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Lynne Jones (Birmingham, Selly Oak): I understand the hon. Gentleman's concern about the rush to create PCTs. I attended a meeting of the PCG in my area last summer and can confirm that pressure has been put on those organisations. Indeed, a PCT has been created in my area despite the fact that the majority of GPs voted against it. However, I am not so sure about the new clause. There should be a delay but, when the health authorities are abolished, who will carry out the responsibilities currently delegated to PCTs?

5 pm

Mr. Burns: The hon. Lady, who represents a Birmingham constituency, alludes to a considerable problem with primary care trust status in her area. There was a great deal of opposition to the proposal. As she knows, there could be serious problems if—God forbid it does not happen—there were to be a hiatus as a result of the change. As she rightly said, the health authorities that handle the funding for the provision of services will be abolished and replaced by smaller strategic health authorities that have a completely different function and role.

Most of the functions that health authorities perform will be transferred to primary care trusts. If they are in turmoil as a result of their lack of experience of running the new system, they will face a serious problem and there will be no way out of it. That is why I am desperately trying to impress on the Minister how sensible it would be to provide a little more time. We should not push the policy into the long grass never to be seen again; we should provide more time to allow expertise to be built up.

Mr. Mark Francois (Rayleigh): I want to support my hon. Friend's argument with a practical example from my constituency. Rochford primary care group, which includes several GP practices from Castle Point, considered whether to apply for PCT status but declined to do so in the first instance for a number of reasons. It had general concerns about the Government's proposals, faced some organisational issues and also faced problems with timing. Some of the GPs who were consulted thought that they were being rushed into the change.

My hon. Friend's point is a real one, as evidenced by experience in my constituency. Leaving aside GPs' anxieties about the overall desirability of the proposals, many are anxious about the pace at which the change is being attempted.

Mr. Burns: I am grateful to my hon. Friend and next-door neighbour for a powerful point that backs up the examples that my hon. Friend the Member for North-East Hertfordshire and I have been given from around the country.

My hon. Friend the Member for Rayleigh (Mr. Francois) is absolutely right. He has first-hand experience in his constituency of a problem that is not unique to his area. I am glad that the Minister is here to listen to the very problems that my hon. Friend highlighted.

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Amendments Nos. 6 and 7 would also affect PCTs, as strategic health authorities in England and health authorities in Wales would be created only once there had been proper consultations

in the relevant areas in which the authorities are to be established.

I hope that Ministers in a Government who pay lip service to openness will find the amendments appealing. Before establishing a body that is responsible for strategic planning, it would be sensible that those who have to help to implement decisions and those who will be affected by those decisions should be consulted about the setting up of the authorities and about the crucial strategic role that they will play.

I am heartened and pleased that we tabled such timely amendments. I received on my desk at lunchtime the Secretary of State's speech to the New Health Network, which he gave this morning. I am not sure when you entered the Chamber, Madam Deputy Speaker, but it was interesting to see the Secretary of State for Health dragged here at half-past 3 to respond to a private notice question from my hon. Friend the Member for Woodspring (Dr. Fox). The right hon. Gentleman's interesting and important speech raised a number of issues on which we, through the good offices of Mr. Speaker, had the opportunity to question him, instead of leaving it to journalists.

It was fascinating to see the right hon. Gentleman's reaction. The Benches were much fuller, and we had to look far and wide to find a Labour Back Bencher who was prepared to offer a crumb of support for the contents of his speech. It struck me that if the speech sets out his new philosophy and ethos—the word that he now uses—perhaps his Minister of State will be more amenable to accepting amendments Nos. 6 and 7, which encourage openness and consultation.

In the speech to the New Health Network, the Secretary of State said:

although relevant to the health service more generally, they tie in with the amendments—

as, indeed, the strategic health authorities should relate to patients. He went on:

we will get on to those later because my hon. Friends and one or two Labour Members are not fooled by that—

I welcome the Secretary of State's philosophy on that, but what gives patients a greater opportunity to be involved in decisions about their care than consulting them, with health professionals and local authorities, as part of the local community, before the important strategic

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health authorities are set up? I should have thought that he would be delighted that I am embracing that aspect of his philosophy.

Although the Secretary of State had to concentrate on surviving the questions put by Labour Members this afternoon and possibly has to brace himself for the publicity that he will receive from the national press tomorrow morning and on the airwaves tonight, I hope that he will find a little time to win back some of his lost ground by contacting his Minister of State, whose presence in the Chamber means that he is isolated from him, to explain that the amendments provide a way to involve patients in the process and enable us to do something constructive, which I have been outlining in a high-falutin' way in my important contribution.

Dr. Andrew Murrison (Westbury): I wonder whether my hon. Friend shares my mystification about where in the Bill there is any reference to the plan that the Secretary of State outlined only a short while ago.

Mr. Burns: My hon. Friend raises a rather confusing point. No doubt he was present for the private notice question, so he distinctly heard the Secretary of State say that he had not been dragged to the House today and that we would have the opportunity, during this evening's debate, to discuss the proposals outlined in his remarks. I am not convinced that the Secretary of State is as well acquainted as you are, Madam Deputy Speaker, with the procedures of the House.

Mr. Oliver Heald (North-East Hertfordshire): The Secretary of State has not read the Bill.

Mr. Burns: Certainly not. That is left to the Minister of State.

You, Madam Deputy Speaker, will tell me, rightly, that I cannot discuss the matters on which the Secretary of State was being questioned because they are not in the Bill, but my hon. Friend the Member for Westbury (Dr. Murrison) is right to be mystified. The only part of the Secretary of State's remarks today that is relevant and, more importantly, in order—

Madam Deputy Speaker: Order. The hon. Gentleman is right to say that he should be addressing his remarks to new clause 1.

Mr. Burns: I am extremely grateful, Madam Deputy Speaker, because before you correctly reminded me of that, I was about to say that the only remarks by the Secretary of State that are relevant to the Bill relate to the narrow amendments, Nos. 6 and 7, on the need to consult before setting up strategic health authorities.

I am optimistic that a crumb will fall from the table, as it did in Committee, and the Minister of State will ask, "Why didn't we think of this first?" If the Secretary of State had made his remarks earlier, we could have amended the Bill in Committee. The Minister of State would not have been so hard-nosed in Committee as to oppose our amendments on strategic health authorities. I hope that he will be more relaxed and more amenable to amendments Nos. 6 and 7, which would play an

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important role in empowering local communities before the establishment of strategic health authorities. They would make communities feel that they were part of the system, and people would be reassured that their opinions, ideas and recommendations were being taken into account.

Amendment No. 8 is straightforward. It looks modest but it is important, concerning as it does any funding and financial liabilities conferred on a new primary care trust under the new system. It may represent a belt-and-braces approach because I believe that the Minister of State said in Committee that, with one exception, health authorities do not have deficits. He may therefore argue, and I will listen carefully, that the amendment is not needed because when the new system is established, no deficits or liabilities will be conferred on the PCTs. However, this is an important issue that needs to be considered because nobody wants to strangle the new system at birth with debts that the PCTs did not incur.

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