NHS Reorganisation

I am grateful to have been called because I feel very deeply about the issue. The Government frequently say that they want a patient-led NHS. The consultation document in my area on the mergers of PCTs bears the sub-heading ““Ensuring a patient-led NHS””. My understanding of that phrase seems rather different from the Government’s. It is a glib phrase that sounds good, but to me it really means something: it means that the views of patients and the public are listened to, valued and acted on. Those views should be picked up from a wide variety of sources—independent patient groups, independent patient forums, GP practice participation groups, overview and scrutiny committees and—as the Minister said—health professionals, who have the closest contact with patients. To be fair to the Government, they have tried to listen to people. They organised a large listening event in Birmingham—a 1,000-person citizens summit. However, I have seen some of the questions that were submitted to the summit. They were loaded—they expected only the answer that the Government wanted. One question, about the shifting of care, asked"““To what extent do you support or oppose providing more services closer to home including community hospitals, if this means that some larger hospitals concentrate on specialist services and some merge or close?””" Of course, not many would vote against that proposal, but if people had been given the extra information that in losing those hospitals they would probably lose their local accident and emergency departments, the answer would have been very different. If ever there was a top-down proposal, this is it. It is the very antithesis of a patient-led decision. It is the Department of Health leaning on strategic health authorities, which are leaning on the trusts beneath them to do, in effect, the Government’s bidding for reasons that are largely financial and—as the Health Committee’s report shows—open to very serious question. We should think of the 19 or 20 SHA chief executives and the 200 or so PCT chief executives who are likely to lose their jobs. They are like turkeys planning for Christmas. How can they plan for the future when they know that they are not part of it? How can they be accountable for what they are planning when they are no longer there? Incidentally, when those chief executives have left they may well be paid by the taxpayer if past experience is anything to go by. Take the example of Finnamore Management Consultants, who are used, I believe, quite widely by the NHS to address some of the deficits. If we look them up on the web, the vast majority of their staff are ex-NHS managers. Presumably, they were made redundant. They may even have been sacked, or changed jobs for higher salaries. I tried to find out a bit more about that firm through a parliamentary question, but I had no luck. The response said that responsibility for financial control belonged to strategic health authorities and denied any knowledge of those consultants. That sort of response annoys me intensely. The Government devolve things when they do not want to answer a question, and impose top-down changes while at the same time talking about devolution. I come to my area, west midlands south. I pay tribute to the strategic health authority for carrying out a certain amount of pre-consultation. I regret to say that I responded to that pre-consultation without too many objections because I thought that it was a done deal and that resistance would have little effect. I got into tremendous trouble with some of my friends at home over that passive response. The Health Committee inquiry has brought me round to the other side. A lot has been said already about mergers of SHAs. I do not think that SHAs are of the slightest importance. If they go back to being regional health authorities, good luck to them. On local ambulance trusts, as long as I keep my all-singing, all-dancing local computerised control centre, which is as good as any ambulance authority’s control centre, I shall be satisfied. As Staffordshire Members have said, if there are mergers, they must lead to a levelling up of services, not a levelling down. I object strongly to the merger of the PCTs in my area and I just hope that, with the consultation, local people will really have a chance to make a change. I am not very hopeful because we are being consulted on a preferred option, which sounds the death knell of open, genuine consultation. Many hon. Members have examined the main reasons for mergers. The financial argument does not stand up. As I have said, the Health Committee expressed doubt about that. Restructuring involves redundancies and structures to secure local involvement—but those will be incredibly costly. Another argument is that mergers strengthen the commissioning function. That is already happening. The Minister mentioned collaboration, but collaboration is already happening. For a good example, one has to look only at Whitehall & Westminster World, which I am sure we all read. The current edition describes a national decontamination project. It states:"““Collaborations of up to 8 trusts are now in process and every strategic health authority has signed off a local plan which is consistent with the national plan.””" So collaboration is working already, without the need for mergers. I have objections. Many hon. Members have mentioned the number of reforms. I regret to tell them that they have all got their numbers wrong. During the Health Committee foundation trusts inquiry, we received a list of all the reorganisations from 1982 until the date of that inquiry—there were 21. Since that date, there have been at least another seven, so on a conservative estimate there have been at least 28 reorganisations. As we have heard, PCTs have only been going three years. They are just beginning to find their feet. Reorganisation affects an organisation badly—we were told on the Health Committee that it can take 18 months to recover from the disruption and another 18 months for the benefits appear. Locally, there are tremendous objections to the merger of three PCTs into one. We believe that we will lose some of the professional input from doctors, nurses and physiotherapists. We believe that we will lose the local public health input and, worst of all, we believe that we will lose the local input from patient forums. I believe that it is far, far more important for a PCT in each local area to be coterminous with its district council and its local strategic partnership than for it to be coterminous with a much bigger area. I hope that consultation throughout the country is genuine and that where the status quo is correct, it will remain as an option. Edmund Burke said:"““The people are the masters.””" On 7 May 1997, the Prime Minister said:"““We are not the masters. The people are the masters. We are the servants of the people . . . . What the electorate gives, the electorate can take away.””"