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Baroness Finlay of Llandaff: My Lords, before the Minister sits down, I thank him for informing us about the joint monitoring group on medical student expansion. As part of this, will there be a university representative on the boards of strategic health authorities?
Lord Hunt of Kings Heath: Yes, my Lords.
6.30 p.m.
Baroness Northover: My Lords, I thank the Minister for his reply and noble Lords for their participation in the debate and support for the amendments. Much of what the Minister said today, as opposed to in Committee, is welcome news. Nevertheless, I and many others remain concerned about this area. I do not feel as optimistic as the noble Baroness, Lady Gibson, about how things are going. The status quo is not good enough at the moment. This is an opportunity to try to improve on matters and certainly not to let them go back.
I can think of one current example of an endowment that is supposed to be used for teaching and research, but is being fought for by clinical academics against the understandable desire of administrators to fill a black hole. A duty on the administrators in question would make that situation easier for the clinical academics. There are clever ways of getting round that. Increasing service costs, which the Minister mentioned earlier, is one way in which that money can be tapped into. I see no reason for optimism about the current arrangements.
There is still time for the issue to be addressed. I hope that further thought will be given to it, because there is a shared concern across the House to ensure that education, training and research are promoted in
the NHS at every level. I hope that we can find a way to move forward that would command the support of your Lordships. In the meantime, I beg leave to withdraw the amendment.Amendment, by leave, withdrawn.
Clause 3 [Directions: distribution of functions]:
Baroness Noakes moved Amendment No. 7:
- After Clause 3, insert the following new clause—
The noble Baroness said: My Lords, the amendment would insert a new clause after Clause 3. It deals with the readiness of primary care trusts to take on the additional responsibilities that the Government plan to place on them. We had a useful discussion in Committee on the readiness of PCTs. However, that discussion did little to assuage the doubts that I and other noble Lords had raised. That is why I am returning to the subject.
This amendment is different from that tabled in Committee, which would have deferred the requirement for 100 per cent conversion to PCT status for a year. In the event, we learnt from the Minister that the vast majority of PCGs were scheduled to be converted to PCTs by 1st April. While we had considerable doubts about the conviction of local health professionals to those conversions, the plain fact was that it had happened. The moving finger writes and, having writ, moves on. We have to accept that PCTs are now a fact of life.
However, conversion to PCT status is only the beginning of the story, not the end of it. Conversion to PCT status allows health authorities to delegate some of their functions to PCTs. However, we know that the Secretary of State's aims, as set out in Shifting the Balance of Power, are for PCTs to be responsible for planning and securing the totality of care and services that their population needs. To that end, at least 75 per cent of NHS funds will be in the hands of PCTs in due course.
In practice, PCTs will be expected to carry out virtually all the functions of current health authorities. We have 300 or so PCTs, many of which have been in existence for only a matter of weeks. They are taking over the functions of what used to be 90-odd health authorities, until the other part of the health service restructuring forced that number down to 28.
The key issue addressed by the amendment is whether PCTs will be ready to take over the new responsibilities. The Government have said that they will delegate those responsibilities directly to PCTs from October this year. When we asked the Minister about the Department of Health's process for testing whether PCTs would be ready, we received answers that I found disconcerting. The Minister told us that the decision to allow PCTs to be formed was made on the basis of a number of criteria and that, provided those were satisfied, a PCT would get the go ahead. If the PCT then took on more responsibilities, that was a matter for the board. The strategic health authority also has a role in ensuring effective leadership.
I was grateful for the details about the initial criteria, which the Minister supplied last week, but they have not put my mind at rest. The criteria have a lot of abstracts, such as vision. Even the criterion of fitness for purpose focuses on processes to get adequate staff.
In Committee, I asked the Minister a number of detailed questions about the availability of properly qualified and experienced staff, including chief executives, finance directors, directors of public health and commission staff. I referred to many of the informed studies that identified weaknesses ranging from information management to governance. Remedying those defects is not a requirement of the approval criteria. As long as a PCT has a process, it will pass muster. It is clear that the Secretary of State will be happy to delegate functions to PCTs once the Act is passed without inquiry as to their readiness.
