National Health Service Reform and Health Care Professions Bill

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Mr. Heald: Is the Minister saying that an SHA will have a public health doctor but that a PCT might not, although it could?

Mr. Hutton: PCTs will have a public health function and a public health director. That will not necessarily be a doctor, but a consultant for public health, rather like the present arrangements.

Mr. Heald: As the Minister knows, the BMA is interested in the matter. SHAs will always have a public health doctor and PCTs will have a public health function, but not necessarily a doctor.

Mr. Hutton: Yes, that is broadly how we see the reforms working. We do not want to compromise, or affect the quality of, the public health function as it is discharged by the NHS. That is not on our agenda.

I do not think that there is much else for me to say about these amendments, other than that there are an awful lot of them. I am grateful that the hon. Gentleman has not felt the need to discuss each of them, and I hope that I have not provoked him into doing so. I do not think that they constitute a sensible way forward.

Mr. Heald: Perhaps the Minister will comment on the point raised by the Royal National Institute for the Blind. It has briefed all Committee members about its concern that there should be proper local arrangements between local authorities and the NHS to ensure effective service delivery. Can I tempt him to say whether that would be an SHA role where it concerns the improvement of quality, or a PCT role?

Mr. Hutton: It would be both. Primary care trusts will be able to enjoy the fruits of some of the earlier legislative changes that we made to promote closer working, such as section 31 arrangements under the Health Act 1999 and the care trusts provisions of the Health and Social Care Act 2001. The strategic health authority will have an overall role in making sure that progress is being made in that important area.

Mr. Heald: That is very helpful.

It was not our intention to see the area health authority rise like a phoenix from the grave. If anything, the area health authority role is far more akin to what PCTs will do. I was not going back that far; I simply wanted to discuss whether the strategic health authorities were strategic and had a role and function. I am not very satisfied with the Minister's reply, partly because the details of the functions of SHAs will be set out in an order made by the Secretary of State under the negative procedure that will never be discussed by the House in detail.

Mr. Hutton: I remind the hon. Gentleman that we have followed the pattern that was set by the National Health Service Act 1977, where the legislation requires the establishment of the health authorities, but the functions are left to the Secretary of State to determine. We are following that pattern and it will be open to Opposition Members to call for a debate on the proposals if they are concerned in future.

Mr. Heald: The last time I looked, there were 2,000 negative orders, 30 of which were debated, despite the fact that many hundreds were requested for debate. This Government are a bit worse than we were but, none the less, it is not the tradition to debate negative orders even if the Opposition want to debate them.

The Minister is right that, between 1974 and 1979, many Acts were introduced on the basis that they had wide order-making powers; they were Christmas trees without baubles or skeletons without flesh. One could not tell the details of what would happen as a result of an Act of Parliament. Some people may think that that was a bad trend, but it has been followed; now, much detail is not covered by the Bill, but by orders.

One suspects that layers of bureaucracy are being added, so it is a pity not to be able to see what the functions of the SHAs will be. They will be dealt with by order. We cannot get down to the detail, or see whether the authorities will be doing anything worthwhile. The amendments are probing, but I will not press them.

12.45 pm

Dr. Murrison: I am grateful to the Minister for suggesting that I might be able to remember area health authorities. I can just about cast my mind back to 1974 when those authorities were rearranged, together with district health authorities and regional health authorities, and there is a sense of de''ja vu as we reinvent those structures. That might be fine were they to serve a useful function, but SHAs are looking fairly bankrupt.

PCTs are taking the best and leaving the rest. Although I am grateful for the Minister's views on where the public health function will lie, and reassured that public health consultants will find a role in SHAs, I am concerned that they are a bolt-on to the SHAs to bolster them up. I am pleased to hear that directors of public health will be attached to PCTs and, although I am doctor, I am pleased that directors do not necessarily have to be medically qualified. In the amendment, the Minister did not mention consultants in communicable disease control, so will he mention where CCDCs will sit? I expect that they will sit on SHAs.

We have not yet defined ``strategic''. Words are important; they mean what they say. We need to explore why the Government require the insertion of the word ``strategic''. Why will they be strategic authorities, rather than straight health authorities? We also need to know why 1.5 million has been chosen as a proper figure for a population served by each SHA. Presumably, it is linked with the notion of being strategic.

