National Health Service Reform and Health Care Professions Bill

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Mr. Hutton: I hear the hon. Gentleman's arguments, but they do not accord with the facts; that is the problem. We are not withdrawing money from anyone, so he can forget about that.

Mr. Baron: Even if the authorities do meet performance targets?

Mr. Hutton: We are steadily increasing the resources available to the NHS. The performance assessment framework will work in a different way. Everyone will benefit from the fund. Does the hon. Gentleman not think that it is right that we set targets for the key areas of access to health care services and waiting times? Is that not a responsible role for the Government?

My understanding of the hon. Gentleman's election manifesto was that his party was committed to setting such waiting time guarantees. I am genuinely puzzled by the hon. Gentleman's argument. I accept that he can argue about the balance, but surely he cannot argue about the role of the Secretary of State in the matter. It is not true that we see the Secretary of State's role as guaranteeing a safety net for the NHS; that would be an inappropriate view of the relationship that we want to develop and maintain.

The hon. Member for Billericay is wrong in his analysis. There is no doubt, certainly in the BMA's view, that this is a radical decentralising measure that will affect the NHS for a long time to come; it is the hon. Gentleman's prerogative to disagree with that view. If he, like me, believes in devolving power, he will see that this is the only sensible way to organise a service as large and complex as the NHS and that it is reasonable to go down that road.

Mr. Heald: Under the Bill, 58 powers of the Secretary of State are gained, retained or enhanced. It is true that if some of the powers were implemented in a light regulatory mode, that would be better than if they were heavily prescriptive. Does the Minister agree that it is vital that he allows the Committee to see all the draft orders?

Mr. Hutton: I said earlier that I would do that if the orders were ready.

Mr. Heald: Will the Minister give way?

Mr. Hutton: No, I have answered the hon. Gentleman's question.

Mr. Heald: On a point of order, Mr. Hurst. Clause 1 has at least seven order-making powers and schedule 1 has numerous powers. The Minister has agreed to allow the orders to be seen. If any of them are ready, should he not give them to us so that we can debate them?

The Chairman: That is not a point of order but a matter for debate.

12.15 pm

Mr. Hutton: The hon. Gentleman and I are both lawyers, so we are used to such arguments; it is our trade. The orders are not ready because they have not been drafted. Had they been drafted, they would have been shared with the Committee.

Returning to the substance of the amendment, we have had a wide-ranging debate about the nature of the proposals, their implications for the NHS and their relationship with PCTs, a point on which I agree with the hon. Member for North-East Hertfordshire. It will be important for PCTs to get maximum managerial support as they take on their new roles and responsibilities. The Government have set out our intentions on many occasions. The national primary care development team, under Dr. Barbara Hakin—an outstandingly successful PCT chief executive in Bradford—is helping other chief executives and PCTs to take on their new responsibilities and address the significant challenges that they face.

The hon. Gentleman said that the RCN's description of these proposals was ``ambitious''; they are ambitious because we are ambitious for the NHS.

Mr. Heald: I was referring to the timetable.

Mr. Hutton: It is an ambitious timetable, which leads us to the argument that is fundamental to the amendment tabled by the hon. Member for West Chelmsford. I said earlier that all organisational change meets with some opposition. That is the nature of organisations. Notwithstanding the points made by Opposition Members, there is a strong argument that having identified the changes that must be made, it is better to get on and implement them. The danger with his proposals is that they carry an additional suggestion of delay.

Mr. Burns: Of six months.

Mr. Hutton: Yes, but we could use that six months for another purpose. It is a challenging timetable, but it is achievable. We are on target to get the PCTs, which will be up and running by October 2002, through the system. Having looked at the argument and having heard what the hon. Gentleman has to say, the Committee must decide—given that we indicated the nature of the changes in 1997, developed specific proposals, made a significant start towards achieving results throughout the service and began the reorganisation that these changes will bring through—whether we should say to the NHS and the public at large, ``We need to get these changes in place.''

In the circumstances, the delay that the hon. Member for West Chelmsford proposes would not be helpful. It would serve no purpose other than to cause delay in the way in which he has described. We have a comprehensive system of support arrangements in place to ensure that PCTs will be able to discharge their new responsibilities, and we are currently consulting with the public and the NHS on the boundaries of the SHAs. This is an occasion for us to say that it is time to get on and do the work; that is what I shall ask my hon. Friends to do if the hon. Gentleman pushes his amendment to a Division.

Mr. Burns: I have listened very carefully to the Minister's comments, and I was genuinely grateful for some information that he supplied. He fleshed out our understanding and knowledge of how the clause will work, fulfilling the probing role of the amendment. One or two things that he said have concerned and slightly confused me, although I shall not pursue them in great detail.

