Clause 1 - English Health Authorities: change of name

NHS Reform and Health Care Professions Bill – in a Public Bill Committee on 27th November 2001.

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Amendment moved [this day]: No. 84, in page 2, line 3, at end insert

`provided that such area has an adult population of more than 2 million people.'.—[Mr. Burns.]

Photo of Ann Widdecombe Ann Widdecombe Conservative, Maidstone and The Weald 4:30 pm, 27th November 2001

Before I ask Mr. Burns to conclude his comments, I remind members of the Committee that all mobiles and pagers should be set on silent, or should not be on at all.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

May I be the first, Miss Widdecombe, to say what a pleasure it is to have you as co-Chairperson of our proceedings?

As I was saying when we adjourned for lunch, amendment No. 84 is purely a probing amendment by which we are seeking to find out more about the Minister's views on the composition of the strategic health authorities in terms of the average number of people that each will represent, and to tease out of him more information about how he thinks that SHAs will work.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

It is a fairly fundamental law of physics that large bodies tend to consume small ones, and one of my concerns about SHAs relates to their size. As far as we are able to tell, they will be of diverse size. One of the stringencies placed upon those deciding on their boundaries is that the authorities should relate to a tertiary centre, such as a major teaching centre or major hospital. My own area of the south-west provides an example of where the proposals fall well short of that. The minnow that is Somerset and Dorset—I mean that in the nicest possible way—relates at best to Taunton, which is not a major centre. That will leave Devon and Cornwall looking towards the Peninsula medical school and Plymouth, which is a major tertiary centre. The remaining area of Avon, Gloucestershire and Wiltshire will look towards Bristol royal infirmary and the Bristol teaching hospitals.

That creates real instability. It is likely that there will be some mergers as time goes by. In the south-west, the three SHAs will probably reduce to two, with Somerset and Dorset being split between the SHA for the far west and Avon, Gloucestershire and Wiltshire. Such changes bring more uncertainty for those who work in the service. We should be able to anticipate that to ensure from the outset that SHAs can plan for the long term in a period of some stability. Members of the Committee have commented on the importance of stability in the national health service, which has undergone almost perpetual change since 1974. This is one area where the Government can give a steer by offering the prospect of stability at SHA level.

Of course, reducing the number of SHAs in the south-west from three to two and repeating that across the country would strip out a layer of bureaucracy and associated costs, as well as giving many of them much more cogency. I urge the Minister to think in terms of reducing the number of SHAs, perhaps by increasing the numbers of people that they will serve.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

I was delighted that in the letter from the Secretary of State for Health that was circulated with the White Paper, ``Shifting the Balance'', he emphasised that consultation would take place according to boundaries. Natural geographical boundaries for health care seem to be the most sensible way of deciding the constituent members of strategic health authorities. Will the Minister confirm that the authorities will not be rigidly bound by numbers, whether too small or too great, but that the natural geographical boundaries, whether they have tertiary centres or not, will be used?

I have a natural geographical area in my part of the country that has long been known as West Mercia, which is an example of an ideal grouping without a tertiary centre. I make a plea for geographical boundaries and not boundaries based on absolute numbers.

Photo of John Baron John Baron Conservative, Billericay

Will the Minister consider another issue concerning the boundaries of strategic health authorities pertaining to existing clinical networks? The Government have stated that SHAs would be coterminous with an aggregate of local authorities and that the boundaries would not cut across Government office boundaries. That is fine, but existing clinical networks do not always align with local or central government boundaries. Securing delivery of health care must be the overriding determining factor when resolving difficulties, so consideration must be given to the role of the clinical networks. I hope that the Minister will forgive me if I refer to the BMA again, but it suggested that an appropriate solution might be to manage any lack of coterminosity at the new regional director of health and social care level instead of with the 28 SHAs to ensure that such decisions are taken at the appropriate strategic level. That would give weight to existing clinical network boundaries instead of historical administrative boundaries, which are largely based on geographical features. Will the Minister consider that point, because existing clinical networks are important to the overall functioning of health services at local level?

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I join in the welcome to you, Miss Widdecombe, as our co-Chairman.

I want to add one or two points to those of my hon. Friend the Member for West Chelmsford (Mr. Burns). To have a guideline of 1.5 million residents as the basic unit for a strategic health authority is acceptable, although we could argue about what the number of residents should be. However, some flexibility is required from the Minister if it is to work well. My understanding is that, in some city areas, it is proposed that strategic health authorities should be much larger than 1.5 million residents. I should be grateful if the Minister would tell us whether that is right and give us some idea of the scale of difference that is acceptable to the Government.

In my area, it has been suggested at regional level that Hertfordshire should be combined with Bedfordshire to achieve a unit of approximately 1.5 million; a similar size to Essex, to which my hon. Friend the Member for West Chelmsford referred. That is a convenient way of dealing with the matter and would meet some of the clinical networks, but if there were no constraint in terms of having to use local government units to build strategic health authorities, or by the 1.5 million figure, some of the other issues could be considered. For example, to the east of the county, many patients go to Addenbrooke's hospital in Cambridge. Further down the east side of the county, many residents go to Harlow in Essex for hospital treatment. To the south of the county, Mount Vernon is the cancer centre, as the Minister knows, and many of its patients come from north London.

Everyone at regional level, and everyone else involved, is doing their best to come up with a solution for a strategic authority that will work. Will the Minister explain why the figure should be 1.5 million, because a larger number would give greater flexibility?

What is the thinking on having coterminosity with local government areas? Would that be convenient where social services and the NHS were working together? Does the Minister hope that there will be joint working with mental health services? If that is necessary, what is his response to the submission by the Democratic Health Network, a body set up by the Local Government Information Unit? It states that

``the Government has given no clear rationale for the number of the proposed new SHAs. We would wish to see much closer working between health and local government at both regional and sub-regional level. It will not be helpful that the proposed new SHAs will not be co-terminous with other government regional or sub-regional structures.''

The Minister will know that I am not a great one for regions. However, the network has 100 members from local government; it is a body with a voice. It has asked that question. Will he respond to it? This is not something that I would favour, but it is the Opposition's job to put forward submissions when bodies of importance issue them.

The Democratic Health Network goes on to say:

``If the main role of Strategic Health Authorities is performance management, we do not understand why up to 30 SHAs are necessary and why they cannot be made co-terminous with the English regions . . . which would make it much easier to co-ordinate regional health policy with other areas of regional policy and with political and administrative structures at regional level.''

One can see what it means. The Minister accepts that in parts of the country where there are cities and great urban areas, there should be larger SHAs that fit in with the sub-regional pattern.

I should like the Minister to explain whether this is a patchwork with big SHAs on the one hand and little ones on the other. What is the meaning of the guidance figure of 1.5 million? It obviously means something in Hertfordshire because that region has said that 1.5 million is an important guideline. If something totally different is happening in the west midlands or Yorkshire, how will he reconcile the one with the other? Will the Minister give us a clearer picture of what is going on?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

May I say how pleased we are to see you in the Chair, Miss Widdecombe? My Front-Bench colleagues and I would rather you were in the Chair than on the Opposition Front Bench.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Does the Minister accept that I would always be happy to vacate this slot should my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) want to return to the fray?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

You would rule me out of order if I started to argue the merits or otherwise of appointments to the Opposition Front Bench, Miss Widdecombe. I do not intend to go there, and I notice you no longer intend to go there either.

