Primary Care Trusts

The report on PCT mergers reassured us that public health doctors would not be affected by the £250 million economy. We asked a public health doctor this morning. Obviously, she could not give us a categorical denial that it had happened. We must watch what happens to public health. Savings have been mentioned. One of the objections of my local overview and scrutiny committee in Worcestershire was that there had been no attempt at a business case before the mergers were worked out. The Health Committee report queried those savings. The Government response confirmed that they would be £250 million, but then said:"““These plans will be firmed up once reconfiguration plans are approved.””" So they were very much guessing at what would happen. If SHAs are reduced from 28 to 10 and PCTs from 303 to 152, there will have to be many redundancies among senior staff, who are the most highly paid people. I wonder whether that has been calculated accurately, and also whether driving out high-powered executives will help our competitors. We know of at least one chief executive who left to run one of the private sector companies that are organising the independent sector treatment centres. That is the end of my gripes. I shall briefly discuss the future and how we can make what we have work. Sadly, we cannot undo the changes. One thing that we expressed concern about in the report, that people are worried about and that has been mentioned today, is the local focus. With a local PCT, there is a local director of public health who participates in the local strategic partnership, a local professional executive committee, a local patient forum and local non-executive directors. There are three completely separate localities with separate characteristics, needs and health service provision in my county, yet we have gone back to the days of the county-wide health authority and a total lack of county-wide medical leadership. That is one of the many reasons why I am here. If there had been effective county-wide medical leadership at the time, what happened to put me here might not have happened in the same way. The local focus is crucial. The Select Committee picked up on that in recommendation 21:"““Whatever the size of future PCTs, it is essential that structures to ensure clinical engagement and, most crucially, patient and public engagement are retained at their current levels, covering each natural community.””" The Government response states:"““The Government agrees with the Committee that it is important that structures for engaging with clinicians and patients are not lost through this reconfiguration process.””" Can the Minister absolutely assure us that the local focus will remain? How will that happen? How will clinicians reflect the needs of their local area? Will there still be public health doctors? We are in complete confusion about what will happen to patient forums. The expert panel that reviewed them reported to Ministers and we are waiting with bated breath to hear what it said. My patient forum really works. It has been a vital method of feeding local people’s comments and needs into the PCT, and it has held the PCT to account. We need to know that forums will be resourced and that they will be independent from the NHS bodies with which they deal. I feel strongly about non-executive directors. A whole-county health authority existed at the time my hospital was downgraded. There was a vacancy on the authority during the whole of the consultation and—surprise, surprise—it was for the representative from the north-west of the county. We have just lost the person from that part of the county on the county-wide acute trust board, and now we are to have a county-wide PCT. I wrote to the NHS Appointments Commission, but because it is so keen not to have any political influence at all, it rarely writes to MPs. I made the point that if there is one PCT for a large county, it is essential to reserve positions on the board not only for representatives with expertise in accountancy, management and so on but for those who live in the different parts of the area. If the Minister is allowed to, will he put pressure on the NHS Appointments Commission so that, as a general rule, if there are not applicants for non-executive director posts who reflect the interests of the whole area, the commission should not make an appointment but seek to find applicants who do reflect those interests? We are saddled with the mergers. Some areas have escaped but, remembering how small some of the PCTs are, I wonder whether they will succeed. I hope that the Minister will tell us in particular how local focus will be retained from the point of view of public health, the board membership and clinical, patient and public involvement. Even in a county such as mine and others in which various organisations have been merged into one, fair shares of resources and representation for all localities must be maintained.