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In her written statement of 14 December 2005, my right hon. Friend the Secretary of State set out our intention to consult and to ensure that the benefits outlined in the ambulance review can be fully realised. Following this consultation, the Secretary of State has now decided that from 1 July 2006, most of the existing 29 NHS ambulance trusts will merge into 12, with separate management arrangements for the Isle of Wight. For now, Staffordshire ambulance service will
remain a separate trust, working in partnership with the new West Midlands ambulance service, but will eventually merge at a later date.
Feedback from most areas was supportive of our proposals. However, we have decided to address the publics concern that local responsiveness and flexibility could be lost through having larger trusts by requiring ambulance trusts to ensure that their services are meeting the needs of all localities and populations within their boundaries. Those changes should mean more investment in front-line services as trusts identify savings in back-room functions; improved patient care through providing an opportunity to raise the standard of the service provided by all trusts to the level of the best; better emergency planning, with greater capacity and the capability to respond to major incidents of all kinds; more integrated services; and better career opportunities for staff.
Changes of this kind are inevitably difficult. We have not sought to impose a single blueprint on the NHS; instead, we have listened carefully to representations from all Members and from local communities and organisations. Wherever possible, we have responded positively to them. We have one aim above all: to deliver better health care to patients. I commend this statement to the House.
Mr. Stephen O'Brien (Eddisbury) (Con): I thank the Minister for providing me with a copy of his statement in advance, and for putting local information on the Board for the use of hon. Members.
Since Labour came to office, there have been seven reorganisations of the NHS already, and todays pair are the eighth and ninth. Under the cloak of words such as modernisation or reform, this is change for changes sake. Has the Minister any idea of the effect that the reorganisation has on staff morale, and on the ability to retain the good? It means that underperformers inevitably will be recycled into similar jobs in the new organisations. It causes instability among clinical staffdoctors, nurses and allied professionsand inflicts uncertainty and inefficiency in the NHS supply chain. Above all, is he aware that it leaves patients wondering where they feature in it all?
The Government have form, however. They never allow anything to settle and bed downmuch to the consternation of the hard-working people trying to deliver the front-line patient services. In Government, as in all walks of life, the addiction to constant structural change is a well known technique deployed by those who did not get it right the first timeor the second, third, fourth, fifth or sixth times. Imposing another restructuring and a further reorganisation is a great wheeze to put through changes in a bid to avoid accountability and to keep running ahead of mistakes.
The mounting job losses in the NHS show that the Government are no longer lulling the public, whose trust in the Government, not least in respect of the NHS, has plummeted. Let us look at why the Government have felt impelled to announce yet more changes to the NHS
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): It says here.
Mr. O'Brien: Indeed, it does say it here, because that is what I wrote.
First, let us look at ambulance trusts. Peter Bradleys review concluded that there should be fewer of them, but that they should be larger, yet no evidence for that major change was contained in the report, or made available since. Ministers then decided to reduce the number of strategic health authorities to align with their obsession with regions, notwithstanding the electorates rejection of the idea in the north-east. With sleight of hand, Ministers have used the reorganisation as an excuse to reduce the number of trusts to 12, and then they have ducked the flak by suggesting that that was Peter Bradleys idea and recommendation all along. Will the Minister therefore undertake to place in the Library of the House any evidence that relates specifically to claims that creating large trusts will lead to improvements in patient care?
How does the reorganisation achieve closer integration of all the emergency services? Will the Minister explain how a north-west regional ambulance service will integrate better with the newly merged Merseyside and Cheshire police forcea merger that will be carried out in the teeth of maximum hostility and objection? How will it integrate better with contingency planning in Cheshire, or with the Cheshire fire services move to sub-regional control rooms?
Will the Minister comment on proposals to reduce control room numbers by co-aligning them with the police and fire services? The House should bear it in mind that in Warwickshire, for example, the fire service responds to some 3,000 emergency calls a year, whereas the ambulance services respond to some 100,000.
Who is co-ordinating the reorganisation across Government? Co-ordinated is the last thing that it isperhaps the Deputy Prime Minister has been devoting his time to this matter recently. It is shambolic, inconsistent centralising by an arrogant Government who claim to listen but who choose not to hear the views of those who work on the front line and who know best.
The official consultation on ambulance trusts lasted from the middle of September last year to near the end of March this year, yet the NHS appointments commission sent out letters on 30 Januaryin the middle of the consultation periodasking for nominations for men and women to chair the new NHS ambulance trusts. The question ariseswas not the decision therefore a foregone conclusion?
I have had a letter from Roger Moore, the chief executive of the appointments commission, in which he stated that the recruitment began
at the request of the Department of Health.
