NHS Reform and Health Care

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Mr. Burns: As the Minister says, we have had a long and comprehensive debate on the clause. I do not intend to detain the Committee for long, except to clear up some of the misapprehensions that the Minister tried to spread in his remarks today. I do not understand his Minister's motivation—it may simply be a misunderstanding. I shall make the matter plain, so that he comprehends fully and there is no future misapprehension.

As my hon. Friend the Member for North-East Hertfordshire made clear at column 88, we as a party do not oppose the principle of PCTs. Our argument throughout the debate on clause 2 has focused on what we believe is a hasty rush towards implementation of the reforms, which haste will impose considerable strains on the health service. The Minister went off at a tangent and suggested that we do not understand that the Government currently have no statutory powers to force PCGs to become PCTs. That is self-evident; my hon. Friend and I have always understood that the Government have no such power. However, the purpose of clause 2 is to give them the power to ensure that there is 100 per cent. PCTs by the Minister's deadline of October 2002.

Mr. Hutton: I intervene to confirm that the transition from PCG to PCT status will be conducted and completed under the existing evolutionary provisions of the Health Act 1999, not under any powers of compulsion.

Mr. Burns: The Minister says that, but logically it is not possible for him to give a categorical assurance.

Mr. Heald: Are the changes not being made under the threat of compulsion?

10 am

Mr. Burns: My hon. Friend anticipates my argument. If he will forgive me, I shall finish putting my point to the Minister as he can clear up the matter once and for all. It is my understanding—of the Bill and the explanatory notes—that if in September next year a PCG is not evolving towards PCT status in time for October 2002, the clause gives the Government the power to force the PCG to become a PCT. Yes or no? Am I right or wrong?

Mr. Hutton: As I have just said, the process will be completed by October 2002 and all the PCTs will be established under the evolutionary powers in the Health Act 1999.

Mr. Burns: It was a mistake to invite the Minister to intervene because, parrot-like, he has merely repeated what he has been saying for the past 20 minutes. He has not answered my question. In theory, a PCG might by September or October next year be nowhere near to becoming a PCT—for some quirky reason, it might not want to become one. In those circumstances, the Secretary of State will possess the clause 2 powers to make it become a PCT. That is my understanding of what might happen. The Minister says—events may prove him right in one respect—that although the Government will have that statutory power when the Bill becomes law, they will not need to use it because of the evolutionary process. My hon. Friend the Member for North-East Hertfordshire and I believe that the Government have sought powers under the clause to make PCGs become PCTs by 2002, and that they could use those powers to speed up the process if some PCGs were reluctant to acquire trust status.

Mr. Heald: Does my hon. Friend agree that the clause being unnecessary—because the process will happen anyway—gives even more reason to vote against it?

Mr. Burns: Absolutely. If it is unnecessary, there is no reason for the Government to include the clause in the Bill. The Government insist on including it because they need the reserve powers in case the evolutionary process does not materialise 100 per cent.

Since the Government's intentions were made clear, pressure has been applied to PCGs to rush towards PCT status. That is the nub of our argument and our concern about the undue haste. Our amendments ask—interestingly, in the light of the Minister's timetable—for a delay of only six months, to give PCGs and the embryonic PCTs a little more power to bed in and lay the foundations for their substantially increased and novel functions. The right level of health care might then be provided without any hiccoughs or hiatus. That is eminently reasonable, so I invite my hon. Friends to join me in opposing the clause.

So that there can be no misreading as Ministers and civil servants trawl through the debate over the weekend, we oppose the clause not because we oppose PCTs in principle, but simply because of what we regard as the haste with which we have reached that stage of the reforms and the damage that that haste will cause to the provision of health care throughout the country.

Dr. Harris: I have some brief some points to put to the Minister. First, I reiterate our concern about changes to the NHS that we believe are part of a strategy to make activity appear the same as action, so making it easier for the Government to blame the continuing failings of the health service on anyone but themselves. They are creating reforms in the NHS that appear helpful but are nothing of the kind.

