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Mr. Hutton: I start by referring to Government amendment No. 23 and the Opposition amendments that relate to it. As hon. Members who were members of the Standing Committee will be aware, I agreed in Committee to reflect further on the need for an amendment to provide statutory provisions concerning consultation in respect of the names, boundaries and mergers of strategic health authorities. It is clear that the Bill should now make statutory provision for such consultation and Government amendment No. 23 has been tabled to give effect to that.
I would like to place on record my gratitude to the hon. Member for West Chelmsford (Mr. Burns) and to my hon. Friend the Member for Leigh (Andy Burnham) for drawing my attention to the issue in Committee. It will come as no surprise to the hon. Member for West Chelmsford that I do not think that amendment. No. 6 is necessary. It would restrict the requirement for consultation to health professionals, local authorities and the public.
Amendment No. 23 allows for much wider consultation than the hon. Gentleman is proposing. I have concluded that, given the level of detail required, it would be best to deal with this issue by means of regulations rather than in the Bill. This is in line with, for example, the provisions for consultation on NHS trusts set out in the National Health Service and Community Care Act 1990—legislation introduced by the previous Conservative Government.
In part, that addresses some of the arguments that I wanted to deploy against amendment (a), tabled by the hon. Member for Oxford, West and Abingdon (Dr. Harris), which would put a duty on the Secretary of State to make regulations. We have also already carried out extensive consultation in relation to the first wave of SHAs—the hon. Member for Hexham (Mr. Atkinson) and others have referred to that—and we do not want to have to re-run that process. That would not be in anyone's best interests.
The vast majority of other regulation-making powers in primary legislation—concerning consultation on, for example, health authority structures and boundaries—do not put a duty on the Secretary of State. We have followed the standard pattern in drafting our amendment, which I hope is acceptable to the House.
The hon. Member for Oxford, West and Abingdon was in some confusion about the Government's intentions. I want to make it clear to him that the Secretary of State
will make the regulations about consultation for SHAs. There would be precious little point in tabling the amendment if he were not of a mind to do that.I also want to make it clear that we certainly do not place a lower importance on consultation in the new NHS. It is very important that we involve and carry with us the public, who will be affected by the direction of reform that is being implemented through the NHS. They have a democratic legitimacy and an entitlement to make their voices and views heard at all levels when change is being proposed to health organisations and structures and to local health services.
Rather than preview some of the arguments that the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), will go through later, I shall say that it is clear that the reforms that we are asking the House to support today will strengthen and not weaken the role of public participation and involvement in the NHS.
Dr. Evan Harris: As the Minister has been so clear, it is likely that I will suggest that this matter is not pursued in the House of Lords if the norm in these circumstances is that there should not be a duty to make regulations, but that the Secretary of State "may" do so. Will he reflect, however, on whether the Government—rather than he himself—are very good at consulting? We have heard announcements today about the structure and functioning of NHS trusts, on which there has been very little consultation.
Mr. Hutton: There is an established and democratic procedure for how these things are done. It would be an unusual constitutional innovation for Opposition Members—I know that it is not being proposed today—to impose a statutory duty on a Secretary of State to consult before he was minded to announce any change of policy or to look at a way in which reform might be taken forward. There is a reasonable case for saying that when substantial reform is proposed to the NHS, there should be consultation. That has always been the spirit and practice of the Government; it is one that we intend to take forward. It cannot be argued—in terms of either the Bill or the amendment—that the Government in any way diminish the role of the public, or the voice of the public being heard effectively in the affairs of the NHS; far from it.
Amendment No. 7 would impose a duty to consult before a health authority was established in Wales. However, it is clear that health authorities in Wales will only continue to exist until they are abolished on 31 March 2003. The policy intention in Wales is to create local health boards, as covered in clause 6. The only practical effect of the amendments would be to fetter the devolved powers that the House has already granted to Wales under the Government of Wales Act 1998. While there is no requirement to consult on the establishment of a health authority, the Welsh Assembly has conducted a full and open consultation in relation to the establishment of local health boards in Wales.