I am pleased that concerted work by MPs across Staffordshire and by the shadow health team, supported by huge amounts of work by the people of the county, has caused Ministers to backtrack on axing Staffordshire ambulance service for up to two years. That 24-month period was set out in the handout on the Board in the Members Lobby, but not in the statement. That is a classic fudge, as it puts Staffordshire ambulance trust in the departure lounge. However, will the Minister give the House an assurance that unless the west midlands service is brought up to
the standard of Staffordshire there will be no hint of a merger, whether in two years or beyond?
Given todays statement, any right-thinking person is entitled to regard the Governments consultation as a sham. Constant change will undermine what has already been achieved; for example, by turning round the East Anglian ambulance trust. The Buckinghamshire and Northamptonshire service is about to complete the process of splitting; now they will have to go through the upheaval of being merged again.
We are not against the restructuring of PCTs per se[Hon. Members: Ah.] The Under-Secretary of State for Health, the hon. Member for Bury, SouthMr. Lewis suggests that the whole statement was about PCTs; clearly he was not listening, as much of it dealt with ambulance trusts. On PCTs, as distinct from ambulance trusts, we are not opposed to restructuring, but we have always said that future functions need to be defined before such restructuring takes place.
In 2002, the Department of Health abolished the 11 regional offices of the former NHS executive and about 100 health authorities. Today, the Government are bringing back that map. Has the Minister estimated the cost of that U-turn, which takes us back to the position four years ago? He may talk of the Secretary of States clear commitment in October 2005 about the functions of PCTs, yet three months before that the DOH was equally clear, in Commissioning a patient-led NHS, when it called for PCTs to become
patient-led and commissioning-led organisations with their role in provision reduced to a minimum
by 2008. The Secretary of State backtracked on that commitment, without reassessing whether the proposed structures would be fit for purpose. Now, no one is clear.
As the Health Committee said in January, when it attacked the Governments indecision,
we are appalled at the continuing lack of clarity about whether or not PCTs will eventually divest themselves of provider functions.
The Department of Healths NHS operating framework for 2006-07, published on 26 January, offered little further clarity, stating:
Where PCTs do continue to provide services, they will need to put in place clear governance procedures that ensure that there is no undue influence from the provider side on commissioning decisions.
Will the Minister detail how 15 per cent. management cost savings can be made when the Government are calling for each PCT to have two sets of managersone for commissioning and one for direct services?
The problem for the Minister is that all this restructuring has gone on without putting in place the necessary precondition for its having a realistic chance of success: defining the future functions of PCTs. Will the Minister tell us how many PCTs are predicted to be direct providers of services in two years time? New organisations can hardly be expected to deliver unless and until they have clarity of purpose.
In his statement the Minister said that in some cases the new proposals differ from those suggested by the strategic health authorities and the external panel. Will he tell the House how many PCTs the expert panel proposed should be created overall; and will he publish
in full the panels advice so that we can see to what extent the Government arrived at different decisions and the implications of the variations?
The Government seem only now to be waking up to the cost of the reconfiguration and the redundancies that go with it. Can the Minister confirm that the estimated cost of this latest round of NHS reconfiguration, which will merely take us back to where we were four years ago, will be £320 million? Will he also confirm that at £250 millionthe figure he gave in his statementthe savings will be less than the cost? Is he confident even of that amount, or was the Health Committee right when it said that savings of between £60 million and £135 million were nearer the mark? Are those estimates gross or net, given the cost of the redundancies that will be inevitable to deliver on that Government promise?
What is the time scale? The House is entitled to have that crucial information in a year when the Governments financial control of, and credibility with, the NHS is shot to pieces and the NHS is in confusion and plunged into at least 10 months of uncertainty and chaos at PCT level. This is no way to run an NHS.
Mr. Speaker: Order. The Opposition spokesman took longer than the Minister. I do not want to see that practice continued.
Andy Burnham: Thank you, Mr. Speaker, and in that long speech, I will seek to pick out the points of substance that there were.
There is no confusion. Our aim overall is to improve patient care. That is what we are in business to do, and I can tell the hon. Gentleman without fear of contradiction that patient care is improving. Patients are not waiting for more than six months for in-patient treatment. On the whole, they wait a maximum of 13 weeks for an out-patient appointment. There is clear evidence of progress. That is what guides our changes; it is what guides these changes, so I can assure him that there is no confusion on our part at least.
The hon. Gentleman says that this is change for changes sake. I point out to him that the NHS changes; it is different from what it was in 2000. We have an ambitious programme of reform to drive through in the NHS. We want to ensure that people can choose where they are treated and that the wait for that treatment is short, once the full reform programme is introduced. That will require strong commissioning throughout the NHS. It will require people cleverly commissioning services and using their organisational strength. That is why we are making these changes. He will know that some changes have begun, and some of the changes that we have formalised today have already begun to take shape.
