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Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): The Minister of State, the right hon. Member for Liverpool, Wavertree (Jane Kennedy) and I both come from the same neck of the woods and I have the greatest respect for her. I have heard her use an expression that is often used in Liverpool: "God loves a trier." Well, the Minister really tried today to sell the merits of the reorganisation of PCTs, but I am afraid that she was not very persuasive to Opposition Members.

Reorganisation of my local PCT, which is three years old and cowed by debt, would be disastrous. Next month, Bedfordshire Heartlands PCT will be £20 million in debt, and the only way left for it to recover that debt is to restrict emergency services, which is almost a contradiction in terms. When I spoke to the chair and chief executive of the organisation and asked how they intended to restrict emergency services, the answer was frightening. They want GPs to keep patients with them for longer before calling an ambulance to send them to hospital. I asked what would happen if I were a parent with a child with suspected viral meningitis. What should the GP do in such circumstances? The answer was that they would like the GP to make sure that the child really had the illness. Whereas previously, a GP would dial 999 and have the child sent straight to hospital, now the PCT wants the GP to hang on to the patient.

The proposal caused concern in several areas, not least at Bedford hospital. On Saturday, a consultant from the hospital brought me an e-mail, which I shall happily hand to the Minister once I have removed the top. Bedford hospital is £12 million in debt and its recovery plan to achieve a reduction includes cutting
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10 theatre sessions a week, closing two wards and the children's physiotherapy unit, and restricting the use of agency nurses and doctors. The list goes on.

The e-mail states that unfortunately, there will be a

to achieve

The cuts to achieve that saving will be a further £530,000 from nursing, a further £375,000 from theatres, a further £1.02 million from medical pay, and a further £200,000 from critical care. Those are all front-line service cuts, in addition to the recovery plan. Only £100,000 of those cuts of £2.27 million will come from administration. The e-mail concludes with the words, "An awesome challenge". It is indeed.

Members of my PCT do not want reorganisation. The PCT is only three years old and is staggering under its debts. As the Health Committee report noted, reorganisation will cause damage from which it will take 18 months to recover. The move is not advisable, and will do nothing to aid Bedford PCT or Bedford hospital.

We want to get rid of SHAs, but the Minister asks who would oversee PCTs. May I suggest that she or the Department could do so? SHAs are accountable to nobody and have allowed PCTs to go into debt—by £20 million, in the case of my local PCT. The SHA has no purpose whatever in Bedfordshire. Perhaps if the Minister oversaw PCTs we might have a more efficient service.

Anne Milton: Does my hon. Friend agree that the reforms seem to be less to do with patient care and a patient-centred NHS and far more to do with saving money and getting rid of the debts?

Mrs. Dorries: That is highlighted by the cuts detailed in the e-mail; they are all from front-line services and will have a direct impact on patients. Only £100,000-worth of those cuts will be made in administration and back-room services.

Mr. Brooks Newmark (Braintree) (Con): May I draw my hon. Friend's attention to the situation in my constituency? For more than 10 years local people have been promised a new community hospital, which is still not forthcoming. Does my hon. Friend agree with many of my constituents that the Government are more obsessed with structures than actually delivering front-line services?

Mrs. Dorries: Certainly. Front-line services are paramount. Structures seem to concern the Government, but I ask the Minister to reconsider the reorganisation of PCTs and the damage it would cause to my PCT in Bedfordshire.

9.39 pm

Dr. Andrew Murrison (Westbury) (Con): I have been in and around the national health service since 1979. It has been a quarter of a century of constant change, much of it for the better, but the near recreation of
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regional district health authorities and fundholding rebadged as practice-based commissioning is without precedent. While Ministers are absorbed in rearranging the deckchairs, the Opposition prefer to focus on deficits, because they affect our constituents profoundly.

The Secretary of State for Health may be pleased to dismiss deficits because they represent about 1 per cent. of the NHS budget, but Members of Parliament whose constituencies have PCTs that are in the red know that 1 per cent. means the closure of community hospitals and slamming the brakes on patient services.

We have heard a total of 11 high-quality Back-Bench contributions this evening. The hon. Member for Falmouth and Camborne (Julia Goldsworthy) said that size matters in relation to trusts and authorities. She is certainly right. The hon. Member for Waveney (Mr. Blizzard) also thought that size was important and made a convincing case against a county-wide PCT. He offered a more functional grouping that would cut across local government boundaries and form what he called the people's PCT. Although I might perhaps bridle at the description, I would certainly endorse his    sentiments about functional, not necessarily geographic, linkages.

My right hon. Friend the Member for Suffolk, Coastal (Mr. Gummer) rightly drew attention to a funding formula that hits rural areas with elderly populations. In his constituency, as in mine, that has led directly to hospital closures.

The hon. Member for Carlisle (Mr. Martlew) was mildly critical of PCT reorganisation in his area and made a plea for no more reorganisation—a sentiment that was echoed by many right hon. and hon. Members.

My hon. Friend the Member for Lichfield (Michael Fabricant) emphasised the importance of ambulance response times. I agree that response times should be a crucial determinant in any reorganisation. The hon. Member for Newcastle-under-Lyme (Paul Farrelly) also spoke in support of the independence of the Staffordshire ambulance service. He also supported the thesis of the hon. Member for Waveney in pleading for mergers on a functional, not a geographic or administrative, basis. That thesis is quite correct. The hon. Member for Stoke-on-Trent, South (Mr. Flello) added more support for Staffordshire ambulance service autonomy, based on the so-called golden hour for effective early medical intervention. He also talked about a natural alignment of PCTs in Stoke.