The debate on amendment No. 84 has raised two questions. First, where do we draw the lines in relation to the boundaries of SHAs? The hon. Members for Wyre Forest (Dr. Taylor) and for Billericay (Mr. Baron) have referred to that matter. Secondly, what criteria do we use to draw the lines? The hon. Member for North-East Hertfordshire will be aware from his experience as a Minister that such lines are difficult things to get right. We are putting the structures in place; they are our creation. However, drawing precise boundaries and lines across the map of England is necessarily complicated, and raises issues such as those that the hon. Member for Westbury (Dr. Murrison) mentioned about local perceptions of where boundaries are, and what affinities local people feel with the communities around them.

Opposition Members ask me where we are drawing the lines; we are consulting on that. I hope that all Opposition Members will want to add their views to the consultation process that we have initiated, and some have already. I am sure that the hon. Member for Wyre Forest has, because he is that sort of man. It is up to hon. Members, if they feel concern about such issues, to input into the consultation process. That is the melting pot out of which final decisions come.

The criteria to which Opposition Members have referred—the existence of clinical networks, the importance of coterminosity with local authority boundaries and the issue of regional office boundaries—are important in making decisions about where the boundaries of SHAs should be fixed.

The reference in the consultation document to a guideline population basis of 1.5 million people—not simply adults, to which the amendment refers, but including children—is also important. Of course we need flexibility in such areas when coming to sensible decisions and, wherever we can, we will refer to the weight of local opinion that emerges through the consultation exercise.

We will not make final decisions through an arbitrary approach to those criteria, but the amendment would force us into doing that. We have issued a document referring to the criteria, and I will return in a minute to Opposition Members' concerns about those criteria. The hon. Member for North-East Hertfordshire said that we need flexibility to make the proposals work well. His amendment, by design, removes from the Bill the flexibility that he wants to ensure is a principle underpinning the decision-making process about the boundaries of SHAs. I accept that the amendment was designed to illuminate and inform the debate, but we must look at the proposed words. I have to tell my hon. Friends that it would be a mistake to go down that road.

Important issues have surfaced, such as observing coterminosity with local authority boundaries wherever we can. The amendment would compromise our ability to do that. I am sure that it is obvious to hon. Members that we want coterminosity because health and social care, the two key pillars of our care system, have developed historically as two separate tribes that do not always work well together. We see the consequences of that in various areas in the NHS. Delayed discharge is the obvious example; another is the problem in accessing mental health services. NHS and social care providers need to work together as closely as possible there because mental health lends itself to such a solution. People with mental health problems have a high degree of dependence on social care services. If the NHS is to do its job properly in delivering effective care, those two great pillars of the welfare society must work more closely together.

The principle of coterminosity between the boundaries of SHAs and those of local authorities fits with the strategic development of services that we want to see. That would be difficult to achieve if the boundaries of SHAs cut a big swathe across the boundaries of social service authorities, so that the same social service authority provided services to a range of PCTs in different SHAs. That would not be the sort of strategic development and coherence that we want, and that SHAs are intended to facilitate and promote.

The argument, as in earlier debates, comes down to how we juggle the various criteria, which most hon. Members recognise as important, in a framework that does not twist the Secretary of State's arm, forcing him to make decisions on arbitrary criteria in the Bill that he has no power to waive. If one takes that to its logical conclusion, the difficulty would be presented in stark terms; the hon. Gentleman's amendment would not allow the Secretary of State to constitute an area with a population two short of 2 million as an area that could have a SHA. With respect to the hon. Gentleman, that does not make sense and would contradict the principle of flexibility that I am sure we share.

I was asked a number of pertinent questions about the guideline of 1.5 million in the consultation exercise. The document makes it clear that we have attempted to provide flexibly. He asked me for a guide for the range of populations that could come within the boundaries of a single SHA. It is clear in the proposal for Durham and Tees valley in the north east that if Ministers decided to set up an SHA there, the population that would be served would be 1.2 million.

Another example is in the east midlands. The proposed boundaries for mid-Trent would include Lincolnshire, north and southern Derbyshire, north Nottinghamshire and Nottingham, making a substantial population of nearly 2.7 million. It is obvious that, in ``Shifting the Balance''—and with the consultation under way—there is flexibility over the size of populations that need to be served and serviced by the SHAs. That reflects the important point made by hon. Members about the importance of clinical networks, and the point about tertiary centres made by the hon. Member for Westbury.

We are trying to juggle a number of criteria, which we have set out clearly. We have made no secret about the criteria that we intend to use. We want the proposals to command as much support as possible from the local communities that they will serve. Opposing views are forming part of the consultation process and they will be drawn to Ministers' attention as important arbiters of local opinion. As many hon. Members recognise, we then need to make the judgment of Solomon and are unlikely to be able to keep 100 per cent. of people happy. However, the criteria will be transparent and powerfully informed by the strength of local support for the proposals. Ministers will try to approach the task flexibly with a clear view of the end game. That is not a monstrosity of bureaucracy that cuts across obvious boundaries, but a new system for the NHS that complements the framework of the responsibilities on local authorities and regional officers of government.

Photo of John Baron John Baron Conservative, Billericay 4:45 pm, 27th November 2001

I welcome what the Minister says and ask him to consider how we manage the lack of coterminosity. Any boundary that we draw will probably alienate one small section, but the bottom line is how one manages the lack of coterminosity. When it comes to the boundaries of clinical networks, the answer is to manage that lack at the new regional director of health and social care level, rather than at the SHA level. That would provide one step back to oversee the true strategic approach to managing that matter.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

That is one suggestion, on which I will reflect. However, the consultation exercise, which ends on Friday, is for communities in the NHS, local authorities and the public at large to help us to get the decisions right now. It is important to get coterminosity with local authority boundaries right and to reach decisions that will reflect the natural referral patterns around clinical networks, to which the hon. Member for Billericay referred.

By definition, any organisational change throws up the possibility of upheaval. We want to minimise that disturbance, while getting the basics of decisions right. We will consider the hon. Gentleman's comments, but the role of the regional directors is further away in the back office than he might imagine. It may be helpful to him and other hon. Members if I set out my thoughts in writing.

The amendment has been designed to extract further comments from me on the nature of the boundaries for SHAs. However, the problem with the amendment—as, I am sure, the hon. Gentleman understands—is that if it were to be included in the Bill, it would necessarily require us to run a different consultation exercise. Given all that he and his hon. Friends have said today about not delaying the process unnecessarily and unreasonably—

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Not rushing it. [Interruption.]