On ambulance trusts, the hon. Gentleman claims that we have an obsession with the regionsfar from it. He asks what the connection is with other emergency services. Surely, it makes sense to ensure that, at regional level, there is the contingency capacity to deal with major events and that capacity is planned regionally. I hope that he agrees that there is some logic in doing that. He claims that there is no support, but
Peter Bradleys proposals commanded strong support from within the ambulance service, particularly because they clearly focused on the professional development of those who work in the service, thus giving them the ability to shape ambulance services in future.
The hon. Gentleman claims that we have not listened. Clearly, if he looks at the proposals for PCTs that we are publishing today, he will see that precisely the opposite is the case. We have indeed listened to hon. Membersnot just Labour Members, but Opposition Members, tooand we have taken on board those concerns. He asks where the proposals differ and whether we will put the evidence in the Library. I would be happy to do that, but the reason why we have taken those decisions and listened to those representations from hon. Members on both sides of the House is that we want a consensus of support for the new organisation, because it is our judgment that the organisation will have the best chance of success if it is underpinned by strong community support. That is exactly why we have done that.
The hon. Gentleman asks me whether we will detail where the cost savings can be made. There will be one-off costs in relation to the exercise, but the savings will come year on year. As for the timetable, we expect that the savings from the exercisesome £250 million a yearwill be realised by 2008. That, of course, will be a recurrent saving for front-line services.
There is a logic and coherence to our proposals, and the hon. Gentleman talks of incoherence and confusion among Government Members. I put it to him that the Conservative partys policy at the last general election was to take about £650 million from so-called NHS bureaucracy, as defined by the James review; coupled with that was the patients passport, which would have taken money from the health service. What kind of organisational chaos would the combination of those policies have created?
Steve Webb (Northavon) (LD): I thank the Minister for advance sight of his statement.
The Government abolished health authorities four years ago and created primary care groups and primary care trusts, and they are now merging them back together to create health authorities. Were the Government right to abolish health authorities, and are they right to recreate them? Is that what the Minister is telling the House? Or did they make a mistake four years ago, and will he admit that to the House?
Can the Minister provide evidence of where the£250 million cost saving will come from, given that the Select Committee on Health was very sceptical that savings on that scale could be achieved? He did not answer the Conservative Front-Bench spokesmans question about the number of redundancies that are implied by a £250 million annual saving. How many people will lose their jobs?
On responding to local consultation, I thank the Minister for listening to some very effective lobbying from the west of England, which has resulted in keeping PCTs coterminous with social service
authorities. I welcome that fact, because I was sceptical that the Government would listen on that point. I assume that he already knows that I was pressing for that. I also welcome the fact that, following recent political trends, the south-west of England has turned from blue to orange.
On coterminosity, the Minister said in his statement that about 70 per cent. of PCTs will be coterminous. Is there a limit to that, or will he go further? What is the restriction on having 100 per cent. coterminosity and having real integration of health and social services? How far will the Government go?
What are the promises of PCTs that have been abolished worth? Many of my colleagues are worried that, although they have been promised things by existing PCTs about new community services, the successor bodies may well say that they are not bound by the promises of the predecessor bodies. Can the Minister give us an assurance that, when an existing PCT has made a promise, the successor bodies will honour that promise?
Finally, on the ambulance trust mergers, what confidence can people living in rural areas have that the very large ambulance trusts will not inevitably concentrate on urban centres? Whereas small trusts could respond to local circumstances, larger ones may neglect rural areas to hit their performance targets.
Andy Burnham: I thank the hon. Gentleman for his constructive response. In the course of his remarks, he made the point that we have listened. The hon. Member for Eddisbury (Mr. O'Brien) would have done well to take that point on board. We are not recreating health authorities; the building blocks are the same. The exercise has shown a range of interest in and commitment to primary care trusts around the country. People seem to be attached to them. The changes are not happening everywhere. In my area, in Greater Manchester, the building blocks will largely remain the sameas they will in London. Experience has shown that there is a PCT size that is more effective in commissioning good quality patient care. We are making the changes in that respect and ensuring that the NHS is able to use its strength at local level to drive up quality for patients.
The hon. Member for Northavon (Steve Webb) mentioned coterminosity. I am in full agreement with him on that point. I have long believed that there needs to be much closer working between the national health service and social services at a local level. I fully support such moves, including even pooled budgetsthat kind of approach. I hope that the proposals will pave the way for much greater joint working. There are examples around the country where that working is close. The greater level of coterminosity allows those partnerships to be built. The level is around the mid-70 per cent. mark. We have to strike a balance between representations from local Members and not creating bodies that are too big to do the job. We have sought to manage those tensions. We have produced a significant increase in the number of PCTs that are coterminous with their social services departments. That will be a positive step forward for patients and particularly for older people in those regions.
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