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Mr. Patrick Hall (Bedford): Will the hon. Gentleman explain how the considerable shift of devolution of resources to primary care trusts is a centralising move?

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:

"It is important to say at the start that it is no part of the Government's agenda to impose primary care trusts on the service . . . We want measured change, progression to trust status, driven locally, based on local views. That is why the Secretary of State will be able to establish a trust only after local consultation."—[Official Report, House of Lords, 25 February 1999; Vol. 597, c. 1268.]

Even more explicitly, the former Minister of State for Health, the right hon. Member for Southampton, Itchen (Mr. Denham), told the Standing Committee considering the Health Bill on 27 April 1999:

"it is not part of our agenda to impose PCTs on the national health service . . . 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. 228-29.]

Nothing could be further from what is proposed. Given the breathtaking effrontery with which Ministers have broken their specific promises on the subject in the past, how can we believe anything they say now?

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 not—so much for the GP freedom that was promised. Some existing

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PCTs and PCGs are being rushed into mergers, whether they want to or not, and all the PCTs will be given extra responsibilities, notably commissioning, whether or not they want it or are prepared for it.

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

"process of learning and building on experience".

He also pointed out that

"it is not merely a question of resources to sort out this issue . . . what is needed are managers with the right skills and experience coming through the system. Managers from trusts and health authorities can be taken on, but we are dealing with primary care and they don't necessarily have the skills needed".

The survey pointed out 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. That is a serious discrepancy. Equally worrying is the fact that one in seven PCGs or PCTs still has no financial director.

According to the report, the situation relating to information management and technology was perhaps of more concern. It stated:

"Information to support core functions of PCG/Ts is inadequate and shows little sign of improving. PCG/Ts have made some progress in formulating development plans . . . and increasing"

what the report calls

"connectivity, but shortages of skilled staff and resources make it doubtful whether they will achieve key national targets."

Of greater worry to the authors of the report, to the BMA and many others is whether the changes in the Bill will divert activity and resources away from front-line patient care. Three quarters of the chief executives questioned believed that the reorganisation would delay the delivery of the national plan and a quarter thought that the delay would be severe.

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 House—from 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.

For clarification, I turned to the Government's estimate of public sector financial effects. Line 1, paragraph 184 states:

"None of the provisions in this Bill will entail significantly increased public spending".

Then I noticed that the arrangements for patient and public involvement will necessitate "some" increase in expenditure, that the new functions of the Commission for Health Improvement, or CHI, will result in "some" increase in expenditure and manpower, and that the creation of the Council for the Regulation of Health Care Professionals will have "a small financial cost". So costs are up by "some" amounts, although the Secretary of State

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does not know—or will not say—by how much. Perhaps it is no wonder that the Chancellor is having doubts about him.

How are those costs to be offset? There will be unspecified "reductions in bureaucracy" and "significant savings in management", but no "decreases in manpower" and, best of all, a

"significant increase in volunteer input . . . is forecast to bring about a reduction in costs".

The secret of the plan is unveiled: the WRVS to the rescue. Will the Secretary of State make a commitment now that not a penny will be diverted from front-line patient care while these changes are being implemented? That is what people on the front line want to know.

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 border—all to the detriment of patient care?

Other aspects will cause concern, not least—as has already been mentioned—the 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?

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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:

"This is the most ill-conceived, poorly thought through set of changes in decades. Is the plan to torpedo the implementation of the NHS plan?"

Another said:

"These reforms are a gamble. They may or may not work. Either way, they will inevitably result in more structural changes within the next five years. The government should not implement such risky and costly changes without much clearer analysis and assessment."

But perhaps the greatest insight came from one who said:

"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 for staff at all levels."

That is the story of the Secretary of State, his Bill and this Government.

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