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29 Jun 2006 : Column 158WH—continued
“I have just returned from my local dentist’s surgery after my 6-monthly checkup. I was absolutely horrified and disgusted to be told that because of the Dept of Health’s changes in the provision of NHS dentists, he would be going private in September. This means that the price for a routine checkup (assuming nothing is wrong) is increasing by almost three times. The quality of service will remain the same so the Dept of Health changes will certainly not improve patient care.”
I read that out in relation to the PCT because the two towns of Wellingborough and Rushton adjoin each other. There is no NHS provision in Wellingborough and the PCT has just managed to obtain some new NHS provision in Rushton. Unfortunately, that dental surgery is already full. Appointments cannot be made before December.
Luckily, a local dentist, Dr. Chan, had a Polish dentist available with experience of the NHS because he has been here for a while. He wanted to work in Rushton for the NHS. That would have solved not only Rushton’s problems but those of Wellingborough. I had a chance with my partner’s PCT to argue that, in that regard, Wellingborough and Rushton were the same place. If the PCT were based in Northamptonshire, and the strategic health authority covers the whole of the east midlands, it would not even know that Wellingborough and Rushton were joined together, so there would be no chance of more NHS provision in my area.
Unfortunately, I have just received a letter from the local Heartlands PCT to say that no funding is available. Can the Minister explain that dilemma to me? I complained to the Secretary of State for Health, and a meeting was arranged with the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton). I complained in
November, but like many people in the NHS, I had to wait, only to have my appointment cancelled and then cancelled again. It was only six months later that I actually had the meeting, and the Minister argued with some clarity that it was for the PCT to decide whether to provide NHS dental services in my constituency, but the PCT says that the Government will not fund those services. How, therefore, are Members of Parliament to get somebody to do something about a situation in which there is a Polish dentist available to work in the NHS, but there is no NHS provision in the constituency?
Let me now move from dentistry to what is, in many ways, a more serious issue and give just one example of the problem that we face locally. Our local hospitals are very efficient—the NHS standard is 100, and they work at 85—but our area is underfunded, even by Government standards. We are underfunded by 4.5 per cent., and it is argued that that is because other areas are overfunded. That might sound very neat, but there is a real and serious problem for the patients.
A five-year-old child in my constituency—with your permission, Miss Begg, I will not identify him—had an operation in February 2005. During the operation, three surgical procedures should have been carried out, but one was not. That has meant that that little boy has had to wait in pain for a considerable time. This month, the consultant agreed that the case should be urgent, but despite the fact the little boy is in urgent need of treatment, the consultant said that he could not be treated for five months because of the PCT’s ruling that it had no funding. The consultant opened his diary and showed all the dates when he could have done the operation, but he cannot do it, because the PCT will not allow it. When that argument is put to the PCT, it says that it is because of Government funding and targets. It has been told that everybody must have an NHS operation within six months, so urgent cases are being put back five months to allow everybody to meet the six-month target.
Such an arrangement cannot be right, and it certainly is not the way to achieve local accountability. Indeed, to conclude, the real issue with which I should like the Minister to deal is the local accountability of PCTs as they are now and as they will be in the future.
4.13 pm
Mr. Paul Truswell (Pudsey) (Lab): I am grateful for the opportunity to intrude on the debate as a non-member of the Select Committee. I appreciate that its report was a snapshot in time and I am sure that my hon. Friend the Minister will tell us just how far we have progressed since. Despite the passage of time and events, however, the report remains extremely topical and relevant to people’s experience in Leeds.
As we know, a tablet of stone dropped from the lofty heights of the Department of Health at the end of July. It contained two commandments: “Thou shalt reduce the number of PCTs” and “Thou shalt divest thyself of services”. To a degree, the second commandment has been withdrawn, although how far remains the subject of debate. In my area, for example, the initial requirement for PCTs to divest themselves of services
has led people to spend considerable time looking at various options, some of which would have obvious attractions to staff who wanted to avoid the threat of outsourcing. My fear is that some of those options might be pursued further out of fear and uncertainty about the future and about change, rather than primarily on the basis of what is in the best interests of patients and services.
The proposals that were submitted for reconfiguration in Leeds need to be viewed in the light of the flawed top-down process that the Select Committee report so accurately described, irrespective of the Government’s emollient words in response. They were not carefully considered plans for the improvement and commissioning of services. They were an acquiescent response to the first of the commandments that I referred to a couple of minutes ago. That remains of major concern to us, because in Leeds we have generally found that the PCTs have been a success. They adopted commissioning approaches based on the needs of their communities. They have taken a particularly robust line with the local acute trust. They developed services to meet needs, very much in the way that my hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) described in her area. Indeed, community services were transferred from the then community and mental health trust to the PCT as a means of improving them.
In my constituency, for example, the Leeds West PCT developed a whole range of services responding to local needs, including rapid response teams to prevent unnecessary admission of older people to hospital, thereby addressing a major challenge in Leeds, which is that we hospitalise too many people and keep them there for far too long. A respiratory team has been established to advance the care of patients with certain respiratory conditions. Advanced special practitioners, who are basically senior nurses, are working with patients who have had experience of multiple hospital admissions over a year and regularly require the assistance of their GP, again to address the issue of unnecessary admission.
