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Baroness Carnegy of Lour: When the Minister replies, will he specifically answer the question of my noble friend Lord Howe? Can he assure the Committee that each primary care trust will have a competent chief executive in post and a competent finance director, somebody who is a specialist in public health and also other professionals who are able to deal with the various functions? The Committee needs a precise answer to that question because it is quite clear to anybody, whether they know about the detail of the trust functions or not, that without such people the changeover should not be made.
Lord Hunt of Kings Heath: I find myself somewhat disappointed by the tone of the remarks made in this debate so far about primary care trusts. In our very enjoyable debates on Clause 1 for the whole of last Thursday, the theme of the criticism of the Government was that we were adopting an over-centralist approach. Before us this afternoon there is evidence of the Government's decentralist approach and our aim to ensure that primary care trusts decision-making is as close as possible to GPs, primary care and the patient. Here we come forward with exciting ideas to get decision-making down to that level and the reaction of Members of the Committee who have spoken is shock, horror and, "You can't do this. We are very worried".
I make no apologies for being an absolute enthusiast for primary care trusts. Of course, I accept that there are tremendous challenges for them to take on and that there are those who are expressing some uncertainty about the ability of PCTs to do that. In the main they are not primary care trust themselves, but various pressure and interest groups which normally seek to influence the Government to take a highly centralist approach and wish the Government to continue to do so.
I say right at the outset that my experience in meeting primary care trusts and talking to general practitioners and the staff involved leads me to believe that they are very well able to take on the extra responsibility which they have been given. It is worth remarking that the first primary care trusts were established on 1st April 2000. Subsequent waves of primary care trusts have been established. In April 2001 we had 164 primary care trusts delivering healthcare to 47.7 per cent of the population.
The fact is that there is a great deal of enthusiasm out there for becoming primary care trusts and that is why we have received over 150 proposals from primary care groups and others who wish to become operational on 1st April 2002.
As regards the question asked by the noble Baroness, Lady Noakes, at present it is anticipated that only one primary care group will remain as at 1st April 2002. From that date we expect that there will be 303 operational primary care trusts. The one primary care group which we believe will remain at 1st April 2002 is Braintree which proposes to become a care trust from October 2002. There is one other primary care group, Crosby and Maghull, which is part of proposals to create a South Sefton primary care trust. That is currently subject to a submission to Ministers. If that were not to approved it would become a sub-committee of Bootle and Litherland primary care trust. Therefore, there would be two primary care groups left as at April 2002.
I completely deny that primary care groups have been dragooned into becoming primary care trusts. I have visited any number of such groups and trusts over the past few months. I am absolutely convinced that there is enthusiasm for getting on with the task and being given the enormous responsibility that they have. I am sure that primary care trusts will enable this
crucial inter-relationship between the decisions of GPs and primary care to be pulled together in the work they will do on commissioning, which I am convinced will lead to a much better balance of services between primary care, secondary and tertiary care.To suggest that those primary care trusts are incapable of managing these changes underestimates enormously the calibre of managers, primary care leaders and clinicians within the National Health Service. Already within PCTs which have been established we are seeing better support practice, better support to individual clinicians, better integrated and effective services and better access and design.
As the noble Lord, Lord Clement-Jones, has suggested, we have established a very good development programme to help primary care trusts prepare for operation. They include a co-ordinated development programme, a comprehensive self-assessment toolkit, an integrated whole systems package of development for each strategic health authority community and a robust infrastructure for all key stakeholders to have appropriate influence and to ensure that PCTs are equipped to deliver on the Government's objectives.
At local level, primary care trusts are being encouraged to develop and work collaboratively, to pool knowledge and to share capacity and expertise. I make no apology for that. For some particular functions primary care trusts will need to work together with others. But that does not detract at all from the individual ability of each primary care trust to work effectively. No one has ever suggested that each primary care trust would be totally self-sufficient. But I have no doubt whatever that co-operative arrangements which we determine locally will work effectively.
