Primary Care Trusts

My hon. Friend makes a valid point. I was giving Her Majesty’s Government the benefit of the doubt, which I might now retract. I argued in Committee on the Health Bill in 1999 that GP fundholding was being abolished too quickly and with little debate on the structures that would replace it. We are in a similar situation now. The Government took only 11 weeks to put together the reconfiguration proposals and the 14-week consultation period was certainly not adequate to get sufficient feedback on many aspects of them. In 1999, many medical and professional groups voiced concerns about the rationale behind the structural changes. For example, in my speech on the Health Bill on 13 April 1999 I quoted a letter that I had received from the British Medical Association, which said:"““The Bill heralds yet more structural change for doctors after nearly a decade of major upheavals in the National Health Service. The BMA will work with Government to try to make these changes work but would ask for no more changes for some time after this. We need a period of stability now in which doctors can concentrate on quality of service to patients rather than structural reorganisation.””" There have been 23 major reconfigurations in the NHS since 1974, and the reconfiguration of PCTs is another significant upheaval that negates the request for stability and continuity from the NHS and health care professionals. The general consensus of the Health Committee and those who gave evidence to our inquiry was that the consultation process was insufficient and flawed, to say the least. Not only was the consultation period too short, but it was conducted in a very top-down manner, pushing the Government’s centralising agenda without taking into account the local solutions currently being pursued by PCTs on their own initiative to improve their operating procedures. For example, in its response to the Committee’s report the BMA stated that many PCTs had reported that they were rushed into the merger process, with little or no consultation with local stakeholders. In addition, although strategic health authorities were invited to contribute to the consultation, professional groups and patient representatives were not. For any transition to be successful, it must have all the professionals and patient groups on board at the local level. As has been said, the Government response acknowledges that in many places the NHS is already working collaboratively to commission the best local services in the most effective manner. So why reconfigure PCTs, when the evidence shows that smaller trusts are taking the initiative where collaboration is sensible and right? Not all PCTs are operating optimally, but there are better ways of spreading best practice than imposing uniformity across the board. As the Committee’s report made clear, there is no perfect size for a PCT, and one size certainly does not fit all. In my constituency, Southend-on-Sea PCT will be merged with Castle Point and Rochford PCT on 1 October to form the south-east Essex PCT, which—if my hon. Friend the Member for Broxbourne (Mr. Walker) will allow me to repeat—will be one of five PCTs that will replace the 13 that currently exist in the county. The new PCT will serve a population of 325,000. Southend-on-Sea PCT already works closely with the surrounding trusts and Southend-on-Sea borough council to bring together commissioning functions and provider services in joint health and social service teams. However, although 70 per cent. of new PCT areas will mirror local authority boundaries, the new south-east Essex PCT will be a much more complex organisation, operating across Southend-on-Sea unitary authority and Essex county council, which brings new collaborative challenges. I know that the staff in Southend-on-Sea PCT will work hard to build on the successes that they have already achieved, but that is not to say that the structural upheaval is welcomed; it is not. The Health Committee has estimated that the reconfiguration of PCTs will put the service back 18 months and undermine much of the progress made since PCTs were created in 2002. Clinical, public and patient engagements with each natural community were seen as priorities in the establishment of PCTs four years ago, but the reconfiguration brings those relationships into question. Clearly the non-executive directors, patient and public involvement forums, and professional executive committees of local clinicians that operate around each PCT have a cost, but they are increasingly proving their value, by making PCTs more inclusive in their working. A major way in which the NHS will be destabilised by the reconfiguration of PCTs is, as has been said, through the impact on staff. The Government response to our report informed us that there would be a national primary care trust development programme that would support trusts throughout the transition. Southend has already begun preparing for the changeover, with the first meeting of the primary care trust transition board being held on 27 June. However, will the Minister comment on the success of the programme nationally in reassuring NHS staff about the future of their jobs? Paragraph 21 of the Government response, which has already been mentioned, outlines how staff will be supported, as set out in the human resources framework, which was published in 2005. I would be grateful if the Minister could say what steps are being taken in that respect. What has been the outcome of the proposed consultation under TUPE—the Transfer of Undertakings (Protection of Employment) Regulations 1981—with staff and trade unions on how the restructuring will affect them? The Health Service Journal reported in February 2006 that, according to data submitted by 17 of the 28 SHAs last October, the reconfiguration of PCTs, SHAs and ambulance services could equate to 2,143 job losses. If those figures are calculated for all SHAs, there could be as many as 3,350 job losses, of which 1,307 will be from PCTs in both the provision and the commissioning sides of the service. Once again it seems that cost-cutting has been put before strategic reform with a target of £158 million to be cut in the running of PCTs. As has been said, there is also the question of what retirement protection deals will be available to NHS staff who loose their jobs in the restructuring. In Southend-on-Sea PCT, substantive employment contracts have been guaranteed until June 2007 only, which creates uncertainty about employment in the work force. In its response to the Health Committee inquiry, the BMA argues that there should be more effective management in the NHS. However, as it also points out, it is unclear how that will happen while the reconfiguration focuses on a 15 per cent. cut in management costs rather than takes a more strategic view of how including clinicians in management can help to help strengthen the NHS. One point that was emphasised throughout the Health Committee inquiry was that PCTs’ commissioning functions could be strengthened considerably by trusts working with local professionals and engaging with local clinicians. Clearly, the involvement of general practitioners in practice- based commissioning is essential, and other consultants in a range of specialist areas must not be overlooked. Clearly, the balance between the provision and the commissioning functions of PCTs needs to be readdressed with a view to whether the divestment of services from the former could lead to the strengthening of the latter. To what extent will those improvements be brought about by the large-scale structural reforms aimed at recentering commissioning skills in the larger PCTs, and by spending £250 million less a year on that function? I would be interested to hear the Minister’s response to that. The Government maintain that PCTs’ commissioning functions will be strengthened, but they have not outlined how that will be achieved at the same time as giving better value for taxpayers. In his letter to SHAs on 28 July 2005, Sir Nigel Crisp said that PCTs should perform as providers only as a last resort. However, if they are not to act as providers, it should be made clear who will be responsible for that function. For example, will it be GP practices, private providers or secondary providers? As the NHS Confederation argued, divestment of provision should take place only where it offers demonstrable patient benefit and service improvements and therefore should not apply to all services. The Health Committee report asserts that the question whether PCTs should divest themselves of their provider functions is a debate separate from its inquiry, but concerns were raised throughout the evidence sessions about the fragmentation of services if divestment were to take place on a wide scale. I hope that the Government stick to their response to the report:"““PCTs are no longer required to stop providing services directly. Instead from 2007 they are required to review the services they commission (including service they provide themselves) to ensure they are delivering value for money, quality and equity””." The concluding recommendation of the Health Committee report was that the Government should allow PCTs to develop organically, sharing best practice and collaborating on their own initiative with other trusts on commissioning and service provision. That recommendation has not been heeded. Unfortunately, this debate on changes to PCTs comes a little too late to be useful as the decision to reconfigure the organisations has been made and plans have been put in place for the transition. However, having contributed to the 1999 Health Bill that created PCTs and to the report on changes to them now, I know that the underlying message from health professionals then and now is that continual structural change is damaging to service provision and should not be undertaken lightly.