Clause 2 - Primary Care Trusts

NHS Reform and Health Care Professions Bill – in a Public Bill Committee at 6:15 pm on 27th November 2001.

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Question proposed, That the clause stand part of the Bill.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I welcome the opportunity to debate clause 2, about which we have serious reservations. It is the crucial first clause that deals with primary care trusts. PCTs will be established by orders by the Secretary of State, and the purpose of this short but important clause is to give him the powers to do so.

The arguments about PCTs are a replica of the arguments that we had this morning about SHAs. I am glad that I will not unduly bore you, Miss Widdecombe, because you were not here. We strongly believe, on the basis of even more evidence than there is in respect of SHAs, that the Government are rushing headlong into these reforms without leaving enough time for the preparatory work that is needed to bed them down and have them up and running in time for them to operate at maximum efficiency from the start.

The clause gives the Government powers to ensure that a fundamental change to the health service and its funding will take place by statute. That is important because when they introduced the legislation that set up PCTs—as you will know, Miss Widdecombe, because you were involved in opposing it—they always said, on the record in this House and in another place, that PCTs would be created only by local consent through consultation with doctors, nurses and local communities. The then Health Minister, the right hon. Member for Southampton, Itchen (Mr. Denham), and the Government spokesman in another place, Baroness Hayman, said that the Government had no plans whatever to force PCTs on local communities and health care providers; they were to emerge as and when they wished. All such concerns have been brushed away in this headlong rush to get a piece of legislation on to the statute book.

As I said to my hon. Friend the Member for North-East Hertfordshire, the Secretary of State is confronted with many problems in the health service. Every member of the Committee will know about those through their dealings with constituents. Problems with waiting lists, whether it be the numbers of people waiting or the length of time that they have to wait; waiting times at accident and emergency departments in hospitals all over the country; the trolley waits that we hear so much about in the media and from our constituents; the postcode lottery of getting drugs such as beta interferon: those are the problems facing real people in the real world.

The Secretary of State is confusing activity with action. He thinks that if he introduces yet another structure of reform, he will be seen to be doing something. In truth, as anyone who has one iota of knowledge of the health service will have realised, there is nothing in the clause or the Bill that will help to overcome or minimise the problems facing our constituents day in, day out. They must wait longer for health care from our hospitals and suffer the indignity that the Government have created with a vengeance; a waiting list to get on to the waiting list. The irony is not only that people must wait to go into hospital; they must wait to come out of hospital because of bed-blocking problems. Clause 2 does nothing to deal with those problems.

Photo of Andy Burnham Andy Burnham Labour, Leigh

If the picture is as the hon. Gentleman paints it and the proposals will do nothing to help the health service, why are they supported by organisations across the health service, representing a vast and diverse range of interests?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I can answer that very simply. The hon. Gentleman did not hear what I said; the Bill does nothing to solve the problems facing our constituents, including hospital waiting lists and other health care issues. That is a different point from that raised by the hon. Gentleman.

The clause transfers 75 per cent. of the funding that, under the existing system, goes to the health authorities and the acute trusts directly to the PCTs. That is a significant new responsibility for them because, clearly, they have not had to deal with such matters, which were previously the responsibility of the health authorities. They must also identify and provide for the range of health care within the area that they cover; that is another huge new responsibility.

Photo of Laura Moffatt Laura Moffatt Labour, Crawley

I am not entirely sure what the hon. Gentleman was doing before the 1997 election, but my party and I were talking to GPs about what they wanted. They wanted power in their hands and that is precisely what the Bill enables them to have. To say that it will make no difference to local health care is nonsense.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Strangely, I was also talking to my GPs and I cannot believe that Chelmsford in Essex is different from Crawley in Sussex. If I remember correctly, my GPs were telling me at the time that they were terrified that a Labour Government would take away the extra powers that they had been given as fundholders. They did not want that because they liked the extra freedom and power to be able to look after their patients. That is what I heard from my GPs before the 1997 general election.

Photo of Andrew Murrison Andrew Murrison Conservative, Westbury

Does my hon. Friend agree that what GPs really want is a period of stability with no change to allow them to get on with their job, which is treating patients? Does he also agree with Dr. Charles Webster, to whom he referred earlier, who said that none of this mucking around does much good for morale?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

My hon. Friend is absolutely right. There is a lot to be said for stability, but it must not be a panacea for no action when action is needed.

