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Sir John Butterfill: The Minister has been very generous in giving way. She may remember that Bournemouth used to be part of Wessex regional health authority, which was abolished by the last Conservative Government and was not long lamented, but it had one convincing aspectit took in not only Bournemouth and Poole hospitals, but the Southampton teaching hospitals and Odstock hospital in Salisbury, Wiltshire, all of which co-operated to form one unit. The proposal that is before us now is for either a strategic health authority for the whole of the south-west region, or two authorities for the south-west region divided horizontally. Can she explain why we are not being permitted the possibility of crossing the regional boundary? Is it to do with regional policy, rather than efficient administration?
Jane Kennedy: It is not being driven by regional policy; it is entirely being driven by efficient administration of the NHS. However, there are issues of coterminosity, to which I will come laternot too much later, I hopein my comments.
May I first say that I agree with the Minister that there are too many of these administrative bodies, authorities and trusts and that some reorganisation is called for to achieve some efficiency and reduction in management costs? It would be easier to know where we were going and settle all the boundaries if the Government were consistent about what the reorganisation is actually for. The primary care trusts were set up when the Government abolished GP fundholding. They then suggested that fewer PCTs were required to supervise practice-based budgeting, which is the same thing that they are going back to. They then
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started to consult on the boundaries on the basis that there should be new commissioning authorities. Halfway through, they changed their mind. They now say that the new PCTs will be commissioning authorities and will directly employ a lot of staff. Consulting in that confusion is quite impossible, which is why we have all the outrage about where the boundaries might go. The Government keep changing their mind on what kind of structure they want for the health service and its vital community-based services. Why does not she stop, start again and try to remain consistent?
Jane Kennedy: I agree with a significant part of what the right hon. and learned Gentleman said. If I can get to it, I will explain the reasoning behind the changes that we are bringing forward. I strongly disagree with him on one thing, on which I must pick him up. The only similarity between GP fundholding and practice-based commissioning is that it involves GPs; otherwise, there is absolutely nothing in common between the two systems. Under fundholding, every GP could have a contract with any number of hospitals, wasting enormous amounts of clinical and administrative time in negotiations. Under practice-based commissioning, the PCT will hold the contract with the hospitals and the GPs will use that contract to access services for their patients. There is absolutely nothing in common between the discredited system that the Conservative party instituted and the system that we are taking forward.
I agree with what the hon. Member for Eddisbury said about NHS staff. That hard work is transforming our hospitals, with much reduced waiting times and lists, improved accident and emergency services and newer, more appropriate facilities to meet the changing health needs of 21st century Britain. I suppose I ought to give way to the hon. Member for Somerton and Frome (Mr. Heath).
Mr. Heath: I am most grateful to the right hon. Lady. I simply want to speak for my local hospital. For eight years, we campaigned locally for Frome Victoria hospital and, hallelujah, only two or three months ago it was announced that we would have a new hospital, which is great news and I am grateful to the Government for that. There is now a question about whether the PCT reorganisation and the announcement by the Secretary of State for Health last week have put the capital investment that was to go into Frome Victoria hospital this year in doubt. I do not expect her to know the answer to that now, but will she undertake to write to me to reassure me that Frome Victoria hospital is going ahead as planned?
The hon. Gentleman's persistence has paid off to the extent that I will undertake to look into the matter and write to him to address his concerns about that problem.
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Ninety per cent. of patients' contact with the NHS is within primary care settings. About 900,000 people a day contact a GP or a practice nurse. The challenge now is to improve primary and community services. That is why last week we published the White Paper, "Our health, our care, our say", setting out our plans to do that. It emphasises that good commissioning is essential to improving services for patients. That means that the NHS needs to get better at securing the best possible services, representing good value from a growing range of health care providers. Reforms such as patient choice and payment by results mean that individual decisions to refer and patient choice will in effect drive commissioning. Patients in discussion with their commissions will choose where they want to go for treatment. Payment by results ensures that the money follows the patient to pay for their care. Once established, the payment by results tariff offers the opportunity for adaptation to encourage alternatives to hospital referral.
Mrs. Dunwoody : My right hon. Friend is a lady of tact and intelligence and she must know that that, frankly, is a load of nonsense. The reality is that if we move towards this system, the patient will have no way of knowing the quality of surgeon in a particular hospital, and no way of knowing who has the reputation for killing a quarter of his patients and who has the best outcomes. It is nonsense to suggest that patients will have any way of knowing. What they want are good services of a uniform standard in their own area. That is what they want and this division will make it worse.
Jane Kennedy: I am sorry that my hon. Friend, whom I regard as a very dear friend, takes such a strong opposite view to me. I do not agree with her. I believe that, increasingly, patients will want to know from their GPs the recovery rates for different surgeons and how they perform, as well as how, for example, a hospital performs on MRSA. Those are exactly the kind of questions that people will be asking. Increasingly, they will be able to get the information not only from their GP, but from the internet, where more and more hospitals are providing precisely that kind of information to the patients who receive services from them.
Mr. Andrew Turner (Isle of Wight) (Con): I am particularly grateful to the Minister for giving way because I wanted to congratulate her on recognising the Isle of Wight's need for a unified PCT health service trust, covering acute, ambulance, mental health and community services. However, I wish to follow the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) by asking how can there be choice for patients on the Isle of Wight if there is no money to help them get to hospitals on the mainland. It is choice for the rich, but not for the poor.
That is an interesting point. The difficulties of transport from the Isle if Wight would need to be taken into account and we are still developing
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the detail of the commissioning proposal and how the model will work. Those issues will face his constituents on low incomesI am pleased to hear the hon. Gentleman champion themand their interests will need to be taken into account so that they can achieve a real and genuine choice of services.
Under practice-based commissioning, GPs and other primary care professionalsthe clinicians in daily contact with patientswill be able to redesign services for their patients. All of this allows PCTs to concentrate on a more strategic role. The way we commission needs to be transformed if we are to deliver the next phase of reforms successfully. We need to make commissioning more professional and to learn from the best, and we need to encourage innovation. Above all, we need to make sure that patients have access to the right services in the right place at the right time.
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