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There will, of course, be redundancies as a result of the exercise, but we made it clear at the election that we would be clear about reducing unnecessary NHS bureaucracy. There should be savings made in merging back-room functions, where that can be done, but at the same time we do not want to diminish the power of PCTs to be effective commissioners for their communities. Todays proposals strike that balance.
Mr. Alan Milburn (Darlington) (Lab): I thank my hon. Friend for his statement, which will be widely welcomed. It is good news in my constituency of Darlington, in particular. I also thank Ministers for listening to the views of the many local people who campaigned in large numbers to retain Darlingtons primary care trust. Does he agree that his statement is a sure sign that, in the future, we will need to strengthen still further the working arrangements between not just health and social services, but housing services, so that more peopleparticularly old peopleget access to the locally delivered, locally commissioned seamless services that they surely deserve?
Andy Burnham: I thank my right hon. Friend for his comments. He has done more than anybody in the House to bring about the improving NHS that we have. The PCT structure on the ground is largely due to the changes that he made as Secretary of State for Health. I am grateful for his comments about listening. We have indeed listened. I know that strong representations were made by him and others in the north-east region. As I said to the hon. Member for Eddisbury a moment ago, it was right that we listened to those representations because we want the organisations to command solid local support. I am pleased that we have achieved some success in my right hon. Friends area.
My right hon. Friend made a point about housing. When we consider coterminosity, we all think about social services, but he is absolutely right to say that we can think more widely about links with councils and consider the provision of adequate housing and leisure and cultural services to local populations so that we can really begin to understand how to make people more active. All those possibilities are opened up by greater coterminosity and I am grateful for the welcome given by my right hon. Friend.
Mr. Charles Walker (Broxbourne) (Con): When we in Hertfordshire were faced with the prospect of one PCT, we campaigned for two, so we are delighted that we have got two. The east and north Hertfordshire PCT will serve my constituency. What safeguards will be in place to ensure that that new PCT serves the less-well-off parts of my constituency, such as Waltham Cross and Cheshunt, and does not focus too much of its time onhow can I put this delicately?the posh parts in the north of Hertfordshire?
Andy Burnham: That is proof that we listened to the hon. Gentlemans representations. It is obviously for the champion of the underprivileged on the Conservative Benches to ensure that his local PCT pays adequate regard to the parts of his constituency in
which the health needs are greatest, although, of course, that is something that local responsiveness should pick up.
Jim Dobbin (Heywood and Middleton) (Lab/Co-op): I thank my hon. Friend for his statement. He will be aware that the strategic health authority recommended that the new merged primary care trust that will serve my community and Rochdale be called Rochdale PCT. I welcome the Ministers decision to call it Heywood, Middleton and Rochdale PCT because I think that that is the right order for the name, which is important to my local community. Will he ensure that membership of the new board is representative of the two constituencies and two primary care trusts and, especially, that the resources are evenly spread across both areas?
Andy Burnham: I thank my hon. Friend for his comments. I am pleased that my primary care trust will still be called the Ashton, Leigh and Wigan PCT because I would be in great trouble indeed if it was called something else. I understand that such local connections and ties are extremely important and am pleased that Heywood has been recognised in the name of my hon. Friends PCT. As I said in reply to the hon. Member for Broxbourne (Mr. Walker), it is crucial that the new organisations serve all parts of the areas that they cover and, especially, that they pick out the health needs in those areas and bear down on the health inequalities that are important to him, me and Greater Manchester in particular.
Sir Nicholas Winterton (Macclesfield) (Con): I warmly thank the Minister, his predecessor and the Department of Health for listening to the overwhelming view of the people of Cheshire and establishing not one but two PCTs to ensure that the different cultures of east and west Cheshire are properly reflected in the provision.
It is important that the interests of both sides of Cheshire are properly catered for in the provision of health services. Does the Minister accept that there is concern that the target arrival times are not being met by the existing ambulance service? Will he give an assurance that those target times will be met under the merged ambulance service in the north-west?
Andy Burnham: I am grateful for the hon. Gentlemans warm welcome for the proposal. I hope that we will not see the emergence of an east-west Cheshire split and an explanation of the different cultures between the two. I am grateful for his recognition that we have listened and created a structure with which he is comfortable. Under the new North West ambulance service, which will serve my constituency, too, it will obviously be crucial that
performance is improved across the piece. When improvements need to be made to services, it is important that the body takes particular care to bear down on the problems and ensures that all residents of the north-west can look forward to and enjoy the same standards of service. I am sure that the new service will be focused on those matters.
Mr. Kevin Barron (Rother Valley) (Lab): I welcome the statement and am pleased that the Government have taken notice of local consultation. What we have in front of us is not the top-down method that the exercise was accused of pursuing late last year.
In relation to moving PCTs to be coterminous with local authority social services, what plans does the Minister have to ensure that there will be joint working where the changes took place in this round? It is not always easy to achieve that between local authorities and local health communities, as many of us have experienced. What plans does he have across government to ensure that local social services, health and, probably, housing work well together from day one, as opposed to waiting for that to evolve at a local level over the years?
