NHS Reform and Health Care Professions Bill

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Dr. Evan Harris (Oxford, West and Abingdon): First, I apologise for my late arrival in this afternoon's sitting. I said this morning that as I believe that the whole clause is fatally flawed I do not have much to say about amendments that seek to make it better. I was surprised to find that there is some compromise in the air regarding consultation. I was also surprised, but delighted, to see you in the Chair, Miss Widdecombe. I remember the times that we spent debating the Health Act 1999, sometimes with the Minister. That is where I learned how to deal with Standing Committees. If I perform badly, it will not be a reflection on what I learned from you, Miss Widdecombe. I enjoyed the experience a great deal.

I am somewhat hampered, in that I understand that there may not be a stand part debate. I do not argue with your decision on that, Miss Widdecombe, but I regret it because we have not had an opportunity to debate the fundamental problem—the abolition of health authorities and the creation of larger beasts called strategic health authorities—that none of the amendments tackle. In so far as I am in order, I will attempt to make a few remarks on the order-making powers during discussion on the amendment.

Mr. Burns: The hon. Gentleman has been a member of the Committee since its inception. If he does not feel that any amendments deal with the fundamental issue to which he refers, why has he not tabled amendments to deal with it?

Dr. Harris: The amendment that I would like to table is one that deletes clause 1. I can support that principle by voting against clause 1 on the stand part vote, so amendments are not required. I made that clear earlier, and I am sorry that the hon. Gentleman did not understand my point. I make it again now. We can have long debates about improving something that is fatally flawed, but it is important to come down to the nub.

Mr. Heald: On a point of order, Miss Widdecombe. As one or two hon. Members were not present when you made your ruling, it may be convenient for the Committee if you confirmed that you would allow considerable latitude in the discussion of the amendments.

The Chairman: I am not sure whether my words were ``considerable latitude''. I said that, having examined the scope of the amendments and the clause, I was not minded to allow a stand part debate and that, in the light of that, I was prepared to allow discussion to go slightly wide. I stressed that that was not a general invitation to discuss anything and everything. If the hon. Member for Oxford, West and Abingdon wishes to make remarks that are slightly wide, that will be in order.

Dr. Harris: I am extremely grateful to you, Miss Widdecombe, and to the hon. Gentleman, for that clarification. On Second Reading I made several remarks that I would otherwise have made in a stand part debate, and I do not intend to take up the Committee's time by repeating them. I should be grateful if you would bring me to order should I step beyond the latitude that you have so kindly and wisely granted.

I agree with the principle that it is correct when scrutinising legislation to ensure that the Government are not taking the easy path with the negative procedure for statutory instruments. When we discuss other order-making powers in the Bill, there will be occasion to raise that. The remarks of the hon. Member for West Chelmsford are reasonable in general, but this is not the order-making power upon which to go to war over negative and affirmative resolutions. If every change that was conceived had to go to a Standing Committee, we would spend much time looking at minutiae and miss the bigger picture, and that would, to a certain extent, play into the Government's hands.

The wider picture is yet another example of the continual upheaval in the health service, with the loss by local health authorities of their strategic functions to a much larger body with which local people will find it hard to identify. Although there will be coterminosity, in that we are told that an SHA's wider boundaries will not cross the boundaries of the local authority or the regional office, there will still be a loss, certainly for counties, when, for example, the Oxfordshire health authority that people know so well and sometimes love—or sometimes hate—is removed. It cannot be replaced, even with greater consultation over SHAs and PCTs.

Any gain is lost if the clause is passed, so I do not think that asking for affirmative resolutions when boundary changes occur is especially helpful. There will always be arguments about what the boundaries and the name of the SHA should be. In the end, the Government have to make a decision, and will, presumably, be indirectly held to account for it.

As the Government are taking broad powers to make changes, it is appropriate to question why the Government want to devolve responsibilities to PCTs, which for all their localness, do not have the same understanding of and identity with local communities that health authorities have. Health authorities are population-based groups, whereas PCTs, by definition, cover those people on the list of GPs in the area. While they may be smaller than health authorities, they lose a lot in terms of accountability.

