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11.12 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I congratulate the right hon. Member for Bracknell (Mr. MacKay) on raising primary health care trusts tonight. Although the main subject of the debate is trust status for the Bracknell primary care group, I need to say a few words about the overall framework in which trusts are developing. I also hope to be able to explain the reasons for the decisions that were made in Bracknell, not least to make it clear that the application was not turned down. It never reached the stage of being put before Ministers. I shall try to place that in context.
When we published the national health service plan in July, nobody questioned what was at stake. In many ways, the plan was about reforming the NHS, which had come under attack not only from patients but from within the organisation. People realised that change was necessary. Underfunding hampered the NHS, but so did its operation. The way it was organised to make people wait, the barriers to efficient use of staff, and the chasm between the NHS and social care, all had to be tackled. The NHS needed money, but it also needed change. The NHS plan is about investment and reform, money and modernisation. The money comes at a price; the price is change. The need to change the way the NHS operates is acknowledged in many places, including Berkshire.
We had to consider access to primary care because, during the consultation, the need for more tests, diagnosis and treatment in primary care settings was identified. Proper priority needed to be given to major killer diseases such as cancer and coronary heart disease. We needed to stop postcode rationing for drugs and to secure better access to high-tech equipment. The National Institute for Clinical Excellence has played a significant role in that. However, that change can come about only with the full involvement of everyone in primary care.
We have already allocated some £54.5 million to primary care groups and trusts this year to kick-start the expansion of primary care services, and further investment will follow. It is important that those funds be used strategically to develop new services and improve access to primary care. However, although primary care will receive earmarked funds, those are not the only funds that will affect how services are delivered. More than £20 billion has been devolved to primary care groups and trusts, to commission services. That money must be used responsibly.
The creation of primary care groups was a vital step in the biggest devolution of power and decision making ever seen in the NHS. It brought together doctors, nurses, community nurses, health visitors and local people and put them in the driving seat in deciding how local patients would be looked after and treated. We have set up a central programme of support and development to help to manage the transition, because the cultures of corporation and management that have developed over the past 50 years were and are variable.
For starters--this is extremely close to my heart because I have information technology responsibilities--we have provided some £50 million to help all PCGs to improve their IT infrastructure and data management, so that all the partners in the system can communicate effectively. The national primary care development team was set up to ensure that all PCGs have access to expert advice and support. We expected each group not to reinvent the wheel, but to learn from good practice.
We have issued guidance to ensure that all PCGs have organisational development plans in place that are relevant to their needs. That has already made a real difference to patients, and I shall give examples from the right hon. Gentleman's constituency. He has acknowledged that good work is going on in Bracknell. All those involved show great commitment, and we recognise that. Bracknell has an exercise referral scheme; the Bracknell assessment and rehabilitation team offers rehabilitation packages; waiting
times for physiotherapy services have been reduced by three to six weeks, and additional physiotherapy has been provided in the community; and an innovative project on access to primary care for people with learning disabilities has been developed with the centre for community development.In addition, general practices in Bracknell are participating in a primary care collaborative, which brings practitioners together to develop simple but effective improvements in the way that services are provided. The collaborative is considering access to GPs and nurses and to secondary care and coronary heart disease facilities.
Such examples of good practice have been achieved by ensuring better working across boundaries and the development of robust links between primary and secondary care. That, with a more effective direction of resources, was meant improved services for patients in Bracknell.
The development of primary care groups into primary care trusts provides an unparalleled opportunity. It will allow local health professionals to control budgets that will enable them to shape hospital and community services for patients in their area and to invest in improving the primary and community services provided by doctors, nurses and other local professionals. I am grateful to the right hon. Gentleman for not falling into a trap into which I occasionally fall--I am always quickly told off when I talk about doctors and nurses alone. He acknowledged that more than 60 per cent. of those who work in the NHS are not doctors or nurses but support staff who are part of the chain of care. They are extremely important, and I assure him that we recognise their contribution.
Trusts can develop services more integrated between general practice, community services and social services, and can give patients better access to health care by identifying which services most need developing. Above all, decision making must be brought closer to patients and must be shaped by the professionals who most often meet patients' needs. Nationally, some 40 PCTs are up and running, and more than 130 PCGs have expressed an interest in becoming PCTs from 1 April 2001--which leads me to the concerns raised by the right hon. Gentleman.
Bracknell was one of the PCGs hoping to take the step to PCT status in 2001. Its application was part of a wider plan in Berkshire to move, on a whole-system basis, to six PCTs, which would be broadly coterminous with the unitary authorities, by April 2001.
There is no such thing as a blueprint for PCT applications. Certain criteria must be met, and we have specified four basic criteria. The first involves a vision: applicants must be able to demonstrate their need to become a PCT, and also demonstrate what will be achieved as a result. The second relates to support: applicants must show that their applications have received local support from all stakeholders.
I was disturbed by the right hon. Gentleman's perception of the way in which the first and second ballots went. I hope that, as we move on--and I shall go on to explain how we can move on very positively--any such issues will be resolved, and it will be made clear who is involved. For instance, all general practitioners are involved.