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

The hon. Gentleman and his hon. Friend make the case for no change and for organisational stability. That is precisely what his hon. Friend said and he agreed with it. Perhaps he would explain to the Committee what the structural reforms to the NHS are that his right hon. Friend the shadow Chancellor of the Exchequer has been saying are necessary. How does that square with the desire for no more change?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

As I continue, my view will become apparent to the Minister. Sadly for him, I have not fully developed my argument, which should not come as a surprise, because it was made powerfully by my hon. Friend the Member for Woodspring (Dr. Fox). I echoed his comments on Second Reading and they were echoed by most speakers in our debate this morning on the parallel issue of strategic health authorities. The problem is two-pronged. Having given the PCGs and PCTs power to develop on a voluntary basis with full consultation and consent, as the right hon. Member for Southampton, Itchen (Mr. Denham) and Baroness Hayman said, the Government have made a formidable U-turn, sweeping that away and imposing it in statute.

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

The hon. Gentleman obviously needs time to develop his argument and I am happy to give him that. However, in an earlier debate, did he not pay tribute to politicians who sometimes change their minds on policy?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

Absolutely. No one should remain in a time warp, but politicians usually change their minds over many years when they have discovered that a policy or philosophy is discredited, outdated or irrelevant to changing needs. PCGs and PCTs were created just over two years ago and they are not outdated or irrelevant to needs. The Government have gone against the assurances that were repeatedly given in the House and in another place that PCGs and PCTs could develop on a voluntary and consensual basis.

My second point concerns strategic health authorities. I am even more convinced that the Government are rushing headlong into setting these organisations up and having them in place. We have established from the Minister's helpful contributions that they will all be established by October next year, although the first full financial year of their operation will be April 2003—March 2004. We believe that that is too short a time in which to set them up. More and more people who work in the health service are expressing concern about the rush. They fear that the PCTs—and, even more so, the PCGs that are still developing towards PCT status—will not have built up enough confidence and expertise to be able to cope fully with what they are expected to do. Ministers have boasted frequently that this massive and significant reform is marvellous for the health service. I do not disagree; it is massive, and it is significant in its way. However, I question whether the new bodies—particularly the PCTs, which are heavily reliant on the contribution of local health experts—will have the expertise and confidence to carry out their functions in a workable and clear way from the start.

I suspect that the Minister is aware of that, but if he is not, he will become aware of it with a vengeance. If the expertise is not there and those involved get it wrong, there will be the mother of all protests immediately afterwards. If the Government of the day shifts the money down to that level of the health service, it will become apparent, almost immediately, when problems emerge. Constituents of ours, and patients, will quickly find out that the system is not working.

I do not see how Ministers can be so confident that this scheme will work successfully from the start without hiccups or more serious complications. On the law of averages, I do not think that that is possible. I am not telling the Minister to scrap the Bill because the Government are entitled to introduce reforms and to use their majority to change systems if they want to. However, before the Government mess up the provision of health care, they must ensure that it works from day one. I am not confident—nor are many of those working in the health service—that this will work because so many concerns exist over the fact that experience and the depth of expertise have not been built up to allow such a revolutionary new responsibility to be placed on those people.

There is also a problem of morale. As has been said in earlier debates, we are seeing the abolition of health authorities that are, by the nature of their current functions, significant employers. There are morale problems because of uncertainty over jobs, and the ability to transfer jobs, as health authorities disappear; particularly because, logically, the SHAs will employ fewer people. Presumably, some people will seek employment in PCTs, but they will still be new to that concept even if they have a great deal of experience of working in the NHS.

We helpfully corrected the Minister's figures by saying that, at the moment, we believed there to be 130 PCGs that were not far forward in seeking PCT status. It is a relief to see—from the breakdown of the Minister's figures—that the situation is not precisely as has been suggested, but there are still a number of PCGs that are only moving towards PCT status. Presumably, they will concentrate on achieving that status rather than on what they should be doing once they have it. That will lead to inexperience, uncertainty and, perhaps, a sense of optimism that is not based on reality.

For the Minister's sake, I hope that the Bill is a success, but I do not think that it will be with the current time scale and with what seems like the inexorable rush towards having the system up, running and in place before it has been tried and tested. That is why I do not think it unreasonable to urge Ministers to delay the introduction of the whole system in the same way as we have urged delay for the SHAs. I am not suggesting delay through prevarication simply to prevent the Government from fulfilling their aims; that is not my intention. I am proposing simply a delay, and not an especially long one. We have boiled down the time scale that the Minister gave to six months from October 2002 to April 2003. That is not a long time; in May, June or July 2003, the Minister may, with hindsight, come to dearly wish that he had heeded the advice of others and accepted that delay to allow time to bed in.

