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Health Bill [H.L.]
3.39 p.m.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman): My Lords, I beg to move that the House do now resolve itself into Committee on this Bill.
Moved, That the House do now resolve itself into Committee.--(Baroness Hayman.)
On Question, Motion agreed to.
House in Committee accordingly.
[The CHAIRMAN OF COMMITTEES in the Chair.]
Clause 1 [Repeal of law about fund-holding practices]:
Earl Howe moved Amendment No. 1:
The noble Earl said: At the start of our Committee proceedings, perhaps I may say that regardless of the profound difficulties which we on these Benches have with many parts of the Bill, I shall be guided in what I say both today and on Monday by two principles. The first is that where we oppose, we shall oppose in a constructive fashion. It is no part of our purpose to wreck the Bill, nor will we do so. We will, however, seek to press those issues where we believe we are right and where we believe we can create a better Bill to a Division where necessary. That approach is consistent with the functions and traditions of your Lordships' House and will, I hope, be understood and accepted by the Government.
The second principle to which we shall try to adhere is brevity. I humbly suggest to the Committee that with the sheer number of amendments ahead of us during the
Unfortunately, I cannot be as brief as I would wish with the first amendment, although I shall try. Its purpose is to defer by 12 months the date on which fundholding formally comes to an end. I propose it not in any kind of "die-in-the-ditch" spirit, nor in any way to frustrate the Government's intentions to establish primary care groups and primary care trusts, but to do precisely the opposite.
The Government have had over a year to prepare for the advent of primary care groups and in some areas the transition to PCGs is proceeding reasonably satisfactorily. But that is not the case in a great many other areas. There is an enormous number of obstacles still faced by PCGs and board members in attempting to establish the new structures.
The work involved is considerable. To start with, there is wide dissatisfaction over the question of PCG boundaries and at the moment no mechanism to allow for independent review of health authority proposals. The amount of money made available for the development of PCGs has been woefully inadequate. Many GPs and others have had to give up substantial amounts of their own time, without remuneration, to organise meetings, to discuss the new arrangements with health authorities and to set up steering groups. With PCG boards, the guidance on election arrangements and payments to PCG board members has resulted in appointments being rushed and a woeful lack of information about the time commitment that a board member will need to devote to his or her responsibilities.
Even at this late stage, many PCGs are still in the throes of negotiating their management budgets. Without those budgets, they will not, of course, be able to decide on anything; not their management structures, nor their activities, nor the responsibilities that they wish the health authority to delegate to them. The key issue in many areas is that the per capita level of support is far too low.
There is terrible uncertainty as a result among fundholding staff about their future employment. Where staff have been made redundant, the redundancy payments are often being met out of the pockets of GPs who have had to face the whole messy business of redeployment and redundancy of practice staff with precious little information to assist them.
Local services are being terminated early. We have assurances that contracts for the delivery of specialised services such as chiropody, dietetics and physiotherapy, as well as consultant-led clinics in GP surgeries, would not have to be brought to an abrupt end as a result of PCGs. But that is exactly what is happening in some health authorities where the edict has gone out to terminate those contracts before 1st April.
Guidance is being issued late and piecemeal. Even the revised standing orders and financial instructions for health authorities have yet to be distributed. There is still no information about the IT structures and reporting
The simple fact is that the whole exercise in what is a major change for the NHS has been rushed. At local level, the NHS is simply unable to cope with the timetable that has been thrust upon it by the Government. The result is that many GPs are still, to put it at its mildest, unenthusiastic about PCGs because they see an underdeveloped idea being forced upon them at too rapid a pace, with grossly inadequate financial and managerial support. There is demotivation. They see nothing ahead of them but extra workload. Some of the work will take them away from patient care, without providing their patients with replacement doctors. The doctors are being put in the firing line to take the flak from patients and the public when the NHS finds itself unable to deliver the necessary care because of the woeful degree of under-funding.
My point is therefore a straightforward one. It is to say to the Government: "Stop rushing. Stop making life impossible for doctors and patients all around the country. There is still time, if you choose to take it, to ensure that this important transition is made smoothly and to everyone's satisfaction". For that reason and that reason alone, I beg to move.
Viscount Bridgewater: I support my noble friend Lord Howe in his amendment. The PCGs will be much bigger units than anything equivalent which has been known before. They will be drawn from a diverse series of practices. The fundholders in the first wave are very different in character from many in the later waves of the practices. They will include many sole practitioners with little or no back-up. They will require a tremendous amount of training, to which my noble friend referred. The very size of the PCGs and their diverse nature throughout the country make it advisable that we delay this for a year, as my noble friend suggested.
Baroness Gardner of Parkes: I too support the amendment. The question of redundant staff is causing great anxiety to general practices which find that they have to dispense with their practice manager in order to go into the bigger unit where someone else will carry out the management. Funds do not seem to be available to meet the redundancies.
Baroness Carnegy of Lour: I too support my noble friend largely on the grounds that he has explained; namely, the problems faced by the participants in this enormous change. I was extremely grateful to the Minister for the meeting that she arranged with her team of civil servants who between them knew everything there was to know about the Bill. They were extremely helpful. The Minister even brought three civil servants down from the Scottish Office.
At that meeting I asked about the legality of the position given that arrangements both north and south of the Border were proceeding regardless of the fact that the Bill was only at the early stages of its passage through Parliament. We were told that much that was
This particular clause is essential to the Government's arrangements. It shows an extraordinary disregard for Parliament and is another example--we see more and more--of the Government being prepared to proceed with a scheme, an integral part of which is the abolition of fundholding, before they know whether or not the Bill will become law. For all we know, fundholding may be restored during the passage of the Bill. I understand why the Government are optimistic that it will not be, but they should not make that assumption. This is a very strange way in which to proceed. For that reason the amendment will increase the legality and credibility of the Government's actions and I hope that they will accept it.
Lord Desai: I am somewhat surprised by the very muted way in which the noble Earl moved his amendment. It reminded me of his party's policy on the euro. It does not like it but it does not want to say that and it will do it some other day. It would be nice if he argued that we should keep fundholding. As the noble Baroness, Lady Carnegy, said, perhaps he should have argued for the retention of fundholding. It might have been fun.
Earl Howe: I am grateful to the noble Lord for giving way. I remind him that it was a manifesto commitment of his party, and we do not wish to upset that.
Lord Desai: That is very good to know. If it has been known for some time that the Labour Party will remove fundholding and consultative papers have been issued, those involved should have prepared for it. It has not happened suddenly. Intelligent people should be able to take account of forthcoming events and make allowances for them. This has been known about for some time. Either it has been known for some time that the Labour Party will do it, and therefore adequate notice has been given, or the noble Earl does not like what we are doing. Either way I do not believe that he has an argument.
Page 1, line 10, at end insert ("from 31st March 2000").
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