National Health Service Reform and Health Care Professions Bill

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Andy Burnham: Did the hon. Gentleman read the briefing prepared for Second Reading by the King's Fund? It welcomes the Bill and endorses the proposals in it.

Mr. Baron: I respectfully point out that that welcome contained many provisos. Many dissenting voices suggested concerns at the way in which the Bill is being rushed through. One could refer to the findings in many other surveys. The BMA, which is working at the coal face, thinks that there are real concerns with it.

Mr. Heald: Something such as a PCT is a very good idea, but not if it is micromanaged by the Health Secretary, has 408 targets and is rushed through. Does my hon. Friend agree that there are ideas in the Bill that can be welcomed, but that the trouble is that it is half-baked?

Mr. Baron: I agree with my hon. Friend. The idea that PCTs will decentralise is wrong. If more moneys are being made available and PCTs are allowed to use them as they see fit, that would be decentralising. However, the problem is that targets will accompany extra finance. If those are not met, money will be withdrawn and not made available. This is a further micromanagement of the NHS and not a decentralising measure at all.

Although some may welcome certain parts of the Bill because they believe that it is decentralising, the detail shows that that is far from the case. That is why we need more time to consider the Bill in this place, and to delay implementation. Many in the health profession have severe reservations about the Bill and we need to delay implementation to ensure that patients do not suffer unduly.

11.30 am

Dr. Harris: As I said on Second Reading, I oppose this structural change because it misses the point about the challenges facing the health service. The Government seek to make structural change partly for the sake of seeming to be doing something. I have plenty to say about that, but I will reserve my comments to the debate on clause stand part. I will not respond to all the points, some of which were valid and some of which I would challenge.

I will address my remarks to the time scale. The Government seek to bring about structural change to create a flurry of activity that disguises the failings of the health service and shifts the debate and blame away from them. On the radio on Sunday evening, we heard a clue to Government thinking when the right hon. Member for Norwich, South (Mr. Clarke), the Minister without portfolio, made it clear that he accepted that the health service was not in a much better shape than when his Government came to power four years ago, and that they were running out of time to deliver an improved health service, or even the perception of an improved health service, before the next election. When we see such a rushed time scale from the Government, we must bear in mind that that lack of time will dominate their thinking on a time scale for change.

Mr. Burns: I am sure that the hon. Gentleman would not want to misrepresent the right hon. Member for Norwich, South. That Minister said, rather surprisingly for a member of a Government controlled by spin, that in certain areas the health service was worse under his Government than under the previous one.

Dr. Harris: Yes, I remember that being said. I think that the take-home message is that, on average, the health service is no better. The health service was failing when the Government came to power. They have not only failed to deliver substantive change so far, but have raised expectations of being able to deliver while foolishly sticking to spending plans, which have previously failed the health service, for more than two years.

The Chairman: Order. The amendments are narrowly drawn and we are slipping into a Second Reading debate.

Dr. Harris: Thank you, Mr. Hurst. I could offer the old excuse of being led astray, but I shall not dare.

The Government's proposal for a timetable to make changes by next April is predicated on a hope that structural change will deliver. However, I see no evidence of such structural change if the Government continue to retain so much control and responsibility, and they will continue to deserve much of the blame or praise for what happens. That will do nothing to bring about improved delivery. I suspect that the Government would prefer a time scale in which the changes are introduced by April 2003, but they know that that leaves the changes little time to bed in and would cause additional chaos to that caused in the interim, when new structures are being introduced to under-prepared bodies, hard-pressed managers and health care professionals. They know that they could not run that risk so close to the next election.

Gareth Thomas (Clwyd, West): We are debating an amendment on the timing of the implementation of these changes. Does the hon. Gentleman accept that there has been extensive consultation with regard to the broad thrust of the Government's policy? He need only remind himself that the Government have published several consultation papers over a long period of time, such as ``The NHS Plan: A plan for investment, A plan for reform'' in July 2000, and ``Shifting the Balance''. Unlike the official Opposition, his party has Members from Wales. Although there are several Essex Members on the Opposition Benches, there are none from Wales. Furthermore, the National Assembly for Wales produced a paper called ``Improving Health in Wales—Structural Change in the NHS in Wales''; there has been extensive consultation.

Dr. Harris: I am grateful to the hon. Gentleman for raising that point, but consultation papers do not work if they do not mention the relevant changes. The Library's paper on the NHS plan, which is as good a summary as I have seen, states:

    ``The Plan itself did not promise significant structural change in the roles of NHS institutions''.

Indeed, many organisations that signed up to the NHS plan did not realise, although they should have done, that that did not assure them of the stability they needed to deliver its challenging and sometimes worthwhile plans, proposals and targets. People were lulled into a false sense of security by the promise that, finally, after years of change, there would be stability in the NHS, which would allow it to start delivering for patients and to get on with other areas of the Government's policy, such as the quality agenda. Those organisations were wrong because less than a year after the publication of the NHS plan, which one should have thought would set out structural changes, the Secretary of State issued a press release—a speech went with it—on 25 April, saying that the plan was to be changed, and that this change was going to be brought in quickly.

