Clause 4 - Application by NHS trusts
Health and Social Care (Community Health and Standards) Bill
3:45 pm
Mr Andrew Lansley (South Cambridgeshire, Conservative)
I understand the hon. Gentleman's point; however, it is essentially an issue of timing and phasing in rather than of principle. In his argument, the hon. Gentleman does not dispute that, if we seek accountability to patients and patients exercising greater influence over the structure of services provided to them, it must be done through primary care trusts.
The question then becomes how to reach the point at which the public understand the nature and the role of primary care trusts. As someone—perhaps my hon. Friend the Member for Westbury (Dr. Murrison)—said from a sedentary position, patients encounter their GPs much more frequently than they do their hospital. During a year, many more patients see their GP than attend hospital. Although we have the physical appreciation of the hospital, if, over time, one wanted to create among patients an understanding of the nature of a primary care trust and the role that it
fulfils, so that they had an impetus towards participation in membership, it would not take long for GPs to create that sense of awareness and impetus in their population. That would depend on GPs being minded to give their support, but I suspect that for an application to be submitted the area's GPs would have to go in that direction.
We do not say that all must become foundation trusts in a particular time frame—or perhaps Ministers do take that view. My view has always been that devolved management must have a degree of organic growth. I am not sure that I subscribe to the argument of the hon. Member for West Bromwich, West (Mr. Bailey), but it can be contemplated. However, even if the hon. Gentleman is right, primary care trusts themselves can hold back because, at this stage, they do not think that the public know enough about them to wish to become members. Ministers, too, can hold primary care trusts back.
The second limb of my argument concerns whether it makes sense to leave them out of the legislation. As far as I can see, if they were left out now, we would need new primary legislation to reintroduce them. From past experience, we know that that can be a significant constraint on the timetable and the development of services to patients if structural change is required.