to PCTs: 75 per cent. of total NHS spending will eventually end up in their hands. If the management and organisational structure is not in place by next April, there will be major problems in delivering the services that our electorate want.
The Government have supported the survey carried out by the National Primary Care Research and Development Centre in collaboration with the King's Fund. It suggests that there are many doubts about some PCTs' abilities to absorb the pace of reform. Professor David Wilkin, the project director, has said that the pace of change has been dictated by Government timetables rather than by a
``process of learning and building on experience''.
That point is crucial. We are rushing into something and we need more time to consider it, not only within the House. We must delay the implementation of the legislation or there will be real problems at a time when the real crisis in the NHS—increasing waiting lists and poor care at the point of delivery—is not being confronted, at least not by the Bill as it stands. We should be addressing that, rather than carrying out a fundamental restructuring that no one in the health service or the medical professions wants.