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Rosie Cooper (West Lancashire) (Lab): Does my hon. Friend agree that deficits do not necessarily reflect the excellent standard of health care in hospitals such as those at Southport and Ormskirk in my constituency? They are to be congratulated on being placed among the top 40 hospitals in the country, on having attained level 3 in the clinical negligence scheme for trusts, and on having the lowest MRSA rates in the
country. My constituents should not be penalised for any errors made in strategic health authorities or in the health economy generally. The people should not pay; the executives should sort themselves out.
Andy Burnham: My hon. Friends analysis is absolutely right. Many PCTs in the areas with the highest health needs and the greatest health inequalities have managed to break even and, in some cases, return a surplus. It would be wrong if those PCTs were unable to reap the rewards of that good financial management. The system that we are establishing will ensure that those organisations receive their funds back if they have helped, in-year, to recover the financial position of another health body.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I know that the Minister is new to his post but he had better take care, because this time last year the Secretary of State was 80 per cent. out on the net deficit that the NHS was experiencing. Before he starts quoting a figure of £620 million, he ought to come to the House and tell us the actual unaudited figures at the year-end, rather than speculating on the basis of six-monthly figures. The consequences of that, and of paying off such deficits, are apparent across the country. Job losses were announced at Leeds Teaching Hospitals NHS Trust on Friday, at Nottingham University Hospitals NHS Trust yesterday, and at NHS Direct today, affecting directly the constituents of the hon. Member for Chorley (Mr. Hoyle) and my constituents. The people affected, including nurses who face the prospect of redundancy, deserve better.
The Minister talks about financial control, but will he tell us what is the Governments plan for financial control this year? Is it what the operating framework said in Januarythat every organisation must plan to recover their deficits from 2005-06 and balance their books this year? Or is it, as the Secretary of State told me in April, that every organisation with an overspend must improve this year, and that by the end of the financial year, monthly expenditure should be covered by monthly income? Those are two completely different financial regimes. Which is it?
Andy Burnham: As I said in my response to the main question, provisional out-turn figures for the year-end will be published by my right hon. Friend the Secretary of State in early June, so the hon. Gentleman does not have long to wait. While I accept that difficult decisions are being made on the ground in his constituency and others, the purpose of those is to get the NHS into a stable position so that it is living within its means. There are not widespread redundancies across the pieceas I have mentioned, many parliamentary colleagues have a surplus in their health economy. The problem is focused on the 7 per cent. of NHS organisations that are bearing the vast majority of the deficit. On the hon. Gentlemans question about financial control, he knows that we are putting turnaround teams into those trusts specifically to help those organisations bring themselves back to financial balance by the end of this year. The answer could not be clearer: we are taking the difficult decisions necessary to get trusts back into balance.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): In 1997, 28,046 GPs were working in the national health service. In 2004, that figure increased by 4,692, to 32,738, which is an increase of 17 per cent. Those figures do not include retainers and registrars who represent a potential pool of about 3,000 GPs.
Joan Ruddock: I welcome my hon. Friend to his new position. That national picture is reflected in Lewisham, where we have but four vacancies, compared with 20 in 2002, and recruitment is going well thanks to Government support. Will he ensure, however, that the Government monitor the retention of those GPs, giving extra support to PCTs should it prove necessary? Will he also ensure that patients benefit from increased GP numbers by getting better access to out-of-hours services?
Mr. Lewis: I agree entirely with my hon. Friend. The news from Lewisham is good. She is right, however, that it is essential that we maintain the successes made in GP recruitment, especially in disadvantaged and inner-city areas. That is why we have focused and targeted resources on supporting PCTs in those areas, especially with regard to recruitment and retention. We know that it has not always been easy to attract GPs into some of our most disadvantaged communities. I also agree that it is essential to ensure that improvements in primary care facilitate enhanced access to primary care services in every community.
Dr. Andrew Murrison (Westbury) (Con): I welcome the Minister to his new duties. The National Audit Office tells us that up to 1 million people in England can no longer rely on out-of-hours services from a GP that they took for granted in 1997, despite the figures quoted by the Minister and a 22 per cent. overspend on out-of-hours services. What is he doing about PCTs such as Harrow, Burntwood, Lichfield and Tamworth, Eastleigh and Test Valley South, North Bradford, New Forest, Richmond and Twickenham and Sutton and Merton, which the NAO says are unable to guarantee patients access to a GP at night and at weekends?
