NHS Reform and Health Care Professions Bill

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Mr. Hutton: We have been over this ground. In April 2002, the Secretary of State will use his existing legal powers to complete a merger of health authorities along the boundaries of the proposed strategic health authorities. Clearly, there will not be strategic health authorities in the sense of the Bill at that time, because the Bill will not have passed through both Houses. Later, when the Bill receives Royal Assent—say, by October 2002—we can properly complete the establishment of the strategic health authorities, in accordance with the provisions. That is when the architecture will be symmetrical: the PCTs and the strategic health authorities will be in place and discharging the functions that we decide on in the House. That will complete the process; there will not be a gap, as the hon. Gentleman implied.

Mr. Heald: The point is that there will be a vesting date on which functions are distributed from the health authorities to the PCTs. Will the date be October 2002, or later? I understand that the health authorities will merge. At the moment, they have various powers and duties, which are either delegated to them by the Secretary of State or provided by law. If the health authorities retain all those powers and some of the PCTs have been set up, but not all of them, how are the functions distributed to the PCTs in the period between 1 April 2002, when the mergers occur, and the date when the Bill, assuming it becomes an Act, comes into force? In other words, what is the

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Government's scheme for distributing the functions, before the Bill has been passed? Perhaps the Minister understands; I do not.

We had all thought that 1 April 2002 would be the vesting date. Obviously, that was an over-ambitious view of the time needed for the Bill to become an Act. If that will not be the date, I do not understand how the PCTs will function in the period between now and whatever date is the vesting date. Will the Minister help me?

Mr. Hutton: I thought that I had. The hon. Gentleman is labouring the point and making a substantial mountain out of a very small molehill. He needs to refresh himself about the legislative context of the debate. The functions that are directly transferable to PCTs cannot be transferred until the Bill becomes law. Existing functions conferred by the Secretary of State under the National Health Service Act 1977 will continue to be discharged by health authorities until the process of establishing and delegating functions to PCTs is complete and the Bill becomes law.

Mr. Heald: Will the PCT, as an agent of the health authority, be able to carry out its role from April? In other words, is the clause legislative cover? Perhaps PCTs will acquire more powers in October. A budget must account for transferred functions, but PCTs do not yet know what their budget will be. They assume that it will be what was spent on a function in the previous year plus a bit extra, in line with pronouncements from the Government, the Chancellor and so on. Will the Minister explain how their functions and budget dovetail? If PCTs have a budget at the beginning of the financial year, they will be able to undertake their functions. If they start in October, how will that process work? Will there be a health authority budget for 2002-03, with part of the money given to the PCTs mid-year to help with the new functions? The British Medical Association and the Royal College of Nursing were told that the starting date would be April 2003. How does the timetable for implementation accommodate the functions and the money? Those factors are interlinked, and PCTs are concerned about the Government's intentions.

Mr. Hutton: Under existing legislation, the Secretary of State can directly delegate his functions only to health authorities, and further delegation to PCTs is carried out by health authorities. Certain excepted functions, which include provisions for the special secure psychiatric hospitals, arrangements for local representative committees and most family health service duties, cannot be delegated beyond health authority level. The clause will simplify the system in England by making all the Secretary of State's functions directly delegable to strategic health authorities and primary care trusts. It also removes the concepts of delegable and excepted functions and enables a strategic health authority to direct a PCT on the exercise of any functions.

The clause streamlines the exercise of delegating and dispersing functions throughout the NHS, and transfers significant responsibilities directly to PCTs.

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To labour the point, the transfer completes the process of devolution, which was outlined in the 1997 White Paper and was further developed in ''Shifting the Balance'' and our most recent proposals, so the clause is important. The NHS plan was not just a programme of investment, important though that is. It also set out a process of reform, which will be greatly assisted by the clause. The clause makes a reality of that aspiration.

