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Members of Parliament (Employment Disqualification)

Mr. Peter Bradley accordingly presented a Bill to regulate the remunerated employment a Member of Parliament may undertake: And the same was read the First time; and ordered to be read a Second time on Friday 19 April, and to be printed [Bill 81].

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Orders of the Day

National Health Service Reform and Health Care Professions Bill

As amended in the Standing Committee, considered.

New Clause 1

Readiness of Primary Care Groups and Trusts

'(1) The Health Service Commissioners shall investigate the preparedness—
(a) of Primary Care Groups to become Primary Care Trusts; and
(b) of Primary Care Trusts to receive functions in accordance with this Act.
(2) If after conducting an investigation it appears to a Commissioner that—
(a) a Primary Care Group is not ready to become a Primary Care Trust; or
(b) a Primary Care Trust is not ready to receive functions in accordance with this Act
he shall lay before each House of Parliament a special report.
(3) If a special report is laid in accordance with subsection (2)(a) above, no action shall be taken by the Secretary of State pursuant to section 16A(1) or (1A) of the 1977 Act for the period of one year from the date of laying of the report. amdtpar>(4) If a special report is laid in accordance with subsection (2)(b) above, no functions shall be transferred or distributed to the Primary Care Trust referred to in the report for a period of one year from the date of laying of the report.'.—[Mr. Burns.]

Brought up, and read the First time.

4.38 pm

Mr. Simon Burns (West Chelmsford): I beg to move, That the clause be read a Second time.

Madam Deputy Speaker (Sylvia Heal): With this it will be convenient to discuss the following amendments: No. 6, in clause 1, page 2, line 11, at end insert—

'(c) a Strategic Health Authority shall only be established under paragraph (a) above provided that there has been consultation with health professionals, local authorities and the general public in that area.'.

No. 7, line 11, at end insert—

'(d) a Health Authority shall only be established under paragraph (b) above provided that there has been consultation with health professionals, local authorities and the general public in that area'.

Government amendments Nos. 23 and amendment (a) thereto, 24 to 26, 74, 27 and 28.

No. 8, in clause 8, page 9, line 21, at end insert—

'(2A) In determining the amount to be allotted to a Primary Care Trust, the Secretary of State shall have regard to any liabilities which have been conferred upon it'.

No. 9, line 21, at end insert—

'(2B) In determining the amount to be allotted to a Primary Care Trust, the Secretary of State shall have regard to the health needs of the population served by that Trust.'.

Government amendments Nos. 35, 36, 54, 55 and 61.

Mr. Burns: We tabled new clause 1 because, as we said on Second Reading and in Committee, we believe that there has been an inordinate rush to establish strategic health authorities and primary care trusts. It would be a

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grave mistake, and the height of folly, to rush through reforms in such as way as to leave them half cocked and half baked, so that the Bill does not achieve the Government's aims.

The changes proposed in clauses 1 and 2 are extremely far reaching. Clause 1 proposes to abolish health authorities in England, of which there are approximately 95, and to replace them with strategic health authorities. There will be far fewer strategic health authorities than there are health authorities, and they will perform the key performance management role across the national health service in England. They will be responsible also for providing a lead in the strategic development of services, and for ensuring that all parts of the NHS work together effectively.

The new primary care trusts will have the critical responsibility of providing and funding health care. About 75 per cent. of NHS funding will be handed to the PCTs to provide health care for our constituents around the country. The concern is that there has been far too much of a rush over starting up a new system that is very complex and wide ranging.

I cannot understand why the Government are in such a rush to engineer the reforms. I question whether the structures to be put in place are ready to work without the whole edifice collapsing in confusion and disaster. The Government's rush to implement the changes reminds me of the adage, "Reform in haste, repent at leisure." The British Medical Association has warned that PCTs, where they exist, are relatively new organisations and that, as a result, the demands placed on them may be beyond their capabilities.

The BMA has highlighted the fact that existing PCTs already experience difficulties in recruiting clinical staff, and warns that those problems will be exacerbated. It is also concerned that the timetable within which PCTs are intended to be and up and running is far too ambitions.

