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Mr. Francois: I want to deal with two specific matters: primary care trusts and strategic health authorities. In an earlier intervention, I gave the example of the Rochford primary care trust, which covers part of my constituency and several GP practices in Castle Point. I said that when it was a primary health group, it hesitated before applying for trust status, partly because some GPs were anxious about the pace at which the Government were attempting to push the process forward. I understand that the PCG has now applied for trust status, and that it has recently received formal approval from the Department of Health, or is close to doing so.

In the past few years, GPs have had to cope with a tremendous amount of organisational change, such as the abolition of GP fundholding and its replacement by PCGs. Just as GPs were adjusting to the changes, the Government decided that they wanted them to be organised in PCTs rather than PCGs. More responsibility is associated with the former. Today, the Secretary of State made a speech which, it is worth reiterating, was not delivered in the House. He said that there may be further changes to the organisation and responsibilities of PCTs. I cannot pursue that further now if I am to remain in order. However, it is fair to point out that there will have been three, potentially four, major changes in almost as many years to the organisation by means of which GPs deliver primary care to the public.

As we all know, GPs are busy. They can be expected to accommodate only so much change without its adversely affecting their ability to provide an adequate service to the patients whom they serve.

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I shall give a practical example from my constituency. In the town of South Woodham Ferrers, a number of GPs have lists in excess of 2,000 patients long; one has a list in excess of 3,000. It defeats me how people who have to cope with that many patients can also realistically be expected to find the time to cope with yet more organisational change of the type alluded to earlier today.

All the strategic health authorities were originally meant to be going live by 1 April this year. The Government have said repeatedly that they intend to adhere to that deadline, despite being told by many people who work in these areas that it would be practically impossible to do so. We are now some two and a half months away from that deadline, yet the senior appointments have not yet been confirmed in many strategic health authorities. Even in those SHAs whose chairmen and chief executives have been confirmed, the principal directors who will report to them have, in most cases, not been. The senior management teams in a large number of the SHAs are not yet in place, even though they are supposed to go live some two and a half months from today.

There are other major issues to consider as well as the management of the SHAs. The place in which a number of them will be located has not yet been determined. Furthermore, the information technology systems that the SHAs will use has in many cases not been determined, particularly in cases in which perhaps two or three health authorities are being merged into one SHA. Funnily enough, in a number of cases, we find that they are all using slightly different IT systems, which will now require a great deal of work to make them all talk to one another. Alternatively, some of the SHAs might have to go back to square one, abandon the legacy systems that have been inherited and come up with an entirely new IT system.

These are all significant issues that will require a great deal of time and careful thinking. Yet, in theory, all these problems up and down the country will be solved in a matter of a few months. The people working in these areas are putting in tremendous hours to try to make all this happen in the allocated time, but realistically it is not enough. There is only so much that human effort can achieve.

It is worth stressing these points for one fundamental reason. Even leaving aside what has been said this morning and this afternoon, the creation of primary care trusts—and the movement of responsibility and, particularly, funding to those trusts—is a fundamental part of the Government's 10-year plan for the national health service. The creation of strategic health authorities is also an important part of that plan. If these elements are so important to the Government's overall conception, it seems ridiculous to rush them through in such an ill thought out way. If these key building blocks for the scheme are not launched successfully, the whole plan will be in danger of unravelling.

It is not unreasonable to point that out to Ministers, or to ask them, at the eleventh hour, to pause and allocate more time, to give these already overworked people a fighting chance of trying to bring this off.

Dr. Murrison: I am happy to say—and the Minister will be pleased to hear—that in Wiltshire, we are well ahead of the power curve in relation to turning PCGs into

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PCTs. I am conscious, however, of areas of the country in which that is simply not the case. I support PCTs; the Government have built a cogent way ahead for primary care and I welcome that. My concern is that this fundamentally good plan is, as my hon. Friend the Member for Rayleigh (Mr. Francois) said, destined to fail in many areas of the country if it is not given sufficient time.

This week, the Health Service Journal has told us that delays in publishing guidance on the roles and responsibilities of management boards running strategic health authorities are causing grief for 27 chief executives appointed so far. We naturally assume that those people would feel buoyed up by their appointment to new roles, or indeed relieved to have jobs at all at a time of uncertainty in the health service, yet they appear to be fairly critical and worried about the fact that there are aspects of the job about which they are not certain.

