NHS Reform and Health Care Professions Bill

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Mr. Baron: I welcome what the Minister says and ask him to consider how we manage the lack of coterminosity. Any boundary that we draw will probably alienate one small section, but the bottom line is how one manages the lack of coterminosity. When it comes to the boundaries of clinical networks, the answer is to manage that lack at the new regional director of health and social care level, rather than at the SHA level. That would provide one step back to oversee the true strategic approach to managing that matter.

Mr. Hutton: That is one suggestion, on which I will reflect. However, the consultation exercise, which ends on Friday, is for communities in the NHS, local authorities and the public at large to help us to get the decisions right now. It is important to get coterminosity with local authority boundaries right and to reach decisions that will reflect the natural referral patterns around clinical networks, to which the hon. Member for Billericay referred.

By definition, any organisational change throws up the possibility of upheaval. We want to minimise that disturbance, while getting the basics of decisions right. We will consider the hon. Gentleman's comments, but the role of the regional directors is further away in the back office than he might imagine. It may be helpful to him and other hon. Members if I set out my thoughts in writing.

The amendment has been designed to extract further comments from me on the nature of the boundaries for SHAs. However, the problem with the amendment—as, I am sure, the hon. Gentleman understands—is that if it were to be included in the Bill, it would necessarily require us to run a different consultation exercise. Given all that he and his hon. Friends have said today about not delaying the process unnecessarily and unreasonably—

Mr. Burns: Not rushing it. [Interruption.]

The Chairman: Order.

Mr. Hutton: Thank you, Miss Widdecombe. I need protection from the bad boys on the Opposition Front Bench who sometimes misbehave. It is clear that the amendment tabled by the hon. Member for North-East Hertfordshire would strike out the present consultation exercise and require us to start again. I have explained the timetable by which we are currently operating. We intend that the changes will come through in October 2002 and take full effect from April 2003, but the amendment would make it harder to stick to that. The hon. Gentleman might not agree with that timetable—that is his prerogative—but, from my point of view, the amendment would delay progress of the reforms that we want to see.

Mr. Heald: I have two points to take up with the Minister, which I raised during my short contribution. The first concerns the regional aspect. If Hertfordshire and Bedfordshire were placed together, they would constitute a sub-regional group because they are a quadrant of the region. I forget the precise name—perhaps it is the western quadrant—but I note that an expert sitting not far from the Minister may be about to tell him the answer. According to Government thinking, will such sub-regional structures form the basis of the strategic health authorities? Is there a regional aspect to the matter? As the Minister will recall, the Democratic Health Network is keen to have such an aspect, as it clearly would be a good thing from its point of view.

Secondly, the Minister will recall intervening when the point was made that people in the west midlands are concerned that the strategic health authority might prove too large. What area and population will the west midlands authority cover? Will it be a large authority such as that for mid-Trent, to which he referred, with well in excess of 2 million people?

Mr. Hutton: I do not have in front of me details on the proposals for the west midlands, but as our debate progresses I might be able to get that information. However, the ``Shifting the Balance'' consultation document made it clear that in establishing the two principles that we intend to follow, we will not allow the boundaries of strategic health authorities to cross Government Office boundaries. That is an important point, and further than that I am not sure I can go today. In a sense, the hon. Gentleman and his hon. Friends are asking me to announce decisions on certain strategic health authority boundaries. I cannot do so because consultation has not finished and it would be wrong for a Minister to pre-empt that process.

Mr. Burns: May I seek clarification on something that the Minister said to my hon. Friend the Member for North-East Hertfordshire a moment ago, so that we do not get totally confused? In an earlier debate, the Minister said that, in effect, all PCTs would be in place by October 2002, when the system comes into effect. However, about three minutes ago—just before my hon. Friend's intervention—I think he said that although PCTs will be in place by October 2002, they will take full effect from April 2003. Assuming that I heard him correctly, I find that confusing.

Mr. Hutton: I do not want ever to confuse the hon. Gentleman. I was referring to the first full financial year in which the arrangements will take place, which, obviously, is April 2003. The basis for the measures will not come into operation until October 2002, which is the half way point. I repeat that I was referring to the first full financial year.

