National Health Service Reform and Health Care Professions Bill

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Mr. Heald: What is the difference between paying, purchasing and commissioning?

Mr. Hutton: The hon. Gentleman knows perfectly well that we are not introducing the internal market that the Conservative party inflicted on the NHS with precious little support from anyone within it.

I have one caveat and cautionary note for Conservative Members. They are rediscovering their enthusiasm for public services, but they will not convince anyone in the country at large who remembers the enthusiasm shown by the previous Conservative Adminstration for public services. We are unlikely to accept any lectures from Conservative Members on that subject.

12 noon

The hon. Member for Billericay (Mr. Baron) made a very good speech by reading the BMA's briefing. The association obviously has a friend in the hon. Gentleman.

Mr. Burns: What is wrong with the BMA?

Mr. Hutton: There is nothing wrong with the BMA, which comes to Richmond house regularly. When the Conservative party was in office, the BMA was not allowed into Richmond house. Tory Ministers stopped talking to the BMA because they were so fed up with their criticisms of Tory policies. Now, the Tories have discovered a new enthusiasm for the views of the BMA.

Mr. Burns: Rubbish.

Mr. Hutton: That sums up today's modern Conservatives.

The hon. Member for Billericay is lending his support to the BMA today, but previous Conservative Members have not been prepared to do that regularly in the past. As with other Conservative Members, he disputed whether the reforms would decentralise the NHS. It is the view of the BMA that they are radical decentralising measures, and I was surprised that he did not refer to the association's comments.

Mr. Baron: I have two points to make. The earlier comment that we oppose reform in the NHS is completely wrong. We are saying today that both the NHS and we in the House need more time in which to consider the reforms and implement them. Those at the coal face who must implement the reforms have severe reservations that we are rushing them through too quickly. The purpose of the amendment is to ask for one year's delay in the hope that that will give those who must implement the reforms more time. There is a real danger that a good number of primary care trusts--it is difficult to quantify how many--simply will not be ready for the deadline of 1 April 2002 because of the management and structural issues entailed.

The Chairman: Order. Interventions should be brief and to the point.

Mr. Baron: I apologise, Mr. Hurst. On the BMA, there is no harm in raising the concerns of the BMA and there is justification for doing so. That does not necessarily mean that we are endorsing those concerns. The point is that the BMA is raising legitimate issues and it would be wrong if they were not brought to the attention of the Committee. They should not be dismissed out of hand as irrelevant.

The Chairman: Order.

Mr. Hutton: Thank you, Mr. Hurst. The hon. Gentleman makes a fair point; I am not disputing his right to raise the concerns that the BMA has expressed. I am simply saying that there is a Cassandra quality to his and other Conservative Members' comments.

Mr. Heald: Will the Minister give way?

Mr. Hutton: No, I will not.

The comments of the hon. Member for Billericay diminish the substance and quality of the argument that he is trying to make to the Committee. He cannot have his cake and eat it. That is a luxury of Oppositions and that is what he is trying to do.

Conservative Members have also expressed concern about the number of primary care trusts that have been established. The hon. Member for West Chelmsford implied that very few had been established and were likely to meet the deadline of April 2002.

Mr. Burns: I said that I understood that 130 PCGs had not prepared fully or applied for PCT status.

Mr. Hutton: Unfortunately, the hon. Gentleman is wrong about that and I shall correct his arithmetic. Some 164 PCTs were established by April 2001 and a further 23 from the current round are likely to be approved soon; 23 of the remaining PCGs have been approved for establishment from April 2002; 20 have been approved but have not yet received notification of approval, which will happen shortly; 98 have submitted proposals for approval and are likely to be approved during December and January. Only 11 PCGs are still consulting and we expect all to be constituted as PCTs by April 2002. That has always been the deadline that we and others in the service have worked towards.

Another theme of the comments made by Conservative Members is decentralisation. I have great sympathy with some of the points that have been made. It is impossible to run a service as complex and diverse as the NHS from Richmond house. That is the Government's view and we have been working to find a successful method of devolving and decentralising power, of which this is the most obviously clear example. It is not true to say that the proposals have suddenly emerged during the past few months. Reference has been made to the NHS plan, and my hon. Friend the Member for Clwyd, West (Gareth Thomas) referred to it and to the equivalent document produced by the National Assembly for Wales.