We must explore the need for tertiary centres in SHAs because I understand that one of the key planks in being strategic is that one has access to a tertiary centre. That appears to be the case under most of the proposals for boundaries, but there are several signal exceptions—for example, the SHA that it is proposed will be made up of Somerset and Dorset. It stretches the imagination to suppose that that SHA will have a tertiary centre, so there appear to be a few disconnects in the thoughts that are going into this, which gives me added concern about the notion of being strategic. If the authorities are to be strategic, they need to be uniformly strategic. The signs are that that is not happening.

Mr. Hutton: The hon. Gentleman has asked two further questions and it would be appropriate to respond briefly now, rather than to write to him later. He has asked about the arrangements for communicable disease controls and where the CCDCs will be located —at PCT level or strategic health authority level. That is an issue that we are considering. The chief medical officer is advising the Government about that, and we expect to receive his recommendations by the end of the year.

The hon. Gentleman also asked about tertiary centres and specialist commissioning. We are trying to draw a line between NHS bodies with commissioning responsibilities—PCTs—and those without, including the SHAs. The securing of specialist services will be the responsibility of PCTs, working together in collaborative and cooperative ways. It will be the responsibility of the SHA to ensure that satisfactory arrangements are in place to ensure that that process is working. For the next financial year, the current regional specialist commissioning groups will continue to exist, making sure that PCTs can build up the capacity effectively to discharge that function, with clear responsibility to ensure that there is a planned transition and to develop the PCT capacity to commission those services from 2003 onwards.

Mr. Heald: I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Mr. Burns: I beg to move amendment No. 84, in page 2, line 3, at end insert

    `provided that such area has an adult population of more than 2 million people.'.

I say from the outset, to avoid any confusion, that this is a probing amendment. In the absence of any draft regulations, I seek to tease out from the Minister some more information on the nuts and bolts of the SHAs.

The Minister will be aware that subsections (2), (3), (4) and (5) are also subject to amendments at a later stage, which have been selected, so we will have the opportunity to debate other aspects of SHAs, but the Government have included in the Bill the power to establish SHAs for England, without specifying, for a variety of eminently reasonable reasons, their detailed intentions.

The figure of 1.5 million has been bandied around as the average population that the Government anticipate an SHA will cover. Staff from the North Essex health authority seem to be working on the basis of one SHA for Essex, which would in effect be a merger of the North Essex and South Essex health authorities, giving a population of about 1.5 million. Our amendment refers to an adult population of 2 million, so, clearly, if the Government were to accept it—as I have said, it is a probing amendment—the figure would be higher because it excludes children and young people under the age of 18.

We know from the Bill that there cannot be cross-border SHAs between England and Wales. For various reasons, I think that that is a wise decision, and an inevitable one for the Government. Interestingly, under clause 1(4)(b), the Secretary of State may, by order,

    ``abolish a Strategic Health Authority''.

I would like press the Minister on that. If he has a belt and braces approach to the Bill, he will get any eventuality into the legislation. I assume that that provision is there so that if a future Government wanted to re-organise the structure of SHAs by merging some into larger units, they would have the powers without having to revert to primary, or even secondary, legislation. Can the Minister confirm that that assessment is correct?

That raises a problem, depending on the population basis. If the level is 1.5 million, and if the Government rigidly stick to that throughout the country, any abolitions or mergers of SHAs—I presume that, in most cases, abolition of an SHA would be to enable a merger—could establish very large organisations. Those could be vulnerable to the accusation of potential detachment from the area that they seek to serve strategically because they cover too large a geographic area.

Alternatively, that provision might be in the Bill because the Government, for various reasons, wanted some areas to have SHAs covering more than 1.5 million people, if that were their average guideline figure. With experience and hindsight they might want to make an SHA larger because it was too small to fulfil Ministers' and the Department's original intentions.

I am not saying that 2 million adults, with however many children there might be, is an ideal figure, or that 1.5 million is right or wrong. From the only experience I have—on the ground in Essex—that figure seems more or less sensible, as it reflects the county boundary and keeps local roots for the body. However, will the Minister share with the Committee more information about his and the Department's thinking on the shape, form and size of SHAs in England?

 
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Prepared 27 November 2001