Standing Committee A
Thursday 29 November 2001
[MR. ALAN HURST in the Chair]
Primary care trusts
Question proposed [27 November], That the clause stand part of the Bill.
Question again proposed.
The Minister of State, Department of Health (Mr. John Hutton): We had an unexpectedly long debate on clause 2 on 27 November. As the hon. Member for West Chelmsford (Mr. Burns) said, the clause is an important part of the Bill. At times, the debate became acrimonious, which is regrettable. I am not sure why the hon. Member for North-East Hertfordshire (Mr. Heald) lost his usual equilibrium, but I hope that he recovered during the interregnum.
Mr. Oliver Heald (North-East Hertfordshire): I hope that the right hon. Gentleman will agree that I was polite and courteous as usual throughout the debate, but I was being provoked.
Mr. Hutton: That is a good plea in mitigation, and I will give it due consideration when I come to apply my sentence.
The debate was important, because the establishment of primary care trusts is an important part of the Government's reform agenda for shifting the balance of power and devolving more responsibilities to the front line of the national health service.
The hon. Member for Oxford, West and Abingdon (Dr. Harris) is concerned about whether the Audit Commission will assess the savings that the Government believe will accrue to the NHS as a result of the proposed changes. He also wondered whether I would allow the Audit Commission to make such a study. As he probably knows, Ministers do not decide what the Audit Commission examines. It has been given responsibility to perform the value for money audit of the NHS and can look into whatever aspect it chooses. That is not a matter for me to decide, nor should it be. I have no doubt that it will fully discharge its responsibility.
Dr. Evan Harris (Oxford, West and Abingdon): I thank the Minister for clarifying that issue. Will he confirm that the Audit Commission has neither confirmed nor denied the Government's claims that they have made savings in NHS management costs, because it has not looked into them?
Mr. Hutton: That is correct. The Audit Commission has not looked into the matter, as I said. We are confident that savings in the NHS will be made as a result of the proposed reforms. The money saved by the reforms will be reinvested in front-line health services, which is an important principle.
There was some discussion about whether the reforms have a different motive. The Government consider the reforms to be about empowering, and devolving power to, front-line health services. That is the most sensible way for any large organisation to conduct itself. Some Opposition Members attribute another motive to the reforms. The hon. Member for Oxford, West and Abingdon described that motive in a nutshell when he said that the reforms sought to shift blame, not redistribute the balance of power, in the NHS. The Liberal Democrats are making a false, but predictable, argument. They are the real conservatives on the subject of reform in the NHS: they oppose change, resist reforms that will empower the front line, and stick their heads firmly in the sand. We have always made it clear when we talk about the future of the NHS that there are two processes that need to go hand in hand. One is investment, and we are making sure that that the NHS has access to record amounts of new investment which will allow us to close the gap between public expectation and capacity in the NHS. That investment needs to go alongside reform; the money itself will not be sufficient. It is depressing that the Liberal Democrats, who would like to present themselves as a party with radical new ideas, are so deeply entrenched in their conservatism about the future of the NHS.
Dr. Harris: It is not my intention to return to matters that we have already discussed and the record will show that I did not repeat the extended allegations that I made on Second Reading because they were matters for Second Reading.
I accept that the Minister has a different view about these reforms, but does he accept the principle that in certain circumstances the NHS will be hampered by continual change. Does he accept that there is an argument that at some point change becomes the enemy of progress because it distracts people on the front line, of which he talks so fondly, from getting on with the job of treating patients?
Mr. Hutton: Well of course any Government have to make judgments on such matters. What I am saying to the hon. Gentleman is that his solution of no change is simply not compatible with the reality facing the NHS at the moment. That is why I say to him, the Committee and my hon. Friends that these reforms are essential if the extra investment is to work in the way that we envisage it working for the NHS.
