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Session 2005 - 06
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Standing Committee Debates

Strategic Health Authorities (Establishment and Abolition) (England) Order 2006 (S.I. 2006, No. 1408)



The Committee consisted of the following Members:

Chairman: John Bercow
Afriyie, Adam (Windsor) (Con)
Austin, Mr. Ian (Dudley, North) (Lab)
Blunt, Mr. Crispin (Reigate) (Con)
Campbell, Mr. Ronnie (Blyth Valley) (Lab)
Cruddas, Jon (Dagenham) (Lab)
Duddridge, James (Rochford and Southend, East) (Con)
Eagle, Angela (Wallasey) (Lab)
Irranca-Davies, Huw (Ogmore) (Lab)
Kennedy, Jane (Liverpool, Wavertree) (Lab)
Lancaster, Mr. Mark (North-East Milton Keynes) (Con)
Lewis, Mr. Ivan (Parliamentary Under-Secretary of State for Health)
McIsaac, Shona (Cleethorpes) (Lab)
Mactaggart, Fiona (Slough) (Lab)
O'Brien, Mr. Stephen (Eddisbury) (Con)
Pugh, Dr. John (Southport) (LD)
Ruddock, Joan (Lewisham, Deptford) (Lab)
Webb, Steve (Northavon) (LD)
Geoffrey Farrar, Committee Clerk
† attended the Committee

Fourth Standing Committee on Delegated Legislation

Thursday 26 October 2006

[Mr. John Bercow in the Chair]

Strategic Health Authorities (Establishment and Abolition) (England) Order 2006 (S.I. 2006, No. 1408)

