National Health Service Reform and Health Care Professions Bill

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Mr. Burns: I am grateful to the hon. Gentleman. I appreciate that language is important. I was trying to be realistic about what is happening, rather than fall into the Millbank spin. He will appreciate that language will become more important if the Secretary of State has his way and brings back the internal market, about which Government Members have been so rude for the past few years. However, I digress.

Health authorities, which have been localised to cover smaller areas than the proposed SHAs, will be abolished in the next four or five months if the proposed time scale is kept to—and it will be. Many of their functions will be transferred down to PCTs, which will cause a problem because at least 130 primary care groups have not even applied for PCT status. There will be a headlong rush if the Government are to have all the PCTs in place before the 1 April 2002 deadline. Everyone knows that when structures change—especially when significant additional responsibilities and functions are placed on those structures—there is great uncertainty and a sense of feeling the way forward. Do Government want such a situation to arise? Do they fully appreciate the implications of what they are doing within their proposed time scale?

SHAs will be discussed in detail in connection with later amendments. They, too, will be finding their way in the early stages following their creation. I suspect--the Minister may be able to enlighten us--that there is conflict in several areas: for example, have the SHAs' geographical areas been resolved satisfactorily? I presume not, because that is one of the matters that the consultation process is to examine. Stories are beginning to circulate of people in some parts of the country being confused about why their geographical area is to have only one or two strategic health authorities whereas another area, perhaps in the same region but geographically separate, is to have significantly more SHAs covering its population.

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Staffing will need to be arranged. It is fair that the Government have time scales for appointing chairmen and chief executives designate, but SHAs will need other staff. Their full role will need to be sorted out and the way in which the Government want them to fulfil their functions will have to be made clear. We must also examine the functions that the health authorities have had, in particular the handling of health service funding, which is to pass from the SHAs to the PCTs. I suspect that that will raise many problems if care is not taken, mainly because the new bodies will lack experience.

I urge the Minister to say more about the progress of the consultations and the time scale between now and 1 April 2002, especially the crucial issue of whether there will be enough time to have in place bodies that are fully competent and capable of fulfilling their functions on 1 April 2002. They might not have enough time to prepare.

Dr. Richard Taylor (Wyre Forest): I am pleased to be here because it is important to have an Independent Member on a Committee such as this one. I am speaking not as one who has a political background, but for patients and the professions. I support the amendment because as soon as we have strategic health authorities, we must have primary care trusts. I am very concerned that only a few PCTs have been formed so far; although they may be ready to go, I am sure that those that are still PCGs will not be ready, bearing in mind the extra services that they will have to take on which were previously county-wide. In my county, Worcestershire, two of the three groups are still PCGs and have no idea of how they will take on the extra responsibilities.

I strongly support the amendment. It was because I do not wish to delay the Bill that I did not vote against the programme motion.

Mr. Heald: I am following the hon. Gentleman's speech closely. Does he agree that it is extraordinary that some PCTS still have no idea what their budgets will be next year?

Dr. Taylor: To picking up that point briefly, my own PCT knows that it will get 75 per cent., but it badly wants to know 75 per cent. of what.

I support the amendment. I am in favour of much of the Bill, but the changes could be introduced more slowly to give some PCTs the option to start under the old health authorities so that primary care groups have a little more time to get ready.

Mr. John Baron (Billericay): I, too, support the amendment. It is easy for members of the Committee to make political points, but the Bill must be properly thought through because it will introduce fundamental changes to the workings of the NHS.

I want to highlight some early findings of the British Medical Association and other bodies that have suggested that we should take more time to consider the Bill. The general feeling in the medical profession is that it is being rushed through: for example, at a meeting in the west midlands a couple of weeks ago, senior health, local government and business representatives reached a consensus that the planned configuration of strategic health authorities and regions will be too large and diffuse to engage effectively with primary care trusts and local authorities.

Mr. Hutton: As I understand it, the hon. Gentleman is saying that the strategic health authorities will be too large, but he will be aware that Conservative Front Benchers have tabled an amendment suggesting that they should be larger still. Will he support that amendment?

Mr. Baron: My point is that there has not been enough clear and joined-up thinking about the responsibilities of SHAs in terms of their communication and relationship with PCTs. That leaves open many questions that people in the medical profession cannot answer: for example, how will conflicts be resolved? The BMA has noted that PCTs will be accountable for their performance to SHAs through individual performance agreements. That is fairly straightforward. However, SHAs will also be expected to manage the performance of PCTs across organisational boundaries and to broker solutions if necessary. The BMA has questioned how conflicts between SHAs will be resolved—although they will be accountable to the Secretary of State.

The BMA is concerned, as are we, that neither the Bill nor the document on shifting the balance of power within the NHS allocates responsibility for safeguarding or fostering academic activity. Unless such provision is made, benefits to the health service, including clinical service and education, will be lost. Moreover, the decline in recruitment and retention in academic medicine will continue.

The BMA has pointed out that it is unclear whether the responsibility for co-ordinating and collaborating on the provision of tertiary services will lie with SHAs or with the new regional directors of health and social care. I hope that that will be made clear in the course of the Committee's proceedings. The Bill does not make it clear to those who have to operate at the coalface how such issues are to be resolved. We need to give it more careful consideration and delay its implementation until it is suitably amended.

I have another concern, which has already been touched on by other hon. Members. Although PCTs are not directly linked to SHAs, there is a strong connection with the operation of the NHS at the coalface. My concern is that PCTs are not ready for the responsibilities that they will be taking on from next April. From visits to the two PCTs covered by my constituency, I know that they feel that, organisationally, they are a little behind the curve. I know that some PCTs are already up and running, but the fact remains that there will be quite a rush into mergers between PCTs and PCGs, whether that is wanted or not.

PCTs are taking on responsibilities for which some of them—not all, but a good number—are not fully prepared. I think that I am right in saying that one in seven of existing PCTs do not have a finance director. That is crucially important because there will be a major shift of resources to PCTs: 75 per cent. of total NHS spending will eventually end up in their hands. If the management and organisational structure is not in place by next April, there will be major problems in delivering the services that our electorate want.

The Government have supported the survey carried out by the National Primary Care Research and Development Centre in collaboration with the King's Fund. It suggests that there are many doubts about some PCTs' abilities to absorb the pace of reform. Professor David Wilkin, the project director, has said that the pace of change has been dictated by Government timetables rather than by a

    ``process of learning and building on experience''.

That point is crucial. We are rushing into something and we need more time to consider it, not only within the House. We must delay the implementation of the legislation or there will be real problems at a time when the real crisis in the NHS—increasing waiting lists and poor care at the point of delivery—is not being confronted, at least not by the Bill as it stands. We should be addressing that, rather than carrying out a fundamental restructuring that no one in the health service or the medical professions wants.

Andy Burnham (Leigh): The hon. Gentleman says that no one in the health service wants the changes. Why did most major health organisations welcome the Bill's measures in the briefings that they sent for Second Reading?

Mr. Baron: At the moment, because the Bill is being rushed through so quickly, we are getting a response from a wide sector in the NHS and from medical bodies generally. We are getting conflicting messages from that, because no one has had time truly to consider the implications. Various reports commissioned by bodies such as the King's Fund or the National Primary Care Research and Development Centre say that the Bill is being rushed through. No doubt, the Government will find voices that say that it is not, but the bottom line is that many working in the NHS think that it is.

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Prepared 27 November 2001