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

I am following the hon. Gentleman's arguments closely, and they have a certain familiarity. Given his many concerns, where are his amendments to the clause?

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

As the Minister probably knows, because I am sure that he reads the Order Paper—or, at least, his parliamentary staff does—there are two amendments to clause 2 on the Order Paper. The first seeks to postpone the introduction of PCTs until 1 April 2003; the second concerns the order-making powers. As the Minister also knows—and as I heard many of his colleagues say when his party was in opposition—the joys of Opposition spokesmen in not having the Rolls-Royce facilities of a first-class civil service really tax their ingenuity. The Minister will know that the amendments are starred and that, in their wisdom, Miss Widdecombe and Mr. Hurst have, rightly, not selected them.

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

I hear the hon. Gentleman's points, and I have some sympathy with them, but can I ask where all the Short money is going? He has £3 million of it.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I think that you would chastise me quickly, Miss Widdecombe, were I to seek to answer that question.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I hope that you agree, Miss Widdecombe, that the Minister gets full marks for trying it on but, sadly, he will not be successful tonight.

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

I think that the Conservatives' decision not to table amendments to the clause is right, because they have the same approach as me. On reflection, they may have tabled some amendments that were starred, but they are quite right if they have decided that the clause is so flawed that it needs to be opposed in its entirety. The clause is unamendable and unimprovable if one is opposed to the measures for reorganisation that the Government are taking. I welcome the fact that the Conservatives also take that view.

Photo of Simon Burns Simon Burns Shadow Spokesperson (Health)

I heard the hon. Gentlemen's comments with interest. I am grateful to him for contributing at this stage in my speech and thank him for his comment. I will not detain the Committee any longer because, as the hon. Gentleman said, the clause is important. We have serious concerns because we believe that the Government are mistaken in seeking to rush the matter. I am sure that many of my hon. Friends wish to raise important points about their concerns.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

I have one brief question. I am relieved to hear that the establishment of PCTs will be delayed until October 2002 and fully implemented in April 2003, but I am very concerned about the possible transition vacuum. What will happen when health authorities have gone, SHAs are in place and PCTs are not yet established?

Photo of John Baron John Baron Conservative, Billericay 6:45 pm, 27th November 2001

I add to the valid concerns expressed by my hon. Friend the Member for West Chelmsford my concern at the speed with which PCTs are being introduced. I question whether PCGs and PCTs are ready for the reforms. I think that the changes in the Bill, especially in relation to the establishment of PCTs, will divert activity and resources away from front-line patient care when it is most needed. It seems that the remaining 130-odd PCGs will be rushed into becoming PCTs whether they like it or not, and some existing PCTs are struggling.

I draw the Committee's attention to a study undertaken by the National Primary Care Research and Development Centre in collaboration with the King's Fund, which was supported by the Department of Health. The second national tracker survey of 71 primary care groups and trusts, to which reference has been made, concluded:

``Progress in commissioning, health improvement and partnership working is slower. Lack of reliable and timely information and insufficient managerial capacity remain problems.''

Professor David Wilkin, project director of the survey, said that

``there is a real danger the management of the organisational changes is going to divert attention from the core functions of improving care.''

He also said that the pace of change is being dictated by Government timetables rather than by a

``process of learning and building on experience''.

It is easy to dismiss such observations, but the fact is that this group, which has the backing of the Department of Health, has severe reservations about the speed at which PCTs are being brought into existence.

I have two further concerns about the introduction of PCTs, one of which relates to skills and the other to funding. On skills, Professor Wilkin pointed out that resolving this issue is a question not of extra resources, but of getting managers with the right skills and experience into the system. Managers from trusts and health authorities can be, and indeed are being, taken on, but they do not necessarily have the skills needed to cope with the additional roles and functions that PCTs will be taking on. In my view, that will cause some concern and disruption to the delivery of care.