Perhaps I am wrong, but I hope that my comments have been of some value to hon. Members who have raised these concerns. The amendment is completely unworkable and unacceptable. It would build rigidities into a system that, as the hon. Member for West Chelmsford himself has said, has a paramount need for flexibility. I urge my hon. Friends to reject it.

Mr. Burns: You were not here, Miss Widdecombe, when, at the beginning of my remarks, I made it plain to the Minister that these were probing amendments, and, to be fair to him, he has fully acknowledged that fact. We are grateful for the further information that he has made available.

I should be the first to agree with the Minister that if the amendment were to be agreed to tonight, it would place any future Secretary of State, regardless of their political complexion, in a straitjacket. I sympathise with the Minister's comments that if one were two people short of 2 million, one would not be able to set up a SHA, which clearly would be ludicrous. That was not our intention in so far as we used the amendments as a vehicle to probe him, a process that proved illuminating and enlightening. In light of his response, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

5 pm

The Chairman: Before we come to amendment No. 85, for the convenience of the Committee I should say that having examined the scope of the amendments and clause 1, I am not minded to have a stand part debate on clause 1. I am therefore happy for members of the Committee to go a little wide in the course of the debates on the following two amendments. That is not a general invitation.

Mr. Heald: I beg to move amendment No. 85, in page 2, line 7, at end insert—

    `(c) A Strategic Health Authority shall only be established under paragraph (a) above provided that there has been consultation with general practitioners, nurses and other health professionals in that area.'.

The Chairman: With this we may discuss the following amendments: No. 86 in page 2, line 7, at end insert—

    `(cc) A Health Authority shall only be established under paragraph (b) above provided that there has been consultation with general practitioners, nurses and other health professionals in that area.'.

No. 87, in page 2, line 14, at end insert—

    `and such an order shall only be made following consultation with health professionals, local authorities and other interested parties in that area as to the name proposed.'.

No. 88, in page 2, line 21, at end insert—

    `and such an order shall only be made following consultation with health professionals, local authorities and other interested parties in that area as to the name proposed.'.

Mr. Heald: The amendments are designed to ensure that there would be consultation with general practitioners, nurses and other health professionals in the area concerned before the establishment of a SHA, or a health authority in Wales. The Minister has already said that there has been consultation with the public concerning the general concept, and that consultation, which is due to be completed shortly, is continuing on the boundaries of SHAs. The decision on the boundaries will be made in December of this year.

The proposed provision is designed not to duplicate that process, but to allow wider consultation on the establishment of a SHA. It would allow issues such as the impact of the changes on local implementation of the NHS plan, and other practical matters, to be dealt with on the basis that local practitioners can bring their common sense and experience of events in their area to bear on the decision. If a SHA was not ready for implementation, or if it would damage patient care to implement a SHA, it need not go ahead. The Government would know the worst and be able to react to it.

Worries are being widely voiced about whether the changes are for the best, and there is a long article about the subject in this month's Health Service Journal. The article cites commentators who take the view that the effect of these changes will be negative, and it points out that there seems to be an irresistible urge for Ministers to put their stamp on the NHS, often to political time scales that do not fit with time scales that would effect substantial and good-quality change in the system. The article quotes a professor of health economics at York university, Alan Maynard, who describes structural re-organisation as

    ``a wonderful substitute for change . . . It's displacement activity, a whole lot of smoke with everybody doing an awful lot, but nothing that creates change at all. You change the name, you change the sign on the door—what difference does that make to the service? Implementing real change is perhaps a 10-year enterprise . . . reorganisation distracts everybody—but does concentrate people's minds on the bottom line, which is `Am I going to have a job tomorrow?'''

Managers should be worrying about how to implement the NHS plan and other improvements.

The article quotes other people, such as Dr. Charles Webster, the author of the official history of the NHS, who states:

    ``I think the majority of reorganisational changes are done as a surrogate for spending more money.'' A battery of criticisms is being levied.

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