Our profound hope is that with the reconfiguration such innovation and good practice can continue and be disseminated in a much larger PCT area. In Leeds we are talking about moving from five PCTs, the largest of which serves a population of just under 200,000, to a single PCT serving a population of more than 720,000.
Jim Dowd (Lewisham, West) (Lab): I would not expect the hon. Gentleman to know the answer in detail, but can he compare the actions being taken in his native city of Leeds and the bold way they have gone about merging the PCTs with the absolute lack of commitment and timidity of the Government with the PCTs in London?
Mr. Truswell: My hon. Friend is absolutely correct to anticipate that I cannot answer that question, but I am sure that his intervention will have found its mark.
In fairness, my Leeds colleagues and I were not opposed in principle to the changes—we would not take a luddite approach—nor to the proposal to reduce from five PCTs to one. On the basis, however, of the sparse information placed before us in the so-called
consultation exercise, we could not support the proposal as it stood. The picture of how the new PCT would look and function was and, I am afraid to say, remains far too unclear. We were conscious that the proposals were not the result of an organic process but were initiated directly and exclusively as a result of Sir Nigel Crisp’s letter of 28 July. Neither we nor our constituents have had any opportunity whatsoever to consider or contribute to a tangible model of what the new structure would like. We were not looking for detailed nuts and bolts. That would clearly have been unrealistic, given the timescale of the process, but we did require a clear indication of how the key areas of activity—especially the local focus—might continue to be achieved in Leeds. Certainly, as I say, we were happy that the five PCTs were achieving that.
Like the Select Committee, we appreciate that savings released from reducing administrative cost can be reinvested in patient care. We understand the frustrations of the many voluntary organisations in our city that have to deal with five separate commissioners, although there was a degree of lead authority work taking place to address some of those problems. We recognise the problems of working closely with partners such as the local authority and its relevant departments.
In our response to the SHA consultation we stressed what we wanted to see coming out of the reconfiguration. The points are reflected in a number of the recommendations made in the Select Committee on Health report. I do not intend to take up time reiterating them, because they have been covered by a number of other hon. Members.
It goes without saying that the reconfiguration must maintain and build upon the achievements of our existing PCTs, especially in developing strong local focus and initiatives to meet the needs of our communities. We raised our concerns about whether the move from five PCTs to one could achieve that in a meeting with our right hon. Friend the Secretary of State in the autumn. As a result of our representations, we were pleased that John Bacon’s letter of 30 November to Mike Farrar, the then West Yorkshire SHA chief executive, contained the following sentence:
“Concerns have been expressed about the risk of losing a strong local focus, particularly in Leeds, and it is therefore essential that the consultation document explains how you will sustain this focus within a larger PCT.”
We were therefore hugely disappointed that the consultation document contained just a few glib sentences on that point. In subsequent discussions with Mr. Farrar, he made a number of positive assertions regarding that and other aspects of the issue that we discussed. He asked us to trust him, and we might well have done so. He is an extremely good and effective officer. Unfortunately, and inexcusably for a Yorkshireman, he has now disappeared over the Pennines to become the chief executive in the north west.
We now have a new chief executive of the SHA and a new chair. They, of course, have a much larger area to deal with, not only West Yorkshire but the whole of Yorkshire and Humberside. It seems likely, without wanting to pre-empt the process, that the new PCT chief executive will come from outside the area. We also await the appointment of a chair. The Select
Committee’s concerns on the issues of continuity and responsibility were, I believe, well-founded from the point of view of our experience in Leeds.
At PCT level, it feels as though there is a centrifugal force pulling the emphasis from localities towards the centre and, at SHA level, pulling it from the west Yorkshire area to a Yorkshire and Humberside level. Whether practice-based commissioning will provide a countervailing centripetal force is totally unclear to us at the moment. There has been precious little in the consultation process, or since, to demonstrate how that would work. The Select Committee’s comments on that point remain entirely valid, from our point of view.
From my parochial point of view, I continue to ask myself—and anyone else who is listening—how local issues that I have been able to pursue with a PCT with good local knowledge will be resolved in future. I shall reflect and echo the comments made by the hon. Member for Wellingborough (Mr. Bone). To whom do I speak—and will they have a grasp of the issues in the locality when I contact them—about problems or concerns relating to GP practices, such as the need for new or developing premises? To whom do I speak about local dental provision? My area has been consistently defunded over the years by the exodus of dentists from the NHS. Even though that defunding is being stopped by the retention of funding at local level, where will the funding for re-provision go once we have a pan-Leeds PCT?
My colleagues and I have made a number of other points that are effectively expressed in the Select Committee report. The consultation, for example, had no real tangible substance other than the proposal to move from five PCTs to one. Even that was in the context of a broader document that covered the whole of the west Yorkshire region.
