House of Commons Hansard Debates for 7 Feb 2006 (pt 27)

Several hon. Members rose—

Madam Deputy Speaker: Order. I remind right hon. and hon. Members that Mr. Speaker has imposed a 10-minute limit on Back-Bench speeches.

7.56 pm

Mr. Bob Blizzard (Waveney) (Lab): I suspect that most hon. Members will want to speak tonight about the reorganisation of the primary care trusts. I must say how good it is to have PCTs in the first place. Most hon.

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Members will wish to support their local PCT, and I suspect that that support is based on the fact that they are local, because that is their great strength. They are able to focus the NHS on a local area, more accurately assess local need, and receive fair funding provision based on applying the formula to a precise local area. They can also develop good local relationships with GPs, pharmacists, other providers and the voluntary sector. They can be held to account locally by local stakeholders, not least patients and hon. Members.

Waveney PCT, which serves my area, is the best thing that has happened to that area organisationally. However, with the introduction of GP practice-based commissioning, mergers are necessary. In determining the new configuration, we should apply the same principles that I have just given as the benefits of PCTs, so that the merged bodies can effectively focus on and serve a local area. For my area, that has to be a merger between Waveney and Great Yarmouth PCTs.

I have mentioned Great Yarmouth PCT, so I must declare an interest in that my wife works for it. However, my wife long ago gave up calculating what might be the consequences for her of NHS reorganisations in our area, because she has been reorganised four times in the past 10 years. We can all agree that we could do with less reorganisation in the NHS, but my area has had at least one positive result from all the reorganisations we have had, in that clear lessons have been learned about what works and what does not work in the area. We know that county-wide NHS organisation does not work for my constituency, but the Great Yarmouth and Waveney combination does. When we had Suffolk health—

Mr. Gummer: Does my constituency neighbour agree that it is a remarkable fact that the other part of Waveney covered by the PCT is in my constituency, and we agree entirely that it should be amalgamated as he suggests? Did not it take much effort to get the authorities even to allow that alternative to be discussed, and is that not the problem with the consultation?

Mr. Blizzard: When the right hon. Gentleman and I, and every strand of clinical opinion in our area, are in agreement, the SHA and the Secretary of State should listen.

Before I was elected, the provision of resources under the Suffolk health authority did not meet the needs of my area; we merely received a share of the Suffolk average and the needs and deprivation in our part of the county were not taken into account. That organisation was remote and out of touch. It instituted locality management, but that negated the savings that it claimed would be achieved. We ended up with bad relations between the health authority and the community, and even worse relations between the health authority and the medical professionals.

Fortunately, our Labour Government created Waveney primary care trust. I thought we had won and that we had been delivered from the unbearable. Since the trust was created, Waveney has worked closely with Great Yarmouth, even sharing the same chief executive for a time. Before the last election, it was clear that there would be mergers and everybody in our area expected that the natural merger would be between Great Yarmouth and Waveney. In fact, the strategic health

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authority encouraged that, recognising the area as a discrete performance unit for things such as the roll-out of the national programme for information technology. When Sir Nigel Crisp's letter arrived last July, asking PCTs to come up with proposals, everybody locally thought that Yarmouth and Waveney was a no-brainer, and the other PCTs in the respective counties were comfortable with that.

Some time last summer, however, another message came from the centre, which seemed to be talking about county-wide PCTs—the proposal that the SHA made to the Secretary of State, despite representations against it. Because of the strength of our cross-party case and the willingness of the Secretary of State to listen, we now have two options, and there is no doubt that the Yarmouth and Waveney proposal is the healthy option. Those neighbouring areas have similar characteristics, including deprivation factors and health inequalities. They are both very different from their respective counties, from which they are relatively isolated. We share the same general hospital—the James Paget hospital, a three-star trust that is about to achieve foundation status. We have a natural health economy; the two PCTs have for some time undertaken joint working on cancer networks, emergency care and the implementation of National Institute for Health and Clinical Excellence policy, and share some services and a director of public health.

Yarmouth and Waveney has sub-regional status in the eastern region, and the Office of the Deputy Prime Minister has recently created an urban regeneration company spanning the two areas, part of whose remit is a public health agenda to overcome deprivation. The company wants to work with a Yarmouth and Waveney PCT rather than dealing with the separate counties. Both trusts are performing well, with two-star ratings—the best in the area. Yarmouth's budget is in balance. Waveney's budget is close to balance, and KPMG concluded that the trust would be out of deficit next year. Most important, the two PCTs work closely with GPs; there is a 100 per cent. sign-up to practice-based commissioning, which will not happen under a county-wide PCT.