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

Thank you, Miss Widdecombe. I need protection from the bad boys on the Opposition Front Bench who sometimes misbehave. It is clear that the amendment tabled by the hon. Member for North-East Hertfordshire would strike out the present consultation exercise and require us to start again. I have explained the timetable by which we are currently operating. We intend that the changes will come through in October 2002 and take full effect from April 2003, but the amendment would make it harder to stick to that. The hon. Gentleman might not agree with that timetable—that is his prerogative—but, from my point of view, the amendment would delay progress of the reforms that we want to see.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I have two points to take up with the Minister, which I raised during my short contribution. The first concerns the regional aspect. If Hertfordshire and Bedfordshire were placed together, they would constitute a sub-regional group because they are a quadrant of the region. I forget the precise name—perhaps it is the western quadrant—but I note that an expert sitting not far from the Minister may be about to tell him the answer. According to Government thinking, will such sub-regional structures form the basis of the strategic health authorities? Is there a regional aspect to the matter? As the Minister will recall, the Democratic Health Network is keen to have such an aspect, as it clearly would be a good thing from its point of view.

Secondly, the Minister will recall intervening when the point was made that people in the west midlands are concerned that the strategic health authority might prove too large. What area and population will the west midlands authority cover? Will it be a large authority such as that for mid-Trent, to which he referred, with well in excess of 2 million people?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I do not have in front of me details on the proposals for the west midlands, but as our debate progresses I might be able to get that information. However, the ``Shifting the Balance'' consultation document made it clear that in establishing the two principles that we intend to follow, we will not allow the boundaries of strategic health authorities to cross Government Office boundaries. That is an important point, and further than that I am not sure I can go today. In a sense, the hon. Gentleman and his hon. Friends are asking me to announce decisions on certain strategic health authority boundaries. I cannot do so because consultation has not finished and it would be wrong for a Minister to pre-empt that process.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

May I seek clarification on something that the Minister said to my hon. Friend the Member for North-East Hertfordshire a moment ago, so that we do not get totally confused? In an earlier debate, the Minister said that, in effect, all PCTs would be in place by October 2002, when the system comes into effect. However, about three minutes ago—just before my hon. Friend's intervention—I think he said that although PCTs will be in place by October 2002, they will take full effect from April 2003. Assuming that I heard him correctly, I find that confusing.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I do not want ever to confuse the hon. Gentleman. I was referring to the first full financial year in which the arrangements will take place, which, obviously, is April 2003. The basis for the measures will not come into operation until October 2002, which is the half way point. I repeat that I was referring to the first full financial year.

Perhaps I am wrong, but I hope that my comments have been of some value to hon. Members who have raised these concerns. The amendment is completely unworkable and unacceptable. It would build rigidities into a system that, as the hon. Member for West Chelmsford himself has said, has a paramount need for flexibility. I urge my hon. Friends to reject it.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

You were not here, Miss Widdecombe, when, at the beginning of my remarks, I made it plain to the Minister that these were probing amendments, and, to be fair to him, he has fully acknowledged that fact. We are grateful for the further information that he has made available.

I should be the first to agree with the Minister that if the amendment were to be agreed to tonight, it would place any future Secretary of State, regardless of their political complexion, in a straitjacket. I sympathise with the Minister's comments that if one were two people short of 2 million, one would not be able to set up a SHA, which clearly would be ludicrous. That was not our intention in so far as we used the amendments as a vehicle to probe him, a process that proved illuminating and enlightening. In light of his response, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Photo of Ann Widdecombe Ann Widdecombe Conservative, Maidstone and The Weald 5:00 pm, 27th November 2001

Before we come to amendment No. 85, for the convenience of the Committee I should say that having examined the scope of the amendments and clause 1, I am not minded to have a stand part debate on clause 1. I am therefore happy for members of the Committee to go a little wide in the course of the debates on the following two amendments. That is not a general invitation.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I beg to move amendment No. 85, in page 2, line 7, at end insert—

`(c) A Strategic Health Authority shall only be established under paragraph (a) above provided that there has been consultation with general practitioners, nurses and other health professionals in that area.'.

Photo of Ann Widdecombe Ann Widdecombe Conservative, Maidstone and The Weald

With this we may discuss the following amendments: No. 86 in page 2, line 7, at end insert—

`(cc) A Health Authority shall only be established under paragraph (b) above provided that there has been consultation with general practitioners, nurses and other health professionals in that area.'.

No. 87, in page 2, line 14, at end insert—

`and such an order shall only be made following consultation with health professionals, local authorities and other interested parties in that area as to the name proposed.'.

No. 88, in page 2, line 21, at end insert—

`and such an order shall only be made following consultation with health professionals, local authorities and other interested parties in that area as to the name proposed.'.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

The amendments are designed to ensure that there would be consultation with general practitioners, nurses and other health professionals in the area concerned before the establishment of a SHA, or a health authority in Wales. The Minister has already said that there has been consultation with the public concerning the general concept, and that consultation, which is due to be completed shortly, is continuing on the boundaries of SHAs. The decision on the boundaries will be made in December of this year.

The proposed provision is designed not to duplicate that process, but to allow wider consultation on the establishment of a SHA. It would allow issues such as the impact of the changes on local implementation of the NHS plan, and other practical matters, to be dealt with on the basis that local practitioners can bring their common sense and experience of events in their area to bear on the decision. If a SHA was not ready for implementation, or if it would damage patient care to implement a SHA, it need not go ahead. The Government would know the worst and be able to react to it.

Worries are being widely voiced about whether the changes are for the best, and there is a long article about the subject in this month's Health Service Journal. The article cites commentators who take the view that the effect of these changes will be negative, and it points out that there seems to be an irresistible urge for Ministers to put their stamp on the NHS, often to political time scales that do not fit with time scales that would effect substantial and good-quality change in the system. The article quotes a professor of health economics at York university, Alan Maynard, who describes structural re-organisation as

``a wonderful substitute for change . . . It's displacement activity, a whole lot of smoke with everybody doing an awful lot, but nothing that creates change at all. You change the name, you change the sign on the door—what difference does that make to the service? Implementing real change is perhaps a 10-year enterprise . . . reorganisation distracts everybody—but does concentrate people's minds on the bottom line, which is `Am I going to have a job tomorrow?'''

Managers should be worrying about how to implement the NHS plan and other improvements.

The article quotes other people, such as Dr. Charles Webster, the author of the official history of the NHS, who states:

``I think the majority of reorganisational changes are done as a surrogate for spending more money.'' A battery of criticisms is being levied.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Does my hon. Friend agree that, given the problems within the health service, with our constituents facing longer waiting time, problems with accident and emergency services and having to wait on trolleys, the Secretary of State for Health is confusing activity with action?

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I am sure that that is right. The general flavour of the remarks that managers are making in the health service is that because the Prime Minister's promise to increase the spending on health up to the European average, which would involve spending, on one view, £35 billion a year more than we are at the moment, is unrealisable, we are having yet another reorganisation, and there is a developing cynicism out there.

The former head of press and publicity at the Department of Health, a man who has worked under Conservative and Labour administrations, has put it this way:

``I think they are in danger of disappearing up their own fundament.''

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I should tell the Committee that it was Romola Christopherson.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The hon. Gentleman has changed Romola Christopherson's gender. She is a woman.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

In that case, her comments carry even more weight. The Minister would no doubt agree that we should not suggest that her views are in anyway less important because of that. If anything, her experience working over all those years for both Governments gives her a unique position from which to comment.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Unless Romola Christopherson has changed her position recently, I think that she now works in the press department at No. 10. She certainly went from the Department of Health to No. 10, which may be the cause of some of the problems between the Department of Health and No. 10 at the moment.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

There obviously are problems, but I rather doubt whether they are the result of Ms Christopherson going there. It does say in the article that she has retired from the civil service, so it may well be that she is no longer working at No. 10, if she did previously.