PCTs are already experiencing difficulties in recruiting clinical staff who are competent, willing and able to participate, but the problem is not just with such staff. There are also other areas of management for which PCTs are struggling to find recruits. Finance directors play a crucial role, bearing in mind that, by 2004, PCTs will have under their control some 75 per cent. of national health service expenditure. Yet at the moment, a good number of PCTs cannot find finance directors, let alone ones with competent experience relevant to taking on the new roles. I would welcome the Minister's views on that.

I should also like the Minister to deal with the issue of funding. Will PCTs be saddled with health authorities' outstanding deficits as part of the devolution process? If so, PCTs could be left without the resources to implement their devolved responsibilities, let alone to achieve the Government targets on which much of their funding depends. With ever-increasing central directives and no additional resources, there will be arguably little opportunity to improve provision of health care over and above that which has been supplanted. I ask the Minister to clarify the precise funding requirements and relationships, so that we can ensure that PCTs are able to deliver the health care that we expect from them.

Whether in terms of skills or funding, we return to the central concern that PCTs are being rushed. As someone who, I admit, believed that the deadline was April 2002, I am obviously pleased to hear that it is October 2002. However, I have spoken to the two PCTs that cover my constituency, and the Minister might be surprised to learn that they were under the impression that the deadline was April. Moreover, their chairmen and chief executives have told me that they are worried about a management skills shortage.

In conclusion, I can only reiterate the view expressed by many members of the Committee; we should reconsider the timetable that the Government are forcing through, and contemplate introducing the April 2003 deadline.

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

I am conscious of the time and the fact that it would be convenient for us to hear the Minister's reply shortly, so I shall not detain the Committee. We oppose the proposals on imposing PCT status and imposing upon PCTs the transfer of powers from health authorities and we intend to vote against the clause.

I should like the Minister to clarify a couple of points. I echo the comments of the hon. Member for Wyre Forest about the vacuum that will be caused by a delay between the compulsory abolition of health authorities and the establishment of the remaining PCTs capable of taking on this huge range of additional responsibilities.

At what point in the interregnum between the publication of the NHS plan and the press opportunity of 21 April 2001 did the Government decide to change their position of allowing PCGs to choose PCT status and take this measure to impose PCT status on them?

Do the Government recognise the contradictions in their position? I shall try to cover this in less confrontational terms than those used on Second Reading. The Government have an agenda to end what they describe as the postcode lottery of prescription and the provision of treatment. I accept that my party has previously used those descriptors in expressing concern about the situation, but I have never been convinced that local decision making about priorities in a cash-limited system is always a bad thing. Indeed, it need not be local at the commissioning level; it could be local at the prescribing level. Does the Minister appreciate that any system that does not have completely centralised control will involve some geographical variation in the provision of services and the availability of treatments? He cannot say that he wants to devolve power, budgets and responsibility locally while at the same time seeking to abolish, or at least bear down on, geographical variations in the provision of treatment—what he calls the unacceptable variations of the postcode lottery.

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

I am genuinely puzzled by the hon. Gentleman's comments. The logical conclusion of his argument is that there should be centralised control of the NHS, yet that is clearly not his view.

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

I have written articles, which I would send to the Minister if I thought that he would read them, arguing that one cannot in all honesty say that there should be an end to geographical variations in the provision of treatment, or what some people lazily call the postcode lottery. Such decisions are not made in a lottery fashion, but after due deliberation by hard-pressed commissioners with limited budgets and a sense of guilt that they cannot fund everything that they wish to. The Government cannot bear down on that at the same time as saying that there will be devolution of real power, budgets and responsibility to the health authority or PCT.

Organisations such as the BMA should be cautious before accepting the Government's offer of all this responsibility and a budget to spend, because they will at the same time either centralise decision making to clamp down on what they describe as unacceptable geographical variations or use the opportunity of this apparent devolution to ensure that the blame for the inability to provide services in the postcode lottery is placed on PCTs, as was previously the case with health authorities. There are two different positions, and I am not clear which one the Government are adopting. I urge organisations such as the BMA to hold fire on deciding whether they think that this is a good thing until they understand whether what is being devolved on them is blame or the ability to make rationing decisions within a capped budget.

Unless the Government clarify which way they will go, the accusation will stand that they seek merely to decentralise the blame for rationing. This is going wider than PCTs, and I can remember having many debates around the subject of rationing with you, Miss Widdecombe, in which we shared a common view that we must be up front about the issue and then discuss the degree of rationing of additional funds.

