NHS Reorganisation

Part of the debate – in the House of Commons at 9:39 pm on 7 February 2006.

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Photo of Andrew Murrison Andrew Murrison Shadow Minister (Health) 9:39, 7 February 2006

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.

Keith Vaz was worried about the abolition of his local PCT and the non-appearance of a new general hospital in Leicester—that, of course, involves a £574 million PFI scheme.

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.