NHS Reform and Health Care Professions Bill

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Mr. Burns: I welcome the opportunity to debate clause 2, about which we have serious reservations. It is the crucial first clause that deals with primary care trusts. PCTs will be established by orders by the Secretary of State, and the purpose of this short but important clause is to give him the powers to do so.

The arguments about PCTs are a replica of the arguments that we had this morning about SHAs. I am glad that I will not unduly bore you, Miss Widdecombe, because you were not here. We strongly believe, on the basis of even more evidence than there is in respect of SHAs, that the Government are rushing headlong into these reforms without leaving enough time for the preparatory work that is needed to bed them down and have them up and running in time for them to operate at maximum efficiency from the start.

The clause gives the Government powers to ensure that a fundamental change to the health service and its funding will take place by statute. That is important because when they introduced the legislation that set up PCTs—as you will know, Miss Widdecombe, because you were involved in opposing it—they always said, on the record in this House and in another place, that PCTs would be created only by local consent through consultation with doctors, nurses and local communities. The then Health Minister, the right hon. Member for Southampton, Itchen (Mr. Denham), and the Government spokesman in another place, Baroness Hayman, said that the Government had no plans whatever to force PCTs on local communities and health care providers; they were to emerge as and when they wished. All such concerns have been brushed away in this headlong rush to get a piece of legislation on to the statute book.

As I said to my hon. Friend the Member for North-East Hertfordshire, the Secretary of State is confronted with many problems in the health service. Every member of the Committee will know about those through their dealings with constituents. Problems with waiting lists, whether it be the numbers of people waiting or the length of time that they have to wait; waiting times at accident and emergency departments in hospitals all over the country; the trolley waits that we hear so much about in the media and from our constituents; the postcode lottery of getting drugs such as beta interferon: those are the problems facing real people in the real world.

The Secretary of State is confusing activity with action. He thinks that if he introduces yet another structure of reform, he will be seen to be doing something. In truth, as anyone who has one iota of knowledge of the health service will have realised, there is nothing in the clause or the Bill that will help to overcome or minimise the problems facing our constituents day in, day out. They must wait longer for health care from our hospitals and suffer the indignity that the Government have created with a vengeance; a waiting list to get on to the waiting list. The irony is not only that people must wait to go into hospital; they must wait to come out of hospital because of bed-blocking problems. Clause 2 does nothing to deal with those problems.

Andy Burnham: If the picture is as the hon. Gentleman paints it and the proposals will do nothing to help the health service, why are they supported by organisations across the health service, representing a vast and diverse range of interests?

Mr. Burns: I can answer that very simply. The hon. Gentleman did not hear what I said; the Bill does nothing to solve the problems facing our constituents, including hospital waiting lists and other health care issues. That is a different point from that raised by the hon. Gentleman.

The clause transfers 75 per cent. of the funding that, under the existing system, goes to the health authorities and the acute trusts directly to the PCTs. That is a significant new responsibility for them because, clearly, they have not had to deal with such matters, which were previously the responsibility of the health authorities. They must also identify and provide for the range of health care within the area that they cover; that is another huge new responsibility.

Laura Moffatt (Crawley): I am not entirely sure what the hon. Gentleman was doing before the 1997 election, but my party and I were talking to GPs about what they wanted. They wanted power in their hands and that is precisely what the Bill enables them to have. To say that it will make no difference to local health care is nonsense.

Mr. Burns: Strangely, I was also talking to my GPs and I cannot believe that Chelmsford in Essex is different from Crawley in Sussex. If I remember correctly, my GPs were telling me at the time that they were terrified that a Labour Government would take away the extra powers that they had been given as fundholders. They did not want that because they liked the extra freedom and power to be able to look after their patients. That is what I heard from my GPs before the 1997 general election.

Dr. Murrison: Does my hon. Friend agree that what GPs really want is a period of stability with no change to allow them to get on with their job, which is treating patients? Does he also agree with Dr. Charles Webster, to whom he referred earlier, who said that none of this mucking around does much good for morale?

Mr. Burns: My hon. Friend is absolutely right. There is a lot to be said for stability, but it must not be a panacea for no action when action is needed.

Mr. Hutton: The hon. Gentleman and his hon. Friend make the case for no change and for organisational stability. That is precisely what his hon. Friend said and he agreed with it. Perhaps he would explain to the Committee what the structural reforms to the NHS are that his right hon. Friend the shadow Chancellor of the Exchequer has been saying are necessary. How does that square with the desire for no more change?

