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Grant Shapps (Welwyn Hatfield) (Con): Will the hon. Gentleman tell us how expanding a PCT or an SHA to cover a much wider region would make it easier to persuade it to consult and carry out its work properly? Surely that would be a move in the wrong direction.

Mr. Flello: No, I think that the opposite is the case. In north Staffordshire at the moment, there are about a dozen primary care trusts going off in all directions. However, a much smaller number would be able to focus much more closely on a hospice such as the Donna Louise Trust, for example, and address its funding in a much more focused way.

Rosie Cooper (West Lancashire) (Lab): Widening SHA areas to a regional authority area would resolve some serious anomalies. In my area of west Lancashire, for instance, PCTs are responsible to the Cumbria and Lancashire SHA, while the hospitals are responsible to the Cheshire and Merseyside SHA, which is an absolute nonsense. The reality is that the challenge for the Government is to make PCTs big enough to be strong commissioners and for there to be a tension in the system, and small enough to be absolutely responsive to the needs of local areas. The size of an organisation should not be easily dismissed.

Mr. Flello: I am grateful for that intervention, as it brings me to the point made by the hon. Member for Falmouth and Camborne (Julia Goldsworthy) about the idea that one size is okay as long as it is bigger. That is not what this is about. The issue is not one size; it is what is an appropriate size for merging PCTs. I hope that the consultation, once the SHAs get their paws off it, will be about making sure that PCTs are the right size for the localities concerned.

Julia Goldsworthy: Will the hon. Gentleman therefore list any primary care trusts that will either get smaller or stay the same size under the reconfiguration strategy?

Mr. Flello: I would love to have the data to hand to be able to give the answer to that question. The hon. Lady's comment has no doubt been heard by my hon. Friend the Minister.

I am conscious of the ever-ticking clock. Before I move on to the ambulance service, however, I want to refer to a telling point that was made to me about three
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years ago by someone who was at that time a manager in the health service, and that relates to my observation about the comments of Opposition Members that everything was rosy up to 1997. That point was that NHS managers had for so many years been used to try to save money, cut budgets and reduce funding, that they did not necessarily have the expertise to apply the huge amount of money that they were suddenly given. I hope that my hon. Friend the Minister will return to that point in her wind-up.

Many comments have been made about the ambulance service. The hon. Member for Lichfield (Michael Fabricant) and some of my hon. Friends have rehearsed the arguments in relation to Staffordshire very well. A couple of points have not been mentioned. As everyone knows, the M6, which has perhaps more cars on it than any other road in western Europe, gets very congested from time to time, notably on Friday evenings. It only takes a fairly small incident for the motorway to become closed. Frequently, when it is closed or subject to huge delays, some drivers using that motorway are taken ill. One of the things that the Staffordshire ambulance service has been used for in the past—which, as I understand it, it would not be able to do under the proposals—is ferrying off the motorway people who have been taken ill or diabetics who must eat at certain times of the day and suddenly find themselves stuck in traffic for three or four hours and not able to eat. They can be moved off the motorway to a place where they can receive suitable treatment or be treated at the roadside. That is an important role, which shows the innovation and dedication in Staffordshire ambulance service.

Comments were also made about fast access and survival rates. In certain parts of the country—I will not name them, for fear of upsetting residents of those areas—if someone is taken ill with something like a heart attack, he or she has no chance of survival because the ambulance services there do not bring anybody to hospital alive in such circumstances, whereas in Staffordshire one has a very good chance of survival.

Mr. Stewart Jackson: I am listening intently to the hon. Gentleman's eloquent speech expressing his sincerely held beliefs. Does he agree that one of the problems with the mergers is that we have had, in effect, phoney consultations? In my area of the eastern region, under the auspices of the NHS Appointments Commission, a chairman's post was advertised a full nine weeks before the public consultation ends. Does he not agree that that undermines public confidence in the efficacy of such public consultation?

Mr. Flello: The clock ticks ever faster, but I am sure that those comments have been heard.

Today the Staffordshire Sentinel reported that the chief executive of the local ambulance service had suggested that he should form a private company. No doubt that would pose ideological problems for some Members, who would not want a private sector organisation to be funded through the NHS, although it had done such a fantastic job in the past. That would cause some angst to us on the Labour Benches.

In principle, it is not necessarily a bad idea to merge ambulance services, because in some areas best practice could be shared. What the west midlands does not want
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is to lose the fantastic service provided in Staffordshire for something that will not be as good. If the reverse were happening and Staffordshire were the dominant area, that would be better.

9.11 pm

Dr. Richard Taylor (Wyre Forest) (Ind): I am grateful to have been called because I feel very deeply about the issue.