In the areas that I know of, the names of the PCTs do not necessarily follow those of natural communities. The Government will have difficulties naming SHAs under some of the powers that the amendment is discussing, when trying to identify natural communities.

Mr. Hutton: The hon. Gentleman is not right in what he said about primary care trusts. PCTs come in various shapes and sizes. For example, the PCT that covers my constituency is coterminous with the previous boundaries of the health authority.

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Dr. Harris: The concept of the boundary of the PCT is a curious one. As I understand it, the people served by the PCT are those who fall within the ambit of the primary health care services in that area. Indeed, one of the arguments for the establishment of the PCT was the focus that the Government want to give to primary care to have a greater role in commissioning outwith health authorities. Health authorities cover geographically defined areas, and there will be some significant overlap in population terms between PCTs, simply because they are at the boundaries of conurbations. I do not know whether the Minister —

Mr. Hutton: The hon. Gentleman is right on that point, but he is wrong in assuming that there is no possibility of coterminosity between PCTs and health authority boundaries. Often there will be. Some PCTs are set up on the same boundaries as health authorities.

Dr. Harris: Presumably they have seen the virtue of that conterminosity with the commissioning population. Therefore, if commissioning is the key—certainly some of the functions of the commissioning and overseeing of services—I would prefer to see that done and supervised on a population-based approach.

Mr. Hutton: Once again the hon. Gentleman has missed one important factor—the PCTs are established following local consultation. I accept his point about the boundaries sometimes being a mysterious process, but whatever the boundaries are, they are informed by the strength of local opinion, particularly with the GPs and in primary care.

Dr. Harris: There would be more merit in that argument as a total rebuttal if the formation of PCTs was an option that local populations could choose following consultation. But the Bill, and specifically the next clause—which I will not deal with now—does make that compulsory, and therefore less of a consultative issue.

It is relevant to the discussion to ask the Minister for clarification on a matter that he raised earlier, which we could not discuss then. He provided a clarification note about the functions currently conferred on health authorities and transferred under the Bill in the main to PCTs and, in one example, to SHAs, with regard to which he has an order-making power, which we are discussing here.

Personal medical services and personal dental services will be transferred to SHAs because, as the Government explain in their note, technical and legal barriers prevent the direct conferral of all PMS and PDS functions to PCTs in the Bill because the National Health Service (Primary Care) Act 1997 requires a distinction between the commissioner and the provider of PMS and PDS pilots. I understand that. I was concerned about the loss of the purchaser-provider split when PCTs were going to be doing the providing, as well as the commissioning and running themselves.

Does the Minister think that there is an argument for ensuring that more of those services, particularly the management of family health services and general medical services, might have been transferred to a SHA rather than to a PCT, where there will be a concern that it is the people against whom there may be complaints and general issues of performance who are in charge of managing that performance.

Mr. Hutton: It is important that those services should be as close to the front line as possible. That is why we have taken the decision on the point he mentions. Personal medical services are particularly difficult because some PMS pilots are directly provided for by PCTs and it is important to respect the commissioner-provider divide. That is regulated under clause 4, so I am sure that we will have an opportunity to discuss it later.

Dr. Harris: On that basis, I shall not pursue it any further now.

On Second Reading, I raised the question of the public health function. Concerns have been raised and while there is certain support for the concept of moving the public health function from local health authorities to PCTs, concern has also been raised about the loss of expertise and people through that change, and the loss of a strategic overview because SHAs will be much larger and will have a rival in the shape of a more local director of public health. How will the Minister ensure that we do not lose the effective public health function? I hope that he will accept that it has been performed well at health authority level so far. In respect of infectious disease control and other matters, the regimes are tried and tested at that level. It would be unfortunate if, despite gaining the benefits that the Minister claims for this move, the public health function was lost. There is a question over whether sufficient specialist expertise exists in public health to provide the function under multiple PCTs, rather than under a single health authority.

I am grateful for your patience, Miss Widdecombe, in allowing me to stray beyond the exact boundaries of the amendment. I shall seek a Division at least on clause 1 stand part and, because of our concern about change for the sake of it and appearing active to hide failure to deliver, my party cannot support what amounts to vandalism of the health service.

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Prepared 27 November 2001