As we heard on Second Reading and again in Committee, the Standing Committee considering the Health Bill in 1999—which became the Act that made possible the establishment of PCTs—was told by the former Minister of State at the Department of Health, who is now Minister for Police, Courts and Drugs, the right hon. Member for Southampton, Itchen (Mr. Denham), that it was important to emphasise that the Government did not

He added that it was

In another place, the former Health Minister Baroness Hayman made exactly the same point and gave the same assurances that there would be no rush to create PCTs, but the Government have performed a complete U-turn and are now doing precisely what they said they would not do when the 1999 Act went through this House a mere two and a half years ago.

Not only Conservative Members are worried. Severe concerns have been expressed by members of the health professions that the proposals are being rushed through. A recent survey in the Health Service Journal showed that 46 per cent. of chief executives in NHS organisations believed that PCTs would be unable to cope with enlarged responsibilities, and that 33 per cent. of them thought that

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the time scale and scale of the changes were unrealistic and dangerous. One chief executive has called the reforms a recipe for disaster, and another has described them as the most ill conceived and poorly thought out set of changes in decades.

The King's Fund, in collaboration with the National Primary Care Research and Development Centre, has carried out a tracking survey on primary care groups and trusts. It suggests that there are many doubts about the ability of PCTs to absorb the pace of reform. Professor David Wilkin, the project director, said that the pace of change was being dictated by Government timetables rather than by a process of learning and of building on experience. He also pointed out:

The survey pointed out that the average number of managerial, financial and administrative staff employed by primary care groups was 6.8, compared with an average number for primary care trusts of 15.8—a serious discrepancy.

Equally worrying is the fact that one in seven PCGs or PCTs still has—or had at the end of last year—no financial director.

The Minister of State, Department of Health (Mr. John Hutton): I am reluctant to interrupt the hon. Gentleman's measured flow, but he is aware, because he raised the same point in Committee, that primary care groups are sub-committees of health authorities and are under no obligation to employ their own finance director. They use the finance directors employed by health authorities, which is a perfectly sensible arrangement.

Mr. Burns: I appreciate what the Minister says, but PCTs will have to employ finance directors when health authorities are scrapped. It is by no means certain that the finance director of a health authority will become the finance director of a PCT. [Interruption.] The Minister says "obviously". I accept his observation, but I argue that it adds to the force of my case. I suspect that many PCTs around the country will have finance directors without direct experience of working in the health service, with all the nuances and differences that those responsibilities cover.

4.45 pm

According to the report, the situation with regard to information management and technology was perhaps of more concern. It states:

It goes on to say:

Of greater worry to the authors of the report, to the BMA and to many others is whether the changes in the Bill will divert activity and resources from front-line patient care. Three quarters of chief executives questioned believed that the reorganisation would delay delivery of the national plan, and a quarter thought that the delay

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would be severe. That would obviously have a critical impact on the delivery of patient care and the ability to provide the seamless flow of patient care when the changeover occurs.

Our new clause seeks to save the Government from themselves by laying down procedures to ensure that changes to the delivery of health care under clause, 1 and especially clause 2, are introduced smoothly, successfully and without undue haste. We propose that the health service commissioners should investigate the preparedness of PCGs to become PCTs and the preparedness of existing PCTs to fulfil the functions that the Bill places on them.

Under our new clause, where it is found that a PCG is not ready to become a PCT or—possibly more important because of the unseemly rush of PCGs to become PCTs—where it is found that a primary care trust is not ready to carry out its functions, a special report would be laid before both Houses of Parliament. There would then be a period of 12 months when no action was taken, so as to establish a breathing space to allow PCGs and PCTs to prepare themselves adequately to perform their duties and functions. I hope that the House agrees that our suggestion is eminently sensible and that it will avoid the confusion and chaos that will result from fragile new bodies carrying out immense new duties with too little or no experience.

If our Committee debates are anything to go by, Ministers will respond in an ostrich-like way. They will refuse to remove their heads from the sand and will try to reassure us that everything is proceeding satisfactorily, that there is nothing to worry about and that there are no problems. I am sure that they will trot out the same statistics as we heard in Committee at the back end of last year.

