Examination of Witnesses (Questions 160
- 173)
THURSDAY 10 NOVEMBER 2005
CHANGES TO
PRIMARY CARE
TRUSTS
Q160 Dr Taylor: Two of you have said
that mergers are inevitable and that you are quite happy with
them. How are you going to maintain the local focus when you lose
the separate PCTs? Are you going to maintain PECs or the equivalent
of PECs in each sort of area? How are you going to do it?
Mrs Rhodes: Where I come from
we will have a locality structure, I do not think there is any
doubt about that. It is yet to be decided what the actual function
of the locality will be as opposed to the function of the central
PCT.
Q161 Dr Taylor: But the aim will
be to take clinicians on board in localities, will it?
Mrs Rhodes: Yes, whether we have
an expert reference group or a locality board or whatever way
we do it. In the everyday work of commissioning and providing
care they will be engaged at that level.
Q162 Dr Taylor: What will you do
about patient and citizen involvement?
Mrs Rhodes: It will probably be
at all levels.
Q163 Dr Taylor: Will you try to keep
forums where you have got them at the moment or will you go with
one PCT, one patient forum?
Mrs Rhodes: I cannot answer that
at the moment.
Mr Barrett: I think it is fair
to say that we are only at the start of the process at the moment
and therefore we have not put all the jigsaw pieces in place.
I think a lot depends on the geography of the area. Derbyshire
is a fairly reasonable sized area. To have just one may not be
the best way forward.
Q164 Mr Amess: Mr Hollins, you have
two Essex men on the Committee so we are very interested in what
goes on in our county. I represented the town, as you are aware,
for 14 glorious years. I knew all the general practitioners, I
was closely in touch with all that went on in Basildon Hospital
and many of the staff remain my friends today. The written evidence
you have given to the Committee is pretty devastating, frankly.
You point out that already unsettled staff, particularly in provider
services are voting with their feet by moving to organisations
perceived as more stable and this time this will be the acute
sector of the NHS or mental health trusts. You say, "This
is highly counter-productive at a time when Government policy,
through patient choice and good medical practice, is focusing
on admission avoidance and managing long-term conditions in the
community." That is pretty devastating. Is there anything
else you want to add to the impact on staff?
Mr Hollins: It is pretty obvious
that if somebody is uncertain about their future role in life
they will worry. All the PCTs are in the same position right now
and so the job opportunities for people to move will be limited.
The turnover at the hospitals is relatively high and therefore
there are opportunities for community nurses to go into what might
be seen as a `safer ship'. One thing I would like to say about
the provider side of it is that when the policy came out in July
we were very surprised that provider services were in the equation
with regard to being disaggregated from PCTs. There had never
been any hint whatsoever from the Department of Health that such
a policy was in the pipeline. As a rule you do tend to get some
advance information about what the thinking is. For this to hit
the decks in a raw state actually knocked us off our seats to
some extent. Since then there has been a statement about how it
may or may not be in or out of the PCTs. One thing I would like
to ask today is if you could get absolute clarity for us as to
whether the provider services are in or out but not like "shake
it all about" because our provider services have been the
poor relations of the NHS for many years. I know some staff in
our community that have had different employer names on their
pay slips and have been tuped five times in less than ten years.[1]
I think it is time to treat them as equal citizens to the acute
and the mental health and to build them up so that they can be
a solid provider of services. We need to have contracts which
are strong and equivalent to the other providers so they can be
commissioned from.
Q165 Mr Amess: The Committee has
heard what you have said. No doubt you are making robust representations
not only through the local authority but through the Member of
Parliament who represents part of my old constituency. You are
literally Basildon stand alone, the PCT?
Mr Hollins: In terms of?
Q166 Mr Amess: It is just the town
itself, the new town?
Mr Hollins: Yes.
Q167 Mr Amess: Nothing else?
Mr Hollins: It excludes Wickford
and Billericay. It is a population of about 110,000.
Q168 Mr Amess: I am the last person
to want to put words in people's mouths. Would you say that this
is a crisis that you are facing at the moment in terms of staffing
levels?
Mr Hollins: No, I do not think
so. Our turnover, fortunately, is one of the lowest in Essex in
terms of the NHS Trusts. Over the last 12 months we have been
blessed by the fact that when we advertise for clinical staff
we do get quite a long list of applicants.
Q169 Mr Amess: I hope you are not
pinching them all from Southend.
Mr Hollins: I hope not.
Q170 Chairman: Have any of the others
anything to add in terms of staff morale?
Mr Barrett: Just a comment in
terms of some practical examples. I was talking last week with
one of my matrons in a community hospital in Buxton. She has lost
four qualified nurses in the last few weeks to the local foundation
trusts and they have gone because of uncertainty about their future,
fear about effectively being privatised. Even though clearly we
try and dispel the rumours as best we can, the rumours are out
there. Let me give another example. One commissioning manager
with 32 years NHS experience, aged 56, has decided to take early
retirement because he cannot face another NHS reorganisation.
Mrs Rhodes: I think there is a
very serious risk in destabilising some essential community services.
Where I come from, at the moment we have not seen a drift of staff,
but they are so uncomfortable about their futures that it is only
a matter of time. It will happen, I am sure.
Q171 Mr Burstow: I am rather attracted
by this idea of `hokey-cokey' policy making which was being described
just now. I think your perspective on this is clear around this
question of divestment, but it would be useful to hear all three
of our witnesses give their view as to whether or not you are
clear, in the light of what has been said subsequent to the letter
from Sir Nigel Crisp of 28 July, that the direction of travel
is to minimise service provision by PCTs in the future and if
you are not clear, why are you not clear? What do you believe
needs to be done by ministers to make you absolutely clear about
the direction of travel?
Mrs Rhodes: I feel cautiously
optimistic, but I hand on heart cannot say to the staff in the
PCT that they will stay with the PCT because that decision is
very clearly being given to the PCT boards. We also do not know
what the White Paper is going to say. Without that it would be
unwise to give staff false hopes. We are not doing that.
Q172 Mr Burstow: So for you the White
Paper is a very key part of this process and what is written in
that will influence it a lot?
Mrs Rhodes: Absolutely.
Mr Hollins: I agree. I think it
is unclear at the moment. Our SHA has tried to get clarification
of the latest statement and the view coming back is that there
is no change to policy, ie PCTs will divest themselves of provider
services at some point.
Mr Barrett: I would be quite happy
to see PCTs divest of their provider services to another NHS organisation,
we could be talking about a care trust for instance, and there
would probably be some advantages in terms of economies of scale.
There is an argument that some provider services within small
PCTs are perhaps too small. I think we could achieve the benefits
in terms of decoupling commissioning and providing. The PCT would
then be commissioning that service from an NHS care trust.
Q173 Mr Burstow: That would be a
reinvention of NHS community trusts, would it not?
Mr Barrett: Yes. That is probably
why it is not going to happen, because it is going to create new
organisations when we are trying to save money by reducing organisations.
Chairman: Thank you very much indeed
for coming along this morning. It has been very useful for us
for the purposes of this inquiry.
1 TUPE-Transfer of Undertakings (Protection of Employment)
Regulations 1981 Back
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