Primary Care Trusts

It is a great honour to follow the hon. Member for Staffordshire, Moorlands (Charlotte Atkins), who made an excellent and powerful speech. I shall come to the issue of local accountability, which was also raised by the hon. Member for Dartford (Dr. Stoate) when he suggested directly elected PCT members, which seemed to have a lot of merit. One of the problems that I have had as a new Member of Parliament is getting NHS matters sorted out. I complain to the Minister, who writes me a very nice letter saying that it is the PCT’s responsibility, but when I write to the PCT, it tells me that it is the Government’s fault, because the PCT is underfunded. The Chairman of the Health Committee mentioned the issue in his powerful opening remarks about independent providers. My PCT, Northamptonshire Heartlands, had a problem when on 30 November the Prime Minister stood up and announced suddenly that nobody would have to wait more than six months for an NHS operation. The problem was that my hospital could not possibly meet that target, so the PCT had to provide for the independent sector to reduce the numbers on a very short contract. That worked, but the knock-on effect was that the PCT ran out of money this year, which meant ward closures and cutbacks everywhere. Local accountability in the mergers worries me greatly. The Government are right to try to get the best combination for health care. The only question to be answered is: does this improve health care for patients in my area? In Northamptonshire, we have a slight problem. We were bolted on to the bottom of the East Midlands strategic health authority—a huge, not really geographical area. We are part of the worst funded SHA in the country, and we are at the bottom geographically, so we lose out. But at least we had a PCT that covered my part of the county. There were three PCTs in Northamptonshire, which divides neatly into two. When the Government considered police forces, they decided that Northamptonshire should have two basic command units. When they considered local development, they decided that it should have two development agencies, given that we are required to build 167,000 new homes during the next few years. It seems strange that we have one PCT for the whole county when everything else has been done on a natural north-and-south basis. That failure in local accountability is at the heart of our problems in Northamptonshire. As a new Member, I was drawn into a lot of meetings about the proposed PCT mergers. There were lots of cross-party meetings with Labour and Conservative Members. I went to my local hospital, they came up here and we had lots of briefings. It suddenly dawned on me that it must be costing an absolute fortune, not only because of the actual cost of the meetings but because of the time taken from the PCT managers, who should have been focusing their resources on health care in my area. It then struck me that we have had ongoing problems in Rushton, where there are three local NHS health care units on three sites, when they should have been brought together on one site. For more than five years, efforts have been made to sort that out but, of course, it went by the by. No one wanted to talk about it, only about what would happen when the PCTs merged. My fear is that, when we have one PCT, the Rushton project will disappear for another five years. It will not be of interest to anyone. In the run-up to the election, one of the matters that I campaigned on and which came out top through our local listening to Wellingborough and Rushton surveys was the need for a local community hospital. The Government have said rightly that they are in favour of community hospitals. Both my acute hospitals are outside the constituency, so people must travel for half an hour or more to reach them. I have just been successful in getting Heartlands PCT to recognise that that would be a good idea when it is about to be abolished. I now have to go through the whole process again, without local accountability. To a certain extent, I regard matters as change for the sake of change in a quick period. I believe that change should have been made over a period on the basis of what was best for each area. Clearly, we should not have had three PCTs in Northamptonshire, but two. However, there seemed to be an overall plan in the east midlands, at least, that there would be county-wide PCTs. Perhaps the Government had that design in mind before they went into the project. Many hon. Members have protested, as a result of which their area was altered. Unfortunately, perhaps the new hon. Members who represent parts of Northamptonshire—there was more than one—did not have the clout that some of previous hon. Members had or did not know how to get the decision changed. If we are to have a proper consultation, it should not require people afterwards with the biggest stick or the most influence to change things. I know that the Government thought that what they were doing was in the interests of the NHS, but I consider that they failed in Northamptonshire. I received an e-mail today. It said:"““I have just returned from my local dentist’s surgery after my 6-monthly checkup. I was absolutely horrified and disgusted to be told that because of the Dept of Health’s changes in the provision of NHS dentists, he would be going private in September. This means that the price for a routine checkup (assuming nothing is wrong) is increasing by almost three times. The quality of service will remain the same so the Dept of Health changes will certainly not improve patient care.””" I read that out in relation to the PCT because the two towns of Wellingborough and Rushton adjoin each other. There is no NHS provision in Wellingborough and the PCT has just managed to obtain some new NHS provision in Rushton. Unfortunately, that dental surgery is already full. Appointments cannot be made before December. Luckily, a local dentist, Dr. Chan, had a Polish dentist available with experience of the NHS because he has been here for a while. He wanted to work in Rushton for the NHS. That would have solved not only Rushton’s problems, but those of Wellingborough. I had a chance with my partner’s PCT to argue that, in that regard, Wellingborough and Rushton were the same place. If the PCT were based in Northamptonshire, and the strategic health authority covers the whole of the east midlands, it would not even know that Wellingborough and Rushton were joined together, so there would be no chance of more NHS provision in my area. Unfortunately, I have just received a letter from the local Heartlands PCT to say that no funding is available. Can the Minister explain that dilemma to me? I complained to the Secretary of State for Health, and a meeting was arranged with the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton). I complained in November, but like many people in the NHS, I had to wait, only to have my appointment cancelled and then cancelled again. It was only six months later that I actually had the meeting, and the Minister argued with some clarity that it was for the PCT to decide whether to provide NHS dental services in my constituency, but the PCT says that the Government will not fund those services. How, therefore, are Members of Parliament to get somebody to do something about a situation in which there is a Polish dentist available to work in the NHS, but there is no NHS provision in the constituency? Let me now move from dentistry to what is, in many ways, a more serious issue and give just one example of the problem that we face locally. Our local hospitals are very efficient—the NHS standard is 100, and they work at 85—but our area is underfunded, even by Government standards. We are underfunded by 4.5 per cent., and it is argued that that is because other areas are overfunded. That might sound very neat, but there is a real and serious problem for the patients. A five-year-old child in my constituency—with your permission, Miss Begg, I will not identify him—had an operation in February 2005. During the operation, three surgical procedures should have been carried out, but one was not. That has meant that that little boy has had to wait in pain for a considerable time. This month, the consultant agreed that the case should be urgent, but despite the fact the little boy is in urgent need of treatment, the consultant said that he could not be treated for five months because of the PCT’s ruling that it had no funding. The consultant opened his diary and showed all the dates when he could have done the operation, but he cannot do it, because the PCT will not allow it. When that argument is put to the PCT, it says that it is because of Government funding and targets. It has been told that everybody must have an NHS operation within six months, so urgent cases are being put back five months to allow everybody to meet the six-month target. Such an arrangement cannot be right, and it certainly is not the way to achieve local accountability. Indeed, to conclude, the real issue with which I should like the Minister to deal is the local accountability of PCTs as they are now and as they will be in the future.