The amendment would provide for a detailed examination of each of the PCTs by the Audit Commission. Noble Lords may recall that when we discussed a similar amendment in Committee, the requirement was for an examination by the Commission for Health Improvement. The Audit Commission is more independent than CHI, although we shall return to that question later. The assumption in the amendment is that the Audit Commission would carry out readiness investigations.
The scheme of investigation is simple. The Audit Commission would investigate the readiness of every PCT to carry out the functions that were to be
There are two aspects of that procedure that I should like to note. First, the Audit Commission should publish its findings so that they are available not just to the Secretary of State, but to the strategic health authority, the patients forums, local authorities and others. Transparent processes are healthy processes. Secondly, subsection (2) deals specifically with two aspects of readiness. The first is
In that connection, perhaps the Minister will comment on the fact that it has now been decided that the annual development programme for PCT leaders is regarded as "neither appropriate nor helpful", according to a letter from the Modernisation Agency on 15th April. It is up to PCTs to decide whether to take part. Do the Government now believe that PCT people do not need a development programme, or is this a recognition that PCTs are struggling so much that time out for so-called development would be a straw that broke the camel's back?
The second aspect of subsection (2) is finance. If it is not clear that the PCTs have adequate finance to meet their responsibilities, as well as any inherited deficits, they should not go ahead. Financial stability must be an important prerequisite. In Committee, I spoke to a separate amendment dealing with the transfer of deficits to PCTs. I was disappointed that the Minister told us that the Government were set on saddling PCTs with the deficits of their forebears. It is important to see whether the PCTs can cope with the deficits that they will inherit.
I acknowledge that the criteria for PCT formation include detailed financial management questions, but they are not being considered immediately before PCTs are burdened with extra responsibilities. Finance is tight. There is plenty of anecdotal evidence that PCTs will be struggling with the deficits that they have inherited—deficits in the strict accounting sense and the much more important hidden or underlying deficits. The amendment would test, on a PCT-specific basis, whether those pressures can be coped with and whether there is sufficient money in the system overall, on an NHS-wide analysis.
I hope that the Minister will welcome this revised amendment and see the need for a detailed examination of PCT readiness before going ahead. I beg to move.
"READINESS OF PRIMARY CARE TRUSTS
(1) The Audit Commission shall investigate every Primary Care Trust with a view to establishing whether that Primary Care Trust is ready to carry out functions which the Secretary of State may transfer to it by way of a direction under section 16D of the 1977 Act.
(2) In carrying out an investigation under subsection (1), the Audit Commission shall consider in particular—
(a) whether the Primary Care Trust has staff of the right number, quality and experience to deal with the functions which may be transferred; and
(b) whether the finances of the Primary Care Trust are sufficient to meet the functions which may be transferred and any deficits which are to be transferred to it.
(3) If the Audit Commission considers that a Primary Care Trust is ready to carry out the functions referred to in subsection (1), it shall publish a report to that effect and shall send a copy of the report to the Secretary of State.
(4) If the Audit Commission considers that a Primary Care Trust is not ready to carry out the functions referred to in subsection (1), it shall not publish a report under subsection (3) but shall publish a notice setting out the matters that would need to be dealt with before a report under subsection (3) could be issued, and shall send a copy of the notice to the Secretary of State.
(5) If the Audit Commission has published a notice under subsection (4), the Secretary of State may request the Audit Commission to carry out a further investigation with a view to publishing a report under subsection (3).
(6) The Secretary of State may not make a direction under section 16D of the 1977 Act unless the Audit Commission has published a report under subsection (3).
(7) The Secretary of State shall pay the Audit Commission an amount equal to the full costs incurred by the Audit Commission in acting under this section."
"whether the Primary Care Trust has staff of the right number, quality and experience".
That is crucial. It will not be enough to say, as the Minister said in Committee, that there is a PCT development programme in process, or it is up to the chief executives to acquire the right staff.
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