NHS Reform and Health Care Professions Bill

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Mr. Colin Challen (Morley and Rothwell): That person may have seen six changes in the past 30 years, but how many of them were brought about by Conservative Governments and what was the cost of them? Will the hon. Gentleman refer to some of the quotations—he may have them in his notes—from the majority of people, who have reacted positively to the proposals?

Mr. Heald: I shall answer the hon. Gentleman directly, as I like to do. I would vigorously defend the reforms of Lady Thatcher, of course, but he would not. I heard his colleagues criticise our changes year after year. They said that it was wrong to reorganise constantly and to use that as an alibi for not investing the money; they said that it was disruptive, the wrong approach and a waste of time. I heard that time after time, and I got sick of it. The hon. Gentleman will get sick of it this time. All the expert commentators who criticised Conservative reforms now say that what is taking place is exactly like the Thatcher days. How does he feel about that?

Labour Members have spent years building the myth that the wicked Conservatives were responsible for reorganisation, but now it is Labour who are reorganising, and its reorganisation is stupid, pointless, ill thought out, a waste of time, ludicrous and rushed through in the face of the objections of the BMA and the RCN.

7.15 pm

Mr. Challen: I asked whether the hon. Gentleman would provide quotations from those who support the changes; his figures relate to the 15 per cent. or 22 per cent. who do not, which is less than a third. Let us hear from the 66 per cent. of people who support the change.

Mr. Heald: The hon. Gentleman can give me some quotes when he makes his contribution to the debate. I have said it already, but I am happy to take interventions on this matter. The PCTs are something that can be built on; they are a good idea if they are done in the right way. The evolutionary change proposed by the Minister's predecessor is worth while. Why, then, should we settle for 408 targets? Why insist on rushing through the change, breaking commitments that were given only two years ago? Why ignore what doctors and the various nursing organisations are saying? It is stupid to put a political timetable above the interests of patients and patient carers.

Andy Burnham: The hon. Gentleman seems to have rewritten history. Does he not recall that the changes to the internal market, which he robustly defended, were rushed through in the teeth of opposition from the British Medical Association? However, the BMA has outlined its broad support for the Bill. The hon. Gentleman said that there was no difference between the reorganisation of the Conservative Government and that proposed by the present Government. The major difference is that the current reorganisation is accompanied by record investment in the NHS. It is a rather large difference.

Mr. Heald: Actually, Labour Members are being quite complimentary about the Thatcher reforms, saying at least that the process had led to the reforms and that the reforms lasted for an extended period. I commend an article, headed ``Suits you, sir'', which states:

    ``As Parliament prepares to enshrine in law the latest of a long line of NHS reorganisations, Laura Donnelly overcomes a sense of deja vu and wonders what is so good about this year's model.''

I commend the article to the hon. Gentleman; he will find the analogies in it deeply embarrassing.

Dr. Harris: We can have lengthy discussions about what opinion polls tell us and what focus groups say—which is what so-called interest groups are—but the key question in the modern NHS is whether the reforms have anything to offer. What evidence there is suggests that the primary care trusts are quite fragile, and that they are still coming to terms with their existing work load. The evidence suggests that imposing the reorganisation on them runs counter to what the Government presumably seek to achieve.

Mr. Heald: I do not always agree with the hon. Gentleman, as he knows, but I do on this occasion. Sometimes, the Government may want an alibi for reorganising everything because they got themselves into a mess, had a bad winter and so on; but they may still do the right thing, rather than the easy political thing. It is sometimes a good idea to behave like a Government, rather than like a spin merchant.

Andy Burnham: The hon. Member for Oxford, West and Abingdon has just attacked the very principle of primary care trusts. The hon. Member for North-East Hertfordshire needs to come clean; is he attacking the principle of bringing decision-making in the NHS closer to the patient, or is he pleading for more time? Which is it? If he agrees with the hon. Member for Oxford, West and Abingdon, is he also against the principle of PCTs?

Mr. Heald: The hon. Gentleman needs to listen, because I have made it clear time and again that PCTs are a good basis on which to progress. PCTs are a good idea. This is an evolutionary process, but it is wrong to coerce PCGs in the way suggested by clause 2. I am also saying that the time scale is wrong. It is not as if Conservative Members are saying something only for a political purpose. This is what the doctors and nurses are saying. It is what the professionals—the chief executives—are saying. The only people who do not understand that is the Minister and those Labour Members who want to support him, despite the evidence. It must be deeply wounding to some Labour Members to see parallels such as this:

    ``Margaret Thatcher had the inclination to kick the fridge when things were going wrong.''