The other point that emerged during our debate on clause 2 concerned the nature of the clause. There was a lot of rhetoric from the Opposition about imposing obligations to establish PCTs, and so on. We need to consider the issue in a more accurate way than we managed on Tuesday when Opposition Members were speaking about it.
One thing that Opposition Members have lost sight of in their concerns about clause 2 is that in the earlier debate on Tuesday I made it clear that by October 2002 we will have 100 per cent. coverage in England of PCTs. We will be practically there in April. Only a dozen or so primary care groups will not be constituted as trusts by that date.
What Opposition Members completely failed to pick up on was that that will be done under the existing voluntary provisions in the Health Act 1999. Throughout the debate on Tuesday it was suggested that we were using some power of compulsion to compel people to create PCTs. We have no such powers of legal compulsion at all. The process of moving from PCGs to PCTs is under way, and people will be aware of that in their own constituencies. Many hon. Members will be involved in the consultation process. But that process of moving from PCGs to PCTs is obviously being conducted outwith clause 2, because clause 2 is just that—a clause of a Bill that is not yet law. The argument that we were using some power of compulsion that we had said we would not use to establishment PCTs is simply not true.
Dr. Harris: Will the Minister give way on that point?
Mr. Hutton: No, let me finish my argument.
Clause 2 imposes a duty on the Secretary of State to ensure that PCT coverage remains comprehensive. That is essential because it is consistent with our ``Shifting the Balance of Power'' proposals.
The other point that needs to be clarified, which, unfortunately, I do not think was on Tuesday, is that it remains unclear to me whether Conservative Members support a shift in the balance of power; whether they believe that that is the right thing to do in relation to reforms in the NHS. I can quite understand their concerns about the speed with which the changes are being made, but on Tuesday I detected a more fundamental objection to the reforms themselves.
I hope that Conservative Members at least—Liberal Democrats will not because they are opposed to these reforms—understand that clause 2 is important because it will ensure that devolution to the front line becomes a reality. Without there being a statutory duty to ensure 100 per cent. coverage of PCTs, the new architecture of the NHS simply cannot be delivered.
Mr. Heald: We are getting into technical and legal areas, but I am trying to follow the Minister's argument. Is he seriously saying that the clause would impose a duty on the Secretary of State that he does not have the powers to achieve?
Mr. Hutton: It is true that, under the Health Act, the Secretary of State is not under a duty in law to establish PCTs. The Bill does impose such a duty, and necessarily so if shifting the balance of power is to work. My point was not so much a technical or legal one; it is a broader issue. The move to establish PCTs is not being done under any power of legal compulsion because the Secretary of State does not have that power of compulsion in primary legislation. He has an opportunity but not a duty to establish PCTs.
Dr. Harris: Does the Minister accept that if one says that someone has an option to do something and then says that if that option is not taken up it will happen anyway, that puts pressure on the person to take the optional route and they may as well prepare for the inevitable? An analogy, in terms of patient consent, is that consent is not valid if what is consented to will happen anyway.
Mr. Hutton: The concept of PCTs commands broad support in the NHS. I am not saying that everyone in the NHS supports the establishment of PCTs, they clearly do not—one hon. Member here does not—but there is a strong consensus in the NHS that this is the right way forward.
The argument on Tuesday was more about the speed of change. If one accepts the principle of devolution to the front line and the new role of PCTs, logically one must support clause 2. The argument about pace of change is a completely different from the fundamental argument about whether there should be PCTs in the NHS. That is a fundamental part of the shifting of the balance of power package. Without the duty to ensure that there is 100 per cent. PCT coverage there would be a hole at the centre.
Mr. Heald: It may be that I am not following the Minister's argument, in which case I apologise. We have always agreed that it is a good idea to develop PCTs in an evolutionary way and that they can form a good basis for the future. What we are objecting to is the fact that the Secretary of State will now be able, under clause 2, to establish PCTs without the sort of safeguards that Ministers had previously promised—that is, that they would emerge in an evolutionary way.