Finally, I should like the Government to address the concern that they claim that these changes will save money in management terms. There are many who argue that if managers can be found to do the work, creating more commissioning authorities while still having SHAs that need people in responsible jobs who are being paid the going rate will increase, or at least maintain, the degree of management. It is hard to understand how the Government can have it both ways. They claim that their new system will not be under-managed, but the new bodies will receive a series of extra powers although they will have little experience, no option to opt in—the enthusiasm is not there—and will simultaneously be asked to deliver huge savings in management costs.

I asked on Second Reading, and I shall ask again today, whether the Government will be willing to subject their claims of management savings in this reorganisation, and others, to the scrutiny of an independent audit body, which the Government could propose and we could discuss? The Government must decide their answers to those questions, which illustrate the confusion that exists. I am concerned that the proposals mean significant upheaval and change, which is not the main priority for the NHS at the moment.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Will the Minister say a little more about one aspect of the structure? It is clear from clause 1, which we have already debated, that there is a power for the liabilities of health authorities to be transferred to SHAs, and no doubt such liabilities could be transferred to PCTs because there are similar powers in schedule 3. Are the Government in a position to explain what will happen to PCTs as regards debts that have built up in health authorities over many years?

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

I can reassure him and the Committee that there is only one health authority that has a deficit. The issue of the potential transfer of liability only arises in that one case. My understanding is that that deficit will be resolved by the end of this financial year.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I am grateful to the Minister. As regards general liabilities and ignoring the question of that one historic debt, which is of course of great interest to me, can he tell us what will happen to the various liabilities that any company, corporate body or in this case health authority has at any particular moment? Are those liabilities something about which he can tell us in Committee?

The evolutionary principle, which was set out in 1999, was designed to ensure that PCGs could not go on to become PCTs if local people in consultation felt that that was right. That decision would have involved weighing up a range of different concerns. It would have involved an analysis both of the PCT's practices in the area and of its strengths and weaknesses; it would have involved looking at the robustness of the management, and thinking about whether staff with particular areas of knowledge could be recruited; it would have been about the premises, their location and a whole range of matters. Of course, above all, it would have looked at the sort of services that would be available to local people.

It is rather shocking to see that the Government have gone back on that approach, and that they have not explained why. I hope the Minister will be able to tell us why he is abandoning the points made by Baroness Hayman, such as the fact that primary care trusts will be established by the Secretary of State, and that progression to trust status will be determined by local views; that the Secretary of State will be able to establish primary care trusts only after local consultation; and that the views of the primary care groups, local GPs and other professionals, as well as the wider community and the local NHS, will be key considerations for the Secretary of State.

Is the Minister really indifferent to bodies such as the Royal College of Nursing, which was obviously told that this scheme was to commence in the year 2003? The Royal College of Nursing has voiced concerns over the viability of the successful implementation of the proposals in the time scale envisaged. PCTs are relatively new organisations, and the expectation that they will be able to provide the proposed services by 2003 is very ambitious. PCTs will need support if they are to take on new responsibilities.

If it were just the Royal College of Nursing—although I would never put it in this way—one might say that only one body of health professionals takes that particular view, but everybody else disagrees. If so, we could do what the Minister seems to want to do, which is to ignore it. However, what the British Medical Association—the main representative group for doctors—says is almost word for word the same. The BMA says that it is concerned that PCTs, where they exist, are relatively new organisations and that the demands may well be beyond their existing capacities. They are already experiencing difficulties in recruiting clinical staff who are able, willing and competent to participate. The BMA states that the PCTs will be up and running by spring 2003; it has obviously been told that as well. This is an ambitious timetable, given that there remain approximately 130 primary care groups, many of which have not yet made any preparations towards PCT status.

In the light of those comments from the two main representative bodies of health professionals, the Committee is entitled to ask the Minister whether the PCGs and PCTs are ready for these reforms. The answer seems to be no. The Minister is aware of the tracker survey, which has already been referred to. This survey states that progressing, commissioning, health improvement and partnership working are slower, and that a lack of reliable and timely information and insufficient managerial capacity remain as problems. Professor Wilkin's views have also been referred to. The message is that the groups are not really ready for this change. The executive summary looks at more detailed points about the wide variation in the numbers and type of staff available to PCTs and PCGs, making the point that this is likely to be reflected in a varying capacity to deliver improved services.