The Minister said that the proposals were both challenging and ambitious. Given the time scale, are the Government being over-ambitious? This debate has in no way reduced my fears that the policy is being rushed and, whatever he may say, my hon. Friends and I are not alone in thinking that. There was concern, which he helpfully cleared up, that the structures would be put in place on 1 April 2002, but some PCGs would not become PCTs until October 2002.

The Minister said, if I understood his comments correctly, that the reforms would not come into operation until October 2002, when all PCTs would be in place. In one way, that is reassuring, and it has certainly clarified the situation. However, that also makes our amendment even more reasonable. Until the Minister gave that clarification, I was asking the Government to give the NHS another 12 months in which to complete preparations so that there would not be a rush that would cause confusion. Following his helpful clarification, I am asking for only six months. I do not regard that as delay or procrastination. I regard that as a commonsense way in which to help the NHS to help those involved and, ironically, to help the Government to get their reforms right, and up and running, in the most effective and efficient way.

When one seeks to be helpful, it is not unreasonable to push an amendment to a Division. I am convinced that when the Government look back on the full year of 2002-2003, they will wish that they had taken our advice and given themselves a breathing space of six months in which better to lay the system's foundations.

Question put, That the amendment be made:—

The Committee divided: Ayes 6, Noes 10.

Division No. 2]

AYES
Atkinson, Mr. Peter
Baron, Mr. John
Burns, Mr. Simon
Heald, Mr. Oliver
Murrison, Dr. Andrew
Taylor, Dr. Richard

NOES
Blears, Ms Hazel
Burnham, Andy
Challen, Mr. Colin
Fitzpatrick, Jim
Havard, Mr. Dai
Hutton, Mr. John
Moffatt, Laura
Thomas, Gareth
Touhig, Mr. Don
Ward, Ms Claire

Question accordingly negatived.

Mr. Heald: I beg to move amendment No. 2, in page 1, line 6, leave out `Strategic' and insert `Area'.

The Chairman: With this we may discuss the following amendments: No. 3, in page 1, line 11, leave out `Strategic' and insert `Area'.

No. 4, in page 1, line 14, leave out `Strategic' and insert `Area'.

No. 5, in page 2, line 2, leave out `Strategic' and insert `Area'.

No. 6, in page 2, line 8, leave out `Strategic' and insert `Area'.

No. 7, in page 2, line 9, leave out `Strategic' and insert `Area'.

No. 8, in page 2, line 16, leave out `Strategic' and insert `Area'.

No. 9, in page 2, line 18, leave out `Strategic' and insert `Area'.

No. 10, in page 2, line 19, leave out `Strategic' and insert `Area'.

No. 11, in page 2, line 20, leave out `Strategic' and insert `Area'.

No. 12, in page 2, line 23, leave out `Strategic' and insert `Area'.

No. 13, in page 2, line 27, leave out `Strategic' and insert `Area'.

No. 14, in clause 3, page 3, line 11, leave out `Strategic' and insert `Area'.

No. 15, in clause 3, page 3, line 12, leave out `Strategic' and insert `Area'.

No. 16, in clause 3, page 3, line 15, leave out `Strategic' and insert `Area'.

No. 17, in clause 3, page 3, line 16, leave out `Strategic' and insert `Area'.

No. 18, in clause 3, page 3, line 19, leave out `Strategic' and insert `Area'.

No. 19, in clause 3, page 3, line 27, leave out `Strategic' and insert `Area'.

No. 20, in schedule 1, page 44, line 6, leave out `Strategic' and insert `Area'.

No. 21, in schedule 1, page 44, line 8, leave out `Strategic' and insert `Area'.

No. 22, in schedule 1, page 44, line 12, leave out `Strategic' and insert `Area'.

No. 23, in schedule 1, page 44, line 14, leave out `Strategic' and insert `Area'.

No. 24, in schedule 1, page 44, line 17, leave out `Strategic' and insert `Area'.

No. 25, in schedule 1, page 44, line 19, leave out `Strategic' and insert `Area'.

No. 26, in schedule 1, page 44, line 21, leave out `Strategic' and insert `Area'.

No. 27, in schedule 1, page 44, line 24, leave out `Strategic' and insert `Area'.

No. 28, in schedule 1, page 44, line 27, leave out `Strategic' and insert `Area'.

No. 29, in schedule 1, page 44, line 29, leave out `Strategic' and insert `Area'.

No. 30, in schedule 1, page 44, line 31, leave out `Strategic' and insert `Area'.

No. 31, in schedule 1, page 44, line 35, leave out `Strategic' and insert `Area'.

No. 32, in schedule 1, page 44, line 37, leave out `Strategic' and insert `Area'.

No. 33, in schedule 1, page 45, line 2, leave out `Strategic' and insert `Area'.