The article also states:

``David Hunter, professor of health policy and management at Durham University, is concerned that `we don't seem to have learnt anything from the mistakes we made then . . . What is even more worrying is that at times of other changes, at least one or two parts of the system have been stable. This time, it's everything that's changing. It looks like a recipe for disaster.'''

Mr. Hunter makes the point, which I do not think has been made so far in this Committee, that about three years ago, the Secretary of State for Health at that time, the rt. hon. Member for Holborn and St. Pancras (Mr. Dobson), said:

``The last thing we want is a big bang reform'' of the NHS. Yet, here we are three years later having yet another reorganisation of the health service. It is hard to understand why the Government are taking this approach.

The Royal College of Nursing also has concerns that there should be a proper balance on the boards of the strategic health authorities, a point that it has made quite forcefully. Would the Minister be happy to see that happen? Clearly, the nursing profession has a particularly important role in that area.

The amendment proposes consultation before action. Does the Minister agree that, instead of airy-fairy consultation on broad principles, or simply looking at boundaries, what is really needed is to ask practitioners on the ground whether their area is suited to the changes? If they think not, let us not have a SHA and all the changes there, or let us leave it until the area is ready. As the Minister knows, we have always accepted that PCTs are a good basis on which to go forward provided that they are properly organised, have the staff that they need, and have had their budgets sorted out with everyone ready to start. The concern is that SHAs could end up being strategic about organisations that are not really strong enough to take the burdens that will be placed on them. I look forward to the Minister's comments on the amendments.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

We have yet to discuss the position of academic medicine in the proposed changes. Academics have been highly critical of the Bill, and with good reason. They are not mentioned in it very much. If SHAs have a role, I should have thought that it would be heavily tied in with academic medicine. We have talked about the different sizes of SHAs and how they might link with tertiary centres. Tertiary centres are intertwined with academic medicine, and I am concerned that insufficient weight is being given to such links. That is certainly suggested by the different sizes that the Minister has implied will come out of the consultation process. If proper tertiary centres are not part of a particular strategic health authority, it will lack an academic focus.

We have progressed in recent years. Academic medicine is no longer solely the prerogative of teaching centres, but, nevertheless, there has been a drift back towards large centres in recent years. Funders seem to be more impressed by large centres, a situation that is likely to continue. Referring from convenience to the south-west, the minnow SHA covering Somerset and Dorset would lack such a tertiary centre, and a proper focus of academic medicine. I am concerned that academics' views and worries about being sidelined are not being properly registered. I hope that the Minister will bear in mind the needs of academic medicine in this country. If SHAs have a role—some doubt is emerging about that—promoting academic medicine in their areas might be it.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

The amendments place me uncomfortably on the horns of a dilemma. This week's Health Service Journal tells us that there is an absolute plethora of consultations. They are running at the rate of about one a week. Much as I want to see meaningful consultation, as alluded to by the amendments, it is difficult to square that with the current tremendous rate of consultation. Consultation is getting into bad repute because it is so often on a preferred option, and that option often succeeds. I believe that there were 32 consultations last year. Can the Minister tell me, now or at a later date, how many of those had a preferred option, and how many of them overturned that option? It would be reassuring if we could sometimes see that consultation was meaningful and overturned the preferred option, which may not be the best one.

Amendments Nos. 87 and 88 mention consultation with

``local authorities and other interested parties''.

Something that we risk losing with the abolition of community health councils is their role as statutory consultees. Will they be replaced with other statutory consultees?

Photo of Andy Burnham Andy Burnham Labour, Leigh 5:15 pm, 27th November 2001

The setting up of SHAs is an extremely important step. They will play an important role in working across an entire region to raise the general standard of health and to tackle the fundamental problems, such as health inequalities, that were bequeathed to us by the Conservative Government. For example, they will play a key part in consultations with regional development agencies.

The problem with the amendments is not their principle, but the fact that they are too narrowly drawn in focusing first on NHS staff and health professionals and, secondly, on the name proposed for the SHA rather than more widely on its boundaries. That does not reflect current practice in the health service, where there is wide consultation not only within the profession, but across community, local and voluntary groups. There may be a case for enshrining that good principle in legislation.

Perhaps the Government might consider amendments that, instead of focusing too narrowly on health professionals, would require consultation with the range of bodies that are affected by the creation of SHAs.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

That was an interesting speech. The hon. Member for Leigh (Andy Burnham) gives the distinct impression that he supports the idea of consultation, but thinks that the trouble with the amendments moved by my hon. Friend the Member for North-East Hertfordshire is that their scope is too narrow in terms of who would be consulted. I assume that he has conceded the principle of the amendments but thinks that their scope should be widened. Carrying that to its logical conclusion, if we pressed them to a Division he would support us with the proviso that, if they were accepted, he would try to amend them on Report to widen their scope so that they were 100 per cent. consistent with his views.

Photo of Andy Burnham Andy Burnham Labour, Leigh

The real problem with the amendments is that they do not reflect current practice in the NHS and in Richmond house. They are far too narrowly focused on health professionals and NHS staff. The hon. Gentleman cannot have been listening when I said that SHAs will have an impact far beyond the NHS, especially in terms of regional government and regional development agencies. I do not support the amendments, but I do not think that the Minister would have a problem with them in principle.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I am most grateful to the hon. Gentleman. I had forgotten that he is sitting next to a Government Whip, so no doubt he had to put it on the record that he had overstepped the mark and was heavily backtracking to remain within the bounds of the controls.

My hon. Friend the Member for North-East Hertfordshire has moved some important amendments today and, unlike the hon. Member for Leigh, he is right because it is crucial that when an important new structure with the vital role, as the Government keep telling us, of the strategic overview of health care provision throughout the country is set up, there should be consultation within the local community. Perhaps, as the hon. Gentleman said, we have been a little modest in suggesting who the consultations should be with. Perhaps the amendments are right in principle and would enhance and improve the Bill, but need to be considered further at a later stage to ensure that we have not missed out any people or organisations that should be included in the consultation process. I presume that the Minister will also be sympathetic to the amendments, even if he believes, like his hon. Friend, that they are a little narrow in suggesting who should be consulted.

There is a similar precedent for consultation. At the beginning of the debate, Miss Widdecombe, you kindly said that we could go slightly wide of the amendments, but I assure you that I do not seek to test your patience and I shall watch you very carefully so as not to overstep the bounds. I am trying to explain that there is a precedent. During the proceedings of the Health Act 1999, Miss Widdecombe, you were the shadow Secretary of State for Health and leading for the Opposition. You will be familiar with the fact that when the Government set up the PCTs they were anxious that they should emerge as voluntary organisations after full consultation with the local community. We are setting up new groups or structures within the health service and there is a precedent for the SHAs--the original powers taken by the Government to set up the PCTs and PCGs in 1999. I am sure that you will remember, Miss Widdecombe, that the then Minister of State, ironically, Standing Committee A, during the afternoon--there are many similarities that I hope will keep me in order--on 27 April 1999, said:

``Given some of the comments that have been made, it is important to emphasise that we do not intend a headlong rush''--

We have heard a lot about headlong rushes today, particularly this morning--

``to be made into PCTs and that it is not a part of our agenda to impose PCTs on the national health service.''

