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5.15 pm

Finally, amendment No. 9—again, a straightforward amendment—states:


A modest proposal: I assume that few people in the Chamber would disagree with its sentiments. It is important that the funding of health care is based on the needs of the local population and, of course, there are different needs in different parts of the country and among different populations. Off the top of my head, in my own area of mid-Essex there is a pressing need for even more money than the increase because, as the Minister is all too aware, our hospital waiting lists have not fallen for a single day below the level at which they were when the Government came to power on 1 May 1997. I have said before, and have told the Prime Minister, who does not seem to have an answer, that there is a pressing need to take into account local considerations; for some reason, the Government cannot honour their promise to bring down waiting lists in mid-Essex.

There are other interesting criteria. I am sure that you are an avid reader of Hansard, Madam Deputy Speaker. One should look at the figures; I am choosing my words carefully because, I confess, I made a mistake 10 days ago in a written question. I asked the Government for health spending per head of population in Sedgefield, West Chelmsford, South-West Surrey and North-West Hampshire. Their response surprised me although, in another way, it did not. Funnily enough, Sedgefield receives noticeably more funding per head of population than West Chelmsford, South-West Surrey and North- West Hampshire—but not according to the answer, because, to be fair to the Minister of State, I was not specific and asked only for the amount. He gave me the weighted amount; his answer showed that the four areas, give or take £10 or so, each received about the same.

If one asks the question that I should have asked—"What is the actual spend?"—the amounts are significantly different. Sedgefield gets significantly more per head of population than the other constituencies. I do not imagine that that was the case 10 years ago and I imagine that, in a few years' time, it will not be so.

Dr. Evan Harris (Oxford, West and Abingdon): My understanding is that the weighted capitation allocation

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formula was introduced by the Conservatives as a change from the one used by the old resource allocation working party. It was amended on the advice of the University of York by this Government or the previous Government. Nevertheless, the hon. Gentleman will find that it has always been the case that deprivation, because of greater health needs, rightly leads to greater funding.

Mr. Burns: I accept that. I thought that that was what I was saying about the amendment: different circumstances—including social deprivation, but others as well—determine the amount of health spending. We are trying to include that in the Bill; we must have regard to the population's health needs. To be fair, RAWP, for reasons that I shall not go into, was a flawed system, certainly for people in the home counties. My right hon. Friend the Member for South-West Surrey (Virginia Bottomley) changed the system to one that depended more on allocation per head of population. Indeed, when the Secretary of State first came to the Department as a Minister in 1997—

Madam Deputy Speaker: Order. The hon. Gentleman will now get back to the main point in his amendment.

Mr. Burns: Thank you, Madam Deputy Speaker.

When funding allocations are made to PCTs, it is important that the needs of the population served by that trust are taken into account, for health rather than political reasons. On those grounds, I hope that the Minister will accept the amendment. One lives in hope. It is a new year, and the Minister is a reasonable man.

Finally, I urge the Minister to consider carefully the time scale for the changeover to PCTs. It would be a crying shame if their introduction was marred by the fact that the system did not run smoothly. With the money that will be available, there is potential for PCTs to make a real difference to local people.

Dr. Evan Harris: I shall comment briefly on the amendments in the group and speak to my amendment (a) to Government amendment No. 23, before the Minister moves the amendment. The hon. Member for West Chelmsford (Mr. Burns) knows that I share his concerns about the speed of the change being imposed on the health service and the fact that there is to be yet more structural change. There seems to be no coherent strategy emanating from the Government under the Health Act 1999. As the hon. Gentleman said in Committee and repeated today, the national plan did not envisage that all primary care groups would have to become primary care trusts, no matter what.

As I said on Second Reading and in Committee, part of the motivation for the changes seems to be that the Government want to be seen to be doing something and are therefore substituting activity for action. I expect that the Government will resist the new clause for the same reasons as they have done before.

Amendments Nos. 6 and 7 may well be covered by provisions in the Bill. Government amendment No. 23 deals with consultation issues. There is little enthusiasm for yet more amendments on that subject, such as amendments Nos. 6 and 7, because of the consultation arrangements already included.

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I recognise that Government amendment No. 23 is a response to concerns raised in Committee by the hon. Member for Leigh (Andy Burnham) and others.

Mr. Heald: The hon. Gentleman should give credit to my hon. Friend the Member for West Chelmsford (Mr. Burns), who spoke to the amendment. The hon. Member for Leigh then agreed.

Dr. Harris: I am more than willing to do so. I apologise if the hon. Member for West Chelmsford is deeply offended by not having had due recognition of the fact that he raised concerns about the degree of consultation. We all agree that there should be adequate consultation about strategic health authorities when boundaries and names are changed. I feel so strongly about the matter that I tabled an amendment to Government amendment No. 23, which would specify that the Secretary of State "shall", not simply "may", make regulations. I hope that the hon. Member for West Chelmsford will support that.