The Government frequently say that they want a patient-led NHS. The consultation document in my area on the mergers of PCTs bears the sub-heading "Ensuring a patient-led NHS". My understanding of that phrase seems rather different from the Government's. It is a glib phrase that sounds good, but to me it really means something: it means that the views of patients and the public are listened to, valued and acted on. Those views should be picked up from a wide variety of sources—independent patient groups, independent patient forums, GP practice participation groups, overview and scrutiny committees and—as the Minister said—health professionals, who have the closest contact with patients.

To be fair to the Government, they have tried to listen to people. They organised a large listening event in Birmingham—a 1,000-person citizens summit. However, I have seen some of the questions that were submitted to the summit. They were loaded—they expected only the answer that the Government wanted. One question, about the shifting of care, asked

Of course, not many would vote against that proposal, but if people had been given the extra information that in losing those hospitals they would probably lose their local accident and emergency departments, the answer would have been very different.

If ever there was a top-down proposal, this is it. It is the very antithesis of a patient-led decision. It is the Department of Health leaning on strategic health authorities, which are leaning on the trusts beneath them to do, in effect, the Government's bidding for reasons that are largely financial and—as the Health Committee's report shows—open to very serious question. We should think of the 19 or 20 SHA chief executives and the 200 or so PCT chief executives who are likely to lose their jobs. They are like turkeys planning for Christmas. How can they plan for the future when they know that they are not part of it? How can they be accountable for what they are planning when they are no longer there?

Incidentally, when those chief executives have left they may well be paid by the taxpayer if past experience is anything to go by. Take the example of Finnamore Management Consultants, who are used, I believe, quite widely by the NHS to address some of the deficits. If we look them up on the web, the vast majority of their staff are ex-NHS managers. Presumably, they were made redundant. They may even have been sacked, or changed jobs for higher salaries.

I tried to find out a bit more about that firm through a parliamentary question, but I had no luck. The response said that responsibility for financial control belonged to
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strategic health authorities and denied any knowledge of those consultants. That sort of response annoys me intensely. The Government devolve things when they do not want to answer a question, and impose top-down changes while at the same time talking about devolution.

I come to my area, west midlands south. I pay tribute to the strategic health authority for carrying out a certain amount of pre-consultation. I regret to say that I responded to that pre-consultation without too many objections because I thought that it was a done deal and that resistance would have little effect. I got into tremendous trouble with some of my friends at home over that passive response. The Health Committee inquiry has brought me round to the other side.

A lot has been said already about mergers of SHAs. I do not think that SHAs are of the slightest importance. If they go back to being regional health authorities, good luck to them. On local ambulance trusts, as long as I keep my all-singing, all-dancing local computerised control centre, which is as good as any ambulance authority's control centre, I shall be satisfied. As Staffordshire Members have said, if there are mergers, they must lead to a levelling up of services, not a levelling down.

I object strongly to the merger of the PCTs in my area and I just hope that, with the consultation, local people will really have a chance to make a change. I am not very hopeful because we are being consulted on a preferred option, which sounds the death knell of open, genuine consultation.

Many hon. Members have examined the main reasons for mergers. The financial argument does not stand up. As I have said, the Health Committee expressed doubt about that. Restructuring involves redundancies and structures to secure local involvement—but those will be incredibly costly. Another argument is that mergers strengthen the commissioning function. That is already happening. The Minister mentioned collaboration, but collaboration is already happening. For a good example, one has to look only at Whitehall & Westminster World, which I am sure we all read. The current edition describes a national decontamination project. It states:

So collaboration is working already, without the need for mergers.

I have objections. Many hon. Members have mentioned the number of reforms. I regret to tell them that they have all got their numbers wrong. During the Health Committee foundation trusts inquiry, we received a list of all the reorganisations from 1982 until the date of that inquiry—there were 21. Since that date, there have been at least another seven, so on a conservative estimate there have been at least 28 reorganisations.

As we have heard, PCTs have only been going three years. They are just beginning to find their feet. Reorganisation affects an organisation badly—we were told on the Health Committee that it can take 18 months to recover from the disruption and another 18 months for the benefits appear. Locally, there are tremendous objections to the merger of three PCTs into one. We
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believe that we will lose some of the professional input from doctors, nurses and physiotherapists. We believe that we will lose the local public health input and, worst of all, we believe that we will lose the local input from patient forums.

I believe that it is far, far more important for a PCT in each local area to be coterminous with its district council and its local strategic partnership than for it to be coterminous with a much bigger area. I hope that consultation throughout the country is genuine and that where the status quo is correct, it will remain as an option.

Edmund Burke said:

On 7 May 1997, the Prime Minister said:

9.21 pm

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