I beg to move,
That this House
believes the structures of the NHS should serve the needs of the service and patients;
notes the Health Select Committee's report on Changes to Primary Care Trusts (HC 646);
regrets the mishandling of the reorganisation of primary care trusts (PCTs) by the Department of Health;
wishes to see administration costs minimised;
further believes that structure must follow function and that the future functions of PCTs have not been clarified;
further believes that strategic health authorities should be abolished;
further believes that ambulance trusts should not be required to undergo restructuring unless the services themselves request it;
fears that restructuring proposals will seek to mask the consequences of £1 billion worth of deficits across the NHS;
further regrets the loss of morale amongst NHS staff in PCTs;
and calls on the Government to enter into a new and genuine debate about NHS structures, so that the service can better meet its aim of comprehensive quality healthcare available to all, based on need not ability to pay.
As we start this debate, let us agree about the common ground between us. Nothing that I shall say this evening undermines or undervalues the constant, dedicated and professional work done by NHS staff. Doctors, nurses—indeed, my wife is a nurse—the service's many other clinical and technical staff, porters, volunteers, cleaners, even managers and administrators all are highly skilled and good at their jobs.
I pay tribute to them and their work. The Opposition's job is to press the Government to optimise their support for what NHS staff do in delivering taxpayer-funded health care that is free to all who need it at the point of use. I say that with deep conviction, as one of my children recently had to undergo a serious operation at Alder Hey hospital in Liverpool. Neither he, my wife, nor I can praise highly enough all those NHS staff who were involved in his excellent treatment.
Like the country at large, the Opposition regard the NHS as a top priority. We are optimistic about its future and determined to see it improve. It therefore comes as a surprise to most people that a great many NHS trusts face serious and worsening deficits totalling something of the order of £1 billion gross, with wards being closed and services curtailed.
We have just finished a debate on the vital matter of mental health and, even there, cuts are being made in availability, provision and access. We are now debating the Government's latest proposed reorganisation of primary care trusts, strategic health authorities and ambulance trusts. One fears that it is a case of the Government fiddling while Rome at least smoulders. As soon as the Government hit the inevitable choppy waters—in this case, ballooning deficits in a quarter of all trusts—that were the inevitable consequence of their own policies and targets as well as their most recently introduced organisational and structural tinkering and meddling, they reach for their reorganisation manual yet again.
My hon. Friend is making a strong case. Is there not a danger that the amalgamation of these trusts could impose a lot of extra administrative costs as a result of new logos, new staff—owing to the need to employ regional and local people—and new properties? That is the last thing that we want to spend money on at a time when we need more to spend on nurses and doctors, certainly in my area.
My right hon. Friend is correct. There is always a transfer cost associated with any such move, but it is nonsense to incur such costs when there is no identifiable benefit, given that it will involve hard-pressed taxpayers' money that is needed for front-line services.
When the Conservatives were in power, we had 47 trusts in the Scottish health service. Under the Scottish reorganisation, that figure has been reduced to 15. We also reduced the number of senior managers by 27 per cent. and those savings have gone into paying for front-line staff. Does the hon. Gentleman not welcome that?
I am sure that the Scottish Executive would very much like to debate that matter, but this House has no jurisdiction over it. I hope that the hon. Gentleman will reflect on that point, having taken up time in this debate with a matter over which we have no authority whatever.
My right hon. Friend is right. Roll on the time when we are in Government and can introduce English votes for English laws.
There have already been six reorganisations since Labour came into office. The merger of strategic health authorities and primary care trusts will represent the seventh, and the forthcoming merger of NHS ambulance trusts will be the eighth.
I am grateful to the hon. Gentleman. Am I to take it from his remarks that he does not believe in an integrated national health service covering the whole of the United Kingdom?
I hope to mention the hon. Lady in dispatches later in my speech. I am intrigued by her question, because I hope that she knows—not least because of my own personal connection with her—that we have a strong commitment to the NHS as a national health service. By "national", we mean the United Kingdom. However, we must recognise that the authority and accountability for NHS services in Scotland has now been devolved and it would therefore be inappropriate for me to take up the House's time dealing with matters of Scottish accountability.
The Government have an addictive personality disorder and we are constantly told that all such habits are costly and have dire consequences. We have been here before. As recently as 2001, the Government announced that 302 primary care trusts were to be established as statutory bodies to replace the health authorities and that nine regional offices of the NHS executive were to be abolished in favour of 28 strategic health authorities. The Government's proposals for PCTs and SHAs effectively return the NHS to the same map that they abolished only three years ago. The Health Committee slated this U-turn, stating:
"A return to structures which are similar in size and function to previous Health Authorities raises important questions about why the shortcoming now being identified"— by the Government—
"could not have been easily anticipated and addressed before the PCTs' introduction three years ago".
Most worryingly, the cost of this reorganisation will reach £320 million, which I think gives a quantified answer to the question that my right hon. Friend Mr. Redwood asked earlier. Given the increased resources that have rightly been made available for the NHS, it is little wonder that there is a constant refrain from constituents and clinical staff alike of, "Where has all the money gone?"
I understand the hon. Gentleman's point about reorganisation in the NHS, but will he explain why the motion that he is supporting calls for another one, namely
"that strategic health authorities should be abolished".?
Is that not another example of the kind of reorganisation that he is decrying?
I have some respect for the hon. Gentleman's normal analysis, but he must recognise not only that we would replace strategic health authorities if we had the chance, but that they will naturally become extinct in three years anyway, if the Government have the courage to implement that move. We are simply trying to save some money by advancing that change rather faster.
Is my hon. Friend aware that the chief executive of the Northamptonshire Heartlands primary care trust, Peter Forrester, has to spend half his time in some weeks battling to save that popular primary care trust, which is taking him away from giving his time to front-line issues?
I gather that wards are also being closed in Northamptonshire. That situation is replicated right across the country. I was talking to a local physiotherapist the other day and she told me that her job description required her to administer for 25 per cent. of the time and give physiotherapy for 75 per cent. She then told me that the situation was now reversed and that she was now lumbered with all the administration, because the Government are stealthily removing administrative support in an effort to avoid the charge that they are diminishing front-line services.
How can there be any sense in the Government proposing changes to the structure of primary care trusts unless they have first established with clarity what the functions of the PCTs are to be? The Government's document, "Commissioning a patient-led NHS", called for PCTs to become
"patient-led and commissioning-led organisations with their role in provision reduced to a minimum" by 2008. In the face of fierce opposition from NHS staff employed by PCTs, from MPs, and from the Royal College of Nursing—which launched, but has now withdrawn, an application for judicial review of the decision—the Government have since retreated from their strident position. The Secretary of State said on
"I know that many of you were very unhappy about what we said at the end of July . . . I am very sorry that many staff have been caused such anxiety . . . Any move away from the direct provision of services will be a decision for the local NHS within the framework set out in the forthcoming White Paper and after local consultation."
There we have it: the Government's U-turn. So far, so normal for this Government, but, even though common sense would dictate that they should, they did not even review the design of the new PCTs to ensure they were fit for their new purpose as commissioners as well as local providers. Those roles encompass massively different skills and levels of authority, governance and accountability, as anyone with even a smattering of management experience could see.
"we are appalled at the continuing lack of clarity about whether or not PCTs will eventually divest themselves of provider functions".
The Department of Health's NHS operating framework for 2006–07, published on
"From 2007 each PCT will be expected to review formally and systematically whether local services are delivering high quality, effective and efficient care . . . There is no requirement for PCTs to divest themselves of provision, and nor will there be in the future . . . Where PCTs do continue to provide services, they will need to put in place clear governance procedures that ensure that there is no undue influence from the provider side on commissioning decisions."
On that last point, incidentally, I have to say that I am already receiving letters—I expect that my hon. Friends on the shadow health team are, too—alleging a growing web of conflicts of interest and worse. That is no laughing matter for a Government-designed system, as it makes the Government complicit, and they will be guilty of intended consequences, on which we will be required to hold them to account.
The Health Committee also noted that NHS organisations were given less than a month, during the summer holiday period when many key figures were absent, to put together proposals for changes to local services. The chair of North West London SHA described the consultation process as "flawed". The Health Committee concluded:
"if the Government truly believes in a patient-led NHS, it should have started its reforms with a patient-led consultation process, rather than the top-down process we are clearly seeing".
Apart from the fact that the Government are clearly attempting to fulfil their own manifesto promise of £250 million of cuts, the hon. Gentleman should not read so much into the note distributed to him and his fellow Back Benchers by the Labour health team, and signed by the special advisers to the Secretary of State, that tries to suggest that that is our position, not recognising that it is nothing to do with the policy that we promote.
Quick consultations always suggest a foregone conclusion. I have been contacted by GPs in my constituency who work within the Central Cheshire PCT and who are worried that that is the case. They understand that the Government's current preferred option is that all four existing Cheshire PCTs became one, but fear that that will be too large, impacting on local links, covering different care pathways and looking to both Manchester and Liverpool, which is inappropriate for my constituents. With them, I favour Central Cheshire and Eastern Cheshire PCTs combining. They are also concerned, as are all Opposition Members, that those structural changes are a deliberate ploy by the Government to mask the consequences of deficits and their impact on patients.
My hon. Friend is right. Today, the Gloucestershire health community issued a press release and the chief executive of the acute hospital trust said that the current difficulty with deficits will be magnified by the significant reduction in prices paid with the changes in the national tariff. The trust in Gloucestershire faces a cut of £21 million—a 7 per cent. reduction in its spending next year—if it treats the same number and mix of patients and will face tremendous challenges that will lead to job losses. Those are the problems faced in Gloucestershire.
I am grateful to my hon. Friend, who is working hard for his constituents. He recognises that there is nothing worse than a Government who provide perverse incentives for all the wrong directions and decisions to be taken in an effort to try to meet their targets.
I am conscious of the need to get to the end of my remarks to allow more Members to speak. If my hon. Friend will forgive me, I will not take too many interventions.
The Cheshire GPs fear that there will be a levelling down of services and cuts to front-line patient services if there is a merger with the debt-ridden Cheshire West and Ellesmere Port and Neston PCTs. As has been outlined, good PCTs such as Central Cheshire are now to be penalised to prop up disastrously underperforming ones such as Cheshire West, which has KPMG in. The Government are 100 per cent. responsible for that muddle, as well as for the deficits resulting from rising cost pressures and the cost of meeting Government targets.
Why are the Government charging ahead with all that? It is neither for NHS patients nor those who work in the NHS, but that is what the Minister will no doubt claim when she responds. One only needs to witness the collapse in morale among NHS clinical and non-clinical staff to know that the Government are in serious denial. Can anyone doubt that the Government are conducting a sham consultation on all these changes? Can it be in doubt that the Government will not break the habits of a lifetime, have no intention of respecting the consultation processes and certainly not the responses, and will press on with their proposals regardless of the responses received? We need look no further than yesterday's announcement on the police for proof of that.
The proposed merger of strategic health authorities into remote bodies aligned with Government offices for the regions is, despite all the Government's ever more wild and shrill protestations, yet another manifestation of their addictive personality—their obsession with regionalisation, even though SHAs have patently failed in their key task of performance managing NHS organisations. One does not get a £1 billion deficit if one has been a success.
Unlike Rob Marris, I welcome the motion's proposal to abolish SHAs. Does the hon. Gentleman agree that they do not seem to have any function, that their strategic functions should be carried out by the Department of Health and that their planning and capacity functions should be carried out by PCTs? There is no point in having them at all.
I am glad to hear that the hon. Gentleman has come to our view. He is correct that SHAs have lost all their purpose and are therefore no longer a worthwhile or value-for-money option for the taxpayer.
"I, my constituents and many Labour Members have no confidence any more in what is an increasingly Stalinist and out of touch health authority", to which Mrs. Dunwoody—who, I am glad to see, is in her place—added,
"It is not nearly that competent."—[Hansard, 31 January 2006; Vol. 442, c. 159–60.]
The way in which SHAs have undertaken their responsibility for performance management is a disaster. The Secretary of State has sent in turnaround teams to PCTs—proof, if ever there was, of the failure of SHAs to oversee those trusts, and an immense additional and avoidable burden on the taxpayer. I would not mind the Government paying McKinsey were there no Merseyside and Cheshire SHA, but the imposition of KPMG on 18 trusts up and down the country at vast expense shows that the SHAs have not been doing their job. The taxpayer is paying twice over, and over the odds the second time: once for the SHA employees who are supposed to keep trust finances in order and once for the consultant to sort it all out. Surely the Department should ensure that it employs people who can do the job and sacks those who cannot. The turnaround programme is proof that SHAs are not up to it, that this three-year-old Government design has failed and that SHAs should therefore be scrapped. In any other walk of life, and under any other Government, it would be plain that SHAs have failed, and that some, such as Surrey and Sussex, have presided over an almost complete collapse in their health economy. We can, and should, dispense with SHAs. We just wonder whether the Government have the courage to take that obvious step.
We now come to the ambulance trusts. In June 2005, the Government's review of ambulance services, "Taking Healthcare to the Patient", was published. It recommended a reduction in the number of NHS ambulance trusts from 31 to 28. However, on
No one in the ambulance service called for this change.
Will my hon. Friend consider the Two Shires ambulance trust, shared between Northamptonshire and Buckinghamshire? It is a three-star trust, which will not only be torn apart but reconstituted, with our trust as part of a much wider regional trust and the other going to the south-east? Something that is perfectly effective that has its headquarters in my constituency is being destroyed and its seat of decision making is being removed to a place about 100 miles away.
I am grateful for the example that my hon. Friend outlines. He will derive great comfort from the fact that he is not alone, but no optimism, from the case to which I am about to refer.
I am about to mention Staffordshire, so my hon. Friend might want to hold on.
The ambulance tsar, Peter Bradley, made a clear case for restructuring Avon, Gloucestershire and Wiltshire ambulance trusts, and for a revision of the Thames Valley trust. The Government took that as an excuse—it was not in the report, and at best they might claim, as a cloak, that it was implied—to reduce the number of ambulance trusts down to nine, 10 or 11. To implement that, the NHS Appointments Commission sent out letters on
My hon. Friend may know that Staffordshire ambulance trust is regarded as one of the best in the country. Indeed, later tonight I shall present a petition with many thousands of signatures, because the people of our area are incensed at the fact that the trust is to be merged into a west midlands service. Does he accept that we are deeply concerned?
I fully accept that my hon. Friend and his constituents are, rightly, deeply concerned. I shall deal with Staffordshire shortly and I hope that he will be able to combine what I say with the representations that he is already making.
The proposed regionalisation is simply not service-led. In fact, it is diametrically opposed to what the service needs. It is not enough that the people of the north-east rejected the Government's regionalisation agenda out of hand, which led to the withdrawal of similar proposals in the north-west and Yorkshire and Humberside. In a forlorn attempt to save the Deputy Prime Minister's face—I shall not inquire what type of face it is—the Government will ram the proposal through anyway, as part of their dogmatic regionalisation agenda.
For ambulance services, local knowledge is key, as are small, efficient management structures. Where trusts have been merged, their quality has been destroyed. The trust that used to serve my constituency, the Cheshire ambulance trust, had three stars. It was merged with the Merseyside ambulance trust. The ensuing crisis has been so appalling that the chief executive of the joint Cheshire and Merseyside ambulance trust conveniently "resigned". The greater tragedy is that the trust has descended to a nil star rating.
Only this weekend, I had cause to test the service. A horse rider fell on the road just outside my house, severely injuring her head. It was a serious injury. Luckily, my wife was on hand to give professional nursing help, as it took over half an hour for the ambulance to arrive. It had to be guided in by the nearest people who could be contacted by mobile phone, as the Warrington call centre never understood where we were.
Concerns have also been expressed about the merger of Staffordshire, West Midlands, Coventry and Warwickshire, Herefordshire and Worcestershire, and Shropshire ambulance trusts. There have been proposals to reduce control room numbers by co-aligning them with the police and fire services. The fire service in Warwickshire responds to some 3,000 emergency calls a year, whereas the ambulance services respond to some 100,000 emergency calls. Both Staffordshire and Coventry and Warwickshire ambulance trusts are three-star rated. Where is the benefit in amalgamating them, especially if they suffer the same fate as Cheshire? It is not patient-led, it is no closer to the patient and it does not centre the service on local knowledge. The only changes that should ever happen are those requested by the ambulance service itself.
My hon. Friend Michael Fabricant has highlighted fears over the merging of Staffordshire ambulance trust, joining other Members from his area to meet the Secretary of State. He has pointed out that Staffordshire ambulance trust has the fastest 999 response time in Europe. He has met constituents living in Lichfield and Burntwood who would probably be dead today, because of slower ambulance response times, had Staffordshire been subsumed into the West Midlands trust.
I note what my hon. Friend says. When he met the Secretary of State for Health, she assured him and the Members who accompanied him that no decision had yet been made, but she did explain that there was a move towards regional emergency services. Where have we heard that before? In connection with police and fire services? Is it possible that the Conservatives may be right in saying that the Government's addiction to regionalisation is driving all the proposals?
I will not give way, because I am about to end my speech.
In their addiction to meddling, the Government turn to reorganisation whenever they face a crisis or their latest headline grabbing wheeze turns out—predictably—to disappoint. For all that, we see PCTs being forced to merge when there is as yet no clarity about their purpose. We see the Government clinging to SHAs while, at huge cost to the taxpayer, bringing in consultants to do the job that the SHAs were hired to do when the obvious answer to anyone but an over-proud Government would be to scrap the SHAs. We see ambulance trusts being forced into a dogmatic regionalisation agenda, having to bend to the Government's will although no one in the service advocates it and although there is no prospect of a better, speedier service for patients.
We want better NHS services for our constituents. They do not deserve to suffer the cuts that are being forced on PCTs and other trusts to get the Government off the hook of the failure of their policies and their financial mismanagement of the PCTs, SHAs and ambulance trusts that they themselves set up only three years ago. Of course we also want administration costs to be minimised. The way in which to do that is to reduce the amount of administration and bureaucracy, rather than bringing about yet another reorganisation. Our constituents and NHS patients will not fall for the latest Government ploy to mask their own policy failures.
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
"welcomes the Government's determination to reform primary care trusts (PCTs) and strategic health authorities (SHAs) to ensure all patients get the services they need, to shift the focus of services more towards prevention and tackling health inequalities, to engage better with GPs in developing services that meet patients' needs, to reduce bureaucracy and to deliver better value for money for taxpayers;
further welcomes the widespread support within PCTs and SHAs for the principles on which Commissioning a Patient-Led NHS has been based;
and further welcomes the Government's consultation on reforming ambulance trusts to ensure more care is provided in the home and at the scene, to give better advice to patients over the telephone and to deliver faster response times to save more lives, in line with the recommendations from the National Ambulance Adviser Peter Bradley's review 'Taking Healthcare to the Patient: Transforming Ambulance Services.'."
I think that this is the first occasion on which I have crossed swords with Mr. O'Brien. I well remember the by-election in July 1999, when the hon. Gentleman only just held off a challenge from Labour. That near-success was almost entirely due to the excellent campaign, whose slogan was "Vote Labour or the fox gets it". None the less, it is a pleasure to see the hon. Gentleman at the Dispatch Box. He has consolidated his position in Eddisbury, on which I congratulate him. I wish him a long career as an Opposition spokesman.
The NHS is being restored to good health. It has more doctors, more nurses and better facilities. The revolution in quantity of care must, however, be matched by a revolution in quality of care, with equal access for all and no charges for operations. That means new types of health provision, more say for patients in how, where and when they are treated, and tackling ill health at source.
I should like a moment to get into my speech, I will give way later, but I am very conscious of the 10-minute limit on Back-Bench speeches and—like the hon. Member for Eddisbury—I want to keep my remarks to a minimum if I can.
The phrases that I just used are the promises that we made in our manifesto. That is what these structural changes are set to achieve. I hoped that the hon. Member for Eddisbury would pay a bit more attention to the manifesto on which he stood at the last election. That manifesto pledged to implement the James report, which had a clear attitude to what should happen to PCTs. Only nine months ago, the Conservatives said that they would radically reduce the intrusive bureaucracy that the PCTs had become, removing 30,000 administrative staff and saving £636.6 million a year. We did not hear whether that was still the hon. Gentleman's policy. The thrust of his argument consisted of an objection to the reorganisation that we are proposing.
The Minister and I will agree that in the past five years the NHS budget has indeed increased substantially, while productivity has unfortunately failed to increase at the same rate. Does the hon. Lady agree that the NHS has one of the most committed work forces in the country, and that its biggest failure is the failure to engage properly with its professional staff—the doctors and nurses who are capable of delivering all the service changes that she proposes? Does she agree that much more needs to be done in that regard?
It is a pleasure to see the hon. Gentleman restored to us in good health. When he is not here, the House is the poorer for it. His point is fair. When consultations are taking place, it is important for those who have strong views, particularly those who are most closely affected—patients and the staff who deliver services—to be listened to, and to be involved in the consultations.
I want to finish my comments about the motion.
In our manifesto, we said that by removing £250 million from the management costs of PCTs and SHAs we could redirect the resource to front-line NHS services. Within nine months, we are fulfilling our promise and the Conservatives are breaking the promises made in their manifesto. We have heard no word from them about what they would do about PCT administration. We may have turnaround teams assisting the NHS organisations that are struggling with deficits, but the Tories have a turnaround leader who changes their policy every five minutes.
A tiny proportion of the amount that we spend on administration in the NHS is spent on consultants. I do not have the exact figure to hand. I will look into the detail, but I am confident that we use consultants to very good effect. That is demonstrated by the way in which services are improving.
I am spoilt for choice. May I make one more point on the James review, and then I will give way?
The James review recommended the abolition of strategic health authorities. In the motion we see that writ large, but we have heard nothing from the hon. Member for Eddisbury about who will oversee the expenditure of taxpayers' money in the regions, and who will maintain strategic oversight of service development across a wider geographic area. As my hon. Friend Rob Marris said, it is a question not of reorganisation per se, but of what kind of reorganisation we take forward.
The House would agree that there is probably no magic number in relation to the size of population that is appropriate for a primary care trust, but if 150 primary care trusts covering the 50 million population of Great Britain—just over 300,000 people per PCT—seems appropriate, why are we getting rid of a successful one, Charnwood and North West Leicestershire, which serves a population of about 250,000, which is about the right size, which is big enough to deliver services, and which is effective and small enough to be accountable to the three MPs that represent its area? Why is that being absorbed into a 650,000 mega-doughnut outside the city of Leicester?
My hon. Friend makes a strong point about the concerns in his area. I will come on to those questions in a moment, if he will allow me.
Surely the answer to the Tory criticisms is that we do not hear so much now about people on trolleys who cannot get beds in hospitals. Had there been the deficits under the Tories that they are attacking tonight, we would have had hospital closures. Instead, under this Government we have new hospitals.
I will make some progress, if I may.
I know that the reconfiguration of strategic health authorities, primary care trusts and ambulance trusts has aroused a great deal of interest. The Health Committee recently published a report that provides a helpful contribution to the debate. We will respond in due course to that report, but I am glad of the opportunity today to explain the position and what the Government are doing to change the structure of those organisations for the benefit of patients and to improve value for money.
Investment in the NHS is rising rapidly—it has risen from £33 billion in 1997–98 to more than £90 billion in 2007–08—but that increase will bring us to the European average of GDP spent on health services, which shows how far behind the UK fell under the tender care of the Conservative party.
The Minister has been very generous in giving way. She may remember that Bournemouth used to be part of Wessex regional health authority, which was abolished by the last Conservative Government and was not long lamented, but it had one convincing aspect—it took in not only Bournemouth and Poole hospitals, but the Southampton teaching hospitals and Odstock hospital in Salisbury, Wiltshire, all of which co-operated to form one unit. The proposal that is before us now is for either a strategic health authority for the whole of the south-west region, or two authorities for the south-west region divided horizontally. Can she explain why we are not being permitted the possibility of crossing the regional boundary? Is it to do with regional policy, rather than efficient administration?
It is not being driven by regional policy; it is entirely being driven by efficient administration of the NHS. However, there are issues of coterminosity, to which I will come later—not too much later, I hope—in my comments.
May I first say that I agree with the Minister that there are too many of these administrative bodies, authorities and trusts and that some reorganisation is called for to achieve some efficiency and reduction in management costs? It would be easier to know where we were going and settle all the boundaries if the Government were consistent about what the reorganisation is actually for. The primary care trusts were set up when the Government abolished GP fundholding. They then suggested that fewer PCTs were required to supervise practice-based budgeting, which is the same thing that they are going back to. They then started to consult on the boundaries on the basis that there should be new commissioning authorities. Halfway through, they changed their mind. They now say that the new PCTs will be commissioning authorities and will directly employ a lot of staff. Consulting in that confusion is quite impossible, which is why we have all the outrage about where the boundaries might go. The Government keep changing their mind on what kind of structure they want for the health service and its vital community-based services. Why does not she stop, start again and try to remain consistent?
I agree with a significant part of what the right hon. and learned Gentleman said. If I can get to it, I will explain the reasoning behind the changes that we are bringing forward. I strongly disagree with him on one thing, on which I must pick him up. The only similarity between GP fundholding and practice-based commissioning is that it involves GPs; otherwise, there is absolutely nothing in common between the two systems. Under fundholding, every GP could have a contract with any number of hospitals, wasting enormous amounts of clinical and administrative time in negotiations. Under practice-based commissioning, the PCT will hold the contract with the hospitals and the GPs will use that contract to access services for their patients. There is absolutely nothing in common between the discredited system that the Conservative party instituted and the system that we are taking forward.
The increased investment that I mentioned earlier, together with the hard work of 1.3 million NHS staff—and I am pleased to join the hon. Member for Eddisbury—
The hon. Gentleman must contain himself. I will give way in a moment.
I agree with what the hon. Member for Eddisbury said about NHS staff. That hard work is transforming our hospitals, with much reduced waiting times and lists, improved accident and emergency services and newer, more appropriate facilities to meet the changing health needs of 21st century Britain. I suppose I ought to give way to Mr. Heath.
I am most grateful to the right hon. Lady. I simply want to speak for my local hospital. For eight years, we campaigned locally for Frome Victoria hospital and, hallelujah, only two or three months ago it was announced that we would have a new hospital, which is great news and I am grateful to the Government for that. There is now a question about whether the PCT reorganisation and the announcement by the Secretary of State for Health last week have put the capital investment that was to go into Frome Victoria hospital this year in doubt. I do not expect her to know the answer to that now, but will she undertake to write to me to reassure me that Frome Victoria hospital is going ahead as planned?
The hon. Gentleman's persistence has paid off to the extent that I will undertake to look into the matter and write to him to address his concerns about that problem.
I now wish to make some progress because I am conscious of the time, and I know that many Back Benchers want to participate in the debate.
Ninety per cent. of patients' contact with the NHS is within primary care settings. About 900,000 people a day contact a GP or a practice nurse. The challenge now is to improve primary and community services. That is why last week we published the White Paper, "Our health, our care, our say", setting out our plans to do that. It emphasises that good commissioning is essential to improving services for patients. That means that the NHS needs to get better at securing the best possible services, representing good value from a growing range of health care providers. Reforms such as patient choice and payment by results mean that individual decisions to refer and patient choice will in effect drive commissioning. Patients in discussion with their commissions will choose where they want to go for treatment. Payment by results ensures that the money follows the patient to pay for their care. Once established, the payment by results tariff offers the opportunity for adaptation to encourage alternatives to hospital referral.
My right hon. Friend is a lady of tact and intelligence and she must know that that, frankly, is a load of nonsense. The reality is that if we move towards this system, the patient will have no way of knowing the quality of surgeon in a particular hospital, and no way of knowing who has the reputation for killing a quarter of his patients and who has the best outcomes. It is nonsense to suggest that patients will have any way of knowing. What they want are good services of a uniform standard in their own area. That is what they want and this division will make it worse.
I am sorry that my hon. Friend, whom I regard as a very dear friend, takes such a strong opposite view to me. I do not agree with her. I believe that, increasingly, patients will want to know from their GPs the recovery rates for different surgeons and how they perform, as well as how, for example, a hospital performs on MRSA. Those are exactly the kind of questions that people will be asking. Increasingly, they will be able to get the information not only from their GP, but from the internet, where more and more hospitals are providing precisely that kind of information to the patients who receive services from them.
I am particularly grateful to the Minister for giving way because I wanted to congratulate her on recognising the Isle of Wight's need for a unified PCT health service trust, covering acute, ambulance, mental health and community services. However, I wish to follow Mrs. Dunwoody by asking how can there be choice for patients on the Isle of Wight if there is no money to help them get to hospitals on the mainland. It is choice for the rich, but not for the poor.
That is an interesting point. The difficulties of transport from the Isle if Wight would need to be taken into account and we are still developing the detail of the commissioning proposal and how the model will work. Those issues will face his constituents on low incomes—I am pleased to hear the hon. Gentleman champion them—and their interests will need to be taken into account so that they can achieve a real and genuine choice of services.
Under practice-based commissioning, GPs and other primary care professionals—the clinicians in daily contact with patients—will be able to redesign services for their patients. All of this allows PCTs to concentrate on a more strategic role. The way we commission needs to be transformed if we are to deliver the next phase of reforms successfully. We need to make commissioning more professional and to learn from the best, and we need to encourage innovation. Above all, we need to make sure that patients have access to the right services in the right place at the right time.
I congratulate my right hon. Friend on what she has said so far. Does she agree that the reconfiguration offers a wonderful opportunity, where there is local support, to adopt new commissioning models that perhaps locate all the services that patients need in one site? In Swindon, there is a great deal of support for integrating caring organisations and social services with primary and hospital care commissioning. Does she agree that there is a good opportunity here to move forward?
I am grateful to my hon. Friend, and I agree with him.
As with PCTs, there are clear and compelling reasons for change in the way in which ambulance services are structured. The range of care they provide is expanding, taking health care to patients who need an emergency response, providing urgent advice or treatment to patients who are less ill and providing care to those whose condition or location prevents them from travelling easily to access health care services.
Spending on ambulance services has increased by over 75 per cent. since 1997, which has helped to bring about improvements to services. Over the past two years, the Government have met, and exceeded, the standard that at least 75 per cent. of 999 calls from patients with immediate, life-threatening conditions should have an ambulance respond to them within eight minutes. This has been achieved in spite of consistently increasing demand for ambulance services.
Will my right hon. Friend ensure that Mr. O'Brien understands that the reason Staffordshire ambulance service is so successful is not because of local knowledge—nowadays we have computer systems that deal with that matter—but the unique operating system that means that emergency ambulances are put where they will be needed? That unique system means that a merger of the west midlands ambulance services cannot work unless the Staffordshire ambulance service is allowed to have its operational independence.
My hon. Friend has made a sustained and consistent case for the ambulance trust that she knows so well. I repeat that no decision has yet been taken on the consultations that are taking place on PCTs, ambulance trusts or strategic health authority reform. I have heard my hon. Friend make that point on many occasions and we are listening to the representations that are being made. We know that there is more that ambulance trusts need to achieve if we are to realise our vision for ambulance services and integrated urgent care. To do this, we need organisations that have the capacity and capability to plan for tomorrow as well as to deal with today. That is not achieved through small organisations struggling to deal with huge agendas, or through unnecessary duplication of procurement planning and support services. However, it can be achieved through collaboration and getting best value. This reconfiguration is about delivering for the taxpayer. It is about combining high-quality leadership with retaining the best of what can be delivered locally. It is not about change for change's sake.
In the case of ambulance trusts, there was a clear view from stakeholders that the lack of coterminosity and the small size of some trusts were acting as barriers to improved patient care. This view was reflected in the recommendations of the recent ambulance service review. To achieve the change we are aiming for, we want SHAs to lead the process of reconfiguration locally. We have asked them to work with their local stakeholders, including MPs from both sides of the Chamber, and to put forward proposals for the reconfiguration of ambulance trusts, PCTs and SHAs against a set of national criteria.
On that very point, will the Minister undertake to listen genuinely to the case being made by some local people and organisations? Some PCTs are very good and the Minister is right to say that services in many areas, such as Epping Forest, have improved. We have an excellent PCT and it would be such a pity if it were to be swallowed up in a large regional organisation and if the opinions of local people were not listened to. I am sure that the Minister would genuinely wish to listen to the people who require and benefit from the services.
The hon. Lady argues strongly that we should listen to local people. I understand that the county council in her area does not share her view. Presumably, it also represents local people. Clearly, it will be a real effort to listen to all sides and to make sure that solutions can be arrived at that achieve the best for the patients, which, in the end, is the objective.
I have listened with interest to what my right hon. Friend has to say, and I ask her please not to take any notice of the county councils on this issue. I do not understand the criteria or the figures on which such amalgamation is based. My PCT is one of the most expensive in my area. In terms of management and administration, it costs £27 a head for every man, woman and child in the area—a sum far greater than that applying to other PCTs in the region. I cannot understand why the Department is still pressing ahead with a PCT that will cover nearly three quarters of a million people and all of south Staffordshire, given that the average figure for west midlands PCTs is 230,000. I am not opposed to any amalgamation that improves services, but I want to know what the criteria are and how they have been arrived at, and how we can provide an effective local service for people on this scale. My right hon. Friend has yet to make the case.
Obviously, there are one or two of my hon. Friends whom we need to work more closely with to persuade them of our case. One of the best ways to give patients more of a say in local services is to empower the health care professionals who are closest to the patients. Larger PCTs do not mean more remote PCTs. That is why practice-based commissioning is being rolled out alongside reconfiguration, giving GPs and primary care professionals more freedom to redesign better services for their patients.
Strengthening local commissioning will mean that the money is spent in communities where there is greatest need, rather than being sucked into areas where the demand is more vocal. As was pointed out earlier, our proposed reconfiguring of organisations will strengthen relationships between health care professionals and local authorities through greater coterminosity. London boroughs and PCTs, for example, are bringing about genuine improvements in the delivery of primary and social care in the boroughs. Those improvements have been enabled by the coterminous arrangement of PCT boundaries with social service local boroughs. Currently, just over 40 per cent. of PCTs are coterminous with local government boundaries, and we expect that figure to rise to almost 80 per cent. as a result of the proposed changes in PCT boundaries.
Ambulance trusts and SHAs are likely to see their boundaries much more closely aligned with those of the Government offices for the regions.
These changes will enable organisations to work together more effectively to tackle priorities such as reducing health inequalities. Conservative Members do not like to hear this because they were not interested in achieving reductions in health inequalities when they were in power.
Does the Minister recall that Peter Bradley's report said that the number of ambulance trusts should be reduced in line with SHAs, of which there are 28? The report said nothing about regions. Does it not occur to her that ambulance trusts work with hospitals, GPs, out-of-hours services and NHS Direct? When do they actually need to work with the regional offices of the Department of Health?
The point that the hon. Gentleman makes is not really very valuable. Benefits will flow from working more closely with other structures. For example, in the event of a very large incident, emergency response is enhanced when services have become used to working together and have developed working policies and protocols. Fewer, larger ambulance trusts will also make it simpler to build the effective relationships with stakeholders that are so important in successfully dealing with major incidents, and in providing the effective delivery of integrated, patient-centred health services.
Our aim is an NHS that is free to all of us and personal to each of us. We are delivering it through high national standards backed by sustained investment, by using new providers where they add capacity or promote innovation and, most importantly, by giving more power to patients over their own treatment and their own health. I ask the House to support the amendment.
I am sure that today's Conservative Opposition day debate will give some flavour of the rapid structural changes that our national health service will go through in the coming years. The restructuring of primary care trusts has followed a very hasty timetable. That timetable was announced during last July's parliamentary recess, and the initial consultation period closed on
Initially, the proposed changes were supposed to coincide with trusts shifting toward a commissioning, rather than provider, role. That led to outcry in this place, and to Adjournment debates initiated by Labour Members. There was also outcry from the 200,000 workers directly employed by PCTs, who suddenly did not know how much longer they would have a job, or who their employer would be. They did not know whether it would continue to be the PCT, or whether it would be a private sector charity or the voluntary sector. Following some rapid rowing back, the Secretary of State adopted a new position whereby PCTs would move to a commissioning role only as and when they decided to. However, the chief executive of the NHS has not formally withdrawn his reference, contained in his initial letter, to the 2008 deadline by which PCTs should move over fully to a commissioning role. I should be very grateful if the Minister clarified that contradiction.
There is still a lack of clarity as to the future function of our PCTs. However, the rationale behind the new structure seems clear: it is not a one-size-fits-all approach, but a case of "any size, so long as it's bigger". This approach constitutes a move away from the rationale employed during the previous restructuring of PCTs, which took place only three years ago, whereby greater connection was sought with local communities. Only an "any size, so long as it's bigger" rationale can explain why London's PCTs are expected to move from a structure that already provides coterminosity with social services to being even bigger beasts, while Cornwall looks set to have its three PCTs reduced to just one. That is indeed a move towards coterminosity, with local authorities providing social services; then again, the existing structures are under review, so the local authorities may in any event change shape. Their future remains in some doubt.
As if this dog's breakfast were not enough, ambulance trusts are also up for reconfiguration. The intention is not to improve services to the public, but to fit the "any size, so long as it's bigger" mantra by reducing the number of ambulance trusts from 31 to 11.
Ignoring the principle of not fixing things if they are not broken, it seems that even the best-performing ambulance trusts—such as the Staffordshire trust, which has a three-star rating and is the highest performing trust, according to Government targets—are likely to be merged. As Charlotte Atkins said in her earlier intervention, it is not the size of the trust that determines how well it performs—and is there any point in fixing something that is not broken? Surely the emphasis should be on co-operating and sharing best practice with other trusts, rather than on introducing the concept of contestability, which will put trusts in competition with one another.
If the principle is to apply to PCTs and ambulance trusts, SHAs must automatically follow suit, according to the "any size, so long as it's bigger" mantra. They must go through similar upheavals, with the changes to be completed by April 2007.
Does my hon. Friend agree, given her experience in her own area, that PCTs had a difficult task in dealing with rural areas in particular, and that some have made a superb job of it? Mendip PCT, in my area, has really got to grips with delivering primary health care in a rural area. It is a great shame if that is now to be put at risk by reorganisation—by putting the PCT into a bigger structure that simply will not have the same feel or be able to cope with the difficulties of scale associated with rural areas.
I thank my hon. Friend for that contribution, and that is certainly the feedback that I am getting from my constituents. In the past, there has been a very good relationship between the local PCT and the services offered. There is real concern that a move to a bigger authority will lead to the loss of links that have been built up in the past few years, and that that will have a detrimental impact on the services provided. However, only one proposal—for a single primary care trust—has been put forward for consultation, and the argument is that it will provide a more strategic role. If that is the case, why would we continue to need a strategic health authority?
The changes do not stop at PCTs, ambulance trusts and strategic health authorities. Other significant changes will kick in this year, including payment by results, practice-based commissioning and even the new dental contracts, which are all closely interrelated with the changes in the structures. Sir Nigel Crisp was not kidding when he said:
"2006 will be an important transitional year for the NHS."
That is possibly the understatement of the year.
When I talked with the chair of an NHS trust in my constituency last week, the point was made—the Minister made it again today—that this is not a time of evolution for the NHS, but a time of rapid and continual revolution. It is unclear what the NHS will look like when we reach the end of this year. A series of potentially destabilising changes will take place simultaneously in an already uncertain climate, in which a quarter of NHS trusts already have to deal with deficits. The impact of many of the changes, even if taken in isolation, is largely unknown because many have not been properly piloted. There has certainly been no piloting of the possible cumulative impact of the changes.
For example, payment by results will start in the next financial year, but concerns are already being raised about the tariff levels for some operations. In Norway, a system of payment by results was introduced at 60 per cent., not for 100 per cent. of care, and it was seen to create perverse incentives, so it was scaled back to 40 per cent. But this Government think that the best approach is to introduce 100 per cent. payment by results straight off, and damn the consequences—even if that may create even greater financial insecurity and instability for many trusts already struggling with deficits, and even if it will lead to incentives to give every headache patient a CT scan to add to their treatment. Such perverse incentives are like the small butterfly wings flapping that create a hurricane further down the line.
Another example of inadequate piloting before rolling out the changes can be seen in the new dental contract. We will not know what the impact of the new contract will be until it rolls out across the country, but I know from surveying dentists in my constituency that about 75 per cent. are thinking of leaving the NHS altogether as a result. That is another unknown factor to be added to an already unstable and high-risk situation. The changes look increasingly like ingredients for a rushed recipe for disaster.
Why the hurry and impatience from the Government? After all, they have had eight years to formulate a solution. Is it the funding time scale of increased investment in the NHS, and the looming end to increased investment in 2008, that is causing the panic? If the changes are not in place and bedded down by then, is their future success even more in doubt? Or is it the hurry to find those pesky efficiency savings demanded by the Gershon review? If so, it would explain the "any size, so long as it's bigger" rationale.
Will the savings be real, or will many of them be lost in setting up and branding the new structures? Given that many PCT mergers will have to take place in mid financial year, has the Department made any assessment of the extra costs of having to file two separate accounts, or any of the other transition costs that will result from the changes?
It is clear that it is not the wishes of the public that are driving the changes. That is evident from the amount of time given to consultation on the changes—and often from what proposals are put forward for consultation. As I said, in Cornwall only one proposal for a single primary care trust has been put forward for consultation, so there is no choice of options for the local people.
The Secretary of State's own consultation in Birmingham also showed that the Government's priorities for the NHS were not those of the invited public. The citizens summit in Birmingham last year showed that the public were not interested in improving contestability or even the choice agenda—especially in rural areas, where getting to the local hospital is already enough of a struggle for most people. What they were interested in was increased GP opening hours and out-of-hours provision, which the Government did away with in the most recent contract negotiations. Whatever the priorities of the public—indeed, in spite of their needs and priorities—the changes continue to be pushed apace.
The irony is that at the end of all the changes—three upheavals under this Labour Government—we will be back almost exactly where the NHS was when Labour came to power. Bigger primary care trusts will have become like the health authorities, strategic health authorities will be more like the regional authorities that Labour abolished, and GP fundholders will have become practice-based commissioners. What is even more ironic is that the Conservatives oppose the proposals that will take us back to the last days of their Government.
Greater local democratic accountability could provide better mechanisms to reflect and serve local needs and bring the accountability for underperforming trusts closer to home, rather than centralised up to the Secretary of State. Instead of pursuing and pushing forward contestability at all costs, when the regulatory framework is undeveloped and in some cases gives private providers an unfair advantage, surely trusts would be better served through greater co-operation and sharing best practice.
The Health Committee, in a recent report, described the changes that have been undertaken since Labour came to government as an
"ill judged cycle of perpetual change."
This year and future years represent a time of change and an exposure to huge risks for many NHS bodies. That in turn represents great uncertainty for NHS staff and patients alike. It is time for the Department of Health to take greater account of the needs of the public rather than the steamroller of centralised reform, which takes no account of the need for locally accountable bodies to lead locally appropriate reform and locally appropriate provision for our health services. Bigger is certainly not always or automatically better.
