Clause 1 - English Health Authorities: change of name
NHS Reform and Health Care Professions Bill
4:30 pm
Mr Oliver Heald (North East Hertfordshire, Conservative)
I join in the welcome to you, Miss Widdecombe, as our co-Chairman.
I want to add one or two points to those of my hon. Friend the Member for West Chelmsford (Mr. Burns). To have a guideline of 1.5 million residents as the basic unit for a strategic health authority is acceptable, although we could argue about what the number of residents should be. However, some flexibility is required from the Minister if it is to work well. My understanding is that, in some city areas, it is proposed that strategic health authorities should be much larger than 1.5 million residents. I should be grateful if the Minister would tell us whether that is right and give us some idea of the scale of difference that is acceptable to the Government.
In my area, it has been suggested at regional level that Hertfordshire should be combined with Bedfordshire to achieve a unit of approximately 1.5 million; a similar size to Essex, to which my hon. Friend the Member for West Chelmsford referred. That is a convenient way of dealing with the matter and would meet some of the clinical networks, but if there were no constraint in terms of having to use local government units to build strategic health authorities, or by the 1.5 million figure, some of the other issues could be considered. For example, to the east of the county, many patients go to Addenbrooke's hospital in Cambridge. Further down the east side of the county, many residents go to Harlow in Essex for hospital treatment. To the south of the county, Mount Vernon is the cancer centre, as the Minister knows, and many of its patients come from north London.
Everyone at regional level, and everyone else involved, is doing their best to come up with a solution for a strategic authority that will work. Will the Minister explain why the figure should be 1.5 million, because a larger number would give greater flexibility?
What is the thinking on having coterminosity with local government areas? Would that be convenient where social services and the NHS were working together? Does the Minister hope that there will be joint working with mental health services? If that is necessary, what is his response to the submission by the Democratic Health Network, a body set up by the Local Government Information Unit? It states that
``the Government has given no clear rationale for the number of the proposed new SHAs. We would wish to see much closer working between health and local government at both regional and sub-regional level. It will not be helpful that the proposed new SHAs will not be co-terminous with other government regional or sub-regional structures.''
The Minister will know that I am not a great one for regions. However, the network has 100 members from local government; it is a body with a voice. It has asked that question. Will he respond to it? This is not something that I would favour, but it is the Opposition's job to put forward submissions when bodies of importance issue them.
The Democratic Health Network goes on to say:
``If the main role of Strategic Health Authorities is performance management, we do not understand why up to 30 SHAs are necessary and why they cannot be made co-terminous with the English regions . . . which would make it much easier to co-ordinate regional health policy with other areas of regional policy and with political and administrative structures at regional level.''
One can see what it means. The Minister accepts that in parts of the country where there are cities and great urban areas, there should be larger SHAs that fit in with the sub-regional pattern.
I should like the Minister to explain whether this is a patchwork with big SHAs on the one hand and little ones on the other. What is the meaning of the guidance figure of 1.5 million? It obviously means something in Hertfordshire because that region has said that 1.5 million is an important guideline. If something totally different is happening in the west midlands or Yorkshire, how will he reconcile the one with the other? Will the Minister give us a clearer picture of what is going on?