This is my point:

``We want measured and voluntary change, and progression to trust status that is driven locally and based on local views. Full and proper consultation must therefore always occur before a PCT is established, and due consideration should be given to the views of a full range of local stakeholders.''--—[Official Report, Standing Committee A, 27 April 1999; c. 252.]

The then Minister, like the hon. Member for Leigh, had a broader vision of the bigger picture than I have, and that is my fault. The hon. Gentleman's criticism is that our amendments are too narrow, and I accept that. I plead guilty.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

It is only right that I should plead guilty, because I drafted the amendments. Does my hon. Friend agree that the reason for choosing those particular stakeholders was because the Royal College of Nursing had said that it was worried about the time scale envisaged for the proposals, which talked about new organisations. It was concerned that the programme was ambitious and the BMA—the doctors—said much the same. It used the words ``ambitious timetable''. Those concerns came to us, but I accept that I may have drafted the amendment too narrowly.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

My hon. Friend is right to draw attention to those important views from outside bodies whose members are working day after day in the health service and who have a far greater comprehension of what is going on than any politician.

Although the Minister was referring to PCTs, the precedent exists and we strongly believe, as does the hon. Member for Leigh in a wider way, that the same criteria for consultation, discussion and consent should apply to the SHAs before they are established. Given the power of our arguments, I hope that the Minister would be prepared to accept the pleading from his hon. Friend, and from us, and agree to the amendments as a halfway house, or building block, that can be improved on, enhanced and expanded by the Government on Report. The Government could use their majority to ensure that we improve the Bill in such a fashion.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

This has been a useful debate and I thank all hon. Members who have taken part. The hon. Member for West Chelmsford asked me to take into account the arguments of my hon. Friend the Member for Leigh, which I am prepared to do because he made a good case with good arguments. I should also say that I am grateful for that, just in case, with the Whip sitting next to him, I cause any problems, but I am not trying to encourage other hon. Friends. I want to put what I am saying on record because I do not want to be disingenuous to the hon. Member for North-East Hertfordshire who moved the amendment.

My hon. Friend is right. The architecture of the Bill includes a duty on the Secretary of State to set up SHAs, so we must be clear that the Bill will require him to do that anyway. He is right about the principle of consultation and the argument must take place in that context. We believe, and I hope that the Committee will endorse the view, that it should be a statutory duty to set them up. We could not pull the rug from under the Secretary of State and say that they cannot be set up under certain circumstances. The proposals are coherent.

SHAs should cover every part of England, but I accept the point made by my hon. Friend that the National Health Service Act 1977, or any other subsequent piece of legislation, which the Conservative had 20 years to change and amend, does not require consultation on the establishment of health authorities, and it never has done. Currently, the Secretary of State is required to establish health authorities under statute. My hon. Friend is right to draw attention to the fact that previous Governments, as well as this one, have operated the practice of consulting the public, professions in the NHS and groups outside on proposals to change the boundaries of health authorities; mergers are an example. We are in the middle of consultation now about the establishment of the new SHAs.

I could not accept the suggestion of the hon. Member for West Chelmsford that we should consult on the principle of establishing SHAs because we believe that that should be covered by an express duty on the Secretary of State. As suggested by my hon. Friend the Member for Leigh, there is scope for considering consultation processes under the Bill in respect of changing the name of health authorities and the boundaries and mergers of SHAs. I am prepared to reflect further on that and consider amendments on Report if necessary. The principle, to which my hon. Friend referred, is important and I am happy to consider it further.

I am prepared to reconsider how the proposals will affect SHAs in England, but I cannot accept the amendments as they would apply to Wales, for two reasons. First, those are devolved matters. This House has given responsibility for them to the National Assembly for Wales, and we should respect that devolution settlement, not seek to fetter the Assembly's powers in that way.

Secondly, more practically and perhaps importantly, the health authorities in Wales will be abolished by 2003 anyway. There seems little point in establishing such consultative proposals for bodies that will be scrapped in Wales in 18 months' time. With that caveat, and bearing in mind my hon. Friend's request to look at boundary changes and name changes, I can tell the hon. Member for North-East Hertfordshire that we will reflect further on the matter and table an amendment, if possible, on Report. I hope that, in that spirit, he will not press the amendment.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health) 5:30 pm, 27th November 2001

The Minister's approach has been constructive. I join him in congratulating the hon. Member for Leigh. His viewpoint met us halfway and encouraged the Minister to move further as well.

The Minister has not gone the whole distance, as we would like him to. He says that he will consider placing consultation requirements in the Bill, which is welcome, and he mentioned consultation on names and boundaries. However, he did not agree to consultation on practical matters such as whether an SHA could deal locally with robust arrangements that were ready to be put in place, or whether the timing was right. Many concerns expressed have been on such matters as insufficient staff for PCTs and arrangements not being fully in place, as we have discussed, for a start in October or even in April 2003.

I should like to press the Minister further. Is he simply agreeing to consultation on names and boundaries with the wider group of people mentioned by the hon. Member for Leigh, or is he prepared to consider consultation on some of the more practical issues that I raised about whether local arrangements are ready for the changes to be implemented, whether staffing of PCTs is sorted out and so on? In other words, is he prepared to find out from doctors, nurses and local people whether the proposals can, practically, be implemented?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I have probably gone as far as I can today in giving commitments to the Committee to re-examine the proposals. I shall certainly reflect on what the hon. Gentleman has said, but I repeat the point that I made at the outset: there will, I hope, be a statutory duty to establish SHAs, and I would treat with extreme caution any proposal from the hon. Gentleman that that should somehow be subject to caveats, or made conditional upon another range of circumstances. The Secretary of State will have to be satisfied that the SHAs are capable of delivering the functions that he has in mind for them. That is his responsibility, and he must discharge it. I have gone as far as I can on areas where we can look at amendments to the Bill.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

We have seen some progress on the amendments, so, in that spirit, it would be right for me to withdraw them. I hope that the Minister will consider what the BMA and the RCN have said. Obviously, if the representative bodies of the two main health professions combine to say that they are worried about the time scale for arrangements being enforced, that is a matter for concern. We hoped that this consultation process would be a way, not of second-guessing the Minister, but of ensuring that local services do not collapse, with inadequate management, causing a deterioration and the delay of much of the progress that we hope to see during the coming years. I hope that the Minister will think further on the matter; he has said that he probably will. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I beg to move amendment No. 90, in page 2, line 33, at end insert—

`(2A) Subsection 126(1) of the 1977 Act is amended by the insertion after the word ``Parliament'' of the words ``; save that no statutory instrument shall be made under section 8 above unless a draft of the instrument has been laid before, and approved by resolution of, each House of Parliament.''.'.