I suspect that most hon. Members will want to speak tonight about the reorganisation of the primary care trusts. I must say how good it is to have PCTs in the first place. Most hon. Members will wish to support their local PCT, and I suspect that that support is based on the fact that they are local, because that is their great strength. They are able to focus the NHS on a local area, more accurately assess local need, and receive fair funding provision based on applying the formula to a precise local area. They can also develop good local relationships with GPs, pharmacists, other providers and the voluntary sector. They can be held to account locally by local stakeholders, not least patients and hon. Members.
Waveney PCT, which serves my area, is the best thing that has happened to that area organisationally. However, with the introduction of GP practice-based commissioning, mergers are necessary. In determining the new configuration, we should apply the same principles that I have just given as the benefits of PCTs, so that the merged bodies can effectively focus on and serve a local area. For my area, that has to be a merger between Waveney and Great Yarmouth PCTs.
I have mentioned Great Yarmouth PCT, so I must declare an interest in that my wife works for it. However, my wife long ago gave up calculating what might be the consequences for her of NHS reorganisations in our area, because she has been reorganised four times in the past 10 years. We can all agree that we could do with less reorganisation in the NHS, but my area has had at least one positive result from all the reorganisations we have had, in that clear lessons have been learned about what works and what does not work in the area. We know that county-wide NHS organisation does not work for my constituency, but the Great Yarmouth and Waveney combination does. When we had Suffolk health—
Does my constituency neighbour agree that it is a remarkable fact that the other part of Waveney covered by the PCT is in my constituency, and we agree entirely that it should be amalgamated as he suggests? Did not it take much effort to get the authorities even to allow that alternative to be discussed, and is that not the problem with the consultation?
Before I was elected, the provision of resources under the Suffolk health authority did not meet the needs of my area; we merely received a share of the Suffolk average and the needs and deprivation in our part of the county were not taken into account. That organisation was remote and out of touch. It instituted locality management, but that negated the savings that it claimed would be achieved. We ended up with bad relations between the health authority and the community, and even worse relations between the health authority and the medical professionals.
Fortunately, our Labour Government created Waveney primary care trust. I thought we had won and that we had been delivered from the unbearable. Since the trust was created, Waveney has worked closely with Great Yarmouth, even sharing the same chief executive for a time. Before the last election, it was clear that there would be mergers and everybody in our area expected that the natural merger would be between Great Yarmouth and Waveney. In fact, the strategic health authority encouraged that, recognising the area as a discrete performance unit for things such as the roll-out of the national programme for information technology. When Sir Nigel Crisp's letter arrived last July, asking PCTs to come up with proposals, everybody locally thought that Yarmouth and Waveney was a no-brainer, and the other PCTs in the respective counties were comfortable with that.
Some time last summer, however, another message came from the centre, which seemed to be talking about county-wide PCTs—the proposal that the SHA made to the Secretary of State, despite representations against it. Because of the strength of our cross-party case and the willingness of the Secretary of State to listen, we now have two options, and there is no doubt that the Yarmouth and Waveney proposal is the healthy option. Those neighbouring areas have similar characteristics, including deprivation factors and health inequalities. They are both very different from their respective counties, from which they are relatively isolated. We share the same general hospital—the James Paget hospital, a three-star trust that is about to achieve foundation status. We have a natural health economy; the two PCTs have for some time undertaken joint working on cancer networks, emergency care and the implementation of National Institute for Health and Clinical Excellence policy, and share some services and a director of public health.
Yarmouth and Waveney has sub-regional status in the eastern region, and the Office of the Deputy Prime Minister has recently created an urban regeneration company spanning the two areas, part of whose remit is a public health agenda to overcome deprivation. The company wants to work with a Yarmouth and Waveney PCT rather than dealing with the separate counties. Both trusts are performing well, with two-star ratings—the best in the area. Yarmouth's budget is in balance. Waveney's budget is close to balance, and KPMG concluded that the trust would be out of deficit next year. Most important, the two PCTs work closely with GPs; there is a 100 per cent. sign-up to practice-based commissioning, which will not happen under a county-wide PCT.
A Yarmouth and Waveney PCT would have to work with the two county council social care departments, but that is not a problem. It is already happening; both councils organise their social care on a locality basis, each matching the Yarmouth and the Waveney PCT areas. There is already a strong record of partnership, with joint and developing initiatives, integrated management arrangements and integrated services under section 31 agreements, and each county leads for the other; for example, Norfolk provides social care services for Suffolk at the James Paget hospital. Social care is not a problem, and as those departments become less and less of a provider, patient choice will take patients from my area across the county boundary.
The proposed PCT would be large enough to realise economies of scale. The required savings of 15 per cent. could be made, but the PCT would be sensitive enough to know and meet local needs. However, I question whether, faced with the two options—the one that the SHA put to the Secretary of State and the one that the community and its representatives put to the Secretary of State—the SHA is behaving neutrally. We have some concerns. In the consultation document, the SHA said that the Yarmouth and Waveney option would
"inhibit the development of practice-based commissioning".
The people who know—GPs—wholly contradict that; they say that the county-wide option would inhibit that development. There were questions about size, but smaller PCTs in other parts of the country are proposed as single options. We should not fall foul of the size rule.
"There is no standard, national template. The proposals could be based on large or small PCTs, providing that they deliver what is required locally, including a stronger commissioning capability."
I fear that our SHA has a template based on the county model, so I hope that my hon. Friend will reassure us that that is not the view of the Department or the Secretary of State.
Finally, will my hon. Friend keep faith with local people and their representatives? The option that I have proposed is supported not only by me, my hon. Friend Mr. Wright and Mr. Gummer, but by Waveney district council, Great Yarmouth borough council, the two PCTs, the James Paget Healthcare NHS Trust, the patient and public involvement forum, all the GPs, the Lowestoft and Great Yarmouth urban regeneration company and the local strategic partnerships. It is hard to find anybody locally who does not support the proposal. Will my hon. Friend keep faith with the local community and the medical professionals who serve it? The proposed PCT would be the people's PCT. A Great Yarmouth and Waveney PCT would make the reforms in commissioning a patient-led NHS work, but I fear that if we take the other option those reforms could fail.
I entirely agree with what Mr. Blizzard said, and commend him for it. The joint cross-party arrangements show how strongly we feel. I have to depart from the hon. Gentleman, however, when I talk about the strategic health authority. Five Members of Parliament for Suffolk invited their SHA to answer a series of questions, as you will know, Mr. Deputy Speaker, because you were there. The questions were answered in two ways: the SHA could not help, either because the decision was a Government one or because it was a PCT one.
There was no question to which the SHA replied, "Yes, we can do that." It cannot do anything. There is no known position on which the SHA contributes at all. Unfortunately, it has not done the one thing it should have done—overseeing the PCTs to ensure that they did not get into the debt they are now experiencing. The fact that the SHA was unable to do that shows that SHAs have no purpose whatever.
My PCT is very much in debt, as are all the Suffolk PCTs except Waveney. One of the reasons for that debt is that on average, under the funding formula, for every 100p, we receive 90p, while Manchester receives 124p, yet we have a high proportion of old people. The formula hits us strongly; it is not entirely overspending but underfunding that has contributed to the debt.
The unfortunate changes in the way that the funds are doled out have hit rural areas with large numbers of old people. Because of those numbers we used to receive sufficient funding, but that is no longer the case. Labour Members say that we do not have the hospital closures that used to take place, but there are two in my constituency: a full closure in Felixstowe and a half-closure in Aldeburgh. That has happened since the election.
Interestingly enough, before the election, we were told that a reorganisation would take place and a perfectly reasonable plan was proposed that would improve patient care. I supported that plan. I took the chair of the meeting to encourage people who had doubts about it that that was the reasonable thing to do. Immediately after the election, it was announced that that plan was no good and that those involved had found a new model of patient care. That happened in two months—it was a very clever, speedy change—and during that time, the PCT announced that their new model patient plan involved the closure of one hospital and the halving of the other. That was an interesting decision, but we were told that it had nothing to do with money or the general election. I found that most of my constituents were unable to take that quite as literally as it was put.
The problem is that my constituents see a model of care that makes the NHS in my area worse than it has been for 30 years. So I thought that I would ask the Minister a series of simple questions. About a fortnight ago, I asked when the financial and management specialist team would report its findings. I just asked for the date. The answer from the Minister of State, Department of Health, Ms Winterton was:
"I shall reply to the hon. Member as soon as possible."
I then asked how many people made up the team and how many days they spent investigating, and the answer was:
"I shall reply to the hon. Member as soon as possible."
I then asked what representative bodies the group discussed things with, and the answer was:
"I shall reply to the hon. Member as soon as possible."
I then asked the Secretary of State for Health:
"what sanctions are available to her against a primary care trust and its board members should poor administration be found by the financial and management specialist team."
Anyone would think that she ought to know that, but the answer was:
"I shall reply to the hon. Member as soon as possible."
I then asked:
"will she require the NHS Appointments Commission to change its policy of reappointing chairmen and non-executive members of primary care trust boards where those appointees have presided over trusts that are failing or under investigation."
The answer was:
"I shall reply to the hon. Member as soon as possible."
The Minister could have said, "Yes," "No," or, "I'm thinking about it"—but no, there is the same cursory attitude to Members of Parliament who seek information as there is to local people when they go in for consultation. The consultations are a sham, and the only intention is to reach the same conclusion as the Government have decided on anyway. To reappoint to my failing PCT the same people who have presided over the debts, which must now be paid by patients in my constituency, is a scandal.
My right hon. Friend says that the consultation process is a sham. Huntingdonshire PCT has already been informed that some £12 million to £13 million will be taken away from its budget in the 2006–07 financial year. Does he agree that that clearly reflects the fact that this is a sham?
I cannot speak about Huntingdonshire, but it is clearly a sham when we always have the same answers. Let us take the regionalisation of the ambulance service. Is it not amazing? We ask those in the charge of the police, and curiously enough, they suggest the regions as the natural way of policing. We ask people about the fire service, and curiously enough, a whole lot of other people make exactly the same proposal—that for the fire service, the region is the ideal unit. We then ask the ambulance people—well, we do not ask too many of them, but we ask those who might come to an answer—and what do they say? Surprisingly enough, they think that the regions are the answer. We then to the SHA, and it says that regions are the answer. Regions are the answer because the Government want them to be the answer, not because anyone inside those organisations thinks so.
I agree with what my hon. Friend said during the rest of his speech as well, which was that we should at least listen to the ambulance trusts and to others around them. It all seems very peculiar, when none of the ambulance trusts have campaigned for regional operation.
I then asked the Minister about dentists. I said that I could not find any dentists for my constituents in the southern part of my constituency and asked him to tell me where they could be found. He sent a letter back and said, "I rang up NHS Direct and here is a series of dentists." I looked at them. Half of them no longer took NHS patients or had closed their books, and the other half of them were in Frinton. He had not noticed that there is a river between us and Frinton, so instead of the dentists being 10 miles away, they were 45 miles away, unless people can swim. That shows the Government's understanding of my locality. It was a rude letter, too, because it suggests that I could have found out the information for myself—and I probably should have done that, given the sense and intelligence of the answers that I received from the Government.
The Government are now going back to the same pattern as the one that they abolished three years ago in many of the areas that they are talking about. As was suggested by Julia Goldsworthy, who spoke for the Liberal party, the Government are demanding "anything, so long as it's bigger"—I am not sure that she is quite right—unless they can make it a region, when the region is the answer.
The Government are also demanding that we should take seriously their definition of PCTs. PCTs are nothing other than the creatures of the Secretary of State, but she is busy pretending that if the PCT loses money, it is nothing do with her, nothing to do with the control from the centre and nothing to do with the SHA. She says that that is to do with the PCTs. So the Government reappoint the people who made the mistake and fine the locality for the mistake that has been made, because those sums must be found in so short a time that no sane organisation would possibly consider doing so.
I thought that I would find out whether any Minister at the Department of Health had ever run a large organisation, and I find that none of them has done so. There is not a chief executive of any major company, nor even a chief executive of a Government organisation among them. All they have run are things that other people have decided on, and they are now asking us to believe that we should blame the PCTs for the mistakes that have been made by central Government, when those mistakes have been made necessary because central Government have fiddled the funding formula, so that in many areas, particularly in the south and south-east, we are underfunded.
We are therefore asked to be serious about consultation. My local PCT has now consulted on three separate ways to deal with the problems of my constituency in less than 18 months, each of which is dramatically different, and we are told that each has been proposed entirely for clinical reasons. I do not believe that; no one in Suffolk believes it; not even the local Labour party believes it. The only person who does believe it is Chris Mole, who is looking for a job. No one else believes it.
I therefore went to see the Minister of State, the hon. Member for Doncaster, Central—a person whom I respect—and she turned half way through the meeting to the SHA representative and said, "Well, none of these new changes will come in until they're ready, and when they're ready and they take over, then we'll close the hospitals." She was told, "Oh no, you're wrong, Minister: we close the hospitals first, because we haven't got the money to make the changes."
What are the changes? They are to ask for care in the community. We still do not have sufficient people to carry out care in the community now, without the changes. There are no more people to do that work in Felixstowe and Aldeburgh and along the coast that I represent—and if I may say so, Mr. Deputy Speaker, as you are unable to speak, in your constituency next door exactly the same is true. Those who can pay cannot find people to do that work, and we must try to pretend that the poor in my constituency should be faced with an inferior service because money must be saved to pay for debts that now stretch back for years.
I find it impossible to take seriously the Government on the health service. Those of us who represent constituencies such as mine know that the Government have presided over the worst changes to the health service that we can remember. I have represented my constituency for nearly 30 years, and now know that the health service that the Government leave will be significantly worse than the one that I was able to welcome when I was first elected to the House.
I did not really take seriously what Mr. Gummer said. I remember when he was Minister of Agriculture, Fisheries and Food and his Department was a shambles. I was surprised that he said that there had been no improvement. Anyone who has been a Member of the House for any period of time—new Members can be forgiven—will remember the letters that we got about waits for hip replacements of two, three or four years. That does not happen anymore. Although we have a problem with dentists, there have been massive improvements. When people ask where the money has gone and why productivity has not increased, the answer is simple: a lot of money had to be used to pay the staff a decent salary because they were underpaid under the Conservative Government—I sometimes wish that the staff would remember that, too. The reality is that we now have a lot more nurses and consultants.