I know the Minister found it deeply shocking when my hon. Friend the Member for Woodspring said on Second Reading that the average number of managerial, financial and administrative staff employed by PCGs was 6.8, compared with an average for PCTs of 15.8. The number of staff needed to bridge the gap between PCG and PCT status and to perform the sort of detailed, enhanced functions that the Minister proposes raises a key concern. The numbers of staff employed or seconded have increased considerably during the past 12 months, but one in seven PCGs and PCTs still has no finance staff.

PCGs have extended efforts to involve key stakeholders, but the interests of local communities and voluntary organisations are still poorly represented in many PCGs and PCTs. The proportion developing locality groups—something on which the Minister places particular emphasis—is slightly more than one third. However, only seven have delegated budgets to that level.

That body of concerns has come out through the Government-supported tracker survey. Only one fifth of PCG and PCT budgets are in line with national resource allocation targets. Half are developing financial incentives related to clinical governance, but only one third were planning to link the financial incentives to notional practice budgets for hospitals and community services. Given the extent of the Minister's ambition for PCGs and PCTs, that is a long way off the mark.

The background is that responsible health professional bodies such as the BMA are proposing an ``ambitious'' timetable; as I said earlier, that is a bit like Sir Humphrey describing a Minister's decision as courageous. [Interruption.] I am happy to give way to the hon. Member for Weaver Vale (Mr. Hall) if he so wishes, or we could discuss the matter later. The hon. Gentleman may have been suggesting that my recollection of Sir Humphrey was poor, but I stand by it.

The Health Service Journal recently undertook a study of the views of chief executives of NHS bodies. Some 304 chief executives responded, which I would suggest is a very good sample. They produced a series of findings that make sobering reading. Some 45 per cent. of chief executives thought that the inabilities of PCTs to cope with enlarged responsibilities were due to the fact that they lack managerial capacity, resources and vision. A third—33 per cent.—thought that the time scale for the changes was unrealistic and dangerous. Some 29 per cent. thought that the changes were resulting in disruption to delivery and risks to the NHS plan. Almost a third of chief executives believe that the organisational changes involved in the Minister's great NHS plan, designed to deliver all the improvements that we hear so much about, will damage progress.

A fifth of executives—22 per cent.—had concerns about the future of many health authorities, regional office functions and the lack of detail in the proposals. Some 20 per cent. thought that the effect of changes on staff, the loss of key staff, the lack of continuity and the impact on morale were very important. One could go on and on listing the drawbacks that were found in the study. One chief executive was quoted in the survey as saying that

``many of the smaller PCTs and some of the newly appointed chief executives are not going to be able to deliver the new agenda. It is crucial to tackle this issue and not wait for these organisations and individuals to fail.''

That is what we are saying. Why go forward with something half-baked, when allowing it a little extra time to evolve in the way it was originally intended might prevent the mess, which, under the present arrangements, will occur?

Another chief executive put it this way:

``Governments never learn that reorganisations disrupt delivery, demotivate staff and usually fail in their stated objectives. A programme of sustained development and performance management based around the NHS plan would have been far more likely to achieve the Government's stated objectives.''

I have asked myself whether the implementation of the NHS plan would be delayed as a result. Three quarters of the chief executives asked said that it would. One said:

``policy making has been rushed and is inadequately informed by understanding of how the NHS ticks.''

Another said that there was

``a need for a more measured pace if lasting, carefully thought-through reforms are to be achieved''.

Will money be saved? Ministers say in ``Shifting the Balance'' that £100 million will be saved. The chief executives believe that the one-off costs involved in winding down health authorities and other organisations, setting up new ones, transferring staff, changing offices and so on—the sort of churning that occurs when one reorganises—will alone cost £200 million, dwarfing the saving of £100 million. Can the Minister name a single organisation in which change has not brought massive costs? He and I know from debating reorganisations of various sorts over the years that they cost money. If he says that there will be no costs, which is what the summary of the financial effect suggests, can he explain why that will be the case when there normally are?

We must consider the human cost of the reforms. A fifth of the chief executives surveyed were concerned that there would be a loss of experienced staff. Some 15 per cent. said that they planned a career move outside the NHS, and 14 per cent. said that they would retire early. That would be a substantial percentage of chief executives lost to the service. One said that the changes were

``the most ill-conceived, poorly thought through set of changes in decades. Is the plan to torpedo the implementation of the NHS plan? This is my sixth reorganisation in a 30-year career in the NHS. I have always responded positively to change previously. However, these proposals are a recipe for disaster—a blend of lack of insight, ineptitude and disregard from all staff at all levels.''

