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Mr. O'Brien: I am glad to hear that the hon. Gentleman has come to our view. He is correct that SHAs have lost all their purpose and are therefore no longer a worthwhile or value-for-money option for the taxpayer.
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Indeed, SHAs have come under attack from Government Back Benchers. During Health questions last week, the hon. Member for Warrington, North (Helen Jones), who is not in her place, said about the Cheshire and Merseyside SHA,

to which the hon. Member for Crewe and Nantwich (Mrs. Dunwoody)—who, I am glad to see, is in her place—added,

The way in which SHAs have undertaken their responsibility for performance management is a disaster. The Secretary of State has sent in turnaround teams to PCTs—proof, if ever there was, of the failure of SHAs to oversee those trusts, and an immense additional and avoidable burden on the taxpayer. I would not mind the Government paying McKinsey were there no Merseyside and Cheshire SHA, but the imposition of KPMG on 18 trusts up and down the country at vast expense shows that the SHAs have not been doing their job. The taxpayer is paying twice over, and over the odds the second time: once for the SHA employees who are supposed to keep trust finances in order and once for the consultant to sort it all out. Surely the Department should ensure that it employs people who can do the job and sacks those who cannot. The turnaround programme is proof that SHAs are not up to it, that this three-year-old Government design has failed and that SHAs should therefore be scrapped. In any other walk of life, and under any other Government, it would be plain that SHAs have failed, and that some, such as Surrey and Sussex, have presided over an almost complete collapse in their health economy. We can, and should, dispense with SHAs. We just wonder whether the Government have the courage to take that obvious step.

We now come to the ambulance trusts. In June 2005, the Government's review of ambulance services, "Taking Healthcare to the Patient", was published. It recommended a reduction in the number of NHS ambulance trusts from 31 to 28. However, on 14 December 2005, the Department of Health began consultation to reduce the number of NHS ambulance trusts to 11, aligned with Government office for the region boundaries. That consultation will close on 22 March. The Health Service Journal reported on 22 September 2005 that the Department of Health expects the changes to be in place by July—a bit swift for a genuine consultation.

No one in the ambulance service called for this change.

Mr. Tim Boswell (Daventry) (Con): Will my hon. Friend consider the Two Shires ambulance trust, shared between Northamptonshire and Buckinghamshire? It is a three-star trust, which will not only be torn apart but reconstituted, with our trust as part of a much wider regional trust and the other going to the south-east? Something that is perfectly effective that has its
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headquarters in my constituency is being destroyed and its seat of decision making is being removed to a place about 100 miles away.

Mr. O'Brien: I am grateful for the example that my hon. Friend outlines. He will derive great comfort from the fact that he is not alone, but no optimism, from the case to which I am about to refer.

Mr. William Cash (Stone) (Con): Will my hon. Friend give way?

Mr. O'Brien: I am about to mention Staffordshire, so my hon. Friend might want to hold on.

The ambulance tsar, Peter Bradley, made a clear case for restructuring Avon, Gloucestershire and Wiltshire ambulance trusts, and for a revision of the Thames Valley trust. The Government took that as an excuse—it was not in the report, and at best they might claim, as a cloak, that it was implied—to reduce the number of ambulance trusts down to nine, 10 or 11. To implement that, the NHS Appointments Commission sent out letters on 30 January this year, to all MPs, I believe, asking for nominations for chairmen and chairwomen of the new NHS ambulance trusts. Do the Government think that we do not believe that the consultation is a foregone conclusion? Were the consultation genuine, money would not and should not be being spent now on the recruitment process; it is a highly questionable use of taxpayer's money.

Mr. Cash: My hon. Friend may know that Staffordshire ambulance trust is regarded as one of the best in the country. Indeed, later tonight I shall present a petition with many thousands of signatures, because the people of our area are incensed at the fact that the trust is to be merged into a west midlands service. Does he accept that we are deeply concerned?

Mr. O'Brien: I fully accept that my hon. Friend and his constituents are, rightly, deeply concerned. I shall deal with Staffordshire shortly and I hope that he will be able to combine what I say with the representations that he is already making.