Ministers will tell us that by October 2002 PCT coverage in England will be 100 per cent. I was interested to note, when I re-read the Minister's comments, that during the early sittings of the Committee he told us that there would be 100 per cent. coverage by April 2002. During a few sittings of the Committee, that date seemed to slip back to October 2002.

Today, the Minister may be able to update us on the statistics that he gave us in Committee on the current progress of PCGs and PCTs. I suspect that, given the relatively short period that has elapsed since the end of the Committee proceedings, the figures will differ little from those that he gave us on 27 November last year.

The Minister seems rather cheerful, as though there had been a dramatic change in the statistics. I shall read the statistics that he gave us last November, and no doubt he will be able to update us during the debate. While he is doing so he may prove one of the points that I am making about the moral pressure that is being put on PCGs to seek PCT status. They feel under pressure to achieve that status as quickly as possible so as not to miss out, or to cause problems, before October of this year.

Unless the Minister has startling new figures, however, I suspect that we shall hear that 164 PCTs were established by April 2001; that a further 23 were—at the end of last November—likely to be approved shortly; that 23 of the remaining PCGs were approved for establishment from April 2002; and that 20 had been approved but had not yet received their notification of

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approval. I suspect that notwithstanding the Christmas post they will almost certainly have received that notification by now.

The Minister will tell us that 98 PCGs have submitted proposals for approval and were likely to be approved during December 2001 and January 2002. Of course, it is highly unlikely, given the Government's policy, that a PCG will not receive approval for trust status. He will tell us that a mere 11 PCGs are still consulting.

In the not too distant future the Minister will, no doubt, update the figures. From the look on his face, he may even be able to tell us that he anticipates 100 per cent. approval by April 2002. That remains to be seen. However, behind all those statistics and behind whatever new statistics the Minister may shortly give us, a simple fact remains: there has been undue haste because the Government have changed their policy on PCTs. In effect, they have moved from a policy that was wholly voluntary.

The Minister will say that there is currently no legal power to make any group become a PCT. That is true, but the pressure on PCGs to fall in line with the Government's policy and become PCTs is overwhelming, because they know that once the Bill is on the statute book the voluntary nature of becoming a PCT will be removed. We questioned the Minister on several occasions in Committee. He replied that he would ensure 100 per cent. coverage of PCTs in England by October 2002—if necessary, by using the legislation.

PCGs are now becoming PCTs voluntarily, but that masks the pressure they have been under—that of knowing what the future holds for them. Like all hon. Members in the Chamber, they have seen the Bill and know the Government's intentions. As a result of that pressure, many PCGs that were not in the first wave rushed into securing trust status, which they otherwise probably would not have sought within such a relatively short time scale. A great deal of pressure has been put on PCGs to achieve PCT status, and many of them might not be properly prepared to handle their new, highly complex and difficult responsibilities. For those reasons, tremendous problems could arise in the health care provided to our constituents.

My message to the Government is simple, and it is intended to be helpful: they are under no pressure—or only that caused by their own enthusiasm to put their Bill on the statute book to ensure that their proposals are up and running as soon as possible—and they should hold back for a short period. I suggest not that the proposals on trust status should be kicked into the long grass for a decade and a day never to happen, but that the Government should allow a little more time for the experience and expertise to be built up to ensure that, from day one, PCTs operate in a seamless and workable way and that our constituents encounter no hiatus, no teething problems and no other problem with their health care.

As my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) said in Committee, we do not disapprove of the PCT concept, but we want the Government to ensure that PCTs work properly and that they seamlessly fulfil their functions as soon as possible. If something is rushed, there can be no guarantee that that will be the end result. I warn Ministers now that if the transition is not seamless and it is bungled by the rush, terrible problems will arise. People's health will be

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directly affected by any hiatus in the supply of care. Ministers do not want that to happen, which is why I cannot fully understand why they seem to be reluctant to take well-meaning advice simply to delay things a little to give the system time.

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