National Health Service Reform and Health Care Professions Bill

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Mr. Heald: I have one or two points. When Sir Humphrey said to the Minister that something was a courageous decision, the implication was that it was a pretty stupid thing to do. The Royal College of Nursing has described the timetable for the changes as ``ambitious''. I suggest that a similar message is inherent there. To pick up on the point made by the hon. Member for Leigh (Andy Burnham), there are things that individual bodies will welcome in such a Bill, but all the briefings that I have seen raise concerns on a wide range of issues in it.

The Opposition have always said that a PCT, as an idea, is a good basis that could be built on. However, last year, or in 1999, when the Bill that set up PCTs was being passed, the Minister promised that they would not be forced on anyone and could evolve through the patient care group process. What has happened since to make matters so urgent that PCTs are now to be forced on all areas of the country, whether they are ready or not, on 1 April 2002? We think, although the Minister might think this cynical, that it is because there has since been a bad winter and the Prime Minister has promised the unrealistic target—or so it looks, on the proposals that have been made—of getting British health spending up to the European average, which would mean an extra £35 billion a year. This, therefore, is the alibi; organisational change.

The health press, whose writers are almost certainly not Conservatives, echoes those concerns; for example, in the Health Service Journal, an impartial magazine. The magazine believes that we are seeing alibi-building that is unhelpful, disruptive, mistaken and that will slow down the implementation of the NHS plan. It contains articles in which former senior officials from the Department of Health say that the process is extremely unhelpful. The RCN says that the timetable is ambitious.

The hon. Member for Oxford, West and Abingdon expressed concern about how the change will affect management functions. That is an important point. All over the country, there are individuals whose responsibility is the assessment of need, planning, securing health services and improving health. Those individuals work in health authorities, although some of them have transferred to primary care trusts. They provide the important management functions essential to the Government's delivery of the NHS plan.

What are those people doing at the moment? Are they concentrating on delivering the NHS plan? Perhaps the Minister can tell us, but I suspect that at the moment, they are writing their curriculum vitae, because they all need a job. They do not know whether they will be moving to a particular PCT or SHA, or to another region. Many managers in the NHS have pointed out that those people are key to the process of delivering the Government's ambitions and are being disrupted by the change.

Is the system ready for the change? The second national tracker survey of primary care groups and trusts carried out by the National Primary Care Research and Development Centre, in collaboration with the King's Fund and supported by the Department of Health, says that what is needed is not extra resources, but managers with the right skills and experience coming through the system. Although managers from trusts and health authorities can be taken on, they do not necessarily have the requisite primary care skills. As has been said, many of the finance staff are not yet in place.

Clearly there is a political imperative to push this through quickly to provide the alibi for performance in the NHS, but does the Minister really think that the SHAs and PCTs are ready for it to happen on 1 April 2002? In many cases, the necessary staff are not in place and they do not know what their budgets will be. It is a mess in the making. For us to ask for an extra 12 months is not a big deal. It was not prompted by political considerations, but by people who are out there trying to do the job saying that they are not ready. Will the Minister bend on this issue?

Mr. Hutton: I am always happy to bend in the hon. Gentleman's general direction, but, sadly, not on this occasion. The hon. Member for West Chelmsford said that he was afraid that I would reject the amendment out of hand. I will ask my hon. Friends to reject it, but not out of hand, as we have looked at it carefully and listened to Opposition Members. I was left in some doubt about whether the hon. Gentleman wanted to press it to a vote. He described it as a probing amendment, but his hon. Friend the. Member for North-East Hertfordshire made rather more of it. What is its status?

Mr. Burns: The Minister is again showing, as he showed last night, that he is not fully listening. The amendment is two-pronged; it is partly a probing amendment, but there is also a real intent behind it. The probing element addressed the lack of knowledge of what is going on in terms of consultation and the time scale between now and April, and the second element addressed the fact that the measure is rushed. My speech was structured around both those points.

