|NHS Reform and Health Care Professions Bill
Mr. Heald: Will the Minister say a little more about one aspect of the structure? It is clear from clause 1, which we have already debated, that there is a power for the liabilities of health authorities to be transferred to SHAs, and no doubt such liabilities could be transferred to PCTs because there are similar powers in schedule 3. Are the Government in a position to explain what will happen to PCTs as regards debts that have built up in health authorities over many years?
Mr. Hutton: I can reassure him and the Committee that there is only one health authority that has a deficit. The issue of the potential transfer of liability only arises in that one case. My understanding is that that deficit will be resolved by the end of this financial year.
Mr. Heald: I am grateful to the Minister. As regards general liabilities and ignoring the question of that one historic debt, which is of course of great interest to me, can he tell us what will happen to the various liabilities that any company, corporate body or in this case health authority has at any particular moment? Are those liabilities something about which he can tell us in Committee?
The evolutionary principle, which was set out in 1999, was designed to ensure that PCGs could not go on to become PCTs if local people in consultation felt that that was right. That decision would have involved weighing up a range of different concerns. It would have involved an analysis both of the PCT's practices in the area and of its strengths and weaknesses; it would have involved looking at the robustness of the management, and thinking about whether staff with particular areas of knowledge could be recruited; it would have been about the premises, their location and a whole range of matters. Of course, above all, it would have looked at the sort of services that would be available to local people.
It is rather shocking to see that the Government have gone back on that approach, and that they have not explained why. I hope the Minister will be able to tell us why he is abandoning the points made by Baroness Hayman, such as the fact that primary care trusts will be established by the Secretary of State, and that progression to trust status will be determined by local views; that the Secretary of State will be able to establish primary care trusts only after local consultation; and that the views of the primary care groups, local GPs and other professionals, as well as the wider community and the local NHS, will be key considerations for the Secretary of State.
Is the Minister really indifferent to bodies such as the Royal College of Nursing, which was obviously told that this scheme was to commence in the year 2003? The Royal College of Nursing has voiced concerns over the viability of the successful implementation of the proposals in the time scale envisaged. PCTs are relatively new organisations, and the expectation that they will be able to provide the proposed services by 2003 is very ambitious. PCTs will need support if they are to take on new responsibilities.
If it were just the Royal College of Nursingalthough I would never put it in this wayone might say that only one body of health professionals takes that particular view, but everybody else disagrees. If so, we could do what the Minister seems to want to do, which is to ignore it. However, what the British Medical Associationthe main representative group for doctorssays is almost word for word the same. The BMA says that it is concerned that PCTs, where they exist, are relatively new organisations and that the demands may well be beyond their existing capacities. They are already experiencing difficulties in recruiting clinical staff who are able, willing and competent to participate. The BMA states that the PCTs will be up and running by spring 2003; it has obviously been told that as well. This is an ambitious timetable, given that there remain approximately 130 primary care groups, many of which have not yet made any preparations towards PCT status.
In the light of those comments from the two main representative bodies of health professionals, the Committee is entitled to ask the Minister whether the PCGs and PCTs are ready for these reforms. The answer seems to be no. The Minister is aware of the tracker survey, which has already been referred to. This survey states that progressing, commissioning, health improvement and partnership working are slower, and that a lack of reliable and timely information and insufficient managerial capacity remain as problems. Professor Wilkin's views have also been referred to. The message is that the groups are not really ready for this change. The executive summary looks at more detailed points about the wide variation in the numbers and type of staff available to PCTs and PCGs, making the point that this is likely to be reflected in a varying capacity to deliver improved services.
I know the Minister found it deeply shocking when my hon. Friend the Member for Woodspring said on Second Reading that the average number of managerial, financial and administrative staff employed by PCGs was 6.8, compared with an average for PCTs of 15.8. The number of staff needed to bridge the gap between PCG and PCT status and to perform the sort of detailed, enhanced functions that the Minister proposes raises a key concern. The numbers of staff employed or seconded have increased considerably during the past 12 months, but one in seven PCGs and PCTs still has no finance staff.
PCGs have extended efforts to involve key stakeholders, but the interests of local communities and voluntary organisations are still poorly represented in many PCGs and PCTs. The proportion developing locality groupssomething on which the Minister places particular emphasisis slightly more than one third. However, only seven have delegated budgets to that level.
That body of concerns has come out through the Government-supported tracker survey. Only one fifth of PCG and PCT budgets are in line with national resource allocation targets. Half are developing financial incentives related to clinical governance, but only one third were planning to link the financial incentives to notional practice budgets for hospitals and community services. Given the extent of the Minister's ambition for PCGs and PCTs, that is a long way off the mark.
The background is that responsible health professional bodies such as the BMA are proposing an ``ambitious'' timetable; as I said earlier, that is a bit like Sir Humphrey describing a Minister's decision as courageous. [Interruption.] I am happy to give way to the hon. Member for Weaver Vale (Mr. Hall) if he so wishes, or we could discuss the matter later. The hon. Gentleman may have been suggesting that my recollection of Sir Humphrey was poor, but I stand by it.
The Health Service Journal recently undertook a study of the views of chief executives of NHS bodies. Some 304 chief executives responded, which I would suggest is a very good sample. They produced a series of findings that make sobering reading. Some 45 per cent. of chief executives thought that the inabilities of PCTs to cope with enlarged responsibilities were due to the fact that they lack managerial capacity, resources and vision. A third33 per cent.thought that the time scale for the changes was unrealistic and dangerous. Some 29 per cent. thought that the changes were resulting in disruption to delivery and risks to the NHS plan. Almost a third of chief executives believe that the organisational changes involved in the Minister's great NHS plan, designed to deliver all the improvements that we hear so much about, will damage progress.
A fifth of executives22 per cent.had concerns about the future of many health authorities, regional office functions and the lack of detail in the proposals. Some 20 per cent. thought that the effect of changes on staff, the loss of key staff, the lack of continuity and the impact on morale were very important. One could go on and on listing the drawbacks that were found in the study. One chief executive was quoted in the survey as saying that
Another chief executive put it this way:
We must consider the human cost of the reforms. A fifth of the chief executives surveyed were concerned that there would be a loss of experienced staff. Some 15 per cent. said that they planned a career move outside the NHS, and 14 per cent. said that they would retire early. That would be a substantial percentage of chief executives lost to the service. One said that the changes were
|©Parliamentary copyright 2001||Prepared 27 November 2001|