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The clause provides for the Secretary of State to delegate his own health functions directly to PCTs. The provision fully recognises the changing role of the front line. I understand that the Opposition have reservations about the speed of those changes and that they have some fundamental objections to the process of devolution itself. However, this is a very important clause that I hope hon. Members on this side of the Committee will be able to support.

The hon. Member for North-East Hertfordshire asked me a number of questions about functions, and I tried to deal with his question about the timetable. He also asked about resources and how they would be transferred.He referred to a vesting day; the day on which we implement clause 2 will be when we shift all the directly conferred functions. We currently intend to do that around 1 October 2002, so we are envisaging a vesting day in the way that he has described. I cannot confirm to the House that it will be 1 October—it may well be a Sunday—but it will done in October. That is when the functions will be transferred. All the key family health services will be directly conferred and all PCTs will be given the responsibility of delivering those important functions.

The hon. Member for Wyre Forest asked me about resources and, as in all spheres of life, this is the crunch. When the functions transfer, the resources have to transfer with them. It would not be sensible of me to go into the detail of how the precise resources will transfer to each PCT because I am not in a position to have that discussion today. The obvious and only logical position for us is to ensure that the necessary budgetary allocations are transferred on the day on which the functions are transferred.

I am happy to go into more detail at some future point with the hon. Member for North-East Hertfordshire. Perhaps he would like to come into the department, or perhaps he would like me to provide him with a briefing. However, the resource issue, the audit trail, where the money is going; all of these issues will be in the public domain. We have nothing to hide about that. Many of the earlier debates have again become crystallised in this clause. I have tried to respond to the hon. Gentleman's concerns as fully as I am able at the moment.

Mr. Heald: I understand that there is a question over the power of functions that are directly transferred to the PCTs—these functions are listed—but there is also a power for a strategic health authority to direct that a specified function shall be dealt with by the PCT. Are those functions the same ones as are set out in the document that has been given to the Committee, or are

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they a different group of functions? Subsection (2) talks about the Secretary of State's functions going to PCTs. Is that what the Minister was referring to when he talked about the vesting day, or does the subsection apply to both matters?

Mr. Hutton: The power for the strategic health authority to direct a PCT relates to any of its functions. It is important that there is an opportunity for that power to be exercised at some point. The difficulty is how we square devolving power to the front line while continuing to have a power of direction. We have thought about this very carefully; the alternative is to have the Secretary of State issuing directions from the centre. The hon. Gentleman and his hon. Friends will be the first to moan at me that that would mean micromanagement of the NHS by Ministers in Richmond house.

We need to have this power to ensure that the NHS does not become a free-for-all, and that the strategic health authority is able to have that power when necessary. However, it is a power that we have moved away from the Secretary of State down as close to the front line as we can. The power is given to the strategic health authorities. I do not have anything else to say about clause 3, so I shall sit down.

Mr. Heald: I am obviously trespassing on the Minister's good will, but I shall continue. The document on the functions directly conferred on health authorities and transferred by the Bill states:

    ''This table sets out those functions which are directly conferred by legislation on Heath Authorities. There is a large number of functions which are conferred on the Secretary of State by legislation, which can be delegated to Health Authorities. Some functions can, in turn, be delegated by Health Authorities to Primary Care Trusts. The Bill does not deal with these functions''.

These include such things as ambulance services. It then goes on:

    ''It is expected that those of the Secretary of State's functions which are currently exercised by Health Authorities will be delegated by the Secretary of State instead to the Primary Care Trusts.''

It then lists the current health authority functions and the bodies to which they will be transferred.

Clause 3 concerns directions and the distribution of functions. I may be wrong, but I believe that it is concerned with different functions from those in that list. However, it may not be. Is the Minister saying that the list in the document of the current health authority functions that will go to the PCTs is a list of the functions that the strategic health authority will direct the PCTs to do? If so, I can understand that. If not, could the Minister give us an idea of what functions are dealt with? Subsection (2) mentions the Secretary of State's directions and his functions, and the health authority's directions and functions are also mentioned. Is that what the document is about? Are those directions transfers?

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