I was asked about the position of executive appointments. My understanding is that as of 11th March, chief executive appointments had been made in all except six primary care trusts. Clearly, they are crucial appointments. Once the chief executive has been appointed it will then be possible to get on with the appointment of other senior officers. No one could say that as at 1st April every primary care trust will have every senior officer position filled. However, I expect the NHS to have the arrangements in place to ensure a seamless process of transition of responsibility from health authorities and primary care trusts and that health authorities will support primary care trusts to ensure that there are no particular gaps.
Having said that, I turn to Amendment No. 52. It would require the Commission for Health Improvement to investigate whether primary care groups are properly prepared to become primary care trusts and whether they are ready to take on functions under this Bill. While I understand why the noble Baroness, Lady Noakes, makes this proposal, I do not believe that it is a proper function for the commission. CHI's responsibilities are quite specific. It may already carry out investigations into the management,
provision or quality of healthcare, for which primary care trusts have responsibility under the Health Act 1999. Under this Bill we are extending the responsibility of CHI, particularly to carry out general reviews of any aspect of NHS services.The independent review of services by the CHI is of a different order from that proposed in the new clause. It is not appropriate for the CHI to make the decisions envisaged in the new clause. The decision on whether a primary care group should become a primary care trust or whether a primary care trust should take on functions is surely for the Secretary of State to make. In making that decision, the Secretary of State needs to be satisfied in four key areas: the benefits of what will be achieved, the degree of support for the proposal, the fitness of the proposed organisation to deliver and the impact on other organisations.
Having been involved in approving a number of applications for organisations to become primary care trusts, I can confirm that the decision is taken only after the fullest consideration. Careful analysis is undertaken and Ministers ensure that the key questions that need to be asked are posed. We have to be satisfied that the proposed primary care trust can take on the responsibilities that it is to be given.
I understand why questions have been asked about the preparedness of primary care trusts. They are being given an enormous responsibility. However, I am confident that they can take on that role. I have been impressed in my visits to primary care trusts. They do not need delay and uncertainty; they need to press on. I am confident that they can do so.
3.30 p.m.
Baroness Noakes: I thank the Minister for that response, which was not a big surprise. We on these Benches are not against the proposals to devolve functions to primary care trusts; we are against the premature delegation of functions and transfer of responsibilities before those trusts are ready. That was the purpose of my questions to the Minister.
The Minister has said that he has met a lot of enthusiasts. That often happens to Ministers. They do not necessarily meet a representative selection of opinion in the NHS. I am afraid that that is a fact of life.
Lord Hunt of Kings Heath: Health Ministers meet all shades of opinion. I assure the noble Baroness that I have met health authorities, in particular, that have expressed concerns about the transition of power to primary care trusts. However, there is self-interest in some of those concerns. My whole experience of the NHS is that at the end of the day it always rises to the challenge.
Baroness Noakes: I do not doubt the sincerity of the Minister's views, although he has taken an unnecessary swipe at those organisations that have reported lack of preparedness. One would not suspect the King's Fund or district auditors of having a particular agenda.
I asked the Minister whether each of the 300 or so bodies would have a chief executive who had the competencies for new PCT status. He replied that there would be a chief executive in all but six. Will they all be chief executives selected for the competencies of the new PCTs, or will they be chief executives who were in post under the old arrangements, who were not expected to have the competencies of the new roles of PCTs? I understand that there has had to be a reappraisal of those already in post to see whether they are capable of undertaking the role for the new PCTs. However, that deals only with chief executives. I understood the Minister to say that we would then move on to other posts. I asked about qualified finance directors, public health specialists and the staff who will handle functions such as commissioning, as well as the underpinning requirements of money and information systems. I must press the Minister on what progress has been made on those posts. It is all very well to say that chief executives will come in and see to the rest, but there is an awful lot to do if all those posts are not in place or substantially in place by now. Perhaps he will comment on that.
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