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7 Feb 2006 : Column 792
NHS Reorganisation
Madam Deputy Speaker (Sylvia Heal): We now come to the second Opposition motion debate, on the reorganisation of primary care trusts, strategic health authorities and ambulance trusts. Mr. Speaker has selected the amendment in the name of the Prime Minister.
6.47 pm
Mr. Stephen O'Brien (Eddisbury) (Con): I beg to move,
That this House believes the structures of the NHS should serve the needs of the service and patients; notes the Health Select Committee's report on Changes to Primary Care Trusts (HC 646); regrets the mishandling of the reorganisation of primary care trusts (PCTs) by the Department of Health; wishes to see administration costs minimised; further believes that structure must follow function and that the future functions of PCTs have not been clarified; further believes that strategic health authorities should be abolished; further believes that ambulance trusts should not be required to undergo restructuring unless the services themselves request it; fears that restructuring proposals will seek to mask the consequences of £1 billion worth of deficits across the NHS; further regrets the loss of morale amongst NHS staff in PCTs; and calls on the Government to enter into a new and genuine debate about NHS structures, so that the service can better meet its aim of comprehensive quality healthcare available to all, based on need not ability to pay.
As we start this debate, let us agree about the common ground between us. Nothing that I shall say this evening undermines or undervalues the constant, dedicated and professional work done by NHS staff. Doctors, nurses—indeed, my wife is a nurse—the service's many other clinical and technical staff, porters, volunteers, cleaners, even managers and administrators all are highly skilled and good at their jobs.
I pay tribute to them and their work. The Opposition's job is to press the Government to optimise their support for what NHS staff do in delivering taxpayer-funded health care that is free to all who need it at the point of use. I say that with deep conviction, as one of my children recently had to undergo a serious operation at Alder Hey hospital in Liverpool. Neither he, my wife, nor I can praise highly enough all those NHS staff who were involved in his excellent treatment.
Like the country at large, the Opposition regard the NHS as a top priority. We are optimistic about its future and determined to see it improve. It therefore comes as a surprise to most people that a great many NHS trusts face serious and worsening deficits totalling something of the order of £1 billion gross, with wards being closed and services curtailed.
We have just finished a debate on the vital matter of mental health and, even there, cuts are being made in availability, provision and access. We are now debating the Government's latest proposed reorganisation of primary care trusts, strategic health authorities and ambulance trusts. One fears that it is a case of the Government fiddling while Rome at least smoulders. As soon as the Government hit the inevitable choppy waters—in this case, ballooning deficits in a quarter of all trusts—that were the inevitable consequence of their own policies and targets as well as their most recently
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introduced organisational and structural tinkering and meddling, they reach for their reorganisation manual yet again.
Mr. John Redwood (Wokingham) (Con): My hon. Friend is making a strong case. Is there not a danger that the amalgamation of these trusts could impose a lot of extra administrative costs as a result of new logos, new staff—owing to the need to employ regional and local people—and new properties? That is the last thing that we want to spend money on at a time when we need more to spend on nurses and doctors, certainly in my area.
Mr. O'Brien: My right hon. Friend is correct. There is always a transfer cost associated with any such move, but it is nonsense to incur such costs when there is no identifiable benefit, given that it will involve hard-pressed taxpayers' money that is needed for front-line services.
Mr. Jim Devine (Livingston) (Lab): When the Conservatives were in power, we had 47 trusts in the Scottish health service. Under the Scottish reorganisation, that figure has been reduced to 15. We also reduced the number of senior managers by 27 per cent. and those savings have gone into paying for front-line staff. Does the hon. Gentleman not welcome that?
Mr. O'Brien: I am sure that the Scottish Executive would very much like to debate that matter, but this House has no jurisdiction over it. I hope that the hon. Gentleman will reflect on that point, having taken up time in this debate with a matter over which we have no authority whatever.
Mr. John Gummer (Suffolk, Coastal) (Con): Although we have no control over the Scottish Executive, the hon. Member for Livingston (Mr. Devine) will be voting on English trusts in this debate.
Mr. O'Brien: My right hon. Friend is right. Roll on the time when we are in Government and can introduce English votes for English laws.
There have already been six reorganisations since Labour came into office. The merger of strategic health authorities and primary care trusts will represent the seventh, and the forthcoming merger of NHS ambulance trusts will be the eighth.
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) (Lab): Will the hon. Gentleman give way?
Mr. O'Brien: Of course I will give way to my neighbour.
Mrs. Dunwoody: I am grateful to the hon. Gentleman. Am I to take it from his remarks that he does not believe in an integrated national health service covering the whole of the United Kingdom?
Mr. O'Brien:
I hope to mention the hon. Lady in dispatches later in my speech. I am intrigued by her question, because I hope that she knows—not least because of my own personal connection with her—that we have a strong commitment to the NHS as a national
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health service. By "national", we mean the United Kingdom. However, we must recognise that the authority and accountability for NHS services in Scotland has now been devolved and it would therefore be inappropriate for me to take up the House's time dealing with matters of Scottish accountability.
The Government have an addictive personality disorder and we are constantly told that all such habits are costly and have dire consequences. We have been here before. As recently as 2001, the Government announced that 302 primary care trusts were to be established as statutory bodies to replace the health authorities and that nine regional offices of the NHS executive were to be abolished in favour of 28 strategic health authorities. The Government's proposals for PCTs and SHAs effectively return the NHS to the same map that they abolished only three years ago. The Health Committee slated this U-turn, stating:
"A return to structures which are similar in size and function to previous Health Authorities raises important questions about why the shortcoming now being identified"—
"could not have been easily anticipated and addressed before the PCTs' introduction three years ago".
Most worryingly, the cost of this reorganisation will reach £320 million, which I think gives a quantified answer to the question that my right hon. Friend the Member for Wokingham (Mr. Redwood) asked earlier. Given the increased resources that have rightly been made available for the NHS, it is little wonder that there is a constant refrain from constituents and clinical staff alike of, "Where has all the money gone?"
Rob Marris (Wolverhampton, South-West) (Lab): I understand the hon. Gentleman's point about reorganisation in the NHS, but will he explain why the motion that he is supporting calls for another one, namely
Is that not another example of the kind of reorganisation that he is decrying?
Mr. O'Brien: I have some respect for the hon. Gentleman's normal analysis, but he must recognise not only that we would replace strategic health authorities if we had the chance, but that they will naturally become extinct in three years anyway, if the Government have the courage to implement that move. We are simply trying to save some money by advancing that change rather faster.
On 28 July 2005, the Department of Health proposed a reduction in the number of PCTs from the present level of 303 to between 100 and 150, to be aligned with county council boundaries where possible, and a similar reduction in the number of SHAs. Changes to PCTs were expected to be completed by October 2006, and changes to SHAs by July 2006. On 1 December 2005, the Department of Health published the plans that had been submitted to it for consultation, including plans to reduce the number of PCTs to a minimum of 115, and to reduce the number of strategic health authorities to between nine and 11, along the lines of the Government offices for the regions. Consultation on that reorganisation is ongoing, so there is
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no question but that this restructuring plan is of the Government's making. They cannot slither behind the trusts to avoid their direct ministerial accountability.
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