Mr. Lewis: The transition to the new GP contracts, in terms of out-of-hours services, has on the whole been smooth. That was actually confirmed by the recent National Audit Office report. As for the areas where there are difficulties, we need to examine them with the relevant primary care trusts, and ensure that out-of-hours services are available to patients in those communities where that is appropriate. However, the suggestion that the new contracts have led overall to a deterioration in out-of-hours services is not backed up by the very report to which the hon. Gentleman referred.
The Minister of State, Department of Health(Ms Rosie Winterton): An expert panel was set up to consider the evidence collected in our recent review of patient and public involvement. We are currently considering its recommendations, and will make an announcement shortly.
Philip Davies: Does the Minister agree that it is crucial for the public to be involved in decisions relating to health care provision in communities? Does she accept that either abolishing or radically changing the forums only two years after their introduction will be yet another prime example of the Governments permanent revolution of our NHS, which generates a lot of huffing and puffing from Ministers but delivers very little to the public?
Ms Winterton: The hon. Gentleman is right to say that it is important to have good patient and public involvement in local decisions about health care, especially as some 80 per cent. of the budget is now devolved to local level. The reason we want to change the current system of patients forums is that many people in them felt that not enough resources were going to the front line. They felt that they would be able to do more if they had more control at local level, and if there was more accountability. For example, they wanted to work more closely with overview and scrutiny committees. We shall be presenting a great many ideas that I believe will lead to improvements in this important area.
Andrew Gwynne (Denton and Reddish) (Lab): I believe that public participation is key to ensuring that the NHS delivers the quality services that local people want. The advent of foundation trusts has provided more opportunities for the views of local people to be sought through those new structures, but what consideration has been given to strengthening public involvement in the direction and provision of primary care services at that very local level?
Ms Winterton: My hon. Friend is right: public participation is certainly one of the keys to ensuring that there is accountability at local level, and that local people are involved in decision making. That is one of the reasons why we wanted to consider the new structures. As there is a stronger role for primary care trusts in commissioning and as there are fewer PCTs, it is important to ensure that there are good local networks involving not only individuals but local organisations and local authorities in some of that local decision making.
Mr. John Baron (Billericay) (Con): I suggest that the Governments record on this issue is very poor. They replaced the system of community health councils with a system that is not working. Patients forums have cost £12 million more to run, and staff turnover is very
high. The Commission for Patient and Public Involvement in Health was introduced, only for the Government then to announce its abolition. The total cost of that was £100 million. Last year the Government scrapped their plans for reform, and now there is speculation that patients forums themselves will be abolished.
Given that confusion, will the Minister assure the House that the expertise built up by forum volunteers will not be lost in the latest round of Government changes, and will she do her best to get a grip on the shambles?
Ms Winterton: The difficulty that we experienced with the CHCs was that they offered services in different ways. Some would offer complaints services, for instance, while others would not. That is why we set up a whole new structure, including the patient advice and liaison service in local trusts, the Independent Complaints Advocacy Services to deal with complaints, and patients forums to consider patient and public involvement at local level.
We will be looking further into how to improve the current system, as people working in patient forums have identified some difficulties, particularly the problem of ensuring that resources are spent at local level. I can assure the hon. Gentleman that that is exactly why we set up the expert panelto ensure that we improve in future by building on the expertise that already exists in the patient forums.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): The Departments recovery and support unit is working closely with strategic health authorities to ensure that comprehensive child and adolescent mental health services, as defined in the national service framework for children, young people and maternity services, are available to all who need them.
Mr. Jack: In welcoming the Minister to his new post, may I remind him that early in 2004, the then Health Minister, the right hon. Member for Barrow and Furness (Mr. Hutton), told me that an 80-week waiting list for a child to access psychological services was unacceptable? The Cumbria and Lancashire strategic health authority confirmed in March that the waiting time was now 93 weeks, which many would regard as unbearable. I have been told that action has been taken to address that deficit, so will the Minister confirm that he will do everything possible to speed up all the necessary measures to reduce that totally unacceptable waiting period?
Mr. Lewis: I agree with the right hon. Gentleman that that was and is unacceptable and I congratulate him on highlighting those issues. Appropriate action has been taken to deal with the problem, as he has acknowledged. For example, in his locality a number of
new posts and services have been created: a clinical child psychologist, a child and adolescent mental health services assistant psychologist, part-time administrative support, an attention deficit disorder nurse, a primary care liaison specialist post and a
specialist health worker located in the youth offending team. All that investment should significantly improve the position. I hope that the right hon. Gentleman will keep me informed of developments; we certainly expect to see significant progress in the months ahead.