That suggests to me that Ministers have handed down an unrealistic timetable for implementing the changes. Indeed, the second national tracker survey of 71 primary care trusts and primary care groups, which was supported by the Government, says:


In other words, the system is creaking under the pressure of changes in the NHS, which is not in a state to accommodate these changes in this time scale.

May I deal with strategic health authorities, because they have caused considerable grief across the country? A principal reason for that is that they have been insufficiently explained to people. Although it is not for me to be an apologist for the Government, I have spent considerable time reassuring those who have written to me that the SHAs and the boundaries that they impose should not impact on clinical networks and people getting health care as they do at the moment. The fact that they are worried and have had to contact me suggests that the changes are being pursued in such a way and according to such a brief time scale that the message is simply not getting across.

We have heard from the British Medical Association how many loose ends remain, particularly in relation to SHAs. It is concerned about academic medicine, which is in a parlous state. We have yet to hear how SHAs will further the agenda for it. Insufficient thought has been given to that, which shows that insufficient time was available for Richmond house to get its head round the complexity of the NHS and how the proposals will melt into it and improve the situation.

We have yet to hear whether tertiary health services will be the responsibility of SHAs, how PCTs will fit in or whether the regions will have a part to play. In other words, there is confusion—we have not been told. Again, that is not so much the fault of Richmond house or of Ministers; it is just that these things take time to work through, but the time scale is far too tight for that. I fully support the creation of PCTs, which is a positive move for primary care that is to be warmly welcomed, but I share the concerns of my hon. Friends that, in their haste, the Government risk the whole thing tumbling down like a pack of cards.

It is ironic that we are discussing the pace of change and, indeed, change of this nature as a Gallup poll published today shows that 40 per cent. of people think

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that the NHS is getting worse. Admittedly, a cheery and fairly optimistic minority of 13 per cent. reckon that it is getting better, but the balance think that it has remained static. It is difficult to see how the Bill will improve health outcomes—health care to patients—and I have yet to work out how that will happen.

The Government are intent on driving the Bill through, but I urge them to revisit the timetable to which they have committed themselves. In that helpful spirit, I draw their attention to the new clause.

5.45 pm

Mr. John Baron (Billericay): As the Minister is well aware from our deliberations in Committee, I, too, have reservations about the speed at which the reforms are being introduced. I am especially concerned because—if we are to believe the figures—by September 2004 75 per cent. of all spending will be dictated to a large extent by the PCTs. I am also in favour of the concept of localising health care as much as possible to ensure that patient care is given appropriate attention and meets required standards. My concern is that the speed of the reforms will put in jeopardy the foundation stones of the Bill, which in essence I support.

The National Primary Care Research and Development Centre, in collaboration with the King's Fund, has carried out a second national tracker survey of 71 primary care groups and trusts. Professor David Wilkin, the project director of the survey, has commented that


He said that the pace of change was being dictated by Government timetables rather than a


He believes that improvements can be made but that


The PCTs, where they exist, are relatively new organisations and the demands outlined may be beyond their existing capabilities. The PCTs need time to bed in and to get used to the important roles that they will perform in the new structure of the NHS. PCTs are already experiencing difficulties in recruiting clinical staff and those staff able, willing and competent to participate in the new functions. I have visited PCTs—as, I am sure, have other hon. Members—while they are taking on those new responsibilities, and have heard their concern that they cannot find the required calibre of management to fulfil the functions envisaged in the Bill in such a short time. Whether the deadline is spring 2003 or October 2003—as mentioned in Committee—it is an ambitious timetable given the tasks involved. There are some 120 PCGs, many of which are in the early stages of converting to PCT status.

I have two specific concerns about funding, and I would appreciate it if the Minister would address them. First, will PCTs be saddled with the outstanding deficits of health authorities as part of the devolution process? That would leave the PCTs without the resources to implement their devolved responsibilities, let alone achieve the Government's targets. Arguably, with ever increasing central directives and no additional resources, there will

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be little opportunity to improve the provision of health care over and above that achieved by the authorities the PCTs are to supplant.

My second concern is that it is unclear whether PCT funds will be protected from the revenue consequences of any major building projects. If PCTs are not protected from those consequences, concerns will arise in areas where boundary changes following the establishment of strategic health authorities mean that PCTs may retrospectively become liable for the revenue consequences of a major building project.

I am sure that the House would appreciate clarification from the Minister on those two issues. We all know that the devil is in the detail with a Bill of this sort, but those two examples give rise to the legitimate concern that the reforms—especially the establishment of PCTs—are being rushed through without due consideration for the consequences. I for one would much appreciate the Minister's clarification on those issues.


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