I welcome the opportunity for the debate that the Conservatives have given us, although they cannot be taken seriously because when we debated extra money for the NHS—the penny on national insurance—they voted against it. Conservative Members may say that their PCTs are in trouble, but they really would have been in trouble if the Conservatives had won that vote.
Does my hon. Friend agree that Conservative Members have a brass neck when it comes to talking about changing the NHS? He has been a Member for longer than me. Does he remember the hugely expensive chaos that was caused by so-called general management, when our area got the manager of a biscuit company to run the NHS? The family practitioner committee became the family health services authority, and that authority amalgamated with the district health authority. The district health authority was then split between three provider trusts and a commissioning health authority, but the commissioning function was then divided between a health authority and a family health services authority. Are we not hearing absolute doublespeak from Conservative Members?
I remember that well. My only caveat is that the biggest employer in my constituency is a biscuit factory and its manager is very good.
I would like to talk about the situation in the north-west and Cumbria. I must say from the outset that we have had too many reorganisations, so I hope that we get this one right. I was a young member of a city council back in 1972 when the ambulance service was part of the local authority, but I do not know whether Conservative Members advocate going back to that situation. Of course, the service was then taken into the health authority, but we must have had eight or nine serious reorganisations since then. I agree that reform is needed because last time it happened in our area, it was not done very well.
While the hon. Gentleman is talking about massive changes due to reform, is he aware that Essex strategic health authority is trying to remove the excellent cancer centre from Southend hospital? Does he agree that there can be too much change to, and meddling with, NHS structures without any clear purpose or evidence that it will improve service levels and outcomes, which should be our aim?
The hon. Gentleman wanted to get that in. I have got to know him well over the years and suggest that one reason why he lost his seat at one election was the way in which the Conservatives ran the NHS.
Let me come back to the serious problems caused by reorganisation in Cumbria. In 2002, I wrote a letter to the chief executive of the North Cumbria health authority, who has now retired. I said that the proposals being put forward for my area—Julia Goldsworthy used this term—were a "dog's dinner".
My hon. Friend is right.
I said at the time that it was nonsense to create three PCTs in the area of north Cumbria, which used to be Cumberland, for its population of 350,000, but that was what happened. One of the PCTs covered fewer than 70,000 people. All the other north Cumbria Members disagreed with me, as did all the district councils and the county council, but in 18 months, instead of having three management teams, it was decided that there would be one management team and three trusts. We thus have the nonsense at the moment of having three chairs of trusts—one for west Cumbria, one for Carlisle and one for Eden—and those trusts' non-executive members, but one management team. It cost millions of pounds to make the change, but it caused tremendous confusion about which PCT was responsible for which service because, for example, Carlisle and District PCT could end up being responsible for services in west Cumbria. That is why I support the reorganisation.
Cumbria and Lancashire strategic health authority has come up with a solution, but unfortunately it is not the easy one, which would be to keep Morecambe Bay PCT, which is working well and covers the south of the county and part of Lancashire, and create one PCT for north Cumbria. Instead, it has decided to use the county boundaries and go for a county-wide PCT. I accept from Conservative Members that that is basically what the Government want, rather than a reasonable rationale.
Anyone who knows Cumbria will realise that it is vast. Its two centres of population are my constituency of Carlisle and Barrow-in-Furness. Those places are 90 miles apart and have little to do with each other, yet it is suggested that we create one PCT for the area. However, everyone knows that two-tier local government is to be reformed, so we could end up in three years—this is a 50:50 bet—having created a PCT for Cumbria that is not conterminous with the new local government boundaries, which would not make any sense.
The Home Secretary announced yesterday that Cumbria is not really that important because its police service will be in with that of Lancashire—I do not have major worries about that. The ambulance service will be merged, too. I have been to see the chair of my local ambulance trust and the chair of the control. They are not concerned because they believe that being part of a big consortium will create greater buying power, so the service will be able to get the equipment that it has been lacking under the present scheme and thus be brought up to the standard that exists in the rest of the north-west. I do not buy the idea that there is an issue about mergers. If it was left to some hon. Members, we would still have the old county borough of Carlisle ambulance station. We have to think about saving money.
We need a PCT in the north of Cumbria and the one at Morecambe bay. We also need—this was mentioned by my hon. Friend Mr. Wills, who is no longer in his place—to take that process further. The acute trust should manage the community services and, eventually, the social services. We should have a care trust in the north of the county. That works well, as a pilot scheme in Northumberland has shown.
We will end up with another unsatisfactory situation, and we will reorganise again. We do not want any more reorganisation. It is not necessary; it costs money and on many an occasion it has cost us talented people.
The right hon. Member for Suffolk, Coastal mentioned the problem of rural areas. In north Cumbria, the population determines that we have one district general hospital, but because of the geography, that population is split between Carlisle and the west coast, so we need two. We find it very difficult to manage with the moneys that are available. Governments of both parties have ignored that. There used to be a thing called the RAWP, or resource allocation working party, formula—only two people understood it, and one of them was mad—and that never gave us adequate money. We welcome the extra resources from the Government, but I feel, and I may be alone among north Cumbria's MPs, that they have got it wrong. I felt that last time, and I was right then.
I am not here tonight to talk about the South Staffordshire PCT; I am here to talk about the merger of the Staffordshire ambulance service. A few months ago, a friend of mine, a youngish guy, went jogging round Whittington, a village in my constituency. He felt sick. He did not know what was wrong with him. He went home, took a shower and started feeling worse. He went downstairs and suddenly thought, "There's something seriously wrong." He dialled 999 and then collapsed.
All Staffordshire ambulance service staff are paramedics; in fact, the service was the first in the United Kingdom to employ paramedics. The ambulances are strategically placed, controlled by global positioning system satellites, which Staffordshire was also the first to introduce. So the ambulance arrived within five minutes, and the paramedics defibrillated my friend. They gave him an injection of decoagulants and he was taken to Burton hospital; he survived. If that had happened in the west midlands, he would undoubtedly have died. The simple fact is that the response times in the west midlands are far worse than those in Staffordshire. In fact, Staffordshire enjoys the fastest response times not just in the United Kingdom but in the whole European Union.
The hon. Gentleman is absolutely right. In fact, the service's use of those drugs is beyond the normal clinical protocols for the national ambulance services. Staffordshire ambulance service can also provide angioplasty, and through cardiac enzyme testing, which is generally not available elsewhere, it can manage patients with chest pain who are not transported to hospital. There is even a cooling protocol for those with post-cardiac arrest, to stop brain damage and other tissue damage. That is unique, yet the Government, either wittingly or unwittingly, are to destroy it.
The response to life-threatening emergencies within eight minutes in Staffordshire is a staggering 88 per cent. The NHS average is only 75 per cent. In the east midlands, where there has been a merged ambulance service, it is only 75 per cent. These are Department of Health figures. For category B, which are serious emergency call-outs, in Staffordshire the response is within eight minutes 85 per cent. of the time. In the west midlands it is only 46 per cent. of the time, and in the east midlands, the model for a regional system of ambulance services, it is only 27 per cent. of the time. Any doctor will tell you that time is life. There is a golden period in which, perhaps, someone can be rescued from death. The Staffordshire ambulance service succeeds in that while other ambulance services fail.
I suspect that the Minister will say that, if Staffordshire ambulance service is merged with the west midlands, standards throughout will be raised. I do not think so, and nor does the board of the Staffordshire ambulance service. Members of the board say:
"Our concerns are that there is little, if anything, in the documents to explain how high performance will be protected.
Staffordshire consistently responds quicker, saves more lives from cardiac arrest and heart attacks and operates a cheaper response to emergency patients.
Discussions within the West Midlands region lead us to feel more, not less, alarmed at the prospects of standards falling, and of lives being lost which otherwise would have been saved."
All of us as Members of Parliament have a duty of care to our constituents. What can be more important than standing up in this House and trying to do something to stop the unnecessary loss of our constituents' lives? Amazingly, it is estimated that, if other ambulance services adopted the practice of the Staffordshire ambulance service, some 3,000 extra lives a year in the United Kingdom could be saved.
Yet, are the Government saying, "Yes, we will preserve the Staffordshire ambulance service and we will use its protocols across other services"? No, they are not. The Minister gave it away in her introductory speech. She said that the object of the exercise is to provide a regional-based system—but why? If it were a regional-based system that could improve response times, that would be fine by me. I would not care if a regional system were best. If it were larger than a region, that would be fine. I am interested in only one thing, and that is a better service for my constituents. What is clear from looking at the east midlands model and from listening to the professionals in Staffordshire and, indeed, in Birmingham and the west midlands as a whole, is that the fine, high standards maintained in Staffordshire would be lost, and that that would result in lives being lost in Staffordshire and elsewhere.
The irony is that the Government may be concerned solely with saving money, but Staffordshire ambulance service is the most cost-effective service in the country. It says:
"To our knowledge, there are no services of the proposed size anywhere in the world that achieve high performance" as the Staffordshire ambulance service does. We should be rejoicing in this Chamber; the Minister should be saying, "We are proud as a Government that we have achieved that in Staffordshire, and we want to repeat it elsewhere." The Staffordshire ambulance service goes on to say:
"We would argue that the creation of eleven regional services is not only a step too far, too soon, but a barrier to high performance."
The figures are clear; the lives saved are indisputable. If the Staffordshire ambulance service is merged with the west midlands, lives will be lost. They will be unnecessarily lost and this Government will be to blame.
After listening to the two opening Opposition Back-Bench speeches—that of Mr. Gummer and the moving contribution of Michael Fabricant—I hope that the Minister will not groan at a similar refrain in the latest instalment from Staffordshire.
From previous plain-speaking encounters, the Minister and the Secretary of State will be well aware of what a prickly subject ambulances and PCTs are in my constituency and the whole of our county. However, like my hon. Friend Mr. Martlew, before I come to the thorny issues I will accentuate the positive. I shall not reel off reams of statistics, but spending on the NHS in north Staffordshire has almost doubled since 1997. Like for like, it has increased from £267 million in 1997 to £521 million today—a 95 per cent. increase. There is not a single MP who has not seen the benefits of such investment through their constituency casework—shorter waiting lists, fewer complaints about delays in treatment and even the odd thank-you once in a while.
In north Staffordshire, we also have a new medical school in partnership with Keele university. New health centres are bringing better NHS care right to people's doorsteps in Newcastle, as elsewhere in the country. Of course, not everything in the garden is rosy. Like any company, a huge organisation such as the NHS always faces challenges in managing that investment, not least in the face of constant organisational change. The PCTs in my area and the university hospital of north Staffordshire face varying degrees of deficit, despite the increase in spending. That is a pressing management issue but it is important to keep the scale of the problems in perspective. There should be no short-term panic measures conflicting with investment to meet long-term need.
In our area, we were happy to hear from the new management at the hospital last week that plans for our brand-new hospital remain on track—and rightly so, if I may be partisan for a moment as we approach the 100th anniversary of the parliamentary Labour party. The hospital is the single most important investment ever promised by a Labour Government to an area that has stuck with Labour through lean and fallow, through thick and thin.
Aside from painful decisions about costs and deficits, there is little more disruptive and demoralising than constant, continual reorganisation, not least when the benefits are unproven, the perception is of change for change's sake, and the end result may be a reduction in standards, a loss of responsiveness and a more impersonal service in our much-envied NHS. That is where we stand in Staffordshire in respect of proposals to merge the county ambulance service into one super-organisation in the west midlands covering over 5 million people and over 6,000 square miles in all.
My hon. Friend Charlotte Atkins, as well as the hon. Member for Lichfield, referred to the ambulance service. My hon. Friend and neighbour has done sterling work in leading the call for the Staffordshire ambulance service to remain just as it is. She is representing the concerns of her constituents in the border towns and villages of the most northerly part of the west midlands region about a reorganisation that will see yet another HQ based in Birmingham.
Those concerns about local responsiveness are shared by people in my border villages—I will be in hot water if I do not name them all—Audley, Bignall End, Wood Lane, Halmer End, Alsagers Bank, Scot Hay, Miles Green, Betley, Balterley and Wrinehill in the constituency of Newcastle-under-Lyme. Over 3,000 residents from the villages signed a petition that I presented to the Secretary of State before Christmas. Many of them turned out last night, too, at a packed public consultation meeting in Newcastle about the changes, to support the continued operational independence at the very least of the Staffordshire ambulance service. That is a political translation of, "Hands off our ambulances."
I shall not repeat all the arguments made so well by my hon. Friend and neighbour, but I shall give one short anecdotal example, not necessarily to compete with the hon. Member for Lichfield, but to exemplify the common-sense concerns that people have. Fortunately, I have had the need to call an ambulance only twice in my life. The first time was at a funeral in Newcastle about two years ago, when the emotion was too much for one elderly person. He collapsed with a heart attack. I and other people called 999 and got straight through. The ambulance, stationed on a street corner, arrived within four minutes and the paramedics undoubtedly saved his life.
The second occasion was for an emergency with my family here in London before Christmas. In the early hours of the morning, I called the London ambulance brigade not once, not twice, but three times. Each time, I was held up at the call centre with the same pre-recorded message: "We apologise. We are experiencing unprecedented demand for our services." When I got through the third time, the operator told me that they had no record of the first two calls—"Probably because we get so many hoaxes," she said. The air, I am afraid to say, by this time was blue. That is one of the reasons that I have not complained. I would be very embarrassed to listen to the tape recordings. We got to the hospital eventually by minicab. I know that that night, the London ambulance service did not return calls to my mobile and no ambulance ever arrived at my house.
I cannot draw conclusions from one experience, but I can well understand from that experience the plain, everyday concerns of local people in Staffordshire. Those concerns are heightened by the fact that, despite the widespread campaign in the west midlands by our strategic health authority, there is only one option on the table in this consultation, and we are all politicians enough to know what a shortlist of one really means. We need guarantees about the operational independence of Staffordshire ambulance service.
Primary care trusts are the bodies that we set up just over three years ago to make the NHS more local, more responsive and therefore, in everyday terms, more efficient in meeting local needs. Here, I am glad to say that we have had more success, with the Department's help, in making the consultation more meaningful. Instead of just one option, we have two: one for the whole of Staffordshire bar Stoke-on-Trent and one, bringing me even closer in my tryst with my hon. Friend the Member for Staffordshire, Moorlands, for a merger of our two local PCTs.