Andy Burnham: I thank my right hon. Friend for his comments and am grateful to him for making an important point. I think hon. Members on both sides of the House realise that the NHS has perhaps not run the best consultation exercises and has not been as good at listening to local communities as it should be for the fine organisation that it is. The exercise, for all its difficultiesI recognise that there have been difficulties along the wayhas produced a good outcome. The NHS has shown that it can listen to local opinion and come up with structures that respond to concerns expressed on the ground.
My right hon. Friend is right. There is a lot of talk about the need to have joint working between health and social services, but often that talk runs ahead of the reality. His predecessor as Chairman of the Select Committee on Health, David Hinchliffe, the former hon. Member for Wakefield, was passionate about that. He often made that point when I served under him on the Select Committee. I, too, am convinced that we will see real improvements when we have much greater integration of health and social services in my right hon. Friends constituency and mine.
Sir Patrick Cormack (South Staffordshire) (Con): I thank the Minister for recognising the special qualities of the Staffordshire ambulance service. Will he give me the assurance, which he was not able to give my hon. Friend the Member for Eddisbury (Mr. O'Brien), that there will be no question of merger unless the neighbouring merged ambulance service has reached at least the standard of Staffordshire in two years time?
Andy Burnham: The hon. Gentleman makes an extremely important point. He can see from the proposals that we have recognised the strong concerns expressed by him and some of my hon. Friends. The public in Staffordshire clearly feel a strong attachment
to their ambulance service, and rightly so. We have stated clearly that merger is expected within a period of time. I am not going to lay a time frame on that today, but he makes the legitimate point that we would not want Staffordshire ambulance services standards to be eroded in any way.
Mrs. Janet Dean (Burton) (Lab): I, too, welcome my hon. Friends statement. The people of Staffordshire will be pleased that Ministers have listened and that there has been a true consultation. Up to two years will certainly allow time for the West Midlands ambulance service and the Staffordshire ambulance service to be aligned and for protocols to be developed, which I hope will maintain the excellent service. However, if a little more time is needed, I hope that Ministers will consider extending it. Ministers have truly listened, so thank you.
Andy Burnham: I am grateful for those commentsmore like it would be much appreciatedand for my hon. Friends measured words. I am happy to give her the assurance that although we expect merger to be right in due course, I hear what she says. I will relay her words to Lord Warner, who has done a great deal of work to bring about the proposals.
Not long ago I was a customer of Staffordshire ambulance service following a crash on the M6. The standard of care was exceptional and the standard of support provided by the paramedics on site was fantastic. I have good personal reason to endorse fully what my hon. Friend says.
Mr. David Curry (Skipton and Ripon) (Con): North Yorkshire PCT will be the third largest in the country with a population at 765,000, behind only Hampshire and Surrey, yet it covers a huge county of scattered communities. Will the Minister ensure that it is gospel with the new PCT that it should do everything it can to reinforce its working relationships at the local level? If it does not, my constituents will conclude that the Governments only intention is to drain services to a larger regional level, as they have done with the police, with the loss of accountability and of sheer local personality that make public services so valued.
Andy Burnham: The right hon. Gentleman makes an important point. May I refer him to my statement, in which I gave a clear commitment to ensure that structures are in place in the new organisations so that local concerns can be aired or voiced? I therefore agree with him on that point. The new PCT is one of the larger PCTs that have been created today, with the benefit that it has a significant ability to drive up standards for residents. The important thing is to get the balance right, and we believe that, bearing in mind the points that he has made, we have done so.
Tom Levitt (High Peak) (Lab): I accept the logic of coterminosity between social and health services, but I congratulate my hon. Friend on acknowledging that in some circumstances common sense dictates a different solutionhence the retention of Tameside and Glossop PCT, which has the support of 99 per cent. of respondents to the consultation. Does he agree that
such modifications of coterminosity will test the principle of local area agreementsit is none the worse for thatand that areas such as Glossop should not be disadvantaged by the emphasis on local area agreements and local commissioning?
Andy Burnham: May I pay tribute to my hon. Friends efforts to ensure that the voice of people in his constituency, particularly in Glossop, is heard? He is quite right that there are occasional exceptions for people with health ties that do not fit the local government structure. Knowing the area well, I can say that Glossop is one such location. Traditionally, people have travelled north-west into Manchester for hospital care, but technically they are not within the regions local government boundaries. We have listened to my hon. Friends concerns, and we have made an exception, as we recognise that people in the area lean towards the north-west for health care. However, he is right that that exception does not challenge the other structures that have been put in place to improve services on the ground.
Dr. Vincent Cable (Twickenham) (LD): In addition to their local commissioning and partnership functions, how many national targets will the PCTs still have to monitor and report on? In the new, reorganised NHS, approximately how many staff will be deployed in that role?
