NHS Reform and Health Care Professions Bill

[back to previous text]

Mr. Hutton: No, I am not in favour of variable geometry. When I was at school, I never understood it, but with regard to the hon. Gentleman's argument it is clear that it would not be a recipe for consistency and effectiveness throughout the NHS. We must consider the issue in the context of the architecture of the new arrangements between SHAs and PCTs. The purpose of the exercise is to give the grass roots of the front-line

Column Number: 148

services as many functions as possible. Of course, the Secretary of State has to make judgments about the capacity and the capabilities of PCTs to discharge such functions. That is precisely his function and it is part and parcel of the decision making process that he must go through in authorising the establishment of a PCT. That is the right way to discharge those functions effectively, rather than an attempt at variable geometry in the way that the hon. Gentleman proposed. I would not want to signal to the hon. Gentleman that we are considering variable geometry; we are not.

Mr. Heald: According to the list, the current health authority functions listed will go to the PCTs. One function relates to special notices of births and deaths. I do not know what that amounts to—the Minister may be able to tell me—but it is probably not one of the health authority's major functions. However, a PCT may have difficulty in sorting that out.

There may be some mechanism that we have not yet heard about whereby the Secretary of State would simply transfer functions when the trust was ready, and the special notices of births and deaths function would be transferred in due course when it was ready to go on line. It may be that that is one of the powers of the Secretary of State in the schedules. There certainly is a provision in one of the schedules to the effect that the Secretary of State has powers to distribute the functions in a very wide way. Is it possible for the Secretary of State to distribute these functions a la carte or does he have to do them all at once and is the mechanism—

The Chairman: Order. Unless I am wrong, the hon. Gentleman is intervening on the Minister and, if so, the intervention is somewhat excessive.

Mr. Heald: I must accept that I am guilty of excessive enthusiasm.

Mr. Hutton: We do not want to encourage any more of that, thank you very much.

In theory, that is possible because the Secretary of State can exercise that discretion, but it would not be sensible to do so in the context of what we are trying to achieve through shifting the balance of power. We envisage the PCTs taking on the responsibilities and that is why we have set out the provisions today and I have tried to expand upon them in earlier sittings of the Committee. If the hon. Gentleman wants to raise specific questions about the special notices of births and deaths, we shall certainly be able to reconsider the matter when and if we debate clause 3. I do not have any information about that at my finger tips, but I am sure that I can obtain it if he wants.

The amendment is essentially about whether the House should go through the affirmative resolution procedure when the Secretary of State wants to bring a PCT into existence and he has to make the statement that it is ready, willing and able to receive and exercise its functions. According to the amendment, he has only to make that statement, and I do not see how that is an improvement in the scrutiny role.

Column Number: 149

The issue of accountability is important; I do not dispute that. My view is that clearly, as the Secretary of State will hopefully be given powers to make these decisions under this legislation, he is accountable to the House for his decisions. There are various ways open to Members to hold the Secretary of State to account. This is a genuine question that we would need to be further satisfied about. I have no doubt at all that the Opposition Chief Whip will want to reflect on the question. I suppose it is different in opposition, but if the hon. Gentleman succeeded in amending the proposal and, by some miraculous turn of events, the Conservatives became the party of government, he would have to explain to his business managers why hundreds of orders have to be debated on the Floor of the House simply because the Secretary of State has to make a statement. With the benefit of 20:20 vision they might welcome such a proposition, but I strongly suspect that in reality they would not. Most Government Members probably regard the hon. Gentleman's point as a bit of window dressing, and not substantive.

The hon. Member for Wyre Forest made one important point, and I will deal with it. He asked me about functions and resources and, in particular, whether PCTs will have the resources to go with the functions. That is our intention. It is not part of our programme of NHS reform to give grass-roots primary care organisations important new functions but no means to deliver them. We are not stupid. He asked for a simple response, and I have given one.

Opposition Members must bear in mind that, although PCTs will be given new responsibilities, people in the NHS are already discharging them. In this matter, they tend to be working in health authorities. We envisage those people continuing to exercise important responsibilities in the new PCTs, and we want those who wish to transfer to do so. I hope that there is no misunderstanding. The functions are being discharged by public servants in the NHS, and they will continue to be discharged by public servants working for PCTs. The resources that are needed to ensure that the SHAs and PCTs can discharge those important responsibilities will be available.