The Government have had to consult quickly on the structures. Are they finding that they must rush important matters? According to their timetable, it is clear that they have not finished the consultation on the boundaries of SHAs. However, they propose to appoint chairs designate and chief executives designate to bodies for which the boundaries have not been set. Many chairs designate will be seeking to demonstrate in the appointment process that they have local knowledge of clinical networks and partnership issues. Can the Minister reassure me that the Government will not shortlist such positions until their boundaries are settled? If they do so, they will jump the gun, and will discriminate unfairly against applicants whose strength is their knowledge of the local area, or, as it will be called, the strategic area, the boundaries of which have not been set.

The Minister must also respond to the allegation that the unseemly rush in which managers, who are beset by performance targets—many of which are political and distort clinical priorities—that they are hard pressed to deliver have to apply for different jobs within the structure. That cannot be a healthy situation, and although I understand that it is a consequence of change—one cannot oppose all change on that basis—to do so in such a rushed way will cause significant problems at a challenging time. We know that morale is poor.

Mr. Heald: When one transfers a function, one tends to discuss it as though it were inanimate. We are discussing taking away the person who knows everything about, for example, the assessment of need, the planning and securing of health services and the improvement of health in a particular area, and possibly giving someone else the job. Does the Minister agree that the timing must be right in those circumstances, otherwise situations may arise where vital management issues are simply not being addressed?

Dr. Harris: Yes, I concur with that. The point that I want to make is that our most experienced managers are the ones on whom we rely to make some sense out of the balance between patient needs and political needs. Those managers are sorely tried at the moment. Many of the best managers will say, ``Up with this we will not put''—continuous change, continuous blame and the prospect of continuous shifting of that blame, with the myth that 75 per cent of the power is being dissolved locally, when, as Conservative Front-Bench spokesmen put so well on Second Reading, that the opposite is the case.

The combination of the rush and the Government's apparent desire and need to shift the blame on to managers and clinicians will have a dramatic effect on the ability to retain managers, many of whom are effective given the under-resourcing.

I am opposed to the whole proposal, so I am not putting forward amendments to make a proposal to which I am wholly opposed any better or worse, but I have some sympathy with the thoughts behind this amendment. Will the Government jump the gun in terms of appointing or shortlisting chairs designate to strategic health authorities where boundaries have not yet been agreed?

Dr. Murrison: The litmus test for whether the Government are proceeding at too rapid a rate, is how far we are ahead with the appointment of chairs to the strategic health authorities. Perhaps the Minister might like to comment on that. If we are behind the curve, it may show that we are moving too rapidly and that we need more time.

The human aspect that has been alluded to is important, and has perhaps been overlooked in all of this. We are talking about people who have a huge amount of skill and experience as chairs, as members of the general public, and as officers within the national health service, seeing their career's being fundamentally altered by all of this. The way that this will work in practice, is that people will see SHAs as the bodies to which they aspire and PCTs as something to go for in the event that they are unsuccessful in becoming chief executives or chairs of strategic health authorities. Many people will be a need to get the timing right. I can tell the Minister that there is a huge amount of confusion at the moment about those who aspire to chairman roles and those who aspire to be chief executives, and how that time is actually going to pan out.

My chief concern about the timing is due to the palpable confusion in the minds of those among the general public who take an interest in these things. Constituents suggest that there is a very real confusion about the role of PCTs and the role of strategic health authorities. There is concern over the boundaries, and more particularly, about the division of responsibility between the two bodies. We must accept that the Government have got their communication wrong with this matter. It might be very prudent for the Government to think about extending the timetable, which will at least give them some time to get their message across.

There are very real concerns among the general public about how strategic health authorities will affect the treatment that patients receive, and the referral patterns in clinical networks. I am in no way an apologist for the Government, but I have spent some time over the past several days reassuring constituents that strategic health authorities will not affect, as far as I am able to tell, the pattern of referral that they might expect. A great deal of that has to do with changes to the proposed boundaries in my particular constituency.

There is a very real need to get the message across to those people that the NHS is changing rapidly. We have heard the right hon. Member for Norwich, South reflect upon the way in which the NHS has changed for the worse over the past several years. We are rethinking the notion of ``24 hours to save the NHS'', are we not? However, we need to take time. The Bill will implement changes, and although I do not think that they will alter the health outputs that patients will enjoy, it is still important, especially for those working in the NHS—a deeply demoralised group of people—that we calm down, and take our time in considering the Bill. That is why I have voiced my profound concern at the pace at which things are going.

11.45 am

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Prepared 27 November 2001