Being a commissioner in a modern health service in a social care setting is a skill. Maybe we need to do a lot more thinking about the kind of support and development that we offer to people who end up in
commissioning roles in such organisations, because the nature of the commissioning can often determine the quality and responsiveness of NHS and social care.
I agree with my hon. Friend about the importance of public health. The Government will continue to stress PCTs responsibility for focusing on public health. We want to see a continued shift where appropriate from hospital care to community care and primary care. In some areas that is more advanced than in others, but it is important that we keep our eye on the ball and ensure that we are spending more money, time and energy on preventive support than on reacting when we could have done better in the first place.
I pay tribute to my hon. Friends parent-led Sure Start scheme, an example of an innovative local project that is making a difference, probably more than anything because it is parent-led. On the question of staff training and primary care, I agree entirely with her that staff training and development are important. I do not have any figures to hand, but if she wishes me to write to her on the issue, I shall be happy to do so.
I want to reassure the hon. Member for Wellingborough (Mr. Bone) on the question of community hospitals. He is right. The Government are committed to a new and exciting role for community hospitals, and I hope that that will help him in his discussions with his PCT. Just because the management arrangements have changed does not mean, if we are talking about reflecting and meeting the needs of local communities, that the commitment to community hospitals should change. I hasten to add from the Department of Health that it is not for me to dictate to the PCTs the nature of the projects that they should support. [Interruption.] I will give way to the hon. Member for Eddisbury in a moment.
The hon. Member for Wellingborough raised the question of the five-year-old child. It would be wrong for me to comment on an individual case, but it is slightly contradictory that Ministers are asked to make judgments about individual cases at that level when we have devolved resources to the PCTs and asked them to make decisions about priorities. I do not know the level of pain that that child is in right now. That should be important in determining the decision-making process. However, I cannot intervene directly in that individual case.
Mr. Stephen O'Brien: I shall be brief. It may be a point that the Chairman might want to consider by way of intervention if he catches your eye for any final remarks, Miss Begg. I note that on page 69 of its report, the Select Committee put to Lord Warner the point about the possible proposal to put out to tender the commissioning function in Oxfordshire. He assured them that that would not be allowed to happen.
However, an article has just been passed to me that appears in todays Health Service Journal in which it says that the Department of Health is doing precisely
that by asking for bids and tendering-out processes. I was wondering whether the Minister would like to take the opportunity to comment on that.
Mr. Bone: That is a Catch-22 position. The Minister is unable to comment on the case because it is a PCT responsibility. The PCT say that it is the Governments targets that are forcing them to postpone the operation.
Mr. Lewis: I would say to the hon. Gentleman that we give the PCT a significant amount of resource. We give them a major amount of autonomy. Yes, it also has priorities and targets that are set by Government. However, as I understand it the situation is that a five-year-old child is in pain. If it is as clear as the hon. Gentleman has reported it during the debate, he is right to pursue the question whether that childs treatment could not be provided in a more accelerated way. That is all that I can say to the hon. Gentleman. I cannot comment on whether the PCT and managements view, that that is a question of priorities, is a reasonable one. All I can say to the hon. Gentleman is that in any weighing of priorities, the pain of a five-year-old child should be given significant weight. However, I cannot go any further than that. I have probably gone too far as it is.
My hon. Friend, the Member for Pudsey (Mr. Truswell) is obviously frustrated, to say the least, about some of the changes that have been made in his area and some of the ways they have been approached. He expressed support for some of the innovative services that have been provided in recent times and concern that they may be detrimentally affected by those changes.
All I will say to my hon. Friend is that it is important, not to debate decisions that have already been made, but to ensure that the new structure delivers in the way that the Government intended. I am happy to engage in a constant dialogue with hon. Members, including my hon. Friend, to make sure that any fears or concerns that they have will not be borne out. That is not the end of the matter.