The Minister of State, Department of Health (Andy Burnham): With permission, Mr. Speaker, and in the unavoidable absence of my right hon. Friend the Secretary of State, I should like to make a statement on primary care trusts and NHS ambulance trusts. Detailed information for each area has, for the convenience of hon. Members, been placed on the Board since 1 pm.
In my right hon. Friend the Secretary of States written statement of 18 October 2005, she explained that strategic health authorities had been invited to submit proposals to the Department of Health on how to streamline SHAs and strengthen primary care trusts. Four clear criteria underpinned that exercise: the need to improve health and reduce inequalities; to strengthen the PCTs commissioning function; to improve co-ordination with social services through greater coterminosity between PCT and local authority boundaries; and to deliver at least a 15 per cent. reduction in management and administrative costs.
In the intervening period, SHAs have consulted local people, staff and clinicians, partners in local government and a range of other local stakeholders on the proposals for SHAs, PCTs and ambulance trusts. Many right hon. and hon. Members on both sides of the House have offered their views and I am very grateful to them. After local consultations, SHAs submitted their reports and recommendations to the Department. An external panel, established to advise Ministers on the proposals, has since met to consider in detail each proposal for PCTs and SHAs. After receiving its advice, we announced on 12 April that the numbers of SHAs would reduce from 28 to 10.
Ministers have now considered the recommendations and the panels advice on PCTs. I can now inform the House that the number of PCTs will fall from 303 to 152, and that the new organisations will be established on 1 October 2006. The population covered by each PCT will rise from an average of around 165,000 at present to an average of just below 330,000. About70 per cent. of the new PCTs will be coterminous with the boundaries of local authorities with social services responsibilities, which compares with about 44 per cent. of PCTs that are currently coterminous with their local authorities.
In some areas, concerns have been expressed that larger PCTs could lose a locality focus and divert resources away from deprived areas or that smaller PCTs could lack commissioning power. We acknowledge those concerns and have sought to strike a careful balance between those conflicting demands. In response, we propose that four general conditions be applied: first, that all PCTs retain and build on partnership arrangements; secondly, that a strong locality focus must be retained and, where necessary, that local structures should be put in place; thirdly, that all PCTs must deliver their share of the 15 per cent. management cost saving, strengthen commissioning and ensure robust management of financial balance and risk; and fourthly, that the new PCTs and SHAs
should consider how any further conditions relating to issues that arose during the consultation could be applied.
In some areas, the new proposals differ from those suggested by the SHA and the external panel. Having taken into account all the evidence and sought local consensus wherever possible, we have judged that in those circumstances, the alternatives could better satisfy the Commissioning a Patient-led NHS criteria and have the best possible chance of success.
district nurses, health visitors and other staff
will continue to be employed by the PCT unless and until it decides otherwise.[ Official Report, 25 October 2005; Vol. 438, c. 152.]
Our aim in making these changes is to benefit both patients and taxpayers. Fewer, more strategic PCTs will be better placed to ensure effective commissioning of services for patients, and to support the development of practice-based commissioning among GPs and other primary care staff. Patients will receive the right care and treatment in the right place, and at the right time. The taxpayer will see the release of £250 million worth of savings annually, through the merging of back-office functions and a reduction in administrative costs, for reinvestment in front-line services from 2008-09. That could pay, for example, for roughly 50,000 heart operations or major improvements in services for people with long-term conditions, especially older people. The changes will also build stronger partnerships between the NHS and local government.
The reconfiguration of PCTs is the first stage in strengthening the commissioning function. The next stage is a development programme for all PCTs, which will ensure that they are strong, confident organisations fit for driving forward the NHS reforms that we are implementing.
On ambulance trust reorganisation, in June 2005 the Government accepted the recommendations set out by Peter Bradley, our national ambulance adviser, in the review entitled Taking Healthcare to the Patient: Transforming NHS Ambulance Services, which set out a vision for ambulance services. In future, they will provide more care in the home and more treatment at the scene, give better advice to patients over the telephone and ensure faster response times to save more lives. The review made it clear that in order to ensure that ambulance trusts have the right strategic capacity, infrastructure and staff to deliver these improvements in patient care, there should in future be fewer, larger ambulance trusts. These changes will enable standards within the new trusts to be levelled up to those of the best.
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