The behaviour of the present Prime Minister is being compared to that, and we are told that the measure is a sort of knee-jerk reorganisation. I do not accept that anything that Lady Thatcher did was a knee-jerk reaction. After all that criticism and complaint about the process when the Conservative party was last in office, how can Labour Ministers and Back Benchers support this approach?

Laura Moffatt: The hon. Gentleman needs to make his point of view much clearer. He is quoting a minority of people who do not want any change. Why does he quote people whose views he does not share? He has just told the Committee that he liked the idea of PCTs and of returning to a system in which people were in charge of their own communities. His only argument is about timing. Will he be clearer about his argument?

Mr. Heald: The hon. Lady cannot possibly maintain the point that she has just made. She says that the Royal College of Nursing and the British Medical Association support the changes, but those bodies say that the time scale is deeply worrying. Is it wrong for an Opposition spokesman to quote the evidence from the two leading representational bodies and to consider the tracker survey that the Government themselves fund? That cannot be wrong. What are we here for, if we are not allowed to scrutinise legislation by considering all the available evidence and the materials that are there for everyone to see, including important surveys and what chief executives and the important representational bodies think?

We must consider the evidence to see whether legislation holds water. The temptation is to accept what the Whips say, because that is how this whole place is organised. In Committee, we should try to do what the hon. Member for Leigh did earlier, in brokering a sensible middle position that would allow us to go forward. Forcing PCTs into an early change when they are not ready in the way that is proposed is obviously foolish.

Dr. Harris: I would like to set the record straight in respect of the intervention made by the hon. Member for Leigh. He said that an interest group opinion poll showed that there was a problem. I was talking about the academic evidence from people such as Doctors Walsh and Smith at Birmingham University, which suggests that no evidence is offered and that the proposals should take account of existing research. They said that in some areas—such as the plans for PCGs and PCTs—the proposals ran counter to some findings about the size and capacity of primary care organisation. They are simply not ready for the extra duties. The record will show that I never said that those organisations were bad.

Mr. Heald: That is reassuring, because I thought that that is what the hon. Gentleman said. I was slightly nonplussed when I was told that he had said something else. I wondered if I had misheard him.

It is foolish to describe someone such as David Hunt, professor of health, policy and management at Durham university, or Kieran Walsh of Birmingham university's health service management centre and a senior research fellow as if they were simply protagonists in a party-political battle. The hon. Member for Crawley (Laura Moffatt) knows that it is not sensible to describe an eminent professor or a research fellow in the field as if their views were like those of a party politician. They are not. Those people are saying that they, and others, are worried about what is being proposed. How can we ignore that?

On a more practical point, I want to ask the Minister about the powers contained in clause 2. The Secretary of State's role is enhanced by the duty to establish what are to be known as primary care trusts. Instead of simply deciding on a proposal put forward by a primary care group, he will have an enhanced role in the duty to impose PCTs in all areas of England. In addition, it seems that the Secretary of State will have all the powers in relation to strategic health authorities that he had in relation to health authorities. Given that it seems that PCTs will have the same role as that which health authorities used to have, how can the Minister describe clauses 1, 2 and 3 as decentralising?

Clause 2 enhances the power of the Secretary of State. Under the provisions of clause 1, he loses no powers and, if anything, gains a power in respect of the distribution of functions. Where is the decentralisation? If the Minister means that establishing PCTs is a decentralising move in itself—although the Secretary of State will continue to pull all the strings, has been given enhanced powers and will be able to act as he wishes and use the strategic health authorities to impose discipline on the PCTs in respect of targets and performance indicators—that is a funny sort of decentralisation. Perhaps he will explain how clause 2 supports his case on decentralisation. The proposals are ill thought out and rushed. Of course, the Minister could explain in detail how the powers will be used. He has chosen not to and he tells us that the documents are not ready, so it is difficult to agree to clause 2.

Debate adjourned.—[Mr. Fitzpatrick.]

        Adjourned accordingly at twenty-eight minutes past Seven o'clock till Thursday 29 November at half-past Nine o'clock.

The following Members attended the Committee:
Widdecombe, Miss Ann (Chairman)
Atkinson, Mr. Peter
Baron, Mr.
Blears, Ms
Burnham, Andy
Burns, Mr.
Challen, Mr.
Fitzpatrick, Jim
Hall, Mr. Mike
Harris, Dr. Evan
Havard, Mr.
Heald, Mr.
Hutton, Mr.
Moffatt, Laura
Murrison, Dr.
Taylor, Dr. Richard
Thomas, Gareth
Touhig, Mr.
Ward, Ms

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Prepared 27 November 2001