NHS Reform and Health Care Professions Bill

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Mr. Burns: Does my hon. Friend agree that, given the problems within the health service, with our constituents facing longer waiting time, problems with accident and emergency services and having to wait on trolleys, the Secretary of State for Health is confusing activity with action?

Mr. Heald: I am sure that that is right. The general flavour of the remarks that managers are making in the health service is that because the Prime Minister's promise to increase the spending on health up to the European average, which would involve spending, on one view, £35 billion a year more than we are at the moment, is unrealisable, we are having yet another reorganisation, and there is a developing cynicism out there.

The former head of press and publicity at the Department of Health, a man who has worked under Conservative and Labour administrations, has put it this way:

    ``I think they are in danger of disappearing up their own fundament.''

Mr. Burns: Who is that?

The Chairman: Order.

Mr. Heald: I should tell the Committee that it was Romola Christopherson.

Mr. Hutton: The hon. Gentleman has changed Romola Christopherson's gender. She is a woman.

Mr. Heald: In that case, her comments carry even more weight. The Minister would no doubt agree that we should not suggest that her views are in anyway less important because of that. If anything, her experience working over all those years for both Governments gives her a unique position from which to comment.

Mr. Burns: Unless Romola Christopherson has changed her position recently, I think that she now works in the press department at No. 10. She certainly went from the Department of Health to No. 10, which may be the cause of some of the problems between the Department of Health and No. 10 at the moment.

Mr. Heald: There obviously are problems, but I rather doubt whether they are the result of Ms Christopherson going there. It does say in the article that she has retired from the civil service, so it may well be that she is no longer working at No. 10, if she did previously.

The article also states:

    ``David Hunter, professor of health policy and management at Durham University, is concerned that `we don't seem to have learnt anything from the mistakes we made then . . . What is even more worrying is that at times of other changes, at least one or two parts of the system have been stable. This time, it's everything that's changing. It looks like a recipe for disaster.'''

Mr. Hunter makes the point, which I do not think has been made so far in this Committee, that about three years ago, the Secretary of State for Health at that time, the rt. hon. Member for Holborn and St. Pancras (Mr. Dobson), said:

    ``The last thing we want is a big bang reform''

of the NHS. Yet, here we are three years later having yet another reorganisation of the health service. It is hard to understand why the Government are taking this approach.

The Royal College of Nursing also has concerns that there should be a proper balance on the boards of the strategic health authorities, a point that it has made quite forcefully. Would the Minister be happy to see that happen? Clearly, the nursing profession has a particularly important role in that area.

The amendment proposes consultation before action. Does the Minister agree that, instead of airy-fairy consultation on broad principles, or simply looking at boundaries, what is really needed is to ask practitioners on the ground whether their area is suited to the changes? If they think not, let us not have a SHA and all the changes there, or let us leave it until the area is ready. As the Minister knows, we have always accepted that PCTs are a good basis on which to go forward provided that they are properly organised, have the staff that they need, and have had their budgets sorted out with everyone ready to start. The concern is that SHAs could end up being strategic about organisations that are not really strong enough to take the burdens that will be placed on them. I look forward to the Minister's comments on the amendments.

Dr. Murrison: We have yet to discuss the position of academic medicine in the proposed changes. Academics have been highly critical of the Bill, and with good reason. They are not mentioned in it very much. If SHAs have a role, I should have thought that it would be heavily tied in with academic medicine. We have talked about the different sizes of SHAs and how they might link with tertiary centres. Tertiary centres are intertwined with academic medicine, and I am concerned that insufficient weight is being given to such links. That is certainly suggested by the different sizes that the Minister has implied will come out of the consultation process. If proper tertiary centres are not part of a particular strategic health authority, it will lack an academic focus.

We have progressed in recent years. Academic medicine is no longer solely the prerogative of teaching centres, but, nevertheless, there has been a drift back towards large centres in recent years. Funders seem to be more impressed by large centres, a situation that is likely to continue. Referring from convenience to the south-west, the minnow SHA covering Somerset and Dorset would lack such a tertiary centre, and a proper focus of academic medicine. I am concerned that academics' views and worries about being sidelined are not being properly registered. I hope that the Minister will bear in mind the needs of academic medicine in this country. If SHAs have a role—some doubt is emerging about that—promoting academic medicine in their areas might be it.

Dr. Taylor: The amendments place me uncomfortably on the horns of a dilemma. This week's Health Service Journal tells us that there is an absolute plethora of consultations. They are running at the rate of about one a week. Much as I want to see meaningful consultation, as alluded to by the amendments, it is difficult to square that with the current tremendous rate of consultation. Consultation is getting into bad repute because it is so often on a preferred option, and that option often succeeds. I believe that there were 32 consultations last year. Can the Minister tell me, now or at a later date, how many of those had a preferred option, and how many of them overturned that option? It would be reassuring if we could sometimes see that consultation was meaningful and overturned the preferred option, which may not be the best one.