Mr. Heald: The Minister may be labouring under a misapprehension of what we were aiming to achieve with amendment No. 123. He said that it would be wrong to deal with the matter under the affirmative resolution procedure because each order would have to be debated on the Floor of the House, but there would be no need for that. There would be a debate in Committee, similar to the one that we had on Monday, not on the Floor of the House, although there would be provision for seeking to divide the House after the Committee had examined it.

The procedural point is not the most important part of the amendment. If the Minister is saying that the amendment would be acceptable if it used negative procedure, we will examine that option for Report. Our point is that because many PCGs are not ready at the moment—concerns have been expressed widely about that—there should be a duty on the Secretary of

Column Number: 150

State not to impose duties and burdens on PCGs that are not ready for them, or, if he does impose such duties, to make a statement to the House to the effect that they are not only ready, but willing and able to take on the functions. That is a sensible suggestion. If the Minister's only objection is that he believes that we should do that using negative procedure, I would be prepared to withdraw the amendment and reconsider it for Report.

Some current health authority functions, such as the management of family health services, are significant matters. Indeed, as the Minister may agree, it is one of the most crucial functions. General medical services are similarly important, and general practice plays a vital role throughout our constituencies. However, some functions are minor. I raised some points during my long intervention, and I have not yet had a satisfactory answer. I hope that the Minister will be prepared to take up those points briefly. He seems to suggest that all the functions would be given to the PCT at once. If a PCT can manage most of the functions but has difficulties with one or two aspects, for whatever reason, could not most of the functions be transferred? Or would they all have to be transferred because the health authority had been abolished and there was no one to take responsibility? We are keen to probe the practical aspects. It is part of the theme that we have developed throughout the Committee that not all the PCTs and PCGs are ready. We want to be satisfied that the Government have thought through all the issues.

4 pm

Mr. Burns: Given that the Minister seems reluctant to answer my hon. Friend's points, we will reserve judgment and reconsider the matter on Report. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause, as amended, stand part of the Bill.

Mr. Heald: The clause is important because it deals with the key distribution of functions by the Secretary of State, both to the strategic health authority and to PCTs. It states:

    ''A Strategic Health Authority may, in relation to any specified functions of theirs, direct a Primary Care Trust whose area falls within their area to exercise those functions.''

It also provides that

    ''a Strategic Health Authority may not so direct a Primary Care Trust in relation to any functions of the Strategic Health Authority arising under section 28C arrangements if the Primary Care Trust is providing any services in accordance with those arrangements.''

It goes on to provide that the Secretary of State may direct strategic health authorities that specified functions are exercisable or not by PCTs.

The list that the Minister produced, for which I thank him, is helpful in detailing the functions that are currently directly conferred on health authorities and would be transferred by the Bill. Will the Minister comment on the general point that that distribution of functions is fine in that it gives the PCTs responsibility

Column Number: 151

for important issues, such as the management of family health services, general medical services, and so on, but that it has to be seem in the context of the numerous target performance indicators and the fact that the Secretary of State retains numerous powers throughout the Bill? To what extent can the Minister help us with the programme for the transfer of those functions? I asked earlier whether each of the health authority functions would be transferred to the PCTs or whether one range of functions could be ready and another not, so that the changes could be stepped in over a period. Have I misunderstood the way in which that works? Is it a take-it-all or leave-it-all option?

No body other than the PCT can take on the functions. As I understand it, the proposal is to abolish the health authorities before the PCTs are set up. The Minister said earlier that there would be a gap between the strategic health authorities being set up and the PCTs coming into effect. Our original idea, based on the Library brief and ''Shifting the Balance'', was that all the events, including the transfer of functions, would happen on the same day. We would have completion, to use a conveyancing term: on the same day, the authority would pass its powers over, and the PCT would pick them up.

If I am right, and the strategic health authorities are being set up on 1 April 2002 but the PCTs—or some of them—will not be established until October that year or allocated a budget until April 2003, what happens to the distribution of functions?

Previous Contents Continue

House of Commons home page Parliament home page House of Lords home page search page enquiries ordering index

©Parliamentary copyright 2001
Prepared 29 November 2001