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7.55 pm

Joan Ryan (Enfield, North): I am pleased to speak on Second Reading of a Bill that I strongly support. The Bill is not an isolated instrument, but a key component of the 10-year programme of reform specified in the NHS plan. It cements the much needed and overdue foundations of reform that have been carefully laid during the past four years.

The Bill is essential if we are to have a modern and responsive national health service. Its underlying principle is to make the needs of the patient and the concerns of the public absolutely central to both policy and practice.

The crux of the reform is the reorientation of the functions and resources of statutory bodies—most crucially, providing primary care trusts with the main revenue allocation. That revenue will anchor PCTs as the cornerstone of the NHS, through their ability to commission health care as well as to provide it. For many, many years—going back to the Black report—it has been received wisdom that unless we do something about shifting resources to primary care, we shall never tackle the fundamental inequalities that exist in health, especially in relation to social deprivation issues that are key drivers of those inequalities.

It is important that we are extending the limited range of health care services that primary care trusts secure at present to include responsibility for all family health services that are currently provided by health authorities. The patient's first point of contact is thereby significantly enhanced, indirectly empowering the patient.

Allocating revenue directly to PCTs enables resources to be more accurately matched to the needs of local people and their communities, and thus facilitates more effective delivery. The purchasing power of PCTs shifts greater decision making to front-line staff—the best rehearsed in patients' needs and the best equipped to deliver health care. They are thus being given the mechanisms to deliver that care. I have direct evidence of that in my constituency and health authority area. Enfield, North is now part of the Enfield primary care trust; it is up and running and has a devolved budget. It is an absolute joy to read some of the documents issued by the trust and to see some of its practice.

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The primary care investment plan and health improvement action plan say many things. One document notes that the proportion of the resident population from black and ethnic minority groups ranges from 4 per cent. in Town ward to 23 per cent. in Ponders End. It gives a range of deprivation scores.

Those documents really take account of the picture in my local area. They are produced by people who not only know the wards, but work in them. They know the people who live in the wards and they know their needs. That is so important when we are considering the allocation of resources to tackle the health inequalities and the health care needs in our local areas.

Furthermore, the documents refer to partnership—working together and not reinventing the wheel. Partnership working is the absolute cornerstone of such reforms, and it will make the reforms work locally.

The one thing that GPs, other health care practitioners, the PCT and local people tell me is that they welcome these reforms. They do think that they will work; they are excited about them. There is local passion for the reforms, contrary to what the right hon. Member for Charnwood (Mr. Dorrell) said, but the cry is, "Please give us the chance to make them work. We need 10 years for them to deliver in the way that they can." Yes, we shall see gains before 10 years are up, but we want to evaluate, monitor and refine them. There is a belief that the reforms are necessary and that they will deliver.

I should like to say a word about my health authority. In the past 18 months, it has already undergone a merger—it was Enfield and Haringey, and it has become Barnet, Enfield and Haringey. In many ways, it is a trailblazer for what is about to happen under the reform of health authorities into strategic health authorities. I pay tribute to all those in my health authority who have seen through one merger and are now embarking on another. They have worked very hard to make that merger work, and some of them have been devolved to the PCTs. They know that the system will work—it is working for them now. However, they very much welcome the document "Shifting the Balance of Power—Human Resources Framework". That has not been mentioned in this debate.

I met those involved in the local Unison branch, which originally represented three health authorities, then two and now one. A lot of people are involved, and they call the document "St. Bop", so they have some fondness for it. They say that it is important because it is all about partnership working and about empowering and valuing staff. There is a recognition that the NHS cannot be changed without having the staff on board. That document has given them a sense of security, and two of the biggest dangers in any merger are the loss of security experienced by staff and, therefore, the loss of morale, which prevents reform from being driven forward and being effective.

The view of those in my Unison branch is that the human resource framework has given them great encouragement, and they very much welcome it, as well as partnership working. Health unions at national level worked on that document, and it has now come down to our local level. Exactly that kind of partnership, in all aspects of the reform, underpins the Bill and the reforms. That partnership will make the reforms work locally.

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I want to say a word about the plans for patient and public involvement and to give an example from my own casework. In 1998, Mrs. Eileen Webster—one of my constituents—tragically died of cancer. She would have died whatever had happened in hospital. However, she was the victim of a catalogue of serious errors that made her death more difficult than it might have been, especially for her daughter and her husband to deal with. They launched a campaign, Action for Eileen, but they are still involved in the complaints procedure three years on.

Whatever the outcome of that procedure, it can never change the fact that the closest relative of Lisa MacMurdie and her father, Mr. Webster, whom they loved and cared about, died in what they feel were more painful circumstances than necessary, with a lack of dignity and a lack of information. PALS in the hospital could make a vital difference, when that difference is needed. I am glad that they have carried on with their complaint for three years, because people get the health service that they demand, but it is for us to create the framework in which to ensure that people can make those demands in a meaningful and effective way, so that they get the treatment they need when they need it, not three years on when it is far too late.