A briefing paper from the NHS Confederation mentions management costs. Nigel Edwards, its acting chief executive, says about stripping away tiers of management that

    ``Shifting the balance of power in the NHS''

—I assume that he is referring to the document—

    ``actually requires more organisations not fewer. This will bring decisions close to the patient but the consequence is we have gone from 95 NHS management bodies to 307 with this latest reorganisation of the NHS.''

The Government should accept as valid the fears that additional management and bureaucracy are being introduced and about the series of reorganisations. I am generally sceptical about such structural reforms when the urgent need is—as it was last year and four years ago—to give the NHS the resources it requires, not another reorganisation.

On the issue of compulsion, does the Minister accept the argument to which I alluded earlier, that if a person is given a clear option about whether to say yes or no to a proposition and he or she then says yes or no, and if that process is repeated with the threat that the person will have to accept the proposition in future, it is an invalid procedure in terms of the ethical gaining of consent? The choice is meaningless if the decision is to be compulsory anyway.

Will the Minister clarify his announcement today—and perhaps Tuesday, if one reads between the lines—that the go date for the changes is now October 2002 because he wants the process to occur simultaneously throughout the country? I understand why he wants to do that, but the necessity of getting PCTs across the country has put off the target date to a half-year point instead of his original target date of April 2002. Is it understood that people who seek new jobs will have to start them in October 2002 and not earlier?

Mr. Hutton: We have always said that April 2002 relates to the creation of the new strategic health authority. We will use our powers to make sure that health authorities merge by April 2002, but they will not be able to take on responsibilities or the new title of strategic health authorities until and unless the Bill becomes law.

Dr. Harris: I am still unclear. Is the Minister saying that he wants to create some form of shadow strategic health authority, getting the boundaries sorted out by April 2002? The key question is when functions of health authorities transfer to PCTs. If the Minister is saying that that will now happen in October 2002—that may have always been his plan but I was under the impression that it was going to be April 2002—it means that the shadow strategic health authorities will indeed be strategic health authorities in terms of boundaries, but in terms of functions they will for at least half way into the new financial year behave as health authorities. In other words, they will continue to have all the powers—to be discussed under another clause—that will transfer to PCTs. Will the Minister help me out by providing clarification?

Mr. Hutton: I have laid out the timetable many times. The hon. Gentleman's understanding of the timetable for establishing the health authorities is broadly correct. They will be established in shadow form using existing powers to merge health authorities to form larger groups; they will become authorities when the Bill becomes law. We are aiming for that to be done in 2002.

Dr. Harris: Is the Minister saying, in effect, that this section of the Act—as it will be, unless something dramatic happens during the parliamentary process—will come into force on October 2002, or that existing powers will be used to create the relevant geographical structures earlier than that?

Mr. Hutton: I am not in a position to give a precise date for when the provisions will be brought into force, but I will state honestly and openly that that is the broad timetable within which we are working. However, the legal transfer to PCTs of responsibilities and a host of functions cannot take place—I will not rerun the argument that we just had about the nature of clause 2—until the Bill becomes law.

Dr. Harris: To be consistent with the comments that I made on Second Reading, albeit not in this debate, about the reorganisation, I oppose the clause standing part of the Bill.

Question put, That the clause stand part of the Bill:—

The Committee divided: Ayes 10, Noes 5.

Division No. 4]

Burnham, Andy Challen, Mr. Colin Fitzpatrick, Jim Hall, Mr. Mike Havard, Mr. Dai
Hutton, Mr. John Moffatt, Laura Taylor, Dr. Richard Touhig, Mr. Don Ward, Ms Claire

Baron, Mr. John Burns, Mr. Simon Harris, Dr. Evan
Heald, Mr. Oliver Murrison, Dr. Andrew

Question accordingly agreed to.

Clause 2 ordered to stand part of the Bill.

The Chairman: For the convenience of the Committee, I should announce that I have called a meeting of the Programming Sub-Committee for 11.35 this morning. It will be held in this Room after the Committee rises.

Clause 7

Funding of strategic health authorities

and health authorities

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Prepared 29 November 2001