NHS Reform and Health Care

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Mr. Hutton: I take issue with the hon. Gentleman because the safeguards will remain in place if clause 2 becomes law. The essential safeguard is consultation around any proposals to change PCTs, and that will be part of the new legislation. I can quite understand why the hon. Gentleman worked himself up into a lather on Tuesday. It is the responsibility of Opposition Front-Bench spokesmen to do that on occasions. I do not begrudge him that opportunity. He probably felt better for having done so. I am taking issue with the hon. Gentleman and his hon. Friends on their analysis of clause 2.

Throughout the debate on Tuesday, the impression was created by Opposition Members—I have read their remarks carefully—that we would be using powers that we would not have and would not take to compel the establishment of PCTs. That is not true. The hon. Gentleman supports the evolutionary progress of PCTs, and that is happening. The process to 100 per cent. PCT coverage, which will be established by October 2002, is an evolutionary process and has not been driven by any legal powers of compulsion because none will exist.

Mr. Heald: The hon. Gentleman says that consultation is the great protection. Community health councils are one of the statutory consultees. When they are abolished, what will replace that duty of consultation? Who will the consultation be with?

Mr. Hutton: That is already in the legislation: the hon. Gentleman should read it. The CHC role is being replaced. The consultation duties are clear. The consultative role will be changed owing to the abolition of CHCs. The right to object to service reconfiguration—including PCTs—will transfer to local authorities, which have a democratic legitimacy that the CHCs never had. The hon. Gentleman's argument that we are loosening safeguards is without substance. I am sorry that I caused the hon. Gentleman confusion, but the clause does not compel PCGs to become PCTs. How can a clause impose compulsion on PCGs? It cannot.

Mr. John Baron (Billericay): Is the Minister saying that if some PCGs have not become PCTs by October 2002, the Secretary of State would have no power to enforce that, so the timetable would have to be put back?

Mr. Hutton: Clearly, once the Bill becomes law—

Mr. Simon Burns (West Chelmsford): Exactly.

Mr. Hutton: This is hardly a new constitutional principle. When the Bill becomes law, the Secretary of State will have a duty to establish PCTs, which are necessary to ensure devolution. Conservative Members spent Tuesday evening discussing the current process. The hon. Gentleman and the hon. Member for North-East Hertfordshire said that the existing evolutionary process was driven by some legal power of compulsion.

Mr. Heald: No.

Mr. Burns: No.

Mr. Hutton: They should both read their speeches because they made that point on Tuesday and they were absolutely—

Mr. Baron: Will the right hon. Gentleman give way?

Mr. Hutton: No, I must progress.

Both hon. Gentlemen were wrong. They raised other concerns—

Mr. Heald: On a point of order, Mr. Hurst. If the Minister has said on several occasions that he supports evolutionary progress and believes that PCTs are a good basis for it, but that he opposes compulsion, can he pretend that he said something different?

The Chairman: That is a matter for debate, not a point of order, but I am sure that the Minister hears the hon. Gentleman.

Mr. Hutton: I have certainly heard the hon. Gentleman, but that does not change the fundamentals of Tuesday's debate. In breach of an earlier pledge to my right hon. Friend the Member for Southampton, Itchen (Mr. Denham), the hon. Gentleman and other Conservative Members consistently described the process as driven by compulsion. The current process is not driven by compulsion; it is evolutionary and will result in 100 per cent. coverage by October 2002.

Ministers have to make a judgment on PCT applications. I do not dispute the obvious point that when the Bill becomes law, the Secretary of State will have a legal duty to require establishment. That is vital. The hon. Gentleman rails against that, but on Tuesday evening, he did not say whether he thought that compulsion was necessary to ensure delivery of the devolutionary proposals.

The hon. Members for Wyre Forest (Dr. Taylor) and for Oxford, West and Abingdon made good points about that. They described the possibility of a vacuum developing between the establishment of SHAs and PCTs. In that case, SHAs would exist everywhere in the country but not PCTs. That will not happen. We will not activate these proposals. We could not as it would not be logical if there were to be such a vacuum because the whole structure would be incomplete. The structure needs to be complete before the proposals can be fully implemented. As I have said on many occasions in Committee, that will happen by October 2002. That is when all the PCTs will be established and so the vacuum that rightly concerned the hon. Gentlemen will not happen.

Dr. Harris: I accept that I may not have followed this, so I should be grateful if the Minister could be gentle with me if I have missed something. Is he implying that if PCTs do not have full coverage by October 2002, health authorities will not be abolished? Is that throughout the country or just in the relevant areas? If so, has that been announced previously?