Under previous arrangements, when there were community health councils, there was a duty on the Secretary of State to consult on such changes. That duty had existed for 23 years, since the National Health Service Act 1977. It seems that the obligation to consult—that is, the Secretary of State's duty to make regulations—has not exactly fettered Governments in reforming names, structures or boundaries since then. We have been inundated with reforms over those 23 years. If the Government choose to resist amendment (a) to Government amendment No. 23, they must explain why they place a lower priority on consultation than in the past, making it a mere optional extra if the whim takes the Secretary of State.

The question is whether the Government will empower local communities by asking them what they think. I had a useful meeting with the Under-Secretary of State which touched on the matter. She kindly responded by letter, and I hope she will not mind if I quote it. She stated:


She said that the reason for that was:


The only remaining flexibility relates to the ability not to make regulations on consulting local communities. If the Government want such flexibility, it can only be to water down obligations for which they should be providing. I hope that they will reconsider the wording of Government amendment No. 23. If they resist amendment (a) thereto, we will have to raise the matter in the House of Lords.

As I said in an intervention, I am not entirely sure of the purpose of amendment No. 9, or of what it would produce. I understand that allocations that are part of weighted capitation are sensitive to the health needs of the local community. My concern is that the Government often go too far in seeking to take parts of that cake for central allocation, which inevitably does not ensure that allocation is transparent. The formula is complex, but at least we know what we are dealing with and allocations move slowly towards that formula when there is growth in the system.

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I look forward to hearing the Government's response to my concern about Government amendment No. 23.

Mr. Peter Atkinson (Hexham): I should like in particular to address amendment No. 6, which relates to the setting up of strategic health authorities. I echo what my hon. Friend the Member for West Chelmsford (Mr. Burns) said about primary care trusts, as I believe that they have been established too quickly. We often attack the Government for dragging their feet and not producing the documents that we want. For example, in the north-east, we are waiting for a White Paper on regional government—indeed, we are waiting, waiting and waiting. However, in this case, the speed of the changes has been far too great.

An interesting example is the speed with which local health authorities in the north-east had to operate in order to set up a strategic health authority and carry out the consultation that was involved. The Department of Health launched the initiative on 7 September and it had to be finished by 30 November. That was a very considerable job for four health authorities covering a population of almost 2 million. Indeed, it was an enormous job. The chief executives of the health authorities that cover Northumberland, Newcastle and north Tyneside, Gateshead and south Tyneside and Sunderland joined together and set up a small project team in order to carry out the consultation, and it is worth considering what they achieved in that period. They held 38 meetings with the public, and dished out 6,000 copies of the consultation document and 33,000 copies of the summary leaflet. That was all done within the very tight space of time that I have mentioned. Moreover, 12 public meetings were held—one in each authority area. A proper presentation was given at each meeting, but sadly they were not well attended, as so often happens, especially when so little warning is given.

One of the results of such a rushed operation was that members of the general public did not have an opportunity to register what was going on and attend the meetings. We cannot blame the project board for trying, but given the Government's rushed timetable, it was impossible to interest very many local people. The board helpfully published a summary of the consultation process. As well as mailing all the usual suspects, including local authorities, parish councils and so on, it tried to seek publicity in the media and picked 4,000 people at random from electoral registers in order to write to them. The net result, however, was that the biggest attendance at any of the public meetings was in Gateshead, where 20 people attended. The worst attendance was in Ashington, where only one member of the public turned up.

I regret to say that in my constituency, where many people are extremely interested in what goes on, only six people turned up. I know my constituency well, so I am aware that there is very strong community spirit in Hexham. It seems inconceivable that only six people in Hexham were interested in attending a public meeting relating to a matter as important as the establishment of a new strategic health authority and all the primary care trusts that flow from it. Responsibility for what happened can be laid directly at the door of the rushed consultation process.

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5.30 pm

It is worth dwelling on the results of the meetings, which comprised professionals as well as members of the public. The summary states:


That was much on people's minds. The major anxiety of those involved in providing health care in the north-east was that great change was being made extremely quickly. My hon. Friends have identified that, and I do not understand why Ministers have to rush all the changes.

The summary also concluded:


Again, members of the public, those involved in local authorities, health professionals and members of community health councils were worried that the process was being rushed and that more time was needed.

Another lesson is that most people wanted information about the operation of the new systems. They wanted reassurance that the process of change would not create instability in the health service and the health economy. Our amendments are important because it is not necessary to rush matters. I do not understand why the Government should launch a consultation process to set up a strategic health authority that will serve nearly 2 million people on 7 September and expect it to be in place by April 2002, when we are still discussing the measure that relates to it in January.


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