That was not arrived at without a struggle—a bare-knuckle fight would be a better description. I must acknowledge the help of Ministers in the Department, who had to remind the SHA of its duty to be fair and balanced in consultation. Nevertheless, as appeared to be the case in Waveney and Great Yarmouth, it had to be dragged kicking and screaming. It was not good enough to sing the praises of option 1—the super-sized approach—while adding a grudging PS in the first draft of the document: "By the way, here's option 2, which all the local people, voluntary groups, professionals and medics in north Staffordshire support, but we think is rubbish."
I hope that that is not the end of it. Colleagues in the south and east of the county are also balking at being thrown into one super-PCT, and we will support them as they develop their proposals. One of the non-sequiturs used by the proponents of a super-sized PCT for the whole of Staffordshire is that outside the northern sub-region, which is identifiable in its need, there is no coherent health community. That is clearly designed to set one part of the county against another. It is, of course, patent nonsense to suggest that it is better to have one super-sized PCT covering 782,000 people—by far the biggest in the west midlands—that would then have even less in common as regards health needs. When the consultation is finished, I urge Ministers to reject that sort of reasoning and likewise to reject redrawing the NHS simply for the administrative convenience of the officials concerned.
Much has been made, without any evidence, of the benefits of coterminosity on our patch—that is, the alignment of the PCT and county social service boundaries. My hon. Friend the Member for Carlisle mentioned the local government White Paper due this summer, which may mean that coterminosity is a transient concept. From my experience, I wish that Staffordshire social services was shaken up to be just as responsive as my local PCT. That is what the county now says that it is going to do by restructuring it to follow our district boundaries. That remains to be done. The county still has to prove that it can get it right. To use that to justify shuffling the NHS furniture into one super-sized option at the same time defies common sense, particularly given that the PCTs in Newcastle and Moorlands already work well together, and with Stoke. They are getting things right, yet follow two discrete district boundaries.
Other claims have been made for a single PCT, but again without evidence. First, it is said that, by being bigger, it will assist the new practice-based commissioning. There are smaller PCTs in the region and that argument of convenience simply does not hold water. Secondly, it is said that a super-sized option will save on the costs of bureaucracy. That is unproven. The SHA, unable to produce the costings, has recently admitted that the two options would be financially neutral.
That brings me to my concluding observation about the driving force behind the reorganisation—cost savings. Of course we must direct more resources to the front line—we made a manifesto commitment to save £250 million through "further streamlining"—but we must do it intelligently. It is not good enough simply to shake up SHAs, PCTs and ambulance services and say to each of them, "This is your £X million share of the cost savings to bear." It is not good enough for our regional health authority to say from on high, "This is the only option." Like other Members, my target has been the approach adopted by the SHA. I am grateful for the help that has been given by the Department in the consultation on PCTs. On that basis, I will support the Government tonight, but they must continue to listen and learn from the profound concerns that have been expressed throughout this debate.
I echo the sentiments that were ably expressed by my hon. Friend Mr. O'Brien in saying that the NHS is of course a patient-centred organisation—he paid tribute, as I do, to the wonderful work that is done by the nurses, doctors and ancillary workers in our hospitals. I myself spent some time working as a porter in West Suffolk hospital, and I saw the professionalism and good humour of those who work magnificently in our NHS. I emphasise that point because people who work so ably and selflessly in the NHS in Suffolk are under massive pressure and subject to great anxiety because of a crisis in funding and an implosion in some of the services.
Before I became a Member of Parliament in 1992, there was a West Suffolk health authority. We were told that a pan-Suffolk health authority was essential on the grounds of economies of scale, procurement, minimising overlapping and so on. Somehow it was deemed to be the right way to go. A few years ago, we were told that that was all wrong and that we had to have primary care trusts because decisions had to be made more locally and be more attuned to the circumstances of the area. They had to be made closer to the patient.However, a huge error was made. In a county the size of Suffolk, which has a population of only 683,000, no fewer than five PCTs were created, all with expensive chief executives and staff, despite the opposition of Members of Parliament, councillors and health professionals. The Government ignored all their advice. The PCTs were introduced in 2002 and we were told that it would take 18 months to assimilate the reforms. We were supposed to experience the benefits only 18 months afterwards. I say with great regret that there have been few benefits.
The new proposals go full circle, back to a pan-Suffolk health authority. Goodness knows the amount of taxpayers' money that has been wasted in getting back to the future, but the problem is not organisational. As we know from the consultation process, which has elicited responses from throughout the county, the problem is the operation of the funding formula. The Under-Secretary shakes his head, so I shall spell out the matter clearly.
After the first change was made in 1998, I went to the then Secretary of State for Health and pointed out its likely effect on rural areas, especially those with an ageing population. Since 2001, no fewer than four changes have taken place. Suffolk West PCT has the third worst audited deficit in the country and is £13.7 million in debt. West Suffolk hospital, the biggest hospital in the area, is running a deficit of £11.3 million this financial year. The total deficit in the county of Suffolk is £35 million. For the strategic health authority area, it is a gargantuan £85 million. That is the heart of the problem and it springs substantially from the change in the formula for NHS per capita spending, which has discriminated against an essentially rural area with an ageing population. No organisational changes in the county will remedy that.
If the figures sound abstract, I point out that, even in the midst of the consultation process, no fewer than 55 beds have been removed from the West Suffolk hospital in the past few months and 260 staff—15 per cent. of the total—have lost their jobs. Hospitals throughout the county—in Ipswich, Bury St. Edmunds or, indeed, Addenbrookes hospital—are permanently on red or black alert. The position is therefore serious.
We held a meeting here with the strategic health authority—the body that is charged with overseeing the finances of the PCTs—at the beginning of 2005. There was complete complacency in that meeting. The Members of Parliament present understood what was going on, but the SHA representatives seemed to have no grip of the situation. How could that be? Their function was inexplicable to all of us.
By June, the SHA had a new chief executive because the previous one resigned, as did the chairman. When its representatives came up to the House of Commons, their attitude was that we Members of Parliament were being somewhat hysterical, and that the problem that concerned us so much did not exist. However, they had changed their tune when we had another meeting last month. There was a sense of desperation in the SHA management, amid concerns that it might not be possible for Suffolk's NHS trusts even to meet their national insurance and tax liabilities.
As the SHA has overseen the development of such problems, my colleagues on the Front Bench are right that it should be abolished. It has no clear function whatsoever. The SHA's chief executive earns £145,000 a year, and the directors of performance and of service modernisation—what a wonderful euphemism—both earn more than £100,000. Its clinical director gets £150,000 and the chief executive of the work force development confederation £100,000. If those people are being paid such sums to look after three counties, goodness knows what will happen if their responsibilities extend to six. Will they get a proportionate increase in pay? It is no wonder that people feel that the NHS is being undermined by a level of expensive bureaucracy that is not appropriate for its task.
Suffolk is a rural county, and my constituency of West Suffolk gets £1,156 per capita in health service funding. The Prime Minister's constituency gets £1,576, and the Secretary of State's Leicester, West constituency gets £1,428. The Minister of State's constituency, Doncaster, Central, gets £1,489, while the national average is £1,388. If the county of Suffolk received even the national average, we would not be facing the current crisis. The same is true right across the south and south-east of the country.
Of course I accept that there have been medical improvements and huge technological advances over the past few years. That has happened continuously since the NHS was created after the war, but the cuts being made are unprecedented. The White Paper mentions various much cherished and valuable community services but they are now under threat, with rehabilitation beds already being closed down.
The Minister who is to wind up the debate may think that I am exaggerating, but I can tell him that the clergy in and around my constituency have been organising petitions. They are anxious about NHS provision in the area and about the stories that their parishioners tell them. The state of the health service is such that they feel compelled to place petitions about it in their churches and places of worship. The situation is terrible.
Amalgamation may offer some managerial advantage, but the Government must address the problem of funding and deal with the dead hand of the SHAs by abolishing them. Unless those steps are taken, the NHS will never deliver proper value. That will have consequences for the people in our communities who want the service to work and to succeed, and who are hugely disappointed that it is failing to do so in wide swathes of the country.
I shall deal in turn with the issues of PCTs, SHAs and the ambulance service, but I want to begin with a few general comments. We in this House agree that we must ensure that NHS funding is used most effectively on the front line, but we must also accept that we cannot preserve the service in aspic.
At the risk of mixing my metaphors and similes, we might compare the NHS with a supertanker. A vessel that is so big can turn only very slowly, and in the same way change in the NHS must involve many incremental alterations. I shall offer another illustration: if the NHS were a country, the size of its budget means that it would bear comparison with Poland. It is important that we recognise that the NHS needs to change; the question is how those changes are brought about and implemented. We also need quality management and good administrators in the NHS, and we need to value those support staff. Equally, we need to test every pound that goes into the health service to ensure that we get best value for patients.
The Conservatives devalue some of their arguments by suggesting that everything in the NHS was wonderful before 1997, and that it has all become terrible since then. That is contradicted by the Fenton health centre, which has just been opened in my constituency, and by the Willow Bank surgery, which opened about a year ago in Longton. It is also contradicted by all the additional doctors and nurses that we now have.
Does the hon. Gentleman acknowledge that between 1979 and 1997, there was a 64 per cent. real-terms increase in funding for the NHS, and that £1 million was spent on a capital project in the NHS for every week of every year of that Conservative Government?
I am grateful to the hon. Gentleman for that interesting intervention. The revenues from North sea oil would have funded a new hospital roughly every week during that time, yet there were no new hospitals built until we came into Government. Constituencies such as mine saw no infrastructure changes of any note in the period that the hon. Gentleman mentioned. My hon. Friend Paul Farrelly made the point that there has been a 95 per cent. increase in NHS funding in the past few years, thanks to the new investment that is going in. It is disingenuous of the Conservatives to suggest that everything was perfect before 1997 but not since; the opposite is in fact the case.
There are two primary care trusts in Stoke-on-Trent—North Stoke and South Stoke. They were, de facto, merging; they were working together more closely all the time. To suggest having a single PCT for the whole city therefore makes a lot of sense. It is simply making a reality of what was happening anyway. I pay tribute to the work of my hon. Friend Charlotte Atkins on these issues, but there is still a lot of work to be done to ensure that the appropriate options are put in place for the rest of Staffordshire and that they are able to be introduced.
We need to recognise, however, that the existing system is not the most effective. The Donna Louise Trust, the children's hospice in my constituency about which I have lobbied the Under-Secretary of State for Health, my hon. Friend Mr. Byrne, is a perfect example of primary care trusts not working together collectively. In that instance, a smaller number of PCTs might have the clout to do more.
That brings me to the subject of strategic health authorities. The system of consultation has not been open or accessible to the people of Staffordshire; it has not been working. The SHA in charge of putting that consultation system together has done a splendid job, if I can put it like that, of obfuscating and making a mess of the whole thing. If that is its role, heaven help us, but I hope that it will have a much more positive one in future. One such role might be in the managing and integration of services, involving not only the PCTs but social services in coterminous areas. The SHA could have a role to play there.
No, I think that the opposite is the case. In north Staffordshire at the moment, there are about a dozen primary care trusts going off in all directions. However, a much smaller number would be able to focus much more closely on a hospice such as the Donna Louise Trust, for example, and address its funding in a much more focused way.
Widening SHA areas to a regional authority area would resolve some serious anomalies. In my area of west Lancashire, for instance, PCTs are responsible to the Cumbria and Lancashire SHA, while the hospitals are responsible to the Cheshire and Merseyside SHA, which is an absolute nonsense. The reality is that the challenge for the Government is to make PCTs big enough to be strong commissioners and for there to be a tension in the system, and small enough to be absolutely responsive to the needs of local areas. The size of an organisation should not be easily dismissed.
I am grateful for that intervention, as it brings me to the point made by Julia Goldsworthy about the idea that one size is okay as long as it is bigger. That is not what this is about. The issue is not one size; it is what is an appropriate size for merging PCTs. I hope that the consultation, once the SHAs get their paws off it, will be about making sure that PCTs are the right size for the localities concerned.
I would love to have the data to hand to be able to give the answer to that question. The hon. Lady's comment has no doubt been heard by my hon. Friend the Minister.
I am conscious of the ever-ticking clock. Before I move on to the ambulance service, however, I want to refer to a telling point that was made to me about three years ago by someone who was at that time a manager in the health service, and that relates to my observation about the comments of Opposition Members that everything was rosy up to 1997. That point was that NHS managers had for so many years been used to try to save money, cut budgets and reduce funding, that they did not necessarily have the expertise to apply the huge amount of money that they were suddenly given. I hope that my hon. Friend the Minister will return to that point in her wind-up.
Many comments have been made about the ambulance service. Michael Fabricant and some of my hon. Friends have rehearsed the arguments in relation to Staffordshire very well. A couple of points have not been mentioned. As everyone knows, the M6, which has perhaps more cars on it than any other road in western Europe, gets very congested from time to time, notably on Friday evenings. It only takes a fairly small incident for the motorway to become closed. Frequently, when it is closed or subject to huge delays, some drivers using that motorway are taken ill. One of the things that the Staffordshire ambulance service has been used for in the past—which, as I understand it, it would not be able to do under the proposals—is ferrying off the motorway people who have been taken ill or diabetics who must eat at certain times of the day and suddenly find themselves stuck in traffic for three or four hours and not able to eat. They can be moved off the motorway to a place where they can receive suitable treatment or be treated at the roadside. That is an important role, which shows the innovation and dedication in Staffordshire ambulance service.
Comments were also made about fast access and survival rates. In certain parts of the country—I will not name them, for fear of upsetting residents of those areas—if someone is taken ill with something like a heart attack, he or she has no chance of survival because the ambulance services there do not bring anybody to hospital alive in such circumstances, whereas in Staffordshire one has a very good chance of survival.
I am listening intently to the hon. Gentleman's eloquent speech expressing his sincerely held beliefs. Does he agree that one of the problems with the mergers is that we have had, in effect, phoney consultations? In my area of the eastern region, under the auspices of the NHS Appointments Commission, a chairman's post was advertised a full nine weeks before the public consultation ends. Does he not agree that that undermines public confidence in the efficacy of such public consultation?
The clock ticks ever faster, but I am sure that those comments have been heard.
Today the Staffordshire Sentinel reported that the chief executive of the local ambulance service had suggested that he should form a private company. No doubt that would pose ideological problems for some Members, who would not want a private sector organisation to be funded through the NHS, although it had done such a fantastic job in the past. That would cause some angst to us on the Labour Benches.