Photo of Colin Challen Colin Challen Labour, Morley and Rothwell 7:15 pm, 27th November 2001

That person may have seen six changes in the past 30 years, but how many of them were brought about by Conservative Governments and what was the cost of them? Will the hon. Gentleman refer to some of the quotations—he may have them in his notes—from the majority of people, who have reacted positively to the proposals?

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I shall answer the hon. Gentleman directly, as I like to do. I would vigorously defend the reforms of Lady Thatcher, of course, but he would not. I heard his colleagues criticise our changes year after year. They said that it was wrong to reorganise constantly and to use that as an alibi for not investing the money; they said that it was disruptive, the wrong approach and a waste of time. I heard that time after time, and I got sick of it. The hon. Gentleman will get sick of it this time. All the expert commentators who criticised Conservative reforms now say that what is taking place is exactly like the Thatcher days. How does he feel about that?

Labour Members have spent years building the myth that the wicked Conservatives were responsible for reorganisation, but now it is Labour who are reorganising, and its reorganisation is stupid, pointless, ill thought out, a waste of time, ludicrous and rushed through in the face of the objections of the BMA and the RCN.

Photo of Colin Challen Colin Challen Labour, Morley and Rothwell

I asked whether the hon. Gentleman would provide quotations from those who support the changes; his figures relate to the 15 per cent. or 22 per cent. who do not, which is less than a third. Let us hear from the 66 per cent. of people who support the change.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

The hon. Gentleman can give me some quotes when he makes his contribution to the debate. I have said it already, but I am happy to take interventions on this matter. The PCTs are something that can be built on; they are a good idea if they are done in the right way. The evolutionary change proposed by the Minister's predecessor is worth while. Why, then, should we settle for 408 targets? Why insist on rushing through the change, breaking commitments that were given only two years ago? Why ignore what doctors and the various nursing organisations are saying? It is stupid to put a political timetable above the interests of patients and patient carers.

Photo of Andy Burnham Andy Burnham Labour, Leigh

The hon. Gentleman seems to have rewritten history. Does he not recall that the changes to the internal market, which he robustly defended, were rushed through in the teeth of opposition from the British Medical Association? However, the BMA has outlined its broad support for the Bill. The hon. Gentleman said that there was no difference between the reorganisation of the Conservative Government and that proposed by the present Government. The major difference is that the current reorganisation is accompanied by record investment in the NHS. It is a rather large difference.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

Actually, Labour Members are being quite complimentary about the Thatcher reforms, saying at least that the process had led to the reforms and that the reforms lasted for an extended period. I commend an article, headed ``Suits you, sir'', which states:

``As Parliament prepares to enshrine in law the latest of a long line of NHS reorganisations, Laura Donnelly overcomes a sense of deja vu and wonders what is so good about this year's model.''

I commend the article to the hon. Gentleman; he will find the analogies in it deeply embarrassing.

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

We can have lengthy discussions about what opinion polls tell us and what focus groups say—which is what so-called interest groups are—but the key question in the modern NHS is whether the reforms have anything to offer. What evidence there is suggests that the primary care trusts are quite fragile, and that they are still coming to terms with their existing work load. The evidence suggests that imposing the reorganisation on them runs counter to what the Government presumably seek to achieve.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

I do not always agree with the hon. Gentleman, as he knows, but I do on this occasion. Sometimes, the Government may want an alibi for reorganising everything because they got themselves into a mess, had a bad winter and so on; but they may still do the right thing, rather than the easy political thing. It is sometimes a good idea to behave like a Government, rather than like a spin merchant.

Photo of Andy Burnham Andy Burnham Labour, Leigh

The hon. Member for Oxford, West and Abingdon has just attacked the very principle of primary care trusts. The hon. Member for North-East Hertfordshire needs to come clean; is he attacking the principle of bringing decision-making in the NHS closer to the patient, or is he pleading for more time? Which is it? If he agrees with the hon. Member for Oxford, West and Abingdon, is he also against the principle of PCTs?

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

The hon. Gentleman needs to listen, because I have made it clear time and again that PCTs are a good basis on which to progress. PCTs are a good idea. This is an evolutionary process, but it is wrong to coerce PCGs in the way suggested by clause 2. I am also saying that the time scale is wrong. It is not as if Conservative Members are saying something only for a political purpose. This is what the doctors and nurses are saying. It is what the professionals—the chief executives—are saying. The only people who do not understand that is the Minister and those Labour Members who want to support him, despite the evidence. It must be deeply wounding to some Labour Members to see parallels such as this:

``Margaret Thatcher had the inclination to kick the fridge when things were going wrong.''