Mr. Burns: As I continue, my view will become apparent to the Minister. Sadly for him, I have not fully developed my argument, which should not come as a surprise, because it was made powerfully by my hon. Friend the Member for Woodspring (Dr. Fox). I echoed his comments on Second Reading and they were echoed by most speakers in our debate this morning on the parallel issue of strategic health authorities. The problem is two-pronged. Having given the PCGs and PCTs power to develop on a voluntary basis with full consultation and consent, as the right hon. Member for Southampton, Itchen (Mr. Denham) and Baroness Hayman said, the Government have made a formidable U-turn, sweeping that away and imposing it in statute.

Mr. Hutton: The hon. Gentleman obviously needs time to develop his argument and I am happy to give him that. However, in an earlier debate, did he not pay tribute to politicians who sometimes change their minds on policy?

Mr. Burns: Absolutely. No one should remain in a time warp, but politicians usually change their minds over many years when they have discovered that a policy or philosophy is discredited, outdated or irrelevant to changing needs. PCGs and PCTs were created just over two years ago and they are not outdated or irrelevant to needs. The Government have gone against the assurances that were repeatedly given in the House and in another place that PCGs and PCTs could develop on a voluntary and consensual basis.

My second point concerns strategic health authorities. I am even more convinced that the Government are rushing headlong into setting these organisations up and having them in place. We have established from the Minister's helpful contributions that they will all be established by October next year, although the first full financial year of their operation will be April 2003—March 2004. We believe that that is too short a time in which to set them up. More and more people who work in the health service are expressing concern about the rush. They fear that the PCTs—and, even more so, the PCGs that are still developing towards PCT status—will not have built up enough confidence and expertise to be able to cope fully with what they are expected to do. Ministers have boasted frequently that this massive and significant reform is marvellous for the health service. I do not disagree; it is massive, and it is significant in its way. However, I question whether the new bodies—particularly the PCTs, which are heavily reliant on the contribution of local health experts—will have the expertise and confidence to carry out their functions in a workable and clear way from the start.

I suspect that the Minister is aware of that, but if he is not, he will become aware of it with a vengeance. If the expertise is not there and those involved get it wrong, there will be the mother of all protests immediately afterwards. If the Government of the day shifts the money down to that level of the health service, it will become apparent, almost immediately, when problems emerge. Constituents of ours, and patients, will quickly find out that the system is not working.

I do not see how Ministers can be so confident that this scheme will work successfully from the start without hiccups or more serious complications. On the law of averages, I do not think that that is possible. I am not telling the Minister to scrap the Bill because the Government are entitled to introduce reforms and to use their majority to change systems if they want to. However, before the Government mess up the provision of health care, they must ensure that it works from day one. I am not confident—nor are many of those working in the health service—that this will work because so many concerns exist over the fact that experience and the depth of expertise have not been built up to allow such a revolutionary new responsibility to be placed on those people.

There is also a problem of morale. As has been said in earlier debates, we are seeing the abolition of health authorities that are, by the nature of their current functions, significant employers. There are morale problems because of uncertainty over jobs, and the ability to transfer jobs, as health authorities disappear; particularly because, logically, the SHAs will employ fewer people. Presumably, some people will seek employment in PCTs, but they will still be new to that concept even if they have a great deal of experience of working in the NHS.

We helpfully corrected the Minister's figures by saying that, at the moment, we believed there to be 130 PCGs that were not far forward in seeking PCT status. It is a relief to see—from the breakdown of the Minister's figures—that the situation is not precisely as has been suggested, but there are still a number of PCGs that are only moving towards PCT status. Presumably, they will concentrate on achieving that status rather than on what they should be doing once they have it. That will lead to inexperience, uncertainty and, perhaps, a sense of optimism that is not based on reality.

For the Minister's sake, I hope that the Bill is a success, but I do not think that it will be with the current time scale and with what seems like the inexorable rush towards having the system up, running and in place before it has been tried and tested. That is why I do not think it unreasonable to urge Ministers to delay the introduction of the whole system in the same way as we have urged delay for the SHAs. I am not suggesting delay through prevarication simply to prevent the Government from fulfilling their aims; that is not my intention. I am proposing simply a delay, and not an especially long one. We have boiled down the time scale that the Minister gave to six months from October 2002 to April 2003. That is not a long time; in May, June or July 2003, the Minister may, with hindsight, come to dearly wish that he had heeded the advice of others and accepted that delay to allow time to bed in.

 
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Prepared 27 November 2001