NHS Reorganisation

I gather that wards are also being closed in Northamptonshire. That situation is replicated right across the country. I was talking to a local physiotherapist the other day and she told me that her job description required her to administer for 25 per cent. of the time and give physiotherapy for 75 per cent. She then told me that the situation was now reversed and that she was now lumbered with all the administration, because the Government are stealthily removing administrative support in an effort to avoid the charge that they are diminishing front-line services. How can there be any sense in the Government proposing changes to the structure of primary care trusts unless they have first established with clarity what the functions of the PCTs are to be? The Government’s document, ““Commissioning a patient-led NHS””, called for PCTs to become"““patient-led and commissioning-led organisations with their role in provision reduced to a minimum””" by 2008. In the face of fierce opposition from NHS staff employed by PCTs, from MPs, and from the Royal College of Nursing—which launched, but has now withdrawn, an application for judicial review of the decision—the Government have since retreated from their strident position. The Secretary of State said on 11 November 2005:"““I know that many of you were very unhappy about what we said at the end of July . . . I am very sorry that many staff have been caused such anxiety . . . Any move away from the direct provision of services will be a decision for the local NHS within the framework set out in the forthcoming White Paper and after local consultation.””" There we have it: the Government’s U-turn. So far, so normal for this Government, but, even though common sense would dictate that they should, they did not even review the design of the new PCTs to ensure they were fit for their new purpose as commissioners as well as local providers. Those roles encompass massively different skills and levels of authority, governance and accountability, as anyone with even a smattering of management experience could see. On 11 January 2006, the Health Committee attacked the Government’s indecision, saying"““we are appalled at the continuing lack of clarity about whether or not PCTs will eventually divest themselves of provider functions””." The Department of Health’s NHS operating framework for 2006–07, published on 26 January 2006, offers little further clarity. It states:"““From 2007 each PCT will be expected to review formally and systematically whether local services are delivering high quality, effective and efficient care . . . There is no requirement for PCTs to divest themselves of provision, and nor will there be in the future . . . Where PCTs do continue to provide services, they will need to put in place clear governance procedures that ensure that there is no undue influence from the provider side on commissioning decisions.””" On that last point, incidentally, I have to say that I am already receiving letters—I expect that my hon. Friends on the shadow health team are, too—alleging a growing web of conflicts of interest and worse. That is no laughing matter for a Government-designed system, as it makes the Government complicit, and they will be guilty of intended consequences, on which we will be required to hold them to account. The Health Committee also noted that NHS organisations were given less than a month, during the summer holiday period when many key figures were absent, to put together proposals for changes to local services. The chair of North West London SHA described the consultation process as ““flawed””. The Health Committee concluded:"““if the Government truly believes in a patient-led NHS, it should have started its reforms with a patient-led consultation process, rather than the top-down process we are clearly seeing””."