Andy Burnham: I would make a staunch defence of targets. By providing clarity from the centre, we have been able to deliver improvements to the NHS in recent years, so I make no apology for them. However, the hon. Gentleman will know that we have reduced the number of targets and have set fewer priorities, as we need to focus on our true priorities. It is the new PCTs job to ensure delivery of standards. Throughout the process, I am pleased that there has been continued improvement in NHS patient care, and I fully expect the new organisational structure to continue to drive change for patients benefit.
Laura Moffatt (Crawley) (Lab): I firmly believe that the development of primary care trusts has developed a system for GPs that promotes innovation and exciting programmes to improve peoples health in our constituencies, and I congratulate Crawley PCT on its work. How can we ensure that GPs who are determined to drive up standards in a larger PCT can do so and can continue to work with local authorities so that everyone benefits from the new PCT?
Andy Burnham: My hon. Friend makes an extremely important point. General practitioners in her area are at the forefront of leading practice to develop good services at community level. It is a priority for everyone, wherever possible, to deliver services away from the hospital setting and closer to the patients home. I fully endorse that as the way forward, and I applaud the work on the ground in her area. Within the new structure, we are introducing practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area,
so it should give more power to their elbow than they have at present. That is what I would like to see as a result of these changes.
Mr. Michael Fallon (Sevenoaks) (Con): Given that half the beds at Sevenoaks hospital that were temporarily closed in February for financial reasons have now shamefully been removed altogether, what reassurance can the Minister give me that good local hospitals will be any safer inside larger PCTs?
Andy Burnham: The point of the changes is to ensure that PCTs can take a balanced view across a broad area to ensure that patient services are most effectively provided. He would be the first to complain if local priorities were overridden from the centre by targets or central diktat. It is right that at local level people should be able to create the kind of health service they want. Through foundation trusts we want to give local people much greater ownership, control and say over how their hospitals provide services. Ultimately, that is the way in which local people and local communities will have their say over the configuration of hospital services.
Mr. Paul Truswell (Pudsey) (Lab): Great concern has been expressed in Leeds about the continued development of the strong local focus of the five PCTs. Will my hon. Friend ensure that any savings realised as part of the reconfiguration in Leeds are re-invested in Leeds to develop that local focus still further?
Andy Burnham: As my hon. Friend knows, the changes will lead to a Leeds PCT that could provide a powerful voice for local communities across the Leeds area. I am happy to confirm that the savings that will be made as a result of the changes will be directly released for patient care. That is the very reason we are making the changes. We must achieve a balance so that an organisational structure is the right size and is not unnecessarily duplicating back-office functions. Where savings are released, they will be ploughed back into patient care at the front line.
Mr. Gerald Howarth (Aldershot) (Con): Blackwater Valley and Hart PCT and North Hampshire PCT have just gone through a painful reorganisation. They already cover a population of 385,00050,000 higher than the average PCT that the Minister is creating. Now he wants to foist on Hampshire yet another period of turbulence. Can he explain in practical terms how he will deliver the local focus of which he speaks? In particular, how will he ensure that the PCT covering 800,000 people in Hampshire specifically looks after the interests of my constituents, who are served by a hospital in Surrey, next door? That is the question to which they will need the answer tonight, please.
Andy Burnham: The hon. Gentleman raises an important point. Competing demands must be balanced in reaching the right judgment. Those demands are local focus, responsiveness to local need, a commissioner who has the weight and the power to drive a good bargain and get good commissioning for local people, and together with all those things,
coterminosity with social service providers so that we can get joined services at local level. Some of those pressures are pulling in opposite directions and it is difficult to get them into balance. That is why we have no blueprint specifying that a PCT must be a particular size and shape in a particular locality. We have sought to do the best we can to manage the competing priorities. I am pleased to say that in the hon. Gentlemans area there was strong support for a Hampshire PCT coterminous with the local authority boundaries.
Roger Berry (Kingswood) (Lab): I thank my hon. Friend for his statement. I join the growing number of hon. Members in all parts of the House thanking him for its content in relation to the reconfiguration of primary care trusts. I specifically thank him for rejecting the proposal from the Avon, Gloucestershire and Wiltshire strategic health authority to remove existing coterminosity and create even less, and for listening to the opinion of every local council, every local trust, their staff, Members of Parliament, voluntary community organisations, GPs and just about everybody who thought that that proposal was unwise. I thank the Government for making a sound decision.
Andy Burnham: I thank my hon. Friend for his kind words. People have long complained about a democratic deficit within the NHS, and I hope that some of the proposals that we have announced today and campaigns run on the ground by elected representatives throughout the country will show that the NHS can respond to local concerns and put in place a structure in local communities in which people feel confident and with which people identify.
Mr. Crispin Blunt (Reigate) (Con): The Minister has talked about the need for strong community support and coterminosity. Perhaps he will explain which organising genius at the centre of Government has produced a PCT for Surrey, which is welcome, but managed to remove the police, fire and ambulance services from boundaries within Surrey in the same period.
Andy Burnham: This is my second week in the job, and I have just discovered that I am not responsible for police, fire or other emergency services. However, I am pleased that the hon. Gentleman recognises that our NHS structure is the right way to go in Surrey.
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