No. 34, in schedule 1, page 45, line 6, leave out `Strategic' and insert `Area'.

No. 35, in schedule 1, page 45, line 8, leave out `Strategic' and insert `Area'.

No. 36, in schedule 1, page 45, line 10, leave out `Strategic' and insert `Area'.

No. 37, in schedule 1, page 45, line 13, leave out `Strategic' and insert `Area'.

No. 38, in schedule 1, page 45, line 14, leave out `Strategic' and insert `Area'.

No. 39, in schedule 1, page 45, line 18, leave out `Strategic' and insert `Area'.

No. 40, in schedule 1, page 45, line 20, leave out `Strategic' and insert `Area'.

No. 41, in schedule 1, page 45, line 22, leave out `Strategic' and insert `Area'.

No. 42, in schedule 1, page 45, line 25, leave out `Strategic' and insert `Area'.

No. 43, in schedule 1, page 45, line 28, leave out `Strategic' and insert `Area'.

No. 44, in schedule 1, page 45, line 30, leave out `Strategic' and insert `Area'.

No. 45, in schedule 1, page 45, line 34, leave out `Strategic' and insert `Area'.

No. 46, in schedule 1, page 45, line 36, leave out `Strategic' and insert `Area'.

No. 47, in schedule 1, page 45, line 39, leave out `Strategic' and insert `Area'.

No. 48, in schedule 1, page 45, line 41, leave out `Strategic' and insert `Area'.

No. 49, in schedule 1, page 45, line 44, leave out `Strategic' and insert `Area'.

No. 50, in schedule 1, page 46, line 1, leave out `Strategic' and insert `Area'.

No. 51, in schedule 1, page 46, line 4, leave out `Strategic' and insert `Area'.

No. 52, in schedule 1, page 46, line 7, leave out `Strategic' and insert `Area'.

No. 53, in schedule 1, page 46, line 10, leave out `Strategic' and insert `Area'.

No. 54, in schedule 1, page 46, line 13, leave out `Strategic' and insert `Area'.

No. 55, in schedule 1, page 46, line 15, leave out `Strategic' and insert `Area'.

No. 56, in schedule 1, page 46, line 18, leave out `Strategic' and insert `Area'.

No. 57, in schedule 1, page 46, line 19, leave out `Strategic' and insert `Area'.

No. 58, in schedule 1, page 46, line 22, leave out `Strategic' and insert `Area'.

No. 59, in schedule 1, page 46, line 24, leave out `Strategic' and insert `Area'.

No. 60, in schedule 1, page 46, line 27, leave out `Strategic' and insert `Area'.

No. 61, in schedule 1, page 46, line 29, leave out `Strategic' and insert `Area'.

No. 62, in schedule 1, page 46, line 32, leave out `Strategic' and insert `Area'.

No. 63, in schedule 1, page 46, line 33, leave out `Strategic' and insert `Area'.

No. 64, in schedule 1, page 46, line 36, leave out `Strategic' and insert `Area'.

No. 65, in schedule 1, page 46, line 38, leave out `Strategic' and insert `Area'.

No. 66, in schedule 1, page 46, line 40, leave out `Strategic' and insert `Area'.

No. 67, in schedule 1, page 46, line 44, leave out `Strategic' and insert `Area'.

No. 68, in schedule 1, page 47, line 2, leave out `Strategic' and insert `Area'.

No. 69, in schedule 1, page 47, line 5, leave out `Strategic' and insert `Area'.

No. 70, in schedule 1, page 47, line 7, leave out `Strategic' and insert `Area'.

No. 71, in schedule 1, page 47, line 9, leave out `Strategic' and insert `Area'.

No. 72, in schedule 1, page 47, line 15, leave out `Strategic' and insert `Area'.

No. 73, in schedule 1, page 47, line 17, leave out `Strategic' and insert `Area'.

No. 74, in schedule 1, page 47, line 20, leave out `Strategic' and insert `Area'.

No. 75, in schedule 1, page 47, line 23, leave out `Strategic' and insert `Area'.

No. 76, in schedule 1, page 47, line 26, leave out `Strategic' and insert `Area'.

No. 77, in schedule 1, page 47, line 29, leave out `Strategic' and insert `Area'.

No. 78, in schedule 1, page 47, line 33, leave out `Strategic' and insert `Area'.

No. 79, in schedule 1, page 47, line 35, leave out `Strategic' and insert `Area'.

No. 80, in schedule 1, page 47, line 37, leave out `Strategic' and insert `Area'.

No. 81, in schedule 1, page 47, line 40, leave out `Strategic' and insert `Area'.

No. 82, in schedule 1, page 47, line 43, leave out `Strategic' and insert `Area'.

 
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Prepared 27 November 2001