We share the concerns expressed by other Members about the need to retain strong public health functions at local and city level. Of course, we are going from having five teams to having one centralised team within Leeds. Public involvement in health provision at all levels must be promoted. The forums in our city—I am sure that this is the experience elsewhere—have only just begun to find their feet but, as a result of the reorganisation, we have a completely new ballgame.
We must ensure that the present levels of service provision, particularly at local level, are strengthened and enhanced. On that point, we were disturbed to learn that the savings from the reconfiguration in Leeds would not necessarily be recycled into the Leeds health economy. That is totally unacceptable. Leeds faces major challenges in addressing the historical imbalance between community and hospital services. We have two major teaching hospitals, which, over time, have soaked up most of the NHS resources. As a result, we have relatively weak community services, we hospitalise too many people and we keep them in hospital too long. We are also conscious that in the immediate future the acute sector faces major challenges which may require additional resources.
Those are crucial issues and there is precious little time to get them right in the helter-skelter process that hon. Members have described. I sincerely hope that my hon. Friend the Minister will be able to give me some grounds for optimism in his response to the points that I and other hon. Members have raised.
4.25 pm
Steve Webb (Northavon) (LD): I am sure that all hon. Members agree that debates such as this are valuable occasions. We owe a debt of gratitude to the Chairman of the Select Committee, the right hon. Member for Rother Valley (Mr. Barron), and its members, some of whom are with us this afternoon, for a valuable and hard-hitting report. This morning, I refreshed my memory by rereading sections of the report and was struck by the forthright language in which it was couched, to which the right hon. Gentleman referred, which conveys a lot of the anger that was felt at the time. The letter appeared and although there was some precedent, it still felt like a bolt from the blue and was much firmer than anyone expected. It came at precisely the wrong time in the parliamentary cycle and at the wrong time for any meaningful consultation to take place. Although things have moved on, it remains an important document and our debate this afternoon has highlighted some of the issues that need to be considered as we go forward.
Something that strikes me from what I have heard from colleagues around the country is how different everyone’s local case is. My perspective is coloured by coming from an area with a relatively small unitary authority. In our case, to argue for coterminosity was also to argue for localism, and we got it, albeit not under the original proposals. Other hon. Members have referred to wanting a PCT that understands local issues and is coterminous with the social services authority. I was arguing for the same things, but I fully appreciate—the debate has helped me to understand the point—that for some colleagues those two things were in tension.
That leads me to the first key point arising from the debate. It could not be more apparent from the debate that such decisions must be local decisions. I was interested in the comments of the hon. Member for Staffordshire, Moorlands (Charlotte Atkins), who said that she is a great advocate of local decision making, but then implied that because there may be conflicts within an area, there should be some sort of external, independent arbitration. With all due respect, that seems to be entirely misconceived. Local government exists for that purpose—to reconcile the competing claims of different sub-parts of an area. We do not say that just because a county has one bit that wants one thing and another bit that wants another, we need an independent third body to tell it what to do. We resolve the matter through open, local, democratic procedures in the local area.
Charlotte Atkins: If that had happened in Staffordshire we would have been lumbered with a Staffordshire-wide PCT because the county council was determined from the start to be completely undemocratic and perverse and to ignore not only the population in Staffordshire, but its own elected councillors and post-holders.
Steve Webb: That comment opens a whole can of worms. If we are saying that elected people are not listening to their electorate—
Charlotte Atkins: It was worse than that.
Steve Webb: If elected people are not listening to their electorate, any hope of local democratic accountability becomes problematic.
Charlotte Atkins: It was not the elected members who did not listen to their electorate; it was the officers of the county who did not listen even to their own elected members.
Steve Webb: I am not an authority on what happened in Staffordshire, but that suggests to me that the elected members should get a grip.
Steve Webb: The answer to the problem of tensions within a local area, it seems to me, is more democratic accountability, not external independent arbitration by a quango. I cannot follow that logic at all. If the existing democratic structures would not have produced the outcome that the hon. Lady wants, that suggests that the democratically elected people should have been doing their jobs more effectively. That seems to be logical.
The idea seems to be, in essence, that we all have to go cap in hand to the Secretary of State. Opposition Members do not have the same access to Ministers—I do not say that with side, but it is true. I have often heard Government Members say, “I had a meeting with the Minister about this or that,” but it can prove very difficult for Opposition Members to do that. That is a statement of fact. I had a local reconfiguration issue about a hospital. After six weeks of trying to see the Secretary of State, I was eventually offered a meeting with one of the junior Ministers. I phoned her office and was told that she was too busy, but I could have a phone call to the Secretary of State two weeks later. Then, the Secretary of State said to me, “Why didn’t you raise this eight weeks ago?”
There is a more profound issue, which is that these matters are being decided in the wrong place anyway. The Secretary of State is an elected person, but she is not elected by anybody in Staffordshire, or Wellingborough or Leeds, so why are we having to go to her for a decision to be made? Clearly, there are some things that have to be done nationally and strategically, with an overview. However, decisions about local health configuration should be taken at an appropriately local level.
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