The hon. Member for Westbury, who referred to those concerns, should refresh his memory and go back a little further in time. The 1997 White Paper ``The new NHS'' refers in paragraph 3.17 to some of the reforms that we wanted to make to health authorities, including making them leaner with no direct commissioning responsibilities. Those are precisely the proposals that we are implementing in the Bill. They have a longer ancestry than he and other Conservative Members are prepared to give credence to.

Dr. Murrison: The point is that Governments may put such proposals in White Papers until they are blue in the face, but if they do not get them across to the general public they have failed. My constituents believe that the Government are manifestly failing at the moment because there is so much confusion, even among those who take a passing interest in arcane NHS structures, about how things are going and, more particularly, the effect that they will have on them and their ability to access health care.

Mr. Hutton: I accept that that is the hon. Gentleman's view, but it is not mine. It is unlikely that I would ever accept the hon. Gentleman's view about the success or otherwise of the reforms that we are making to the NHS.

Mr. Burns: Will the Minister clarify a point arising from what he said? If I heard him correctly, he said that he expected all PCTs to be in place by October next year. The strategic health authorities will come into effect on 1 April next and the health authorities are abolished. Will those areas that still have PCGs but are awaiting approval to be PCTs by October be able to fulfil the role of a PCT in advance of becoming one?

Mr. Hutton: No. The hon. Gentleman's problem is that he has not fully understood the time scale for making the changes. It is true that we intend to use existing powers to reorganise existing health authorities by 1 April 2002, but it is obvious that the legislation will not be in place by then. There is no prospect of that and we do not envisage being able to implement the legislation until October next year. The reforms will become operational from then onwards and fully operational from April 2003. That is the time scale that we envisage and there seems to have been some misunderstanding about that on the Conservative Benches.

The argument about decentralisation is important and underpins what we are trying to do in this part of the Bill. There is always some political knockabout surrounding centralisation and decentralisation and whether a measure is a devolved one or not. It is a legitimate and important argument, but the data is always tortured until it confesses and the statistics can be used to prove one case or another.

Conservatives may not be aware that during the last year of the Conservative Government, the Secretary of State for Health issued 298 central directions to the national health service. Last year, my right hon. Friend the Secretary of State issued 22 such directions. Most fair-minded people will consider those two figures and decide who were the centralisers and which party wanted to direct and manage the NHS centrally. With the greatest respect to the hon. Member for West Chelmsford, they would not reach his conclusion, based on those figures.

Mr. Baron: On the question whether we are centralising or decentralising—I hope that we will not get into party dogma on this—the Government argument is that the Bill is decentralising because, suddenly, PCTs will be spending about 75 per cent. of the resources available to the NHS. If PCTs had a large element of freedom in terms of how they spent the money, one could agree that that would be a decentralising measure. However, the fact remains that although 75 per cent. of expenditure will be devolved, strict targets and performance criteria will be set from the centre. If these are not met, money could be withdrawn. How can that be described as a decentralising measure? Surely it is micromanagement.

Mr. Hutton: No, it certainly is not micromanagement. It is the proper role of Government, who are accountable to the House, to set the overall standards and framework within which they expect public money to be used in the NHS; the alternative is a free-for-all, and I cannot believe that the hon. Member for Billericay and his hon. Friends support that. There must be a proper balance. I find it genuinely surprising that the hon. Gentleman takes the view that it is not a proper role for Government to determine the overall resources available to the service and to indicate the targets, results and performance to be achieved with the money.

Mr. Baron: The Minister misunderstands. I am not saying that there is no role for Government in running the NHS or that the Government should not provide basic safety nets and guidelines for providing the service at the coal face. However, the Government are arguing that the Bill is decentralising when clearly it is not. The Secretary of State will set microtargets, performance targets and criteria for a swathe of areas, and money will be withdrawn if those are not met. That is micromanagement. There is a role for Government and it is a question of getting the balance right, but they have gone too far in centralising, rather than decentralising.

 
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Prepared 27 November 2001