One of the matters that is legitimate in the debate is for right hon. and hon. Members to play a role in holding their local PCTs and other health organisations to account on how services are delivered at a local level. That need not be in a formal way, but it is an entirely proper part of a Member of the Houses responsibilities to ensure that local delivery organisations meet the needs of their constituents, and, if they do not, to bring that to the attention of the management of those organisations and, ultimately, to that of Ministers.
The significant thrust of what the hon. Member for Northavon (Steve Webb) was saying was that consultations were sometimes of a sham nature. He said that I looked disapproving at that statement. I did not actually. My experience of consultations, across the board in all services, is that sometimes managers issue consultation documentsnot just in the health service, but across the pieceand they know exactly the
decision that they have already made. They know the outcome that they want. The consultation is there to justify the decision that they have already made. Any hon. Member who would not acknowledge having had such an experience at one stage or another, in one consultation or another, would not be living in the real world. Such consultation is not acceptable, and should not be, to the Government or to locally or nationally elected representatives.
I do not think that the hon. Gentleman can describe the consultation as a sham. There is a lot of evidence that major listening took place. The evidence is in the changes that were made as a consequence of the listening. If the consultation were a sham and the Government wanted to drive the changes through on a one-size-fits-all basis, as we have been accused of, we would not necessarily have listened and we would not have made changes, so I do not think that that was entirely fair.
The hon. Gentleman talked about decisions being made locally. That was a big thrust of his argument. The strategic health authorities of course oversaw all of the consultations, not the Department of Health at a national level. However, there comes a point when there has to be some level of arbitration or mediation in making final judgments. Significant differences of opinion are always going to have to have an ultimate arbiter or mediator who comes up with a solution. That solution will not always be acceptable, either to local people or to other stakeholders. In some way there will always have to be somebody who makes a decision. There were very disparate and diverse views as to the best way forward. Obviously, the Government have to create a mechanism to arbitrate and mediate in such a circumstance.
Turning to the contribution of the hon. Member for Eddisbury, the argument that the Conservative Opposition tend to throw at the Government is that all we have done is to throw lots of money at the health service and as a consequence have not seen real improvements. Frankly, that is disingenuous. First of all, we have always made the case for reform alongside investment. That has been the mantra from day one in the way that we have sought to improve our health and social care services. Secondly, it is disingenuous to pretend that there has not been tangible improvement in many of our front-line services as a consequence of the Governments investment and reform programme. I believe that many members of the publicit is not a question of an ungrateful nationwould acknowledge that.
The hon. Gentleman described the financial challenges of the year as the worst crisis in the NHSs history, but I would say that the worst crisis in the NHSs history developed during 1979 to 1997. One of the primary reasons why the Major Government were thrown out of office to the extent that they were was because of the public belief that the health service had been so starved of resources, particularly during the latter years of the Major Government. The Conservative party paid the political price. That was a real crisis. I remember the bed-blocking stories every yearyear after year. They were almost accepted as an inevitable part of what was happening in the national
health service. One only needs to remember from a professional point of view, as well as from a patient point of view, the reality of those years.
The hon. Gentleman also raised questions about commissioning. I agree entirely with his belief in the centrality and importance of getting the commissioning right. The question is not just of commissioning at a practice level within the NHS, but also about how we can integrate commissioning in social and community care, as well as those commissioning functions currently under the national health service.
The hon. Gentleman also raised the question of health inequalities and making sure that, under the new configuration, we do not neglect or allow to become
invisible again some of the most deprived and disadvantaged communities. In my view we have to make sure that post-reconfiguration we continue to target resources on those most disadvantaged, in areas where health inequalities are at their starkest.
The hon. Gentleman also raised the question of the NICE guidelines on infertility. I know there is a fear among some of the organisations involved, but I do not believe that the reconfiguration per se will be a problem for the NICE guidelines. I want to reiterate that we do not believe that the reconfiguration of primary care trusts should lead to that situation