Primary Care Trusts

I think it was. I will want to say something about the transparency issues of that consultation and what we were promised; something that has not yet been delivered to the House. I suggested earlier that the Government rejected our suggestions about patient care and that patient care would suffer as a result of the disruptions caused by the changes or the potential of the changes. The Government commented that a more evolutionary approach to the changes would have benefited some organisations but have been prejudicial to others. That was an interesting comment. If that was the case and given that we were not drawing up statutes here—although I know that my hon. Friend was not in post then—we must ask why we did not look at the issues of SHAs or PCTs on a geographical basis. My own borough of Rotherham has had one PCT for the past three years. In the neighbouring three constituencies, two of which are represented by health Ministers, they have had three PCTs in the same years. Socially and economically that borough of Doncaster is the same as Rotherham. Why did they have three PCTs three years ago, when nothing was laid down about what they should or should not have? Maybe that was when something should have been laid down. With very little acrimony, as far as I know, they are now moving to the one PCT model for their borough, coterminous with local government and everything else, which makes sense. Of course that could have happened without the 28 July letter going out. It was a matter for them. We were not making law or changing law. Maybe a piecemeal approach would have been a better way of doing the reconfiguration in those areas in which it was needed. As I suggested, for PCTs in some areas, like my own, that was not needed. As for the SHA in my part of Yorkshire, that has changed and we now have one big one that covers the same area as the regional ministerial office. Although we have that, there was little or no voice for the public as to whether or not that was wrong thing to do. Most of the debate that we had after 28 July could have been avoided, certainly in areas like south Yorkshire, if we had proceeded in a piecemeal basis as opposed to all at once, as here. The Government have not stated clearly whether or how PCTs would divest themselves of their provider functions. SHAs are therefore being asked to design organisations without an understanding of their ultimate purpose. I thought that that criticism was rightly made. If one was to change providing and commissioning at primary care level, then the shape of the primary care side would be crucial. We lost that, in my belief. The Government’s response made clear that PCTs would not be instructed to stop providing services, but that PCTs would be required to review all the services that they commissioned in 2007, including those provided directly. The Government will issue a fitness-for-purpose tool for the new PCTs in the summer of 2006. I accept that, but again think that the Committee found a weakness in the system when looking at that particular area, which should have been thought out a lot more. Also, we said that the reduction in the number of PCTs would lead to a loss of local contact and responsiveness, which we believed was one of the main arguments for the previous configuration of PCTs. The Government’s response argued that larger organisations could still engage effectively with the local population. The Government commented that the development of effective, professional executive committees would be central to ensuring effective local engagement. They also commented that the roll-out of practice-based commissioning would make services more localised. Over time that might probably be the case, but nobody thinks for one minute that at this stage, while we change the reconfiguration of PCTs, we will have practice-based commissioning at any level at all. We also had concerns that the reforms were cyclical in nature because the new PCTs will be similar in size to the scope of the old health authorities that were only disbanded in 2002. One can imagine what it was like; people sat before the Committee and said that they remembered the changes that they had to make to get into that new structure. They said that it seemed as if we were rolling back into an old structure, which was just a few years down the road. We had to be critical, given what we were confronted with, when we were taking evidence in that area. The Government argued that the NHS had changed radically since PCTs were created and that"““reforms, such as Practice-Based commission and Payment by Results make it especially important that the roles of PCTs are adjusted and strengthened.””" They went onto argue that the reforms do not represent a ““change for change’s sake”” That many PCTs had already begun to merge or worked collaboratively with the neighbours prior to the 28 July letter. They rejected the Committee’s suggestion that the reforms would set the development of PCTs’ core functions back by 18 months. The only thing that I can say is that we will have to wait and see. It seems to me that we are in position of waiting to see exactly whether the Government are right in that analysis or whether there is an 18-month disruption when you do go to having these types of changes inside our health care system. Jill Morgan, from the NHS Confederation, brought that to our attention early on in the inquiry. We commented on the fact that the reforms were largely motivated by financial, rather than service, considerations. We were led to believe that there were going to be savings around the £250 million mark. The most savings with the reconfiguration that we could find was somewhere between £60 million and £80 million. However, it might be that those types of savings do take place. It does not give me any great pleasure to say that the £250 million tag was in the Labour party manifesto. Yet, when we were taking evidence, it was initially denied that that was the reason that those reconfigurations were about to take place. Consequentially, we had to probe it even more.