| Previous Section | Back to Table of Contents | Lords Hansard Home Page |
Earl Howe: My Lords, the House will be grateful to the noble Lord for repeating the Statement.
In 2001, in the document called Shifting the Balance of Power, the Government announced that 302 PCTs would replace the existing health authorities and that the nine regional offices of the NHS Executive would be abolished in favour of 28 strategic health authorities. The announcement today effectively returns the NHS to a very similar organisational configuration to the one which the Government abolished only three years ago. That fact alone is enough to call the judgment of Ministers and officials into question. The Minister mentions cost savings arising from these mergers, but we all know that reorganisation itself carries a very considerable cost. Can the Minister say what the cost is likely to be in redundancy pay? Is the figure I have read of £320 million an accurate estimate?
There is a further issue here. These very far-reaching changes to the structure of PCTs are being made without real clarity on what their functions are supposed to be. Why was it decided to retain the provider role and functions of PCTs when it was initially said by the Government that there was such a compelling case for removing those functions? What is the Government's endgame in view? Will PCTs be encouraged to divest themselves of their provider functions? If it is to be down to local decision-making, what criteria should govern such decisions as practice-based commissioning develops? Finally on PCTs, I would like to pick the Minister up on two particular matters that he mentioned. He spoke of the need to retain a strong locality focus. How does he propose to do that with these larger structures? And what added benefits does the Minister see for the commissioning of services? As he will remember, commissioning is an issue that we have debated in this House in recent months.
Moving to ambulance trusts, I welcome and am relieved by the decision on Staffordshire ambulance service, although its future is still less than clear. But it is not self-evident, despite what the Minister said, that bigger is better in this area. Some of the much smaller trusts which struggle with poorer response times will no doubt welcome a merger and derive a benefit from it, but there is a real issue over whether the creation of
16 May 2006 : Column 194
ambulance trusts over sometimes very large areas like the greater part of East Anglia will do anything at all for responsiveness and flexibility.
Some interesting comments have been published recently on this theme. According to one unnamed chair of an NHS ambulance trust, the former chief executive of the NHS, Sir Nigel Crisp, told him that the changes were driven by the manifesto pledge of the Government to find £250 million of savings in NHS management and administration costs. The chair said that the changes had,
The chief executive of Staffordshire Ambulance Trust, Roger Thayne, has condemned the proposed mergers. He has said that there is,
"no evidence that larger ambulance services are anything [other] than more expensive and do not improve performance and save more lives . . . Services serving a population of more than 2 million cost more and save less lives. The worst thing is we don't know why they're doing this—but I do know it won't save more lives".
That was from an article in the Health Service Journal of 22 September last year. Those comments are entirely apposite. It seems to many that what the Government are now doing is primarily cost driven, not outcome driven. Can the Minister say in what respects the reorganisation of ambulance trusts is designed to integrate ambulance services with the other emergency services? How can such integration be possible when in many instances different services are using different communication and co-ordination systems?
If you talk to those who work in the NHS, you will hear a number of comments at the moment, but one is heard perhaps more than others about the activities of Government. It is: when will they stop moving the deckchairs and let us get on with it? I suggest that it behoves Ministers to ask themselves that question now.
5.32 pm
Baroness Barker: My Lords, I too thank the Minister for repeating the Statement made in another place. Since this Government came to power there have been seven reorganisations of the National Health Service. The announcement today marks the eighth and ninth. The NHS could have wanted nothing less.
As the noble Earl said, four years ago regional health authorities were abolished. Today's announcement begs the question of whether the Government were right then to abolish health authorities or whether they are right now to recreate them in a new form. They must have been right at one point and wrong at another. Would the Minister tell us which?
Secondly, today's Statement made much of the anticipated savings of £250 million. Would the noble Lord tell us the evidence for that figure? In January the Health Select Committee, writing on the subject of PCT reorganisation, said that at best it could estimate savings of between £60 million to £100 million. How was that figure of £250 million arrived at and will it be recurrent? Furthermore, can the Minister tell us the
16 May 2006 : Column 195
anticipated number of redundancies of managers and how will that interplay with the number of frontline staff currently being shed by trusts?
The Minister said in the Statement that there would be an achievement of 70 per cent coterminosity with social services. On behalf of my colleagues, I welcome the fact that the Government have in some cases listened and changed their proposals, particularly on coterminosity in some parts of the country. Given that coterminosity of PCTs and social services remains the same in London, and they represent 32 out of 152 trusts, there must be a substantial part of the rest of the country where there is no coterminosity. Given that the numbers of older people—particularly heavy users of ambulance trust and PCT services—live in areas that are not coterminous and given that at the same time social services are having to deliver against a background of 15 per cent cuts and savings, can the Minister say what the Statement means for the future integration of health and social care services?
