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Dr. Fox: The measure is decentralising only if people have the freedom to do what they like with the money. If the Secretary of State sets the budget and the criteria to be used for performance targets and can withdraw money if people do things that he does not like, that is not decentralising. That may be how new Labour's lexicon defines decentralising, but the rest of us think it a dangerously centralising move.
Not only is the Bill dangerously centralising, but it breaks specific promises to both Houses about the pace and nature of the development of health care. On 25 February 1999, Baroness Hayman told the House of Lords:
The Bill will do nothing to stop the flow of centralised direction and instructions. It will strengthen the hand of the Secretary of State to interfere at local level. The Secretary of State will allocate the money to the PCTs so that he can determine what they will do. He can withhold money; he can set resource limits as well as cash limits; he sets performance rewards. It is micromanagement of policy, and it is folly.
Is the current system ready for this deluge of change? The remaining 130-odd PCGs will be rushed into becoming PCTs whether they want to or notso much for the GP freedom that was promised. Some existing
The Government have financially supported the tracking survey carried out by the National Primary Care Research and Development Centre in collaboration with the King's Fund. The survey suggests that there are many doubts as to the ability to absorb the pace of reform. Professor David Wilkin, the project director, said that the pace of change was being dictated by Government timetables rather than by a
Will the measure save money or cost money? The Secretary of State claims that £100 million will be saved by the reorganisation. We have all heard that before in the Housefrom one side or the other. Hands up all those who think that any reorganisation of the NHS has ever saved money! No one who has ever been involved in running the NHS would think that. No one in the NHS thinks that there will be a net saving; indeed, there may be increased costs.
There is also concern, not least in the BMA comments, that PCTs will inherit health authority deficits and the revenue consequences of capital schemes. As that is of extreme importance, will the Secretary of State now say clearly to the House that PCTs will be given a fair chance by starting with a clean slate? In other words, will he say that they will inherit no health authority deficits or revenue consequences of capital schemes?
It is clear that we are not being given that assurance, so the worry of the BMA and others is very real. Will the Secretary of State give an undertaking that the criteria he uses to allocate budgets to individual PCTs will be published, so that the process is as transparent as possible? We look forward to the winding-up speech. Perhaps when some of the pieces of paper arrive from the civil servants, we shall receive answers to those questions.
Everything will be more confusing in Wales, where the plans are even less clear than those for England. Will 22 commissioning bodies mirroring the local authority be set up or not? How much bureaucracy will be entailed and will the result be territorial disputes on the borderall to the detriment of patient care?
Other aspects will cause concern, not leastas has already been mentionedthe Government's continued malevolence towards the community health councils, whose only crime seems to have been having the audacity to criticise the Government's handling of the NHS. Far too many questions remain unanswered about the new structures and the transition phases.
The Secretary of State was unable to answer one of the most basic questions: who owns the information? CHCs throughout the country keep large amounts of confidential patient information. It would be quite wrong for that information, which contains many patients' complaints about trusts, to go to the trusts, so who owns the information? Someone in the Government must know where the ownership of that information lies, yet neither during the passage of the Health and Social Care Act 2001, nor apparently during that of this Bill can the Government answer a simple technical, but fundamental question.
We find the same lack of detail in the relationship between the new inspection bodies. Given the time required to prepare for any inspection, the BMA asks how such activities will be co-ordinated to ensure that even more time is not diverted from patient care. Indeed, why have the Government not taken the opportunity provided by the Bill to streamline regulation, by creating a single regulatory body covering the private sector as well as the public sector?
Given the Secretary of State's enthusiasm for his concordat and having NHS patients treated in private hospitals, I should have thought it made great sense to create a single regulatory body to ensure that patients are looked after in exactly the same way, irrespective of where the state pays for their treatment. Perhaps the Government will want to rethink that; or perhaps tomorrow's Unison cinema advertising campaign might have something to do with the Secretary of State's new bashfulness.
Perhaps the most depressing thing about this Bill is that it will do absolutely nothing to increase choice for patients. Only this week, data have been published that show an unacceptable level of variation in the quality of care delivered by the NHS. With Labour's abolition of GP fundholding and extra-contractual referrals, which allowed doctors far greater freedom and choice as to where their patients could be treated and by whom, the net effect has been to inform patients that they may live in health ghettos, but that the Government are depriving them of the means to escape to where cure and survival rates are better. It is Labour's role, as the anti-choice party, that damns it most in the health debate.
This Bill is irrelevant to the current NHS crisis. It is hugely centralising, bureaucratic, rushed and wasteful. It will divert time and resources from patient care, and it will offer no choice to patients who have already seen their choice restricted under this Government. It is best summed up in the comments of some of the chief executives quoted in the Government's own report. The first said: