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Mr. Philip Hollobone (Kettering) (Con): Is my hon. Friend aware that the chief executive of the Northamptonshire Heartlands primary care trust, Peter Forrester, has to spend half his time in some weeks battling to save that popular primary care trust, which is taking him away from giving his time to front-line issues?

Mr. O'Brien: I gather that wards are also being closed in Northamptonshire. That situation is replicated right across the country. I was talking to a local physiotherapist the other day and she told me that her job description required her to administer for 25 per cent. of the time and give physiotherapy for 75 per cent. She then told me that the situation was now reversed and that she was now lumbered with all the administration, because the Government are stealthily removing administrative support in an effort to avoid the charge that they are diminishing front-line services.

How can there be any sense in the Government proposing changes to the structure of primary care trusts unless they have first established with clarity what the functions of the PCTs are to be? The Government's document, "Commissioning a patient-led NHS", called for PCTs to become

by 2008. In the face of fierce opposition from NHS staff employed by PCTs, from MPs, and from the Royal College of Nursing—which launched, but has now withdrawn, an application for judicial review of the decision—the Government have since retreated from their strident position. The Secretary of State said on 11 November 2005:

There we have it: the Government's U-turn. So far, so normal for this Government, but, even though common sense would dictate that they should, they did not even review the design of the new PCTs to ensure they were fit for their new purpose as commissioners as well as local providers. Those roles encompass massively different skills and levels of authority, governance and accountability, as anyone with even a smattering of management experience could see.

On 11 January 2006, the Health Committee attacked the Government's indecision, saying

The Department of Health's NHS operating framework for 2006–07, published on 26 January 2006, offers little further clarity. It states:

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On that last point, incidentally, I have to say that I am already receiving letters—I expect that my hon. Friends on the shadow health team are, too—alleging a growing web of conflicts of interest and worse. That is no laughing matter for a Government-designed system, as it makes the Government complicit, and they will be guilty of intended consequences, on which we will be required to hold them to account.

The Health Committee also noted that NHS organisations were given less than a month, during the summer holiday period when many key figures were absent, to put together proposals for changes to local services. The chair of North West London SHA described the consultation process as "flawed". The Health Committee concluded:

Mr. Eric Martlew (Carlisle) (Lab): I remember that the Conservatives fought the election saying that they would introduce £35 billion of cuts, £600 million of which would come from NHS bureaucracy. Where is the hon. Gentleman going to make those cuts? What would he do?

Mr. O'Brien: Apart from the fact that the Government are clearly attempting to fulfil their own manifesto promise of £250 million of cuts, the hon. Gentleman should not read so much into the note distributed to him and his fellow Back Benchers by the Labour health team, and signed by the special advisers to the Secretary of State, that tries to suggest that that is our position, not recognising that it is nothing to do with the policy that we promote.

Quick consultations always suggest a foregone conclusion. I have been contacted by GPs in my constituency who work within the Central Cheshire PCT and who are worried that that is the case. They understand that the Government's current preferred option is that all four existing Cheshire PCTs became one, but fear that that will be too large, impacting on local links, covering different care pathways and looking to both Manchester and Liverpool, which is inappropriate for my constituents. With them, I favour Central Cheshire and Eastern Cheshire PCTs combining. They are also concerned, as are all Opposition Members, that those structural changes are a deliberate ploy by the Government to mask the consequences of deficits and their impact on patients.

Mr. Mark Harper (Forest of Dean) (Con): My hon. Friend is right. Today, the Gloucestershire health community issued a press release and the chief executive of the acute hospital trust said that the current difficulty with deficits will be magnified by the significant reduction in prices paid with the changes in the national tariff. The trust in Gloucestershire faces a cut of £21 million—a 7 per cent. reduction in its spending next year—if it treats the same number and mix of patients and will face tremendous challenges that will lead to job losses. Those are the problems faced in Gloucestershire.
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Mr. O'Brien: I am grateful to my hon. Friend, who is working hard for his constituents. He recognises that there is nothing worse than a Government who provide perverse incentives for all the wrong directions and decisions to be taken in an effort to try to meet their targets.

Mr. Graham Stuart (Beverley and Holderness) (Con): Will my hon. Friend give way?

Mr. O'Brien: I am conscious of the need to get to the end of my remarks to allow more Members to speak. If my hon. Friend will forgive me, I will not take too many interventions.

The Cheshire GPs fear that there will be a levelling down of services and cuts to front-line patient services if there is a merger with the debt-ridden Cheshire West and Ellesmere Port and Neston PCTs. As has been outlined, good PCTs such as Central Cheshire are now to be penalised to prop up disastrously underperforming ones such as Cheshire West, which has KPMG in. The Government are 100 per cent. responsible for that muddle, as well as for the deficits resulting from rising cost pressures and the cost of meeting Government targets.

Why are the Government charging ahead with all that? It is neither for NHS patients nor those who work in the NHS, but that is what the Minister will no doubt claim when she responds. One only needs to witness the collapse in morale among NHS clinical and non-clinical staff to know that the Government are in serious denial. Can anyone doubt that the Government are conducting a sham consultation on all these changes? Can it be in doubt that the Government will not break the habits of a lifetime, have no intention of respecting the consultation processes and certainly not the responses, and will press on with their proposals regardless of the responses received? We need look no further than yesterday's announcement on the police for proof of that.

The proposed merger of strategic health authorities into remote bodies aligned with Government offices for the regions is, despite all the Government's ever more wild and shrill protestations, yet another manifestation of their addictive personality—their obsession with regionalisation, even though SHAs have patently failed in their key task of performance managing NHS organisations. One does not get a £1 billion deficit if one has been a success.

David Howarth (Cambridge) (LD): Unlike the hon. Member for Wolverhampton, South-West (Rob Marris), I welcome the motion's proposal to abolish SHAs. Does the hon. Gentleman agree that they do not seem to have any function, that their strategic functions should be carried out by the Department of Health and that their planning and capacity functions should be carried out by PCTs? There is no point in having them at all.

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