Primary Care Trusts

My hon. Friend is absolutely correct to anticipate that I cannot answer that question, but I am sure that his intervention will have found its mark. In fairness, my Leeds colleagues and I were not opposed in principle to the changes—we would not take a luddite approach—nor to the proposal to reduce from five PCTs to one. On the basis, however, of the sparse information placed before us in the so-called consultation exercise, we could not support the proposal as it stood. The picture of how the new PCT would look and function was and, I am afraid to say, remains far too unclear. We were conscious that the proposals were not the result of an organic process but were initiated directly and exclusively as a result of Sir Nigel Crisp’s letter of 28 July. Neither we nor our constituents have had any opportunity whatsoever to consider or contribute to a tangible model of what the new structure would like. We were not looking for detailed nuts and bolts. That would clearly have been unrealistic, given the timescale of the process, but we did require a clear indication of how the key areas of activity—especially the local focus—might continue to be achieved in Leeds. Certainly, as I say, we were happy that the five PCTs were achieving that. Like the Select Committee, we appreciate that savings released from reducing administrative cost can be reinvested in patient care. We understand the frustrations of the many voluntary organisations in our city that have to deal with five separate commissioners, although there was a degree of lead authority work taking place to address some of those problems. We recognise the problems of working closely with partners such as the local authority and its relevant departments. In our response to the SHA consultation we stressed that what we wanted to see coming out of the reconfiguration. The points are reflected in a number of the recommendations made in the Select Committee on Health report. I do not intend to take up time reiterating them, because they have been covered by a number of other hon. Members. It goes without saying that the reconfiguration must maintain and build upon the achievements of our existing PCTs, especially in developing strong local focus and initiatives to meet the needs of our communities. We raised our concerns about whether the move from five PCTs to one could achieve that in a meeting with our right hon. Friend the Secretary of State in the autumn. As a result of our representations, we were pleased that John Bacon’s letter of 30 November to Mike Farrar, the then West Yorkshire SHA chief executive, contained the following sentence:"““Concerns have been expressed about the risk of losing a strong local focus, particularly in Leeds, and it is therefore essential that the consultation document explains how you will sustain this focus within a larger PCT.””" We were therefore hugely disappointed that the consultation document contained just a few glib sentences on that point. In subsequent discussions with Mr. Farrar, he made a number of positive assertions regarding that and other aspects of the issue that we discussed. He asked us to trust him, and we might well have done so. He is an extremely good and effective officer. Unfortunately, and inexcusably for a Yorkshireman, he has now disappeared over the Pennines to become the chief executive in the north west. We now have a new chief executive of the SHA and a new chair. They, of course, have a much larger area to deal with, not only West Yorkshire but the whole of Yorkshire and Humberside. It seems likely, without wanting to pre-empt the process, that the new PCT chief executive will come from outside the area. We also await the appointment of a chair. The Select Committee’s concerns on the issues of continuity and responsibility were, I believe, well-founded from the point of view of our experience in Leeds. At PCT level, it feels as though there is a centrifugal force pulling the emphasis from localities towards the centre and, at SHA level, pulling it from the west Yorkshire area to a Yorkshire and Humberside level. Whether practice-based commissioning will provide a countervailing centripetal force is totally unclear to us at the moment. There has been precious little in the consultation process, or since, to demonstrate how that would work. The Select Committee’s comments on that point remain entirely valid, from our point of view. From my parochial point of view, I continue to ask myself—and anyone else who is listening—how local issues that I have been able to pursue with a PCT with good local knowledge will be resolved in future. I shall reflect and echo the comments made by the hon. Member for Wellingborough (Mr. Bone). To whom do I speak—and will they have a grasp of the issues in the locality when I contact them—about problems or concerns relating to GP practices, such as the need for new or developing premises? To whom do I speak about local dental provision? My area has been consistently defunded over the years by the exodus of dentists from the NHS. Even though that defunding is being stopped by the retention of funding at local level, where will the funding for re-provision go once we have a pan-Leeds PCT? My colleagues and I have made a number of other points that are effectively expressed in the Select Committee report. The consultation, for example, had no real tangible substance other than the proposal to move from five PCTs to one. Even that was in the context of a broader document that covered the whole of the west Yorkshire region. We share the concerns expressed by other Members about the need to retain strong public health functions at local and city level. Of course, we are going from having five teams to having one centralised team within Leeds. Public involvement in health provision at all levels must be promoted. The forums in our city—I am sure that this is the experience elsewhere—have only just begun to find their feet but, as a result of the reorganisation, we have a completely new ballgame. We must ensure that the present levels of service provision, particularly at local level, are strengthened and enhanced. On that point, we were disturbed to learn that the savings from the reconfiguration in Leeds would not necessarily be recycled into the Leeds health economy. That is totally unacceptable. Leeds faces major challenges in addressing the historical imbalance between community and hospital services. We have two major teaching hospitals, which, over time, have soaked up most of the NHS resources. As a result, we have relatively weak community services, we hospitalise too many people and we keep them in hospital too long. We are also conscious that in the immediate future the acute sector faces major challenges which may require additional resources. Those are crucial issues and there is precious little time to get them right in the helter-skelter process that hon. Members have described. I sincerely hope that my hon. Friend the Minister will be able to give me some grounds for optimism in his response to the points that I and other hon. Members have raised.