The
Committee consisted of the following
Members:
†
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.]
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.