Mr. Hutton: It was a very cleverly structured speech, then. [Interruption.] I am trying to be kind and generous to the hon. Gentleman; I am sure that that will do him no end of good on his own side of the House. He clearly wants to press the amendment to a vote. I shall urge my hon. Friends to reject it, for reasons that I shall explain in a moment.The hon. Gentleman and the hon. Member for Oxford, West and Abingdon performed a rather disappointing and predictable double act. Conservative Members are increasingly opposed to any extra investment in the health service—

Mr. Burns: No, we are not.

Mr. Hutton: It is obvious. The hon. Gentleman has clearly not been reading the recent speeches of his right hon. Friend the shadow Chancellor, nor those of the Leader of the Opposition, who have talked about reducing the share of public expenditure to 35 per cent.

Mr. Burns: Rubbish.

Mr. Hutton: It is rubbish, but it is coming from the Opposition, not the Government.

As my right hon. Friend the Secretary of State said on Second Reading, the Liberal Democrats are opposed to any type of reform in the NHS, even successful reform, that will decentralise and devolve power. They are arch-conservatives in that sense.

Hon. Members expressed several concerns about the whole process. The hon. Member for West Chelmsford referred to the appointment process for chairs and chief executives. No chair or chief executive has yet been appointed to any of the organisations. The advertisements for the chief executive posts that we placed in September made it clear that they would be filled in December and January. It would not be right to pre-empt the consultation's conclusions on strategic health authority boundaries, so we have looked again at the matter and made it clear to those within the field—and, as I understood it, others—that the appointments would not pre-empt the conclusions of discussions relating to ``Shifting the Balance''. I hope that I have reassured hon. Members that it is not our intention to anticipate those conclusions.

Dr. Harris: I do recall that change being made, and I should have made it clear that my main concern was whether shortlisting took place and entry closed before the boundaries were established and full consultation in respect of ``Shifting the Balance'' had finished.

Mr. Hutton: I will get back to the hon. Gentleman on that point. I cannot say for certain that no shortlisting has taken place. I do know that applications are being sifted, and I shall try to confirm later today whether there has been any shortlisting.

I should reiterate that it is not our intention to pre-empt in any way the outcome of consultation on what the boundaries should be. There were some 99 health authorities in England, but there will be about 28 strategic health authorities, although no final decision has been taken in that regard. As we have said on many occasions, that is in our view the right way to deal with change in the NHS, and the best way to motivate and encourage innovation and enterprise on the part of front-line staff.

Mr. Heald: The Minister is giving some very helpful information. When considering the number and size of strategic health authorities, will he be prepared to accept population sizes greater than the 1.5 million guideline? As I understand it, he proposes to accept greater sizes in the north.

Mr. Hutton: The figure is a guideline; there is no statutory basis for constructing such a limit. According to a later amendment, the hon. Gentleman's party wants to create a statutory limit of 2 million. These issues are subject to consultation and we want to take into account the views of local people. The hon. Gentleman will be aware that, in approximate terms, we are trying to form one larger strategic health authority from four existing health authorities. We think that that constitutes the right shape, balance and size.

It is important for Opposition Members to keep in mind a point of which the Conservative party had some experience when in government. Organisational change in the NHS is always resisted. There are always voices saying that we should not change, that we are going too fast, that there should be change in other areas and so on. It is clear that we must think very carefully about all these matters and listen to what the NHS and the public say about such changes, and that is what we are trying to do. However, it is deeply disappointing to hear Opposition Members say that we should keep our heads in a bucket of extremely cold water and resist any sense of the urgent need for change. I find such attitudes very discouraging.

Of course, we must continue to make the case for change and to emphasise why it is important for the NHS, and that is what we are doing. We are definitely not talking about change for change's sake. I agree with the hon. Member for Westbury (Dr. Murrison) that, in that regard, there is a sense of history. He would expect me to say that that is an exaggerated description of some of the reforms implemented by the previous Administration, but I believe that view to be right. The internal market was a shambles that burdened the NHS with tiers of bureaucracy that led people to send bills and chase invoices throughout the service. With great respect to the hon. Gentleman, and given that he worked in the NHS during those years, I cannot believe that he considers that those reforms were sensible, helped the NHS in any material way or added to its efficiency.

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Prepared 27 November 2001