The amendment is very straightforward. As is patently obvious, we are seeking to reverse secondary legislation procedures that will set up SHAs. Unless I am mistaken, there are 58 separate order-making powers—[Interruption.] My hon. Friend the Member for North-East Hertfordshire tells me that it is slightly less than 58, but, in any event, the vast majority of the considerable number of order-making powers in this legislation are negative procedures.

At this point, I will offer to do a deal with the Minister. I will not mention issues that some of his right hon. Friends may have supported in 1983 or in 1987 if he agrees not to offer the bog-standard ministerial response that the Opposition did not do things in the way that I am suggesting when in government. Life has moved on and people have changed their views on certain issues. I shall explain why I have changed my views on the Bill after the Minister has intervened.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

Why is the hon. Gentleman so reluctant to talk about the record of his party in government? He is right to say that life has moved on; he is sitting on the Opposition Benches and we are sitting on the Government Benches.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I shall not digress, except to say that I was not talking about the Conservative Government. I said that I would do a deal with the Minister; unless he advances the hackneyed argument that most Ministers advance these days, I will not remind him that his right hon. Friend the Prime Minister fought the 1983 general election on CND's platform of withdrawal from Europe.

Photo of Ann Widdecombe Ann Widdecombe Conservative, Maidstone and The Weald

Order. CND has no relevance whatever to amendment No. 90, which is concerned with procedures for draft instruments.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I am extremely grateful for that guidance, Miss Widdecombe, because it helps me make the point that life has moved on and that issue is no longer relevant. I hope that the Minister will not offer the hackneyed arguments to which I have referred, but will instead advance an intellectually coherent argument against the amendment—I am sure that he does not accept it—based on reasons why the negative, rather than the affirmative, resolution should be used.

You have graciously and kindly said, Miss Widdecombe, that our debate can go slightly wider, but I shall be careful not to abuse your generosity. As you would have realised had you been here this morning, and as anyone who has studied the clause will realise, it sets up an important new or reformed structure in our health care system. We have argued time and again this morning and this afternoon—I can assure the Minister that we will do so again in respect of clause 2—that the Government are rushing far too quickly into imposing the new structure on the health service. In a spirit of helpfulness, we are urging a more cautious approach that ensures that proper foundations exist on which to build their aims. One way to do that is to accept the amendment, which would reverse the onus to enact secondary legislation through the negative procedure.

This morning, my hon. Friend the Member for North-East Hertfordshire pointed out to the Minister that in one particular Session, there were more than 2,000 negative resolution statutory instruments, of which only 30 or 31 were debated in Parliament. Putting legislation into the negative format gives the Government carte blanche. The way in which the system works in terms of secondary legislation means that it is extremely difficult to find parliamentary time for such matters, especially if the Government are determined to restrict and hamper the Opposition's ability to express an opposing view in Parliament.

It is important for democracy, and it is important for the NHS, that we have affirmative procedures, in which case the order setting up the SHAs would have to be debated in both Houses of Parliament. There would be an opportunity for Members, and those in another place, to scrutinise line by line, as we are doing to the Bill, a far-reaching proposal, which would ensure that the Government have got it right. Even at that late stage, they would have the opportunity to advise or warn the Government if they discovered that there were faults and flaws in their proposals. Once the Government recognised the strength of the case, they would have the opportunity to rectify the problem before inflicting a flawed piece of legislation onto the NHS.

Photo of Peter Atkinson Peter Atkinson Conservative, Hexham

My hon. Friend points out an important aspect of the Bill. In clause 1, the Secretary of State is taking substantial powers to

``vary the area of a Strategic Health authority . . . abolish a Strategic Health authority . . . establish a new Strategic Health Authority''.

If that were done against the will of local people there would be an enormous argument. If, for example, the Secretary of State decided that Chelmsford should be welded into east London, many of my hon. Friend's constituents would become angry. That could be imposed without representation being made unless the Secretary of State was to accept a prayer against that resolution. That is wholly undemocratic.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

My hon. Friend is right, and he anticipates a point that I was seeking to move onto during the course of my remarks. Clause 1 contains substantial powers for the Secretary of State, and he can exercise those powers notwithstanding the Minister's generous concession during our debate on the last group of amendments. It would be a step forward if, on Report, the Minister were to come up with proposals that were acceptable to the House, and they were embodied in the Bill; what a paradox.

The Minister is in a conciliatory mood today, and he has listened to my arguments and those of my hon. Friend the Member for North-East Hertfordshire and the hon. Member for Leigh. He has seen that there is reason to look further, and he may come forward with amendments on Report. It is unusual for the Government to concede a point in Committee to the Opposition, and it is very unusual for a Government Back Bencher to contribute to the debate. However, when such a Back Bencher hits the jackpot and comes up with an idea that the Minister thinks is worthy, that is a bonus, so it must have merit.

The Minister could go away and return with a set of proposals that, for the sake of argument, we might find acceptable. If they were then included in the Bill, the Minister will have increased the powers of consultation on a number of issues that are vital to local people, communities and organisations that are directly affected or which have an interest in strategic health authorities and health care in their region.

That would be a step forward, but the contradiction is that the powers in the same Bill allow the Secretary of State to ride roughshod over the results of any local consultation carried out in good faith if he is not minded to accept the advice or the views that are thrown up during the consultation process. That seems extraordinary. We must be consistent; the consistent approach, given the Minister's earlier statement, is that the Secretary of State should be held to account.

The affirmative resolution procedure could be described as consultation because a Committee of Members of Parliament—reflecting all views and parties, and able to be consulted—have the opportunity to contribute to the debate and decide whether to vote for the order to become law so that the SHAs can be established as the Secretary of State has specified. Alternatively, it could be thrown out--a statutory instrument cannot be amended--and the Secretary of State could be told to look at the matter again because he has got it wrong or is acting in contradiction of the views of local people following the consultation. He could then start again from scratch and return to the matter in the House and in another place.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health) 5:45 pm, 27th November 2001

Does my hon. Friend agree that the section 60 power in the Health Act 1999, which provides wide order-making powers in health matters, has recently been used successfully to allow consultation and the views of those who are not Members of Parliament to be heard? The draft Nursing and Midwifery Order and the draft Health Professions Order were considered yesterday and representatives of the nursing profession, the midwifery profession, health visitors and so on with particular views were able to express them and to lobby Members of Parliament. The same applied to chiropodists and podiatrists who were unhappy with aspects of the Health Professions Order. If such bodies have concerns, it is better, when the time comes for a decision to be made, if they can make representations. The Royal College of Nursing and the BMA both have worries, so would that not be the best approach?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Again, my hon. Friend is absolutely right and I hope that the Minister was listening carefully to the powerful way in which he made his case. It is important that not only Members of Parliament, but outside organisations connected with health care and the national health service have the opportunity to input their views on the proposals in draft legislation, whether primary or secondary legislation. It is equally important that they believe that their views have been considered and given a fair chance. If the Government do not agree with their views, and if both Houses of Parliament do not share those views, it is only right that the orders should go on to the statute book. However, there must be that power to determine whether the Government are right. I warn the Minister that this is the first of several debates about this issue, because most of the order-making powers in the Bill are subject to the negative resolution procedure and most deal with important matters. I hope that he will think carefully about that.