My hon. Friend the Member for West Suffolk (Mr.   Spring) rightly attacked the waste implicit in constant reorganisation and pointed out that it would not address the financial difficulties of his local health economy one jot.

The hon. Member for Wyre Forest (Dr. Taylor) quite correctly slated false consultations. People give of their time freely to consultations in the NHS and elsewhere, and I tend to agree with the hon. Gentleman that it does the process no good at all if those views are not taken seriously. I know from my experience of my own area about the damaging effect that sham consultations can have on the debate locally and nationally. We mentioned briefly the consultation in Birmingham, and I suspect that, like me, he has his own views on that process and its results. He also argued for local PCTs
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that are coterminous with local government boundaries—something that contrasted with some earlier contributions.

The hon. Member for Leicester, East (Keith Vaz) was worried about the abolition of his local PCT and the non-appearance of a new general hospital in Leicester—that, of course, involves a £574 million PFI scheme.

My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) finished by highlighting service cuts that result from the financial recovery plan in her PCT. She feared that PCT reorganisation would set things back 18 months. I would tend to share some of her concerns.

In redesigning services, structure must follow function—not the other way round—but it is not yet clear what PCTs will be responsible for. As for SHAs, many of us are mystified by their current role, let alone what Ministers intend for them in the future. At the moment, the SHAs' ability to be strategic—whatever that means—must be constrained by their preoccupation in areas such as mine with financial deficits. Of course, there will be some benefits to all of this: the perpetual merging, axing and reforming of health bodies is a fantastic way to blur accountability. People who have tried to identify those who should be held to account for deficits know that very well.

We have a number of questions, some of which have been fielded already in today's debate, and we would like the Minister to answer them. First, we would like to know what the Minister intends that PCTs will be doing in the future because that is far from clear. What will be the residual provider function of PCTs? In the summer, "Commissioning a patient-led NHS" said:

However, the Secretary of State, Sir Nigel Crisp and Mr. John Bacon then issued contradictory interpretations of what that meant. The confusion has caused real discomfort to NHS staff who are employed directly by primary care trusts. Furthermore, it has made a complete mockery of the restructuring exercise. How can an organisation possibly be restructured if the people at the top do not have the first idea what that organisation will be doing? If Ministers want to use the private sector more—they say that they do—what message do they think that the vacillation will send to non-NHS providers that are possible partners? It will suggest unreliability.

Ministers might say that PCTs will be commissioning care, but how will they do so when patients are free to choose and book? I have to say that under our proposals, they would be even freer to choose the treatment that they receive and where it is received. If PCTs are largely divested of provider and commissioning functions, will they not simply become GPs' account clerks? If so, will they be further reconfigured to reflect a new vestigial role? If that is not the case, how will we manage the split between providers and commissioners in the new organisations? It seems to me that Ministers are extremely unclear about that point, so any clarity that the Minister can give us today would be most welcome.

The Prime Minister apparently often regrets not being bolder, which is when we understand that he is at his best. How does that fit with practice-based
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commissioning? Does the Prime Minister in fact know full well that abolishing fundholding was foolish and recognise that practice-based commissioning is the closest approximation that he will get without primary legislation and the embarrassment of a complete about turn?

The Government's interpretation of the dubious consultation exercise "Your health, your care, your say" was different from mine and that of several hon. Members who contributed to the debate and people elsewhere. Will the Minister admit the extent to which the consultation was bent to the purpose that had already been devised by his colleagues and confirm specifically that his vision of contestability was largely shunned by the consultees who were selected to give their views? I offer no defence or otherwise of contestability, but it is important that we reflect accurately and sincerely views expressed during the course of consultation exercises. It seems to me that that has not been done in this and other areas. My point obviously relates directly to the consultation in Birmingham, so I would be grateful if the Minister would shed some light on what those who responded in Birmingham thought about contestability.

Where does the Minister think that public health function will reside in the new scheme of things? Those   of   us who take an interest will have witnessed directors of public health being sidelined in PCTs that are largely focused—often unsuccessfully—on financial management. Could it be that the manifest failure to communicate the recent change in policy on BCG vaccination, for example, is symptomatic of the malaise in public health in recent years? The Faculty of Public Health's latest work force survey reveals that more than 100 senior public health posts have already been lost in the past three years. It estimates that the latest reorganisation could lead to the loss of a further 120 posts. I hope that the Minister agrees that that would be grossly unsatisfactory. It would be useful to hear from him how the set of reorganisations will enhance public health function, rather than damage it further.

Will the restructure achieve the Government's intended saving of £250 million, or will it, like most of its type, end up sapping resources from front-line services? If trusts make savings through reorganisation, for example in the merged Avon, Gloucestershire and Wilshire ambulance trust, will the Minister confirm that they will go towards improving front-line services in the trust, rather than being siphoned off to address financial deficits at the strategic level?

In summary, the structure of the NHS is pretty well back to where it was in 1997, when we left it. It would be churlish if I sat down without acknowledging the compliment.

9.49 pm

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