Primary Care Trusts

I am very honoured to be called so early in this debate, and revel in the luxury. It is a pleasure to follow the esteemed Chair of the Health Committee, and to see a new Minister in his place. I always regard a new Minister as, possibly, a new broom. As he was not involved with the report or the response to the report at all, I hope that he will take back some of our criticisms of the report and of the way things were done. I want, first, to talk a little about consultation, because it figured quite largely in our report. The Department of Health considered that as the changes were only managerial, there was no need for formal section 11 consultation. I was really quite bothered about that, because when one thinks about what PCTs provide, such as community hospitals, community nurses, intermediate care beds, and GP beds in other hospitals, it strikes that me that there is quite a big provision element as well. I wrote to the Secretary of State, from whom I received a letter in March, which said:"““I can confirm that there is no duty to consult under section 11… because the SHA, PCT and Ambulance Trust reconfiguration proposals amount to managerial and administrative changes only.””" However, she followed it up with a very powerful, important paragraph:"““However, if there are any proposals to make changes to service provision put forward in the future by the newly reconfigured organisations, there will be a duty on those organisations to involve and consult patients and the public on those proposals under section 11””." In the Government’s response to the Select Committee report, that was repeated. They said:"““Commissioning a patient-led NHS is not about changes to local services. Our policy is clear: decisions about service provision will be a matter for the PCTs to determine locally.””" So, thank goodness the PCTs are absolutely committed to consult on some of the changes that some of us are very worried about. The lack of section 11 consultation was extremely significant because it meant that even if overview and scrutiny committees put in a response, that response had no effect. Under section 11, the response is passed to the Secretary of State for a final decision. If she is not happy, it can go to the independent reconfiguration panel. In my county, all the forums and the overview and scrutiny committee objected strongly. That had no effect at all, I am afraid. I rather fear for the future that the Department of Health will always have the let-out that the definition of management can be rather wide. I have just learned, rather to my horror, that without any form of consultation, because it is possible in the future only if there is a management change, the Department has just placed adverts in the supplement of the Official Journal of the European Union inviting bids from companies that wish to appear on a Government-approved list of suppliers of management services to PCTs, presumably for cases in which a PCT’s management is perceived to fail. It is fairly significant that that came a day or two after the Derbyshire judgment, which, although it did not go in favour of local people, was incredibly helpful in that the judge recognised the wide obligations to consult on NHS bodies that flow from section 11. Still on the subject of consultation, the Government response to our recommendation 9 quoted a letter from John Bacon, sent to all SHAs on 8 December. It said:"““Responsibility for approving PCT consultations, ensuring they reflect the conditionality set out in my 30 November letter and that equal weight is given to all options, rests with the SHA.””" The huge problem is that if the option that local people want more than any other is not even on the list, where does one go from there? We in Worcestershire were completely floored, because we were told that the size of the PCT was absolutely crucial. We have three PCTs with populations of 110,000, 170,000 and 260,000. We were not even allowed to consider the continuation of those three PCTs, or even two PCTs, despite the fact that that was what all local people wanted. The consultation document sent round by the West Midlands South strategic health authority contained the phrase:"““The lack of ‘critical mass’ within these small organisations also compromises the management of financial risk and, in general, reduces the scope for achievement of operational efficiency and value for money. These models would also perpetuate the current high management overheads seen in the PCT sector. This option was not short listed on this basis.””" That leads me to reflect on some of the comments made by the right hon. Member for Rother Valley (Mr. Barron). If we consider the small PCTs that preserved their autonomy, 10 had populations below 150,000, which is tiny. Eight of those were in Government-held constituencies and the two smallest, with populations below 100,000, were Darlington and Hartlepool. They may be coterminous, but it looks as though there is a bit of political influence. I was absolutely delighted to hear from some Opposition Members that they felt that they had influenced things. We in my patch were completely unable to influence things, and we are very upset about that.