Photo of Peter Atkinson Peter Atkinson Conservative, Hexham

It has suddenly occurred to me that my hon. Friend's advice to the Minister is not in the best interests of the Opposition. Most Members of Parliament know that once they interfere in local politics, they are likely to get their hands bitten hard. In this case, the Secretary of State will become a referee between several warring factions who think that boundaries should be somewhere other than where he has decided. Ultimately he will have to adjudicate, thereby becoming deeply unpopular. If he followed my hon. Friend's advice, he would at least avoid some of that flak.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I fully understand my hon. Friend's point and would not want to be a Secretary of State placed in the position that he describes. However, I am afraid that, on this occasion, I cannot agree with my hon. Friend. Democracy, proper consultation and the opportunity fully to debate and consider legislation is more important than the situation in which an individual Secretary of State might find himself.

Too much legislation, especially secondary legislation, is going through the House on the nod. That does a disservice not only to the bodies and organisations that are directly affected by it, but to the working of this place. It also builds up the frustration of interested parties whose lives are affected either by the work that they do in those organisations or through the representative role that they play. Many organisations feel that they are being ignored, bypassed and sidelined on issues that are crucial to many people.

In the light of that, I hope that the Minister will have an open mind and be prepared to think again. I leave him with one thought. When Labour in opposition between 1992 and 1997, many of his colleagues who were then on the Front Bench—I am ashamed to say that I do not remember if he was one of them—made the same speech in Committee against my Government that I have made today against his Government. They spoke passionately and with conviction and belief, but they were frustrated. The Minister must know what we are going through, and I hope that he will want to try to stop that ping-pong effect between the Government and the Opposition.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

First, I apologise for my late arrival in this afternoon's sitting. I said this morning that as I believe that the whole clause is fatally flawed I do not have much to say about amendments that seek to make it better. I was surprised to find that there is some compromise in the air regarding consultation. I was also surprised, but delighted, to see you in the Chair, Miss Widdecombe. I remember the times that we spent debating the Health Act 1999, sometimes with the Minister. That is where I learned how to deal with Standing Committees. If I perform badly, it will not be a reflection on what I learned from you, Miss Widdecombe. I enjoyed the experience a great deal.

I am somewhat hampered, in that I understand that there may not be a stand part debate. I do not argue with your decision on that, Miss Widdecombe, but I regret it because we have not had an opportunity to debate the fundamental problem—the abolition of health authorities and the creation of larger beasts called strategic health authorities—that none of the amendments tackle. In so far as I am in order, I will attempt to make a few remarks on the order-making powers during discussion on the amendment.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

The hon. Gentleman has been a member of the Committee since its inception. If he does not feel that any amendments deal with the fundamental issue to which he refers, why has he not tabled amendments to deal with it?

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

The amendment that I would like to table is one that deletes clause 1. I can support that principle by voting against clause 1 on the stand part vote, so amendments are not required. I made that clear earlier, and I am sorry that the hon. Gentleman did not understand my point. I make it again now. We can have long debates about improving something that is fatally flawed, but it is important to come down to the nub.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

On a point of order, Miss Widdecombe. As one or two hon. Members were not present when you made your ruling, it may be convenient for the Committee if you confirmed that you would allow considerable latitude in the discussion of the amendments.

Photo of Ann Widdecombe Ann Widdecombe Conservative, Maidstone and The Weald

I am not sure whether my words were ``considerable latitude''. I said that, having examined the scope of the amendments and the clause, I was not minded to allow a stand part debate and that, in the light of that, I was prepared to allow discussion to go slightly wide. I stressed that that was not a general invitation to discuss anything and everything. If the hon. Member for Oxford, West and Abingdon wishes to make remarks that are slightly wide, that will be in order.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

I am extremely grateful to you, Miss Widdecombe, and to the hon. Gentleman, for that clarification. On Second Reading I made several remarks that I would otherwise have made in a stand part debate, and I do not intend to take up the Committee's time by repeating them. I should be grateful if you would bring me to order should I step beyond the latitude that you have so kindly and wisely granted.

I agree with the principle that it is correct when scrutinising legislation to ensure that the Government are not taking the easy path with the negative procedure for statutory instruments. When we discuss other order-making powers in the Bill, there will be occasion to raise that. The remarks of the hon. Member for West Chelmsford are reasonable in general, but this is not the order-making power upon which to go to war over negative and affirmative resolutions. If every change that was conceived had to go to a Standing Committee, we would spend much time looking at minutiae and miss the bigger picture, and that would, to a certain extent, play into the Government's hands.

The wider picture is yet another example of the continual upheaval in the health service, with the loss by local health authorities of their strategic functions to a much larger body with which local people will find it hard to identify. Although there will be coterminosity, in that we are told that an SHA's wider boundaries will not cross the boundaries of the local authority or the regional office, there will still be a loss, certainly for counties, when, for example, the Oxfordshire health authority that people know so well and sometimes love—or sometimes hate—is removed. It cannot be replaced, even with greater consultation over SHAs and PCTs.

Any gain is lost if the clause is passed, so I do not think that asking for affirmative resolutions when boundary changes occur is especially helpful. There will always be arguments about what the boundaries and the name of the SHA should be. In the end, the Government have to make a decision, and will, presumably, be indirectly held to account for it.

As the Government are taking broad powers to make changes, it is appropriate to question why the Government want to devolve responsibilities to PCTs, which for all their localness, do not have the same understanding of and identity with local communities that health authorities have. Health authorities are population-based groups, whereas PCTs, by definition, cover those people on the list of GPs in the area. While they may be smaller than health authorities, they lose a lot in terms of accountability.

In the areas that I know of, the names of the PCTs do not necessarily follow those of natural communities. The Government will have difficulties naming SHAs under some of the powers that the amendment is discussing, when trying to identify natural communities.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health) 6:00 pm, 27th November 2001

The hon. Gentleman is not right in what he said about primary care trusts. PCTs come in various shapes and sizes. For example, the PCT that covers my constituency is coterminous with the previous boundaries of the health authority.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

The concept of the boundary of the PCT is a curious one. As I understand it, the people served by the PCT are those who fall within the ambit of the primary health care services in that area. Indeed, one of the arguments for the establishment of the PCT was the focus that the Government want to give to primary care to have a greater role in commissioning outwith health authorities. Health authorities cover geographically defined areas, and there will be some significant overlap in population terms between PCTs, simply because they are at the boundaries of conurbations. I do not know whether the Minister

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The hon. Gentleman is right on that point, but he is wrong in assuming that there is no possibility of coterminosity between PCTs and health authority boundaries. Often there will be. Some PCTs are set up on the same boundaries as health authorities.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

Presumably they have seen the virtue of that conterminosity with the commissioning population. Therefore, if commissioning is the key—certainly some of the functions of the commissioning and overseeing of services—I would prefer to see that done and supervised on a population-based approach.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

Once again the hon. Gentleman has missed one important factor—the PCTs are established following local consultation. I accept his point about the boundaries sometimes being a mysterious process, but whatever the boundaries are, they are informed by the strength of local opinion, particularly with the GPs and in primary care.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

There would be more merit in that argument as a total rebuttal if the formation of PCTs was an option that local populations could choose following consultation. But the Bill, and specifically the next clause—which I will not deal with now—does make that compulsory, and therefore less of a consultative issue.