In principle, it is not necessarily a bad idea to merge ambulance services, because in some areas best practice could be shared. What the west midlands does not want is to lose the fantastic service provided in Staffordshire for something that will not be as good. If the reverse were happening and Staffordshire were the dominant area, that would be better.
I am grateful to have been called because I feel very deeply about the issue.
The Government frequently say that they want a patient-led NHS. The consultation document in my area on the mergers of PCTs bears the sub-heading "Ensuring a patient-led NHS". My understanding of that phrase seems rather different from the Government's. It is a glib phrase that sounds good, but to me it really means something: it means that the views of patients and the public are listened to, valued and acted on. Those views should be picked up from a wide variety of sources—independent patient groups, independent patient forums, GP practice participation groups, overview and scrutiny committees and—as the Minister said—health professionals, who have the closest contact with patients.
To be fair to the Government, they have tried to listen to people. They organised a large listening event in Birmingham—a 1,000-person citizens summit. However, I have seen some of the questions that were submitted to the summit. They were loaded—they expected only the answer that the Government wanted. One question, about the shifting of care, asked
"To what extent do you support or oppose providing more services closer to home including community hospitals, if this means that some larger hospitals concentrate on specialist services and some merge or close?"
Of course, not many would vote against that proposal, but if people had been given the extra information that in losing those hospitals they would probably lose their local accident and emergency departments, the answer would have been very different.
If ever there was a top-down proposal, this is it. It is the very antithesis of a patient-led decision. It is the Department of Health leaning on strategic health authorities, which are leaning on the trusts beneath them to do, in effect, the Government's bidding for reasons that are largely financial and—as the Health Committee's report shows—open to very serious question. We should think of the 19 or 20 SHA chief executives and the 200 or so PCT chief executives who are likely to lose their jobs. They are like turkeys planning for Christmas. How can they plan for the future when they know that they are not part of it? How can they be accountable for what they are planning when they are no longer there?
Incidentally, when those chief executives have left they may well be paid by the taxpayer if past experience is anything to go by. Take the example of Finnamore Management Consultants, who are used, I believe, quite widely by the NHS to address some of the deficits. If we look them up on the web, the vast majority of their staff are ex-NHS managers. Presumably, they were made redundant. They may even have been sacked, or changed jobs for higher salaries.
I tried to find out a bit more about that firm through a parliamentary question, but I had no luck. The response said that responsibility for financial control belonged to strategic health authorities and denied any knowledge of those consultants. That sort of response annoys me intensely. The Government devolve things when they do not want to answer a question, and impose top-down changes while at the same time talking about devolution.
I come to my area, west midlands south. I pay tribute to the strategic health authority for carrying out a certain amount of pre-consultation. I regret to say that I responded to that pre-consultation without too many objections because I thought that it was a done deal and that resistance would have little effect. I got into tremendous trouble with some of my friends at home over that passive response. The Health Committee inquiry has brought me round to the other side.
A lot has been said already about mergers of SHAs. I do not think that SHAs are of the slightest importance. If they go back to being regional health authorities, good luck to them. On local ambulance trusts, as long as I keep my all-singing, all-dancing local computerised control centre, which is as good as any ambulance authority's control centre, I shall be satisfied. As Staffordshire Members have said, if there are mergers, they must lead to a levelling up of services, not a levelling down.
I object strongly to the merger of the PCTs in my area and I just hope that, with the consultation, local people will really have a chance to make a change. I am not very hopeful because we are being consulted on a preferred option, which sounds the death knell of open, genuine consultation.
Many hon. Members have examined the main reasons for mergers. The financial argument does not stand up. As I have said, the Health Committee expressed doubt about that. Restructuring involves redundancies and structures to secure local involvement—but those will be incredibly costly. Another argument is that mergers strengthen the commissioning function. That is already happening. The Minister mentioned collaboration, but collaboration is already happening. For a good example, one has to look only at Whitehall & Westminster World, which I am sure we all read. The current edition describes a national decontamination project. It states:
"Collaborations of up to 8 trusts are now in process and every strategic health authority has signed off a local plan which is consistent with the national plan."
So collaboration is working already, without the need for mergers.
I have objections. Many hon. Members have mentioned the number of reforms. I regret to tell them that they have all got their numbers wrong. During the Health Committee foundation trusts inquiry, we received a list of all the reorganisations from 1982 until the date of that inquiry—there were 21. Since that date, there have been at least another seven, so on a conservative estimate there have been at least 28 reorganisations.
As we have heard, PCTs have only been going three years. They are just beginning to find their feet. Reorganisation affects an organisation badly—we were told on the Health Committee that it can take 18 months to recover from the disruption and another 18 months for the benefits appear. Locally, there are tremendous objections to the merger of three PCTs into one. We believe that we will lose some of the professional input from doctors, nurses and physiotherapists. We believe that we will lose the local public health input and, worst of all, we believe that we will lose the local input from patient forums.
I believe that it is far, far more important for a PCT in each local area to be coterminous with its district council and its local strategic partnership than for it to be coterminous with a much bigger area. I hope that consultation throughout the country is genuine and that where the status quo is correct, it will remain as an option.
Edmund Burke said:
"The people are the masters."
"We are not the masters. The people are the masters. We are the servants of the people . . . . What the electorate gives, the electorate can take away."
It is a pleasure to follow Dr. Taylor, who owes his parliamentary career to a successful campaign to defend Kidderminster hospital—which, I understand, is still there. He speaks with great authority on these matters.
I am sorry that my near neighbour, the Secretary of State for Health, Ms Hewitt, is not here today. I understand that she is unwell. I share a hospital with her, I share a city with her, but I did not share the meal with her last night that caused her illness. We would like her to get well soon and come back to Leicester this Friday, for two reasons.
First, we want to thank her for the huge amount of money that the Government have given to Leicester over the last eight years. There has been an increase of about 98 per cent. in PCT funding, I understand, with three brand new health centres in the city. Two are in my constituency; one in Hamilton and the other soon to start in Charnwood. Secondly, we want to thank her for giving us a PCT that was so responsive to the needs of local people, and I pay tribute to Carolyn Clifton for her excellent work. When I and others have raised issues with her, she has responded swiftly to those concerns and provided us with the services that we need.
That is why I am so surprised that the Government wish to reorganise the PCTs in Leicester when they are doing so well. We have a particular expertise in our part of the city, where we deal with problems different from those encountered by those who live in the constituency of my right hon. Friend the Secretary of State.
With things going so well, so much more money being provided and the PCT being so responsive, I am surprised that the Government feel it necessary to merge the two organisations. I am sure there is a justification—I have heard a justification made on the grounds of money—but there is not a justification in terms of responsiveness to the local community. I hope that when the Under-Secretary of State for Health, my hon. Friend Mr. Byrne, replies, he will give more of a justification than saying that it will save £1.5 million a year, or whatever it is. In a budget so vast and ever-increasing, that sounds like a small amount of money, given that we spent much more than that when we set up the PCTs a few years ago. I hope that we will have a response that justifies that decision.
I am concerned about the abolition of the Eastern Leicester PCT because I am worried about the pathway project, which is central to the rebuilding of the hospital in my constituency, the Leicester general hospital. I have now represented Leicester, East for almost 20 years and I was promised—as were the other right hon. and hon. Members who have represented the city for a generation—that we would have new hospitals as a result of the pathway project.
I understand that because of the reorganisation, the pathway project in Leicester is now on hold. That means that the investment of £761 million that was to be made in the NHS in Leicester will not now take place. That means that we will not get a new Leicester general hospital, nor the extra cancer facilities that we were promised, nor the new children's hospital, which was to be based in Glenfield, in the constituency of my right hon. Friend the Secretary of State. That is a worry to my constituents and me, because we believe that the Government are absolutely sincere in their commitment to spending money on the NHS and spending it wisely.
In addition to the pathway project, other hospitals will also be put on hold. I know that a similar decision has been taken at Barts, for example. I was telephoned yesterday by one of the Barts consultants, who is very concerned that the Leicester changes are being linked to what is happening in other parts of the country. So when the Minister responds, I hope that he can reassure me that the proposed reorganisation of Leicester PCTs—I understand the arguments in favour of such reorganisation, but it needs better justification—will not in any way affect the additional money coming in. I know that some of my colleagues do not favour private finance initiatives—they believe that they will somehow prove unhelpful to local people—but I favour them, because I will get a new hospital out of such expenditure.
I thank the hon. Gentleman for giving way, and I should declare an interest, in that my husband works for a PCT. Does the hon. Gentleman agree that in addition to the reorganisation of PCTs being destabilising, it is ill judged in the extreme, as the Health Committee report said, and patient care will suffer?
There are grave concerns about the proposals. I do not know the situation in Guildford and that part of the country, although I was the European parliamentary candidate for Guildford many years ago; indeed, I cycled over the Hog's Back between Guildford and South-West Surrey. I lost that election by 60,000 votes, however, so it is a part of my life that I do not care to remember. The situation in the hon. Lady's constituency may well be as she describes, but my concern is what will happen in Leicester, and how responsive the changes to PCTs will be to the needs of my constituents.
On PCTs, does the hon. Gentleman not think it very unfortunate that the authorities have put forward a preferred option, which means, in effect, that they are not prepared to consider any other option? That is what happened in east Cheshire, where there is a preferred option of reducing four PCTs to one. In my view there should be two PCTs, in order to recognise the differing cultural needs of east and west Cheshire. Does the hon. Gentleman not support me when I say that a preferred option is not the way to proceed? All options should be equal in the consultation process.
I agree that such matters need to be put out to consultation, but as I have not stood as a European parliamentary candidate—or any other candidate, come to that—in that part of the country, I cannot comment on the configuration there. But it must be right for proper consultation to take place.
That brings me to my final point: the proposed abolition of the ambulance service in my part of the east midlands and the creation of a new east midlands service. Michael Fabricant, who is no longer in his place, and my hon. Friend Paul Farrelly were right to raise in this House their concerns about ambulance response times, and I have an example similar to the one given by my hon. Friend.
I attended a funeral at the Gilrose crematorium, which is in the constituency of my right hon. Friend the Secretary of State. One elderly gentleman there was extremely upset, and he became very ill and collapsed. I telephoned the ambulance service and asked it to send an ambulance to take him from the crematorium literally down the road to Glenfield hospital, which is one of the finest hospitals in the country. I offered to take him in my car, but I was asked by the ambulance service operator not to do so unless I was a doctor, which clearly I am not. I said, "I am not a doctor, I am a Member of Parliament, so could you please send the ambulance as quickly as possible." An hour later, the ambulance still had not arrived. Exactly the same circumstances described by my hon. Friend with regard to the London ambulance service applied to the ambulance service in my example.
Hon. Members may ask why I would want to keep a service that did not respond quickly. Well, I want to keep the service because it is a local service. It is wrong to merge it into such a large area. It is only common sense that the response times will not be as quick as those for a local service.
My very final point concerns the decision by the local health authority to close the Goodwood ambulance centre in my constituency. It is a brand new centre, near the Leicester general hospital. It houses several ambulances and enables them to get to local people much more quickly. The proposal is to close that ambulance station as part of a merger that will cover the whole of Leicester, with another centre built in another part of the city—or, indeed, of the county.
Does my hon. Friend accept that one of the successes of the Staffordshire ambulance service is that ambulances have been taken out of the ambulance centres and placed strategically, where they are likely to be needed, at crossroads or theme parks?
I accept that point, and that is why I want the centre to stay at Goodwood—near the general hospital and next to a major intersection that links Nottingham to Leicester, and the A46 to the A47, which goes to Peterborough. I cannot understand why it will be removed and why we are merging ambulance services. We are, in a sense, misleading people into believing that the proposals are for consultation, while at the same time advertising the top jobs for the new ambulance service in national newspapers. Like other hon. Members, I have seen such advertisements appear at the same time as we are talking about consulting with local people. I hope that my hon. Friend the Minister will bear that in mind.
I am a loyal Back Bencher. I am loyal to this Government, who were elected on a Labour party manifesto. I have great affection for, and am a great supporter of, my right hon. Friend the Secretary of State for Health, who will be a great holder of that office, judging by the White Paper that she introduced last week. But even I am tempted not to support the Government on reorganisation, because of the effects that it will have on local people. I ask Ministers to remember what we did to the national health service university. We created a wonderful organisation and then, a few years later, abolished it, leaving a lot of skilled people without jobs and taking away an important concept for educating and training people who work in the NHS. I ask my hon. Friend the Minister to respond to my points and also give me an assurance that further consultation will be held on those issues, and that local people will be listened to in Leicester and throughout the country.
The Minister of State, Jane Kennedy and I both come from the same neck of the woods and I have the greatest respect for her. I have heard her use an expression that is often used in Liverpool: "God loves a trier." Well, the Minister really tried today to sell the merits of the reorganisation of PCTs, but I am afraid that she was not very persuasive to Opposition Members.
Reorganisation of my local PCT, which is three years old and cowed by debt, would be disastrous. Next month, Bedfordshire Heartlands PCT will be £20 million in debt, and the only way left for it to recover that debt is to restrict emergency services, which is almost a contradiction in terms. When I spoke to the chair and chief executive of the organisation and asked how they intended to restrict emergency services, the answer was frightening. They want GPs to keep patients with them for longer before calling an ambulance to send them to hospital. I asked what would happen if I were a parent with a child with suspected viral meningitis. What should the GP do in such circumstances? The answer was that they would like the GP to make sure that the child really had the illness. Whereas previously, a GP would dial 999 and have the child sent straight to hospital, now the PCT wants the GP to hang on to the patient.
The proposal caused concern in several areas, not least at Bedford hospital. On Saturday, a consultant from the hospital brought me an e-mail, which I shall happily hand to the Minister once I have removed the top. Bedford hospital is £12 million in debt and its recovery plan to achieve a reduction includes cutting 10 theatre sessions a week, closing two wards and the children's physiotherapy unit, and restricting the use of agency nurses and doctors. The list goes on.
The e-mail states that unfortunately, there will be a
"serious financial situation . . . where we will be requiring to make a further all-round cost improvement of 7.1 per cent." to achieve
"a further saving of £2.27 million".
The cuts to achieve that saving will be a further £530,000 from nursing, a further £375,000 from theatres, a further £1.02 million from medical pay, and a further £200,000 from critical care. Those are all front-line service cuts, in addition to the recovery plan. Only £100,000 of those cuts of £2.27 million will come from administration. The e-mail concludes with the words, "An awesome challenge". It is indeed.