Thirdly, applicants will need to show competence with regard to clinical leadership, management capacity, technical systems and skills enabling them to manage
large budgets and provide community services. Fourthly, they must be able to ensure that there will be no detrimental impact on other services, or service providers, within the health system involved.Unfortunately, the Bracknell PCT application did not meet all those criteria. More work is needed to consolidate and realise the plans outlined in the application, and to ensure that the PCT is fit for its purpose. The PCG and the health authority were fully aware of the concerns raised by the NHS executive about their plans, and worked hard to address them. However, it was not possible to complete all the necessary work in time to establish a PCT safely next April. That is unfortunate, but the needs of the patient must always come first.
Once established, PCTs face a huge agenda: expanding the provision of services, integrating services transferred from community trusts with existing primary care services, developing the essential commissioning role, putting in place new clinical governance and quality regimes, and undertaking financial and human resources management on a considerable scale. It is important for them to be ready to take on the task. A PCT in Bracknell would not have been ready by April 2001, and it was felt that it would be irresponsible to let the application proceed.
This is important. It was not that the application was turned down; it was that the negotiations to let it proceed never reached the stage at which it would be put before Ministers.
It is vital for the new PCT to have local support, and the application did not demonstrate the existence of broad local support in Bracknell. I hope that all stakeholders will use the time available to make their support much plainer.
The issue was raised with both the PCG and the health authority in the summer, but only limited progress has been made in the resolution of issues of concern. Let me give a broad example, based on my examination of various other applications and the number of local meetings that have been held. I understand that only 11 have been held in the Bracknell area. I would expect at least 20 to be held. Perhaps, in the right hon. Gentleman's view, his community feels it is working so well that it does not need to demonstrate that; but we need to see evidence of broad local support.
The health authority and the PCG will need to build on the support that they already have over the coming months. I understand that they will be visiting GP practices and working with other professionals to explain the benefits of PCT status. In view of all the work still required to develop robust actions plans and to foster local support, the PCG and the health authority agreed with the regional office that it would be better to withdraw the current application.
The PCG and the health authority will now work to improve the weaknesses identified, and aim to re-submit the application next spring. If the revised application meets the necessary criteria, the new PCT will be established in the autumn and will be ready to go live in April 2002.
No doubt the right hon. Gentleman is wondering what his constituents will suffer as a result of the delay. Let me emphasise that the quality of care received by patients in Bracknell, and indeed in Berkshire as a whole, will not be affected by the plans.
The additional period of development is to ensure that patient care is of a high standard when the PCT assumes its responsibility. Any other course of action would have
been foolish. Good quality service will continue to be provided in the interim. The health authority has already decided to maintain the existing community trust in east Berkshire for a further year for that purpose. In addition, the PCG will be bolstered by a project director to lead and to support further development of services.I note the right hon. Gentleman's concern that there may be a financial loss to the new PCTs in that period of development. He said that all the other PCGs in his area turning into PCTs may have an adverse effect on Bracknell, but I assure him that it will not. PCGs and PCTs receive their resources from the health authority, based on a weighted capitation formula. That will not be affected by the transfer of services later than originally planned.
I make it clear that the further development that the PCG requires before the transition to PCT status is not a reflection of the efforts to date by the staff of the PCG. It is a case of being realistic. I put it on record that the commitment of those who have worked on that so far is fully recognised. There has been much good work, but the local support has not been shown sufficiently. I hope that we can remedy that. Perhaps the debate will help us all to mobilise that support.
We must recognise the task that faces the PCG before the transition can be made. We would not be helping either staff or the people of Bracknell if the change went ahead prematurely. Promising work has already been done. I will expect the health authority to give the chief executive and other PCG staff further support to build on that.
Primary care trusts are central to delivering our vision of the new modern NHS. They will ensure that the right services are available at the right time, in the right location for the right patients.
I note the right hon. Gentleman's specific questions. I cannot look at the application as a Minister; it never proceeded as far as the ministerial decision stage. I certainly undertake--he will have no doubt about it--that I will watch developments in Bracknell carefully and ensure that we come to a position whereby the application can be brought forward.
I was slightly disturbed that the right hon. Gentleman had the perception that people were trying to keep something secret. I know that aspiring PCTs have meetings with the regional office before they submit the application. Those meetings are supposed to be in confidence because it is prior to the application. I understand that some people may not have felt bound by the confidence, but, again, I will take a close look. It is to no one's benefit if ill feelings arise in an area. If that can be resolved, I will look into it.
I fully recognise that the right hon. Gentleman looks forward to his constituents benefiting from PCT status. When the necessary action has been taken, they will. If we can engage the stakeholders more closely on the ground, they will be in a position to take the application forward. Then I will look at it with keen interest, and with greater knowledge of what has been happening on the ground than I had before the debate. Therefore, I am grateful to him for raising the matter. I hope that I have dealt with his questions.
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