The remainder of this group of amendments deal with technical issues to do with the boundaries of primary care trusts. Following the consultation on the new SHA boundaries, it has become clear that a small number of PCTs—perhaps two or three—will cross the new SHA
boundaries. Current legislation does not explicitly state that PCTs which cross health authority boundaries must not be established, but there is an underlying assumption in the way in which the Bill has been drafted that all PCTs will, in fact, fall within one health authority. It remains our intention that, in the vast majority of cases, PCTs should not cross the boundaries of SHAs.There is an argument to be made about the value of consultation and the importance of listening to local voices about where boundaries should be drawn across the NHS. For local flexibility to be maintained, and so that clinical networks—rightly referred to by the hon. Member for Westbury (Dr. Murrison) as important—should not be disrupted, it is important that, in those exceptional cases, it should be possible for PCTs to straddle SHA boundaries, if those boundaries have strong local support and make obvious sense.
The Government amendments make provision for allowing PCTs which straddle SHA boundaries to be established—putting that issue beyond doubt—and provide for each SHA to receive the PCT's annual financial, patients forum and other reports. In essence, this group of amendments will serve to preserve maximum flexibility around PCT boundaries; that supports the principles of local decision making, which is fully consistent with shifting power and responsibility to the front-line. There are a number of points in primary legislation that need to be amended to allow for this, and that is why this group of amendments is relatively large.
Amendment No. 25 makes a number of amendments to schedule 5A of the National Health Service Act 1977: to allow any SHA in whose area the PCT is established to meet preparatory costs; to allow any SHA to make available premises and other facilities during the preparatory period; and to provide for the PCT's annual financial and other reports to be sent to all SHAs in whose area the PCT is established.
Amendment No. 26 provides for any SHA in whose area the PCT is established to give directions to that PCT. Amendments Nos. 35 and 36 make provision for the reports of patients forums to go to all SHAs in whose area the PCT is established. Amendments Nos. 24, 27, 28, 54, 55 and 61 make minor, consequential and technical amendments that are necessary to give full effect to the policy intentions.
The bulk of our time this evening has been spent on new clause 1. I understand fully the concerns expressed by Opposition Members about the pace of change and the way in which the reforms are being handled. However, as was the case when the previous Administration attempted organisational reform of the NHS, there will always be those who say that that should not be done. There will be those who say that it is being done too quickly; some will say that it is the wrong reform.
We have heard all those arguments this afternoon. Of course, when deciding the pace at which change should be made, the Government have to weigh the upheaval and disruption that a change of this scale and magnitude will inevitably cause against the benefits that we envisage that it will bring.
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The Government have to find the balance between those two competing arguments, and we cannot pretend
that they can be spirited away somehow. We therefore must be clear that the reforms, whose potential benefits for the NHS were questioned to some extent by the hon. Member for Westbury, will bring about substantial improvements in the performance, management and delivery of health care services. We are clear about that, and I hope that Labour Members in general are too.As my right hon. Friend the Secretary of State made clear today, the NHS is a large organisation. It has more than 1.2 million employees and treats more than 20 million patients a year. It operates in all our constituencies, at a number of different levels of intensity. It is inconceivable in this modern age that the sort of care that we want to be available could be delivered by the structures that presently exist, given the pressures on services, the introduction of new technologies and the speed at which things change in the delivery of medical services.
Therefore, the change has to happen. It is necessary, although of course it will be difficult for some. That is always the nature of any substantial and radical reforms. These are radical reforms, but our judgment is that they will benefit patients, and therefore all our constituents.
I was interested to hear Opposition Members say that they supported the reforms in general terms, but that their primary concern was about the speed at which the reforms were being introduced. As I said, I fully understand those concerns, but I think that the Government have got the balance and the judgment right.
I am sure that the hon. Member for West Chelmsford moved new clause 1 with the best of intentions, but I do not believe that he has thought through the new clause's implications. First, it would create a new and I believe rather inappropriate role for the health service commissioner, which would add considerably to his already substantial work load. It would also be beyond the role envisaged for him under the Health Service Commissioners Act 1993.
Also, new clause 1 could disrupt the provision of health care services, as it would create a vacuum while PCTs were being investigated, especially in relation to their new responsibilities for family health services. That point was made by my hon. Friend the Member for a Birmingham constituency that I cannot call to mind just now—
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