Members of my PCT do not want reorganisation. The PCT is only three years old and is staggering under its debts. As the Health Committee report noted, reorganisation will cause damage from which it will take 18 months to recover. The move is not advisable, and will do nothing to aid Bedford PCT or Bedford hospital.
We want to get rid of SHAs, but the Minister asks who would oversee PCTs. May I suggest that she or the Department could do so? SHAs are accountable to nobody and have allowed PCTs to go into debt—by £20 million, in the case of my local PCT. The SHA has no purpose whatever in Bedfordshire. Perhaps if the Minister oversaw PCTs we might have a more efficient service.
Does my hon. Friend agree that the reforms seem to be less to do with patient care and a patient-centred NHS and far more to do with saving money and getting rid of the debts?
That is highlighted by the cuts detailed in the e-mail; they are all from front-line services and will have a direct impact on patients. Only £100,000-worth of those cuts will be made in administration and back-room services.
May I draw my hon. Friend's attention to the situation in my constituency? For more than 10 years local people have been promised a new community hospital, which is still not forthcoming. Does my hon. Friend agree with many of my constituents that the Government are more obsessed with structures than actually delivering front-line services?
I have been in and around the national health service since 1979. It has been a quarter of a century of constant change, much of it for the better, but the near recreation of regional district health authorities and fundholding rebadged as practice-based commissioning is without precedent. While Ministers are absorbed in rearranging the deckchairs, the Opposition prefer to focus on deficits, because they affect our constituents profoundly.
The Secretary of State for Health may be pleased to dismiss deficits because they represent about 1 per cent. of the NHS budget, but Members of Parliament whose constituencies have PCTs that are in the red know that 1 per cent. means the closure of community hospitals and slamming the brakes on patient services.
We have heard a total of 11 high-quality Back-Bench contributions this evening. Julia Goldsworthy said that size matters in relation to trusts and authorities. She is certainly right. Mr. Blizzard also thought that size was important and made a convincing case against a county-wide PCT. He offered a more functional grouping that would cut across local government boundaries and form what he called the people's PCT. Although I might perhaps bridle at the description, I would certainly endorse his sentiments about functional, not necessarily geographic, linkages.
My right hon. Friend Mr. Gummer rightly drew attention to a funding formula that hits rural areas with elderly populations. In his constituency, as in mine, that has led directly to hospital closures.
Mr. Martlew was mildly critical of PCT reorganisation in his area and made a plea for no more reorganisation—a sentiment that was echoed by many right hon. and hon. Members.
My hon. Friend Michael Fabricant emphasised the importance of ambulance response times. I agree that response times should be a crucial determinant in any reorganisation. Paul Farrelly also spoke in support of the independence of the Staffordshire ambulance service. He also supported the thesis of the hon. Member for Waveney in pleading for mergers on a functional, not a geographic or administrative, basis. That thesis is quite correct. Mr. Flello added more support for Staffordshire ambulance service autonomy, based on the so-called golden hour for effective early medical intervention. He also talked about a natural alignment of PCTs in Stoke.
My hon. Friend Mr. Spring rightly attacked the waste implicit in constant reorganisation and pointed out that it would not address the financial difficulties of his local health economy one jot.
Dr. Taylor quite correctly slated false consultations. People give of their time freely to consultations in the NHS and elsewhere, and I tend to agree with the hon. Gentleman that it does the process no good at all if those views are not taken seriously. I know from my experience of my own area about the damaging effect that sham consultations can have on the debate locally and nationally. We mentioned briefly the consultation in Birmingham, and I suspect that, like me, he has his own views on that process and its results. He also argued for local PCTs that are coterminous with local government boundaries—something that contrasted with some earlier contributions.
My hon. Friend Mrs. Dorries finished by highlighting service cuts that result from the financial recovery plan in her PCT. She feared that PCT reorganisation would set things back 18 months. I would tend to share some of her concerns.
In redesigning services, structure must follow function—not the other way round—but it is not yet clear what PCTs will be responsible for. As for SHAs, many of us are mystified by their current role, let alone what Ministers intend for them in the future. At the moment, the SHAs' ability to be strategic—whatever that means—must be constrained by their preoccupation in areas such as mine with financial deficits. Of course, there will be some benefits to all of this: the perpetual merging, axing and reforming of health bodies is a fantastic way to blur accountability. People who have tried to identify those who should be held to account for deficits know that very well.
We have a number of questions, some of which have been fielded already in today's debate, and we would like the Minister to answer them. First, we would like to know what the Minister intends that PCTs will be doing in the future because that is far from clear. What will be the residual provider function of PCTs? In the summer, "Commissioning a patient-led NHS" said:
"the direction of travel is clear: PCTs will become patient-led and commissioning-led organisations with their role in provision reduced to a minimum."
However, the Secretary of State, Sir Nigel Crisp and Mr. John Bacon then issued contradictory interpretations of what that meant. The confusion has caused real discomfort to NHS staff who are employed directly by primary care trusts. Furthermore, it has made a complete mockery of the restructuring exercise. How can an organisation possibly be restructured if the people at the top do not have the first idea what that organisation will be doing? If Ministers want to use the private sector more—they say that they do—what message do they think that the vacillation will send to non-NHS providers that are possible partners? It will suggest unreliability.
Ministers might say that PCTs will be commissioning care, but how will they do so when patients are free to choose and book? I have to say that under our proposals, they would be even freer to choose the treatment that they receive and where it is received. If PCTs are largely divested of provider and commissioning functions, will they not simply become GPs' account clerks? If so, will they be further reconfigured to reflect a new vestigial role? If that is not the case, how will we manage the split between providers and commissioners in the new organisations? It seems to me that Ministers are extremely unclear about that point, so any clarity that the Minister can give us today would be most welcome.
The Prime Minister apparently often regrets not being bolder, which is when we understand that he is at his best. How does that fit with practice-based commissioning? Does the Prime Minister in fact know full well that abolishing fundholding was foolish and recognise that practice-based commissioning is the closest approximation that he will get without primary legislation and the embarrassment of a complete about turn?
The Government's interpretation of the dubious consultation exercise "Your health, your care, your say" was different from mine and that of several hon. Members who contributed to the debate and people elsewhere. Will the Minister admit the extent to which the consultation was bent to the purpose that had already been devised by his colleagues and confirm specifically that his vision of contestability was largely shunned by the consultees who were selected to give their views? I offer no defence or otherwise of contestability, but it is important that we reflect accurately and sincerely views expressed during the course of consultation exercises. It seems to me that that has not been done in this and other areas. My point obviously relates directly to the consultation in Birmingham, so I would be grateful if the Minister would shed some light on what those who responded in Birmingham thought about contestability.
Where does the Minister think that public health function will reside in the new scheme of things? Those of us who take an interest will have witnessed directors of public health being sidelined in PCTs that are largely focused—often unsuccessfully—on financial management. Could it be that the manifest failure to communicate the recent change in policy on BCG vaccination, for example, is symptomatic of the malaise in public health in recent years? The Faculty of Public Health's latest work force survey reveals that more than 100 senior public health posts have already been lost in the past three years. It estimates that the latest reorganisation could lead to the loss of a further 120 posts. I hope that the Minister agrees that that would be grossly unsatisfactory. It would be useful to hear from him how the set of reorganisations will enhance public health function, rather than damage it further.
Will the restructure achieve the Government's intended saving of £250 million, or will it, like most of its type, end up sapping resources from front-line services? If trusts make savings through reorganisation, for example in the merged Avon, Gloucestershire and Wilshire ambulance trust, will the Minister confirm that they will go towards improving front-line services in the trust, rather than being siphoned off to address financial deficits at the strategic level?
In summary, the structure of the NHS is pretty well back to where it was in 1997, when we left it. It would be churlish if I sat down without acknowledging the compliment.
Our debate this evening has been very good if, in places, a little less consensual than the debate earlier this afternoon.
In some ways, this debate underlines how far the health service has moved under this Government. When we were elected in 1997, the public's priority, and therefore ours, was to lift the NHS off its knees and rebuild the services that had been ground down over 18 years under the Conservative party. We had to end the inequity of GP fundholding, under which some patients could jump to the top of the queue without rhyme or reason. In particular, we had to rescue our hospitals because, of course, some one in 10 people were languishing, waiting for an operation for two years or more.
The situation today is somewhat different: 100,000 extra staff, the biggest hospital-building programme ever and, as a result, the shortest waiting lists since records began. Indeed, on
Now, having stabilised the NHS, the question facing us is how we move forward. Not only have we introduced new choices of hospitals, but last week we laid before the House our White Paper, which is important because it signals a new direction of travel for the NHS, with greater personal care, greater access to primary care services, a shift of resources into prevention, which I think Conservative Front-Bench Members decided to welcome, and a far better relationship between the NHS and local government.
If the NHS can deliver on that agenda, there is a great prize here to be won—great inroads into health inequalities. Over the past seven years we have made great strides in creating far more opportunity in this country, so surely our challenge now, after the longest record of economic growth and after putting more people into work than ever before, is to make sure that everybody, in every community, has the health and well-being to seize those new chances. That is exactly why we have to update PCTs and ambulance trusts, not because of the damaged legacy that we inherited in 1997, but for the opportunities of 2006.
I know that the Conservative party is firmly fixed in listening mode at the moment, so if the hon. Gentleman will forgive me, I plan for him to listen just a little longer.
My hon. Friend Keith Vaz asked why we have to change—why we have to adapt. Governments have been talking about the need for a shift in the balance of primary care since the 1920s. In 1976, Baroness Castle set out in "Priorities for Health and Social Services" her ambition to move care into the community. The truth is that over the next four years and the subsequent 18 years of Conservative Administrations, we did not achieve that shift in the balance of care. This time, we have to make sure that the shift takes place. I am happy to give my hon. Friend an assurance that the new fair funding that we have introduced will stay in the places to which it has been awarded.
We have to make sure that, where appropriate, PCTs are coterminous with local authorities. We have to make sure that they are strong enough to hold GPs to account. We have to make sure that they can connect effectively with local communities because that is the only way that they will deliver on the ambitions that we set out in the White Paper.
I shall address the hon. Lady's remarks directly in a moment, if she will have a little patience.
My hon. Friend Mr. Blizzard put a powerful case for one of the two options in his local consultation, saying that it was the healthy option, the people's PCT. I am sure that what he said was heard clearly by those local health professionals managing the consultation. I am happy to give him an assurance that there is no template.
My hon. Friend's near neighbour, Mr. Gummer, did himself no favours by quoting answers to named day questions. Frankly, it was shameful of him not to recognise the advances that have been made in his local NHS. It is not worse than 30 years ago, and it is an insult to the performance of NHS staff in his area to pretend that waiting lists and death rates have not come down thanks to the new funding that we have put in, which I might add he voted against—I think—not on one occasion but on four occasions over the past three years.
Mr. Spring added that he was frustrated with the way that funding was not geared to areas of need, but that is exactly what the new funding formula has done. He knows full well that £73 million extra is going to his PCT over the next few years. He has the opportunity over the next few years to distinguish himself by having a conversation with Mr. Dorrell, who is chairing the policy review on health.
The hon. Gentleman has the opportunity to say that his party's fiscal rule that the proceeds of economic growth should be shared between public service investment and tax cuts should not apply to the health service, and he should ensure that the right hon. Gentleman comes out with a clear commitment to match our levels of investment.
Order. I must be allowed to hear the Minister. I have to hear what he is going to say.
Turning to the west midlands, Michael Fabricant made a powerful and persuasive case in which he underlined and celebrated the achievements of Staffordshire ambulance service. It is indeed an ambulance service from which many in the country could learn. He was, perhaps, over-hasty in writing off the performance of the rest of the west midlands, but there is a clear message that we should take from his remarks, and it was underlined by my hon. Friends the Members for Newcastle-under-Lyme (Paul Farrelly) and for Stoke-on-Trent, South (Mr. Flello): there must be localisation of control. Surely the question in this consultation, though, is how we export that excellence, not just to other parts of the west midlands but to other parts of the country, and how we ensure that Staffordshire gets better in future. Surely it has not reached its full potential.
My hon. Friend Mr. Martlew was dissatisfied with current arrangements and welcomed a change. I know that his input into consultation arrangements will be well informed by his previous experience.
Dr. Taylor had a great deal to say about consultation. I was heavily involved in consultation on the White Paper. I would recommend it to Members in all parts of the House. There could well be more listening to be done on health policy.
I listened very hard to Julia Goldsworthy. I was trying to detect any hint of what Liberal Democrat health policy might be. I know that Mr. Kennedy instigated a sweeping policy review not long ago, saying that he would approach it with a blank sheet. That blank sheet, it seems, is his legacy, and from tonight's debate we can deduce that it will withstand the test of time. I can think, therefore, of no better quote than that of the former vice-chair and chair of the Hodge Hill Liberal Democrat party, who led a mass defection to Labour on Saturday night. He said that there is a lack of leadership not just in Westminster but in local communities. I think that I can see what he meant.
No, I will not give way, because I have a bit more to finish.
We did not hear too much about the Conservative alternative. It remains a bit of a mystery, wrapped in an enigma, wrapped in a taskforce, although the alternative for health benefits from quite sensible leadership. We were not expecting an apology for voting against the National Insurance Contributions Act 2002 or against the Finance Acts of 2002, 2003 or 2004, but I thought that we might have heard a little clarification about the new fiscal rule of Mr. Cameron. Are the fruits of growth to be shared with tax cuts, or—
rose in his place and claimed to move, That the Question be now put.
Question, That the Question be now put, put and agreed to.
Question accordingly negatived.
Question, That the proposed words be there added, put forthwith, pursuant to Standing Order 31 (Questions on amendments), and agreed to.
Mr. Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House welcomes the Government's determination to reform primary care trusts (PCTs) and strategic health authorities (SHAs) to ensure all patients get the services they need, to shift the focus of services more towards prevention and tackling health inequalities, to engage better with GPs in developing services that meet patients' needs, to reduce bureaucracy and to deliver better value for money for taxpayers; further welcomes the widespread support within PCTs and SHAs for the principles on which Commissioning a Patient-Led NHS has been based; and further welcomes the Government's consultation on reforming ambulance trusts to ensure more care is provided in the home and at the scene, to give better advice to patients over the telephone and to deliver faster response times to save more lives, in line with the recommendations from the National Ambulance Adviser Peter Bradley's review "Taking Healthcare to the Patient: Transforming Ambulance Services".