A Yarmouth and Waveney PCT would have to work with the two county council social care departments, but that is not a problem. It is already happening; both councils organise their social care on a locality basis, each matching the Yarmouth and the Waveney PCT areas. There is already a strong record of partnership, with joint and developing initiatives, integrated management arrangements and integrated services under section 31 agreements, and each county leads for the other; for example, Norfolk provides social care services for Suffolk at the James Paget hospital. Social care is not a problem, and as those departments become less and less of a provider, patient choice will take patients from my area across the county boundary.

The proposed PCT would be large enough to realise economies of scale. The required savings of 15 per cent. could be made, but the PCT would be sensitive enough to know and meet local needs. However, I question whether, faced with the two options—the one that the SHA put to the Secretary of State and the one that the community and its representatives put to the Secretary

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of State—the SHA is behaving neutrally. We have some concerns. In the consultation document, the SHA said that the Yarmouth and Waveney option would

"inhibit the development of practice-based commissioning".

The people who know—GPs—wholly contradict that; they say that the county-wide option would inhibit that development. There were questions about size, but smaller PCTs in other parts of the country are proposed as single options. We should not fall foul of the size rule.

Will the Minister confirm what was said to me in letters from the Secretary of State and from Lord Warner? I was told:

"There is no standard, national template. The proposals could be based on large or small PCTs, providing that they deliver what is required locally, including a stronger commissioning capability."

I fear that our SHA has a template based on the county model, so I hope that my hon. Friend will reassure us that that is not the view of the Department or the Secretary of State.

Finally, will my hon. Friend keep faith with local people and their representatives? The option that I have proposed is supported not only by me, my hon. Friend the Member for Great Yarmouth (Mr. Wright) and the right hon. Member for Suffolk, Coastal (Mr. Gummer), but by Waveney district council, Great Yarmouth borough council, the two PCTs, the James Paget Healthcare NHS Trust, the patient and public involvement forum, all the GPs, the Lowestoft and Great Yarmouth urban regeneration company and the local strategic partnerships. It is hard to find anybody locally who does not support the proposal. Will my hon. Friend keep faith with the local community and the medical professionals who serve it? The proposed PCT would be the people's PCT. A Great Yarmouth and Waveney PCT would make the reforms in commissioning a patient-led NHS work, but I fear that if we take the other option those reforms could fail.

8.7 pm

Mr. John Gummer (Suffolk, Coastal) (Con): I entirely agree with what the hon. Member for Waveney (Mr. Blizzard) said, and commend him for it. The joint cross-party arrangements show how strongly we feel. I have to depart from the hon. Gentleman, however, when I talk about the strategic health authority. Five Members of Parliament for Suffolk invited their SHA to answer a series of questions, as you will know, Mr. Deputy Speaker, because you were there. The questions were answered in two ways: the SHA could not help, either because the decision was a Government one or because it was a PCT one.

There was no question to which the SHA replied, "Yes, we can do that." It cannot do anything. There is no known position on which the SHA contributes at all. Unfortunately, it has not done the one thing it should have done—overseeing the PCTs to ensure that they did not get into the debt they are now experiencing. The fact that the SHA was unable to do that shows that SHAs have no purpose whatever.

My PCT is very much in debt, as are all the Suffolk PCTs except Waveney. One of the reasons for that debt is that on average, under the funding formula, for every 100p, we receive 90p, while Manchester receives 124p,

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yet we have a high proportion of old people. The formula hits us strongly; it is not entirely overspending but underfunding that has contributed to the debt.

The unfortunate changes in the way that the funds are doled out have hit rural areas with large numbers of old people. Because of those numbers we used to receive sufficient funding, but that is no longer the case. Labour Members say that we do not have the hospital closures that used to take place, but there are two in my constituency: a full closure in Felixstowe and a half-closure in Aldeburgh. That has happened since the election.

Interestingly enough, before the election, we were told that a reorganisation would take place and a perfectly reasonable plan was proposed that would improve patient care. I supported that plan. I took the chair of the meeting to encourage people who had doubts about it that that was the reasonable thing to do. Immediately after the election, it was announced that that plan was no good and that those involved had found a new model of patient care. That happened in two months—it was a very clever, speedy change—and during that time, the PCT announced that their new model patient plan involved the closure of one hospital and the halving of the other. That was an interesting decision, but we were told that it had nothing to do with money or the general election. I found that most of my constituents were unable to take that quite as literally as it was put.

The problem is that my constituents see a model of care that makes the NHS in my area worse than it has been for 30 years. So I thought that I would ask the Minister a series of simple questions. About a fortnight ago, I asked when the financial and management specialist team would report its findings. I just asked for the date. The answer from the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton) was: