I am grateful to the Chairman of the Health Committee for placing that on the record here, as he has done on the Floor of the House with no less an authority than the Prime Minister. I hope that that will urge the necessary responsiveness, let alone response, required to meet what is unquestionably, in my view, a health right, let alone need.
I shall tackle the public health issue, which I promised to come on to when I intervened on the hon. Member for Staffordshire, Moorlands. I hope that the Minister will explain why, prior to the publication of "Commissioning a Patient-led NHS", there was no consultation with public health officials on its potential impact on PCTs' crucial public health functions. The hon. Lady was not the only Member to mention that—I think that it was raised also by my hon. Friend Mr. Bone and others.
According to the BMA, in the next few months, more than 150 directors of public health will lose their jobs. There are now fewer than 1,000 public health doctors. Among other things, the Government have presided over an explosion in sexually transmitted diseases, a crisis of confidence in child immunisations and a failure of readiness to protect the country against pandemic flu. More generally, they have been cavalier in their planning for public health. I believe that the absence of consultation on public health throws up the Government's ignorance when it comes to supporting closer working relationships between local authorities and health organisations.
The Government have defended the restructuring against the Health Committee's charge that organic change would be better by denying that it is change for change's sake. However, this meddling gives the lie to the Government's claim that they are presiding over a decentralised NHS. Central credit, local blame appears to be the order of the day with constant micro-management from the centre. The NHS should be freed up to change organically and to trust front-line professionals to develop an effective health care system. Change should not be continually imposed from the centre.
Ministers continue to promise an efficiency saving of £250 million a year from 2008, despite the Health Committee's assertion that it is more likely to be between £160 million and £135 million. That point was raised noticeably in the excellent contribution made by my hon. Friend Mr. Amess. That promise comes from Ministers who have presided over the largest deficit—two and a half times bigger than the Secretary of State's estimate as recently as
The Health Committee report deemed it essential that structures to ensure clinical engagement and, most crucially, patient and public involvement were retained at their current levels covering each natural community. Does the Minister agree? If so, why have the Government adopted what I think is a Stalinist approach to public involvement in the NHS? The Government have desperately mismanaged public and patient involvement. They split up the structures of individual patient advocacy, complaints investigation and collective patient representation. Patient and public involvement forums have been the creatures of NHS management. They have lacked independence—which is vital for trust and credibility—have had inadequate specialist staff input and have lacked any influence over the consultations on service configuration throughout the country. The Commission for Patient and Public Involvement in Health had been functioning for only six months when the Government announced its proposed abolition.
After the loss of volunteer expertise and independence with the abolition of community health councils—many will remember that I had quite a hand in the campaign and argument against abolition, and we did achieve a stay of execution for a year—patient forums have had a turnover of 62 per cent. in just three years. Too many good independent people who want to help their local NHS have been turned off by poor training, bureaucratic interference and a lack of real influence.
One reason given for abolishing CHCs was that the volunteers who staffed them were not representative of the general public. On
"The commission will go out into communities and hear those different voices and draw in those socially excluded groups and marginalised communities."—[Hansard, 15 January 2002; Vol. 378, c. 226.]
I hope that this Minister is ready today, given that the issue is part of the Health Committee's report, to tell us what evidence he can show for the CPPIH having had any success in recruiting and training people from hard-to-reach groups.
The Minister will know that the Conservatives fought tooth and nail against the abolition of CHCs, trying to protect patients and keep the Government accountable. It is important that none of us is afraid of having effective accountability structures in the NHS, and it is doubly important that patients and professionals are trusted, because the alternative—centrally micro-managing everything—is patently causing a diminution in morale and trust. The Health Committee said that the Minister's view that practice-based commissioning would improve patient and public involvement in health care was not firmly based in any evidence. I hope that the Minister can make such evidence immediately available.
I hope that the Minister will also clarify the impact of PCT mergers on resource allocations. In some areas of the country, PCTs serving more deprived areas have merged with PCTs serving less deprived areas. That is one reason why we managed to resist Cheshire West PCT going into an organisation covering the whole of the rest of Cheshire. Apart from anything else, it would have lost its accountability for the disaster that it had created. How will the Government ensure that, within the new structure, the more deprived areas continue to receive the funding that they need, without creating large sub-bureaucracies in the new PCTs and masking accountability? My hon. Friend the Member for Wellingborough made that point very effectively, among others, in relation to the Rushton example.
I seek an assurance from the Minister that when the Government say "Separate PCTs", they mean separate PCTs in every case, with separate boards, chairmen, chief executives and secretariats. As he has today, my hon. Friend Mr. Walker raised that in a point of order on
The changes to primary care trusts are the result of a rushed, centralised and, in large part, predetermined consultation and have thrown up a vast number of concerns relating to public health, patient and public involvement, resource allocation and the very future of PCTs. The Government have done little to clarify the grey areas in their policy or to address our concerns or those of the Health Committee over the past six months.
Most tellingly, the Health Committee report recommended that a central change agency be established. Surely the agency responsible for strategic oversight of the NHS is the Department of Health. I dare say that the Committee might not have called for such an agency had it felt that the Department of Health was functioning appropriately. The Department and its Ministers have been too busy micro-managing the NHS and, I fear, chasing headlines to concentrate on a coherent policy that puts patients, the public, in each of their recognised localities, and front-line health care professionals in our NHS first.