It is very important that we give power to people on the inside of the NHS, not on the outside, so that they do not have to go to their Member of Parliament or CHC long after the event. That is no use; it does not help people, and I want to stop such things happening to others. I welcome the reforms; they will make a significant difference to health care delivery, to eradicating health inequalities and to ensuring that the people who use our health service feel that it is their health service, so I commend the Bill to the House.

8.5 pm

Dr. Andrew Murrison (Westbury): This Bill is all about shifting the balance of power. It will be successful—it will, without doubt, shift the balance of power from patients and people towards the Secretary of State for Health. It will do so by the direct accrual of powers to the Secretary of State and by injecting confusion and cross-accountability at working level throughout the service. Confusion and complexity are the hallmarks of this Bill.

An indication of the lack of thought that the Government have given to the Bill in their haste to get it through Parliament was given earlier in the Secretary of State's inability to respond to a simple question on the custody of CHC records.

In a similar vein, I was alarmed to find in response to my recent parliamentary question that the Secretary of State did not know where he intends to put the public health function after the abolition of health authorities. No one seems to know whether it would rest with SHAs or PCTs. Even more startling in these troubled times was the revelation that no one seemed to know where consultants in communicable disease control would sit in the new order. Those are the building blocks of health care delivery, and the fact that they are not yet in place supports the assertions of many independent observers that the Bill is woefully immature.

We learn that the CHI will be given statutory powers to enter all premises that are remotely involved with health, including GPs' surgeries and voluntary organisations.

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Several organisations in my constituency will view that as unwarranted centralist busybody interference in their serious business of doing the best for people. They will undoubtedly view it as yet another strand of interference that will prevent them from getting the job done and, frankly, as another reason to throw in the towel.

The British Medical Association has expressed its concerns about the opportunity costs introduced by the burgeoning cult of inspections and audits. There is now a real risk that they will start to detract from patient care, as we spend all our time inspecting one another and disappear in an enormous regulatory paper chase. That concern also featured in the Kennedy report on the deaths following the tragedies at the Bristol royal infirmary.

The NHS is crying out for a period of stability. Perpetual change involves cost not just in monetary terms but in human terms and in the ability of professional and lay people to understand, get to grips with and learn how to use NHS institutions and structures. The CHCs are a classic example. Just as the general public were getting used to them, the Government of the day closed them down and replaced them with a bewildering array of patients forums, the charmingly acronymed PALS and the tongue-twisting Commission for Patient and Public Involvement in Health. There will thus be no building on the undoubted successes of CHCs as independent watchdogs.

Instead of watchdogs, we will have lots of poodles—a fragmented and highly confusing network of poodles. In fact, there will be very many more than at present, and we are having some difficulty in encouraging people to volunteer for the ones that already exist. There will be no independent support from officials, except those described as outreach workers, belonging to the aforementioned tongue-twisting commission. The future does not look bright for patients forums.

Furthermore, we understand that patients forums will be constructed by the NHS Appointments Commission—more cronies, more members of the chattering classes. This worrying cult of complicity will be fuelled by the inclusion of a patients forum member on trust boards. The move is sinister, given the prevailing doctrine of collective responsibility, because it is surely not wise to allow patient advocates to be tarred with the decision making of the trust under scrutiny. Observer status would surely be more appropriate.

The very sensible suggestion of the NHS Alliance that patients forums—if we must have them—should be confined to PCTs surely makes eminent sense. That would be commensurate with the central position of the commissioning bodies and would dispel any confusion that patients might have as they grapple with the multi-tiers of the national health service.

The Bill suggests that community health councils in England will be abolished immediately. In effect, that means that patients will be deprived of an effective watchdog for an indeterminate period unless patients forums emerge from this process fully booted and spurred. However, experience from the early days of the CHCs suggests that that is rather unlikely.

The Government consider that something must be done about health in prisons—too right. However, what we have in the Bill is a soft-focus entreaty for the NHS and the prison medical services to cosy up to one another. It stops well short of the proposals made by Conservative

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Members before the election that the two services should merge. There is nothing here that is likely to deliver improved health outcomes, and particularly improved mental health outcomes, for the population in this country that arguably has one of the greatest needs—those detained at Her Majesty's pleasure.

However, the Bill is not all bad. I welcome the Government's proposal for an Office for Information on Health Care Performance within the Commission for Health Improvement. Several right hon. and hon. Members attended a presentation yesterday at which the imaginative DrFoster software for identifying health status by constituency was unveiled. Although the potential for manipulation will be clear to party politicians, the transparency that is possible from the responsible presentation of data is to be warmly welcomed.

Like many members of my profession who pay increasingly large sums for the privilege of being regulated, I have no great fondness for the General Medical Council. However, tragedies such as those at Alder Hey and Bristol should not encourage the Government to ride roughshod over a system of regulation that has in general worked well over many years. I am afraid that they appear to be doing just that.

My over-riding concern is the Government's abject failure to understand that the improvements in patient outcomes that we so desperately need derive from networks of health professionals doing the very best that they can day in, day out, unfettered by the dead hand of oppressive over-regulation and overweening bureaucracy.

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