The proposed regionalisation is simply not service-led. In fact, it is diametrically opposed to what the service needs. It is not enough that the people of the north-east rejected the Government's regionalisation agenda out of hand, which led to the withdrawal of similar proposals in the north-west and Yorkshire and Humberside. In a forlorn attempt to save the Deputy Prime Minister's face—I shall not inquire what type of face it is—the Government will ram the proposal through anyway, as part of their dogmatic regionalisation agenda.

For ambulance services, local knowledge is key, as are small, efficient management structures. Where trusts have been merged, their quality has been destroyed. The trust that used to serve my constituency, the Cheshire ambulance trust, had three stars. It was merged with the Merseyside ambulance trust. The ensuing crisis has been so appalling that the chief executive of the joint Cheshire
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and Merseyside ambulance trust conveniently "resigned". The greater tragedy is that the trust has descended to a nil star rating.

Only this weekend, I had cause to test the service. A horse rider fell on the road just outside my house, severely injuring her head. It was a serious injury. Luckily, my wife was on hand to give professional nursing help, as it took over half an hour for the ambulance to arrive. It had to be guided in by the nearest people who could be contacted by mobile phone, as the Warrington call centre never understood where we were.

Concerns have also been expressed about the merger of      Staffordshire, West Midlands, Coventry and Warwickshire, Herefordshire and Worcestershire, and Shropshire ambulance trusts. There have been proposals to reduce control room numbers by co-aligning them with the police and fire services. The fire service in Warwickshire responds to some 3,000 emergency calls a year, whereas the ambulance services respond to some 100,000 emergency calls. Both Staffordshire and Coventry and Warwickshire ambulance trusts are three-star rated. Where is the benefit in amalgamating them, especially if they suffer the same fate as Cheshire? It is not patient-led, it is no closer to the patient and it does not centre the service on local knowledge. The only changes that should ever happen are those requested by the ambulance service itself.

My hon. Friend the Member for Lichfield (Michael Fabricant) has highlighted fears over the merging of Staffordshire ambulance trust, joining other Members from his area to meet the Secretary of State. He has pointed out that Staffordshire ambulance trust has the fastest 999 response time in Europe. He has met constituents living in Lichfield and Burntwood who would probably be dead today, because of slower ambulance response times, had Staffordshire been subsumed into the West Midlands trust.

Michael Fabricant (Lichfield) (Con): That is right.

Mr. O'Brien: I note what my hon. Friend says. When he met the Secretary of State for Health, she assured him and the Members who accompanied him that no decision had yet been made, but she did explain that there was a move towards regional emergency services. Where have we heard that before? In connection with police and fire services? Is it possible that the Conservatives may be right in saying that the Government's addiction to regionalisation is driving all the proposals?

Charlotte Atkins (Staffordshire, Moorlands) (Lab) rose—

Mr. Michael Foster (Worcester) (Lab) rose—

Mr. O'Brien: I will not give way, because I am about to end my speech.

In their addiction to meddling, the Government turn to reorganisation whenever they face a crisis or their latest headline grabbing wheeze turns out—predictably—to disappoint. For all that, we see PCTs being forced to merge when there is as yet no clarity about their purpose. We see the Government clinging to
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SHAs while, at huge cost to the taxpayer, bringing in consultants to do the job that the SHAs were hired to do when the obvious answer to anyone but an over-proud Government would be to scrap the SHAs. We see ambulance trusts being forced into a dogmatic regionalisation agenda, having to bend to the Government's will although no one in the service advocates it and although there is no prospect of a better, speedier service for patients.

We want better NHS services for our constituents. They do not deserve to suffer the cuts that are being forced on PCTs and other trusts to get the Government off the hook of the failure of their policies and their financial mismanagement of the PCTs, SHAs and ambulance trusts that they themselves set up only three years ago. Of course we also want administration costs to be minimised. The way in which to do that is to reduce the amount of administration and bureaucracy, rather than bringing about yet another reorganisation. Our constituents and NHS patients will not fall for the latest Government ploy to mask their own policy failures.

7.14 pm

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