Mr. Hutton: No. We will undertake the reform in a sensible way so that it will happen throughout the country at the same time. That is what we have always said we would do and that is what we are currently planning to do from October 2002.

Some concern was expressed about the state of readiness for PCTs. I understand those arguments and they were well put. However, when hon. Members drew attention to the survey they did not point out that the comments were more than a year old. If we had taken no action to address concerns that had been expressed to us about the management capacity and capability of primary care groups as they move to PCT status, that would have been a perfectly valid criticism to raise today. But I referred earlier to measures that we have put in place to enhance and support managers working in PCTs. A national care programme of management support is now available to help PCTs and to help PCGs as they move to become PCTs. We also have a new national leadership centre in the NHS, which is helping managers to prepare for their new responsibilities.

There was a lot of concern about the new commissioning expertise of the PCTs and whether they would find that difficult to absorb as they move up from PCG status, and it was felt that somehow the NHS would lose the commissioning expertise that exists in health authorities. It is clear that as we move to the new model, we will not lose the commissioning expertise in the NHS. Many of the commissioning managers who are currently working in health authorities will want to work in PCTs too. There is strong case to be made for ensuring that we do not lose their commissioning expertise. The Government are committed to ensuring that, in line with the other changes that we are making to support and enhance the role of PCTs. Some of the criticisms that were aired on Tuesday need to be seen in that new and different light.

Andy Burnham (Leigh): Does my right hon. Friend agree that the Conservative Front-Bench spokesmen seem constantly to be contradicting themselves? On Tuesday afternoon, the hon. Member for North-East Hertfordshire (Mr. Heald) said that Labour's

    ``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.''—[Official Report, Standing Committee A, 27 November 2001; c. 87.]

This morning he has gone on at length about how he supports the principles of PCTs. Is my right hon. Friend as confused as I am?

Mr. Hutton: There will be a certain amount of rereading of speeches in the light of that comment.

Mr. Heald: Will the Minister give way?

Mr. Hutton: No. Let me at least finish my point and then I will give way to the hon. Gentleman.

Mr. Heald: This is a pointless exercise.

Mr. Hutton: It is not. What was a pointless exercise was much of the froth that we heard from the hon. Gentleman on Tuesday. He was clearly annoyed because his amendments were not selected because they were starred amendments and he felt sufficiently motivated to indulge in a bit of ranting about this without any notes or thought about the previous positions that his party had adopted. My hon. Friend is entirely right. On Tuesday Conservative Members contradicted their previous positions. That is why I wanted to open my remarks this morning by drawing the Committee's attention to that inconsistency.

Mr. Heald: Anyone can take one line out of context, but on Tuesday I made the point that I have made again this morning. I said:

    ``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.''—[Official Report, Standing Committee A, 27 November 2001; c. 88.]

Mr. Hutton: The hon. Gentleman confirms the point that I was trying to make earlier, which is that he got it wrong on Tuesday. Clause 2 cannot be used to coerce PCGs, because that is not the law of this country. The hon. Gentleman is a lawyer, so he must know that no Government can use a clause in a Bill to coerce anyone to do anything. I do not need to labour the point.

Mr. Baron: Will the Minister give way?

Mr. Hutton: No, I have addressed the issues and do not want to detain the Committee much longer.

One concern raised by Opposition Members relates to finance directors and their role in PCTs. There was a misunderstanding about the quotation that said that one in seven do not have a finance director. It is a legal requirement for PCTs to have a finance director, whereas it is not a legal requirement for PCGs to have one because they are simply constituted as committees of health authorities. The health authority must have a finance director in that capacity, as well as in relation to the PCG. Opposition Members' analysis was wrong.

This long debate has become rather sour. I may have contributed to that with my remarks this morning, but it was important both to place on record some of the misconceptions in which hon. Members indulged themselves on Tuesday and to set out the argument in the correct context. Until Tuesday, we understood that the Conservatives supported the concept of primary care trusts but had arguments to make about the pace of change, just as they supported the principle of devolution but were concerned about the rapid progress towards it. Those concerns should be left to one side because they are not related directly to clause 2.

The clause simply puts the structure that we are designing for the NHS on a proper legal footing. Without a duty on the Secretary of State to require the establishment of primary care trusts, there would be a hole at the centre of the new NHS architecture. If the Opposition support the principle of primary care trusts and want to ensure that they can deliver their new commissioning responsibilities, their argument against clause 2 is inconsistent. An argument about the pace of change is one thing, but it is irrelevant to the clause. For those reasons, I commend clause 2 to the Committee.

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Prepared 29 November 2001