It is relevant to the discussion to ask the Minister for clarification on a matter that he raised earlier, which we could not discuss then. He provided a clarification note about the functions currently conferred on health authorities and transferred under the Bill in the main to PCTs and, in one example, to SHAs, with regard to which he has an order-making power, which we are discussing here.

Personal medical services and personal dental services will be transferred to SHAs because, as the Government explain in their note, technical and legal barriers prevent the direct conferral of all PMS and PDS functions to PCTs in the Bill because the National Health Service (Primary Care) Act 1997 requires a distinction between the commissioner and the provider of PMS and PDS pilots. I understand that. I was concerned about the loss of the purchaser-provider split when PCTs were going to be doing the providing, as well as the commissioning and running themselves.

Does the Minister think that there is an argument for ensuring that more of those services, particularly the management of family health services and general medical services, might have been transferred to a SHA rather than to a PCT, where there will be a concern that it is the people against whom there may be complaints and general issues of performance who are in charge of managing that performance.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

It is important that those services should be as close to the front line as possible. That is why we have taken the decision on the point he mentions. Personal medical services are particularly difficult because some PMS pilots are directly provided for by PCTs and it is important to respect the commissioner-provider divide. That is regulated under clause 4, so I am sure that we will have an opportunity to discuss it later.

Photo of Evan Harris Evan Harris Liberal Democrat, Oxford West and Abingdon

On that basis, I shall not pursue it any further now.

On Second Reading, I raised the question of the public health function. Concerns have been raised and while there is certain support for the concept of moving the public health function from local health authorities to PCTs, concern has also been raised about the loss of expertise and people through that change, and the loss of a strategic overview because SHAs will be much larger and will have a rival in the shape of a more local director of public health. How will the Minister ensure that we do not lose the effective public health function? I hope that he will accept that it has been performed well at health authority level so far. In respect of infectious disease control and other matters, the regimes are tried and tested at that level. It would be unfortunate if, despite gaining the benefits that the Minister claims for this move, the public health function was lost. There is a question over whether sufficient specialist expertise exists in public health to provide the function under multiple PCTs, rather than under a single health authority.

I am grateful for your patience, Miss Widdecombe, in allowing me to stray beyond the exact boundaries of the amendment. I shall seek a Division at least on clause 1 stand part and, because of our concern about change for the sake of it and appearing active to hide failure to deliver, my party cannot support what amounts to vandalism of the health service.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I will reply to some of the points made by the hon. Member for Oxford, West and Abingdon (Dr. Harris) shortly. On public health, he may have missed my earlier attempt to clarify those points. I hope that he will not take offence, but I will send him a copy of my earlier remarks rather than attempt to repeat them. There may be video too, but he would not want to watch that.

On both sides of the Committee, there must be a sense of deja vu about these debates. The hon. Member for West Chelmsford is probably right to say that in opposition my colleagues have tabled similar amendments to those tabled today. During every Bill for which I have ever had responsibility in Committee, amendments have been tabled that seek to do broadly what the hon. Gentleman has tried to do.

I say to the Committee, and particularly to the hon. Member for West Chelmsford—he dealt with similar arguments as a Minister—that my job is to strike the right balance between order-making powers that should be subject to affirmative procedures because of the issues that they raise and those issues that can be dealt with by negative procedures. It is legitimate for hon. Members to disagree with that, but it would wrong for the hon. Gentleman to imply that because I have made a decision on such powers my motive is to sideline Parliament or ignore the parliamentary process to get what I want in a back-handed way. That would not be true.

I have always tried to discharge that aspect of my responsibility to the best of my ability. I recognise the responsibilities that we have to Parliament, to the House and to the democratic process, which we all hold dear. I do not appreciate the hon. Gentleman's suggestion that these clauses have been cobbled together in a deliberate attempt to sideline Parliament because that is not the case.

However, I welcome the hon. Gentleman's new-found role as guardian of the constitution, and he performed it well. It is also appropriate for us to point out what he rightly described as some inconsistencies. This is not all one-way traffic and although he might like a polite veil to be drawn over the record of the Administration in which he served, I am not prepared to do that.

In the context of these debates, it is necessary to compare and contrast. It is perfectly reasonable for me to make the point that if the hon. Gentleman were standing in my shoes—admittedly, it would be a different Bill—I doubt whether he would have drawn the line between affirmative and negative resolutions in any place other than where this Bill has drawn it. It is a question of balance and judgment, and Ministers are accountable in that regard. If the hon. Gentleman were to have ministerial responsibility again, I very much doubt whether his conversion would be translated into action such as that proposed in the amendment.

I should draw the hon. Gentleman's attention to one other point about the amendment that explains why I am unable to accept it. As I understand it, it would require that affirmative resolution procedures be followed in relation to any order to vary the establishment orders, including any order that transfers staff, property, rights or liabilities under this provision. The Opposition Whip, the hon. Member for Hexham (Mr. Atkinson), is present, as is the Government Whip, my hon. Friend the Member for Poplar and Canning Town (Jim Fitzpatrick), and it is incumbent on us as Members of the House to consider whether it is a sensible use of our time to make such matters subject to the affirmative resolution procedure. As the hon. Member for Oxford, West and Abingdon rightly said, this is not a die in the ditch issue, and I am sure that in his heart of hearts the hon. Member for West Chelmsford probably realises that. On this occasion, he has chosen the wrong issue about which to make such points.

There is a sense of ritual familiarity about these arguments, and I do not dispute the passion with which the hon. Gentleman holds his views on the constitutional propriety of this or any other point that he has made, but this was the wrong issue to which to address his concerns. As I have said, the clause deals with the negative resolution procedure in a sensible way and I hope that my hon. Friends will support that view and reject the amendment.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I have listened to the Minister's comments and, naturally, I am disappointed. I thought that, like a number of sinners, he might feel that he could repent, but it is clear that he is not prepared to do so on this occasion. Regrettably, therefore, this is a missed opportunity. I am being in no way derogatory, but the Minister seemed a little sensitive to the apparent suggestion that he was seeking to sideline Parliament. I might so accuse a number of his colleagues, but I would not aim that accusation against him on a personal basis.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I did not assume that the hon. Gentleman was making personal comments.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I am grateful to the Minister for that reassurance. Although I am disappointed that he is not prepared to accept the amendment, I do not wish to press it to a Division at this stage. I should like first to read the official record, reflect on what the Minister has said and consider our position.

Amendment, by leave, withdrawn.

The Chairman, being of the opinion that the principle of the clause and any matters arising thereon had been adequately discussed in the course of debate on the amendments proposed thereto, forthwith put the Question, pursuant to Standing Orders Nos. 68 and 69, That the clause stand part of the Bill:—

The Committee divided: Ayes 9, Noes 6.

Division number 3 Adults Abused in Childhood — Clause 1 - English Health Authorities: change of name

Aye: 9 MPs

No: 6 MPs

Ayes: A-Z by last name

Nos: A-Z by last name

Question accordingly agreed to.

Clause 1 ordered to stand part of the Bill.