Amendments Nos. 87 and 88 mention consultation with

    ``local authorities and other interested parties''.

Something that we risk losing with the abolition of community health councils is their role as statutory consultees. Will they be replaced with other statutory consultees?

5.15 pm

Andy Burnham (Leigh): The setting up of SHAs is an extremely important step. They will play an important role in working across an entire region to raise the general standard of health and to tackle the fundamental problems, such as health inequalities, that were bequeathed to us by the Conservative Government. For example, they will play a key part in consultations with regional development agencies.

The problem with the amendments is not their principle, but the fact that they are too narrowly drawn in focusing first on NHS staff and health professionals and, secondly, on the name proposed for the SHA rather than more widely on its boundaries. That does not reflect current practice in the health service, where there is wide consultation not only within the profession, but across community, local and voluntary groups. There may be a case for enshrining that good principle in legislation.

Perhaps the Government might consider amendments that, instead of focusing too narrowly on health professionals, would require consultation with the range of bodies that are affected by the creation of SHAs.

Mr. Burns: That was an interesting speech. The hon. Member for Leigh (Andy Burnham) gives the distinct impression that he supports the idea of consultation, but thinks that the trouble with the amendments moved by my hon. Friend the Member for North-East Hertfordshire is that their scope is too narrow in terms of who would be consulted. I assume that he has conceded the principle of the amendments but thinks that their scope should be widened. Carrying that to its logical conclusion, if we pressed them to a Division he would support us with the proviso that, if they were accepted, he would try to amend them on Report to widen their scope so that they were 100 per cent. consistent with his views.

Andy Burnham: The real problem with the amendments is that they do not reflect current practice in the NHS and in Richmond house. They are far too narrowly focused on health professionals and NHS staff. The hon. Gentleman cannot have been listening when I said that SHAs will have an impact far beyond the NHS, especially in terms of regional government and regional development agencies. I do not support the amendments, but I do not think that the Minister would have a problem with them in principle.

Mr. Burns: I am most grateful to the hon. Gentleman. I had forgotten that he is sitting next to a Government Whip, so no doubt he had to put it on the record that he had overstepped the mark and was heavily backtracking to remain within the bounds of the controls.

My hon. Friend the Member for North-East Hertfordshire has moved some important amendments today and, unlike the hon. Member for Leigh, he is right because it is crucial that when an important new structure with the vital role, as the Government keep telling us, of the strategic overview of health care provision throughout the country is set up, there should be consultation within the local community. Perhaps, as the hon. Gentleman said, we have been a little modest in suggesting who the consultations should be with. Perhaps the amendments are right in principle and would enhance and improve the Bill, but need to be considered further at a later stage to ensure that we have not missed out any people or organisations that should be included in the consultation process. I presume that the Minister will also be sympathetic to the amendments, even if he believes, like his hon. Friend, that they are a little narrow in suggesting who should be consulted.

There is a similar precedent for consultation. At the beginning of the debate, Miss Widdecombe, you kindly said that we could go slightly wide of the amendments, but I assure you that I do not seek to test your patience and I shall watch you very carefully so as not to overstep the bounds. I am trying to explain that there is a precedent. During the proceedings of the Health Act 1999, Miss Widdecombe, you were the shadow Secretary of State for Health and leading for the Opposition. You will be familiar with the fact that when the Government set up the PCTs they were anxious that they should emerge as voluntary organisations after full consultation with the local community. We are setting up new groups or structures within the health service and there is a precedent for the SHAs--the original powers taken by the Government to set up the PCTs and PCGs in 1999. I am sure that you will remember, Miss Widdecombe, that the then Minister of State, ironically, Standing Committee A, during the afternoon--there are many similarities that I hope will keep me in order--on 27 April 1999, said:

    ``Given some of the comments that have been made, it is important to emphasise that we do not intend a headlong rush''--

We have heard a lot about headlong rushes today, particularly this morning--

    ``to be made into PCTs and that it is not a part of our agenda to impose PCTs on the national health service.''

This is my point:

    ``We want measured and voluntary change, and progression to trust status that is driven locally and based on local views. Full and proper consultation must therefore always occur before a PCT is established, and due consideration should be given to the views of a full range of local stakeholders.''--—[Official Report, Standing Committee A, 27 April 1999; c. 252.]

The then Minister, like the hon. Member for Leigh, had a broader vision of the bigger picture than I have, and that is my fault. The hon. Gentleman's criticism is that our amendments are too narrow, and I accept that. I plead guilty.

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Prepared 27 November 2001