8.55 am
Dr. John Pugh (Southport) (LD): I beg to move,
That the Committee has considered the Strategic Health Authorities (Establishment and Abolition) (England) Order 2006 (S.I. 2006, No. 1408).
It is an honour and a privilege to serve under your chairmanship, Mr. Bercow, especially at this early hour of the day. The health authorities are already a reality. The adverts were out before any Opposition party had an opportunity to oppose or debate this. The Government find themselves, once again, in the position of a dodgy builder applying for retrospective planning permission. Most debates in this place, as we accepted yesterday, end up with a fairly futile outcome. This action is impossible to reverse without massive dislocation to existing services. But there are reasons for examining what the Government have done, even if the Government do not welcome it. I cannot help thinking that Government business managers deliberately timetabled this event for this time so that scrutiny would be the lesser.
Angela Eagle (Wallasey) (Lab): The hon. Gentleman may feel less awake at this time in the morning but some of us are wide awake and ready to scrutinise the order for as long as it takes.
Dr. Pugh: I am sure that is the case.
There are three areas of concern here. First, there are personnel matters; secondly, there are functional issues and thirdly there are questions of accountability. Now that the dust has settled it is well worth airing those issues. It is foolish to suggest that the strategic health authorities are lamented by the public. I have known very few campaigns with the slogan “Save our SHA”. What we have is a reversal to an old system. It none the less represents a massive shift in personnel within the health service and a very hasty one. It is a kind of mad hatter’s tea party.
Observations show that there has been considerable shuffling around. Some new blood has been brought in, but the general effect has been a churn in quangoland within the NHS. Neither type of change has been particularly uncontentious. Where existing personnel have been reallocated there have been complaints about there being a magic circle with jobs being sorted out well in advance. There is some evidence to suggest that people have simply swapped chairs around. Where new blood has been introduced, there has also been some controversy. Merseyside Members have made representations about the lack of prior experience in the health service of the chair of the regional health authority in the north-west.
I recognise that all the appointing has been done by the fully independent NHS Appointments Commission, but it is silly to pretend that it is not influenced by pressure some time or by second guessing Government expectations. It is silly to pretend that it is not limited by people availability, given the limited time frame for action.
James Duddridge (Rochford and Southend, East) (Con): It is an honour to serve under your chairmanship, Mr. Bercow. Could I ask the hon. Gentleman where the hon. Member for Northavon (Steve Webb) is, given that this is so important and he has prayed against this order?
Dr. Pugh: My hon. Friend is entirely confident that the case will be put as he would wish this morning.
James Duddridge: And yesterday.
Dr. Pugh: The principal spokesman for the Conservatives is not here and so I am not quite sure what point the hon. Gentleman is making.
Mr. Stephen O'Brien (Eddisbury) (Con): On a point of order, Mr Bercow. I should be grateful for your guidance on a matter of accountability to establish where the hon. Member for Northavon may be, given that he prayed against the order, forcing us all to be here and thereby incurring taxpayer costs, as the officials have no doubt had to prepare the Minister for the event. That is completely to be distinguishedfrom the shadow Secretary of State who did not pray against the order and is therefore on the Committee. It is a legitimate question to which we need an answer.
The Chairman: I am grateful to the hon. Gentleman, but as I think he knows, that is not a point of order but party political point scoring.
Dr. Pugh: We will return to the subject. The circumstances are not ideal for reorganising the NHS appointments right across the board, particularly in connection with the regional and strategic health authorities. Most people would accept that it has been an appreciable distraction for those executives charged with running the health service. Now that the dust has settled, it is important to find out what has happened, how many people have been re-circulated in the system, how much new blood has entered, and how much politicisation there has been.
Are the new regional health authorities staffed by more people who have political affiliations than those people who staffed the previous authorities? How much transfer has there been between the sectors? For example, some people were involved in strategy, and they therefore have a legitimate claim to be on a regional health authority. Some people have moved from strategy to commissioning, and from commissioning to delivery. The churn has been difficult to explain and justify purely on individual merit. That is important because SRA chiefs, having been appointed, however well that process may have been conducted, find themselves appointing the next level down, the trust heads, either at acute level or at primary care trust level.
On functionality, one RHA replaces many SHAs, but, presumably, TUPE notwithstanding, with significantly reduced staff. That implies a change in function or behaviour. I can best illustrate that by discussing my own neck of the woods. When Merseyside and Cheshire SRA existed, and when issues such as hospital reconfiguration and addressing public disquiet existed—
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): Do I need to consult Department for Transport colleagues about the Strategic Rail Authority? As I understand it, we are here to discuss strategic health authorities. Will the hon. Gentleman be clear?
Dr. Pugh: A slip of the tongue. I am sorry. We are discussing not the SRA, but strategic health authorites. The SHA, which preceded the regional health authority, was a body with which I, as a constituency MP, could get in touch whenever there were issues of substance. It was not too difficult; there were regular briefings, contacts and phone calls. The net effect was that issues were dealt with more elegantly and with more care than I suspect they will be when we deal with the regional body. It was more like dealing with a branch office rather than head office.
As a sign of things to come, I tried to obtain a meeting with the chairman of my local regional health authority, and it took me weeks. There were several reallocations of time, and eventually we met for a brief and somewhat perfunctory half-hour appointment. That format did not exist hitherto, and if that is the shape of things to come, it represents a change to the way in which those institutions operate. The RHAs will be more like the Government office for the north-west than the strategic health authorities of the past. I do not see how the authorities can change in size and scale and remain functionally identical. It is not only a case of taking over the statutory duties under article 6. Strategic health authorities throughout the country have prior commitments to and understandings with local bodies, communities and trusts, which, presumably, the successor bodies will not necessarily honour. In a sense, all bets are off.
My final point is about accountability. A range of regional bodies now dovetail neatly: there are Government offices for every area, regional development agencies, regional assemblies, and now, regional health bodies. Necessarily, they must co-operate on a series of public health agendas. Will the regional health bodies be accountable upwards to the Department of Health, or, in the future, to the regional assembly, Government office or whatever body exists in the region? Will accountability be horizontal as well as vertical? The answer might be implicit in the proposals before us. If it is, I should like the Minister to specify that it is.
9.4 am
Mr. O'Brien: Mr. Bercow, this is the first time I have served under you; it is a great honour and opportunity to do so.
Today’s sitting is interesting, because we had a little 25-minute rehearsal for it a week last Tuesday, when this order was prayed against, having suddenly appeared on the Order Paper as not debatable after10 pm. However, the business on that day folded at about 9.30 pm. I suddenly found myself holding a piece of paper in the Members’ Lobby and was asked immediately to debate the matter. We had some fun doing that, mainly because we needed to establish why we were doing so, given that the order had been made on 25 May, was laid before Parliament on 2 June and came into force on 1 July.
All hon. Members are aware that the Strategic Health Authorities in their local areas and constituencies came into effect on 1 July, during a previous Session, so there was plenty of time to debate it then. There was a question about why we were debating something that was totally implemented within the normal constraints of programming, to which it is well known that Her Majesty’s loyal Opposition takes a fundamental and principled objection. None the less, within those constraints, there has been the opportunity to debate this matter.
Many of the arguments that the hon. Member for Northavon (Steve Webb) advanced—[Interruption.]
Dr. Pugh: Southport.
Mr. O'Brien: I am sorry. That is my mistake, Mr. Bercow. I had been so looking forward to hearing the hon. Member who prayed against the order.I apologise to the hon. Member for Southport(Dr. Pugh), who is an equally esteemed Member of Parliament for the north-west.
We had a quick skirmish a week last Tuesday┬ about a matter of process, and we are still talking about that process today. During the previous debate, I asked from the Dispatch Box would happen if the House were to vote against the measure, given that it had already been implemented. Although a Health Minister eventually scooted along the Front Bench to listen to what I had to say, the Deputy Leader of the House chose to respond, saying:
“The consequences would be dire.”—[Official Report,17 October 2006; Vol. 846, c. 450.]
Can hon. Members imagine what it would be like—irrespective of whether we think that it has been appropriately done—for people to have been appointed as a member of a strategic health authority only to find suddenly that Parliament, having established it, then chooses to vote against it many weeks afterwards? That would have been ridiculous.
Although procedure has been conformed to, there is a question over the use of a prayer. It was right for my hon. Friend the Member for Rochford and Southend, East (James Duddridge) to ask in an intervention where the hon. Member for Northavon is. Although it is far from being a problem for any other Committee member to be here at 8.55 am, it sadly appears to be a problem for the hon. Member, who prayed against the order. So, the opening remark from the hon. Member for Southport was perhaps not quite as justified as he might have hoped.
Mr. Crispin Blunt (Reigate) (Con): I note that the hon. Member for Southport was able to produce no account of where the hon. Member for Northavon is. There was some suggestion that a Thursday morning was a difficult time for Liberal Democrat Members to hold to the Government to account. I was wondering whether it might interrupt their weekend.
 
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Prepared 27 October 2006