I too wish to make some points on ambulance services. I echo the noble Earl's feeling that bigger is not necessarily fitter for function, but given that ambulance services are going to be reorganised at the same time as the reorganisation of police forces, can the Minister say what the implications of that would be for co-ordination of emergency work? Furthermore, if ambulance trusts are to cover much wider areas, what is going to happen to people in rural areas? How will this reorganisation ensure that there is equity between those who live in rural areas and those who live in larger urban areas, whose demands on the ambulance service can be particularly high—particularly high at key points such as evenings and weekends?
This restructuring is to be implemented by October this year. It is being introduced at a time when practice-based commissioning is being rolled out. It is the structural backdrop to the implementation of the White Paper and is being introduced when there is a great deal of uncertainty in all the different parts of the NHS, such as NHS Direct, which this week announced a whole load of job cuts too. Will the targets that PCTs are supposed to achieve, particularly in things like roll-out of practice-based commissioning, be altered in any way while they try to find their way though what seems inevitably to be a summer of job cuts and a winter of confusion?
5.37 pm
Lord Warner: My Lords, there is quite a lot there to respond to. I will do my best to give coherent responses to the points made by the noble Earl, Lord Howe, and the noble Baroness, Lady Barker.
Both raised the issue of redundancy. The £250 million is a conservative estimate of the savings likely to be made—a mixture of staff and non-staff savings, including real estate issues. When people study the changes more closely, they will see that there is a lot of emphasis on sharing back-office services and, in some cases, sharing management systems and doing joint commissioning, too. Some of these provide scope—confidently, we think—for £250 million, which will be
16 May 2006 : Column 196
a recurring saving. It is worth bearing in mind that the redundancies are a one-off payment to secure those recurring savings. We confidently predict that we will get four-year savings in 2008-09 and these will go, as I said when repeating the Statement, on front-line services. These will help particularly with areas around long-term conditions and some front-line services in acute services.
On removing provider functions from PCTs, the Secretary of State, Patricia Hewitt, has made clear on a number of occasions—as have I—that we have no intention of requiring PCTs to divest themselves of their provider functions. However, the trusts will need to continue to ensure that the provider services in their area are fit for purpose. That is why we will be going through, as I said in the Statement, a process of ensuring their fitness for purpose, so that they can ensure that the right services are in place to meet the needs of all the people in their communities, including those in the areas of greatest deprivation, some of whom need new providers and alternative providers to be in place.
Coterminosity was welcomed by the noble Baroness, Lady Barker. We have significantly increased coterminosity with social services through these changes. That was a big issue in the public consultation, which led to the White Paper. People want their services to be integrated. It was not possible to achieve 100 per cent coterminosity. We listened carefully to what local stakeholders said and we have adapted some of the proposals to meet those concerns. There is a balance to be struck in some parts of the country between coterminosity and meeting the needs of health inequalities—also having bodies in place that carry a great deal of public confidence. There is not a lot of point in going through an exercise where more than 12,000 people turn up at public meetings to debate and many more write in with their views, and not listen to those views—particularly where front-line staff such as GPs express their views on the most suitable configuration at a particular local level.
I hear what both noble Lords say about big not necessarily being beautiful in relation to ambulance trusts. I note the welcome of the noble Earl, Lord Howe, for the arrangements in Staffordshire. We listened to the advice that was given to us by our National Ambulance Adviser, as I made clear in the Statement. Peter Bradley consulted a considerable stakeholder group before he fashioned the advice in the report mentioned in the Statement. His views were not the same as those of Roger Thane of Staffordshire—who, let me remind the noble Earl, has resigned and is no longer the chief executive of Staffordshire. Mr Thane has his views—he is entitled to them—but they are not the views expressed by our National Ambulance Adviser and are not necessarily the views which are shared by a large number of people in the ambulance service. We think it is essential to listen to that advice because it makes clear that a number of trusts need to be larger in order to provide the infrastructure and the capability to cope with the changing needs placed on our ambulance service.
16 May 2006 : Column 197
As to rural areas, these proposals will not change front-line services or where ambulance stations are located. There is nothing in the proposals which will require any ambulance trust to change its ambulance stations. Of course, over time, in all places, ambulance stations occasionally have to change because populations have the inconvenient habit of changing and people move to different parts of the country, but there is nothing in the proposals which in any way disadvantages rural areas.
I have tried to deal with most of the points raised. I refute absolutely whatever is attributed to Sir Nigel Crisp in regard to changes driven by the manifesto. It is very clear that we need to strengthen the commissioning function in PCTs. The introduction of practice-based commissioning—which I can confirm we are still aiming to have in place across the country by the end of this year—changes the dynamic; it tends to push in the direction of larger PCTs and more combinations of PCTs because of the functions being carried out in the commissioning sector by GPs.
5.43 pm
| Next Section | Back to Table of Contents | Lords Hansard Home Page |