The behaviour of the present Prime Minister is being compared to that, and we are told that the measure is a sort of knee-jerk reorganisation. I do not accept that anything that Lady Thatcher did was a knee-jerk reaction. After all that criticism and complaint about the process when the Conservative party was last in office, how can Labour Ministers and Back Benchers support this approach?

Photo of Laura Moffatt Laura Moffatt Labour, Crawley

The hon. Gentleman needs to make his point of view much clearer. He is quoting a minority of people who do not want any change. Why does he quote people whose views he does not share? He has just told the Committee that he liked the idea of PCTs and of returning to a system in which people were in charge of their own communities. His only argument is about timing. Will he be clearer about his argument?

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

The hon. Lady cannot possibly maintain the point that she has just made. She says that the Royal College of Nursing and the British Medical Association support the changes, but those bodies say that the time scale is deeply worrying. Is it wrong for an Opposition spokesman to quote the evidence from the two leading representational bodies and to consider the tracker survey that the Government themselves fund? That cannot be wrong. What are we here for, if we are not allowed to scrutinise legislation by considering all the available evidence and the materials that are there for everyone to see, including important surveys and what chief executives and the important representational bodies think?

We must consider the evidence to see whether legislation holds water. The temptation is to accept what the Whips say, because that is how this whole place is organised. In Committee, we should try to do what the hon. Member for Leigh did earlier, in brokering a sensible middle position that would allow us to go forward. Forcing PCTs into an early change when they are not ready in the way that is proposed is obviously foolish.

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

I would like to set the record straight in respect of the intervention made by the hon. Member for Leigh. He said that an interest group opinion poll showed that there was a problem. I was talking about the academic evidence from people such as Doctors Walsh and Smith at Birmingham University, which suggests that no evidence is offered and that the proposals should take account of existing research. They said that in some areas—such as the plans for PCGs and PCTs—the proposals ran counter to some findings about the size and capacity of primary care organisation. They are simply not ready for the extra duties. The record will show that I never said that those organisations were bad.

Photo of Oliver Heald Oliver Heald Shadow Spokesperson (Health)

That is reassuring, because I thought that that is what the hon. Gentleman said. I was slightly nonplussed when I was told that he had said something else. I wondered if I had misheard him.

It is foolish to describe someone such as David Hunt, professor of health, policy and management at Durham university, or Kieran Walsh of Birmingham university's health service management centre and a senior research fellow as if they were simply protagonists in a party-political battle. The hon. Member for Crawley (Laura Moffatt) knows that it is not sensible to describe an eminent professor or a research fellow in the field as if their views were like those of a party politician. They are not. Those people are saying that they, and others, are worried about what is being proposed. How can we ignore that?

On a more practical point, I want to ask the Minister about the powers contained in clause 2. The Secretary of State's role is enhanced by the duty to establish what are to be known as primary care trusts. Instead of simply deciding on a proposal put forward by a primary care group, he will have an enhanced role in the duty to impose PCTs in all areas of England. In addition, it seems that the Secretary of State will have all the powers in relation to strategic health authorities that he had in relation to health authorities. Given that it seems that PCTs will have the same role as that which health authorities used to have, how can the Minister describe clauses 1, 2 and 3 as decentralising?

Clause 2 enhances the power of the Secretary of State. Under the provisions of clause 1, he loses no powers and, if anything, gains a power in respect of the distribution of functions. Where is the decentralisation? If the Minister means that establishing PCTs is a decentralising move in itself—although the Secretary of State will continue to pull all the strings, has been given enhanced powers and will be able to act as he wishes and use the strategic health authorities to impose discipline on the PCTs in respect of targets and performance indicators—that is a funny sort of decentralisation. Perhaps he will explain how clause 2 supports his case on decentralisation. The proposals are ill thought out and rushed. Of course, the Minister could explain in detail how the powers will be used. He has chosen not to and he tells us that the documents are not ready, so it is difficult to agree to clause 2.

Debate adjourned.—[Mr. Fitzpatrick.]

Adjourned accordingly at twenty-eight minutes past Seven o'clock till Thursday 29 November at half-past Nine o'clock.