Primary Care Trusts

The answer to the problem of tensions within a local area, it seems to me, is more democratic accountability, not external independent arbitration by a quango. I cannot follow that logic at all. If the existing democratic structures would not have produced the outcome that the hon. Lady wants, that suggests that the democratically elected people should have been doing their jobs more effectively. That seems to be logical. The idea seems to be, in essence, that we all have to go cap in hand to the Secretary of State. Opposition Members do not have the same access to Ministers—I do not say that with side, but it is true. I have often heard Government Members say ““I had a meeting with the Minister about this or that,”” but it can prove very difficult for Opposition Members to do that. That is a statement of fact. I had a local reconfiguration issue about a hospital. After six weeks of trying to see the Secretary of State, I was eventually offered a meeting with one of the junior Ministers. I phoned her office and was told that she was too busy, but I could have a phone call to the Secretary of State two weeks later. Then, the Secretary of State said to me, ““Why didn’t you raise this eight weeks ago?”” There is a more profound issue, which is that these matters are being decided in the wrong place anyway. The Secretary of State is an elected person, but she is not elected by anybody in Staffordshire, or Wellingborough or Leeds, so why are we having to go to her for a decision to be made? Clearly, there are some things that have to be done nationally and strategically, with an overview. However, decisions about local health configuration should be taken at an appropriately local level. To continue the theme, the right hon. Member for Rother Valley talked about those with the biggest voice. What was interesting was that I heard something different to what he was saying. He was, I think, referring to some cases where it is difficult rationally to justify the outcome and there is some suspicion that a former Health Secretary, or whoever it may have been in a particular case, had undue influence. That is another reason why one vocal person, whoever he or she may be, should not determine such matters. Whoever it is, the decision should be a community decision, made locally and democratically. I agree with the right hon. Gentleman—it should not be just one loud voice that counts. However, I think that the voices that are heard should be elected voices; that is what I was trying to get across. In the Avon area, we had the surreal situation in which everybody who had ever put their name on a ballot paper and got elected to anything had a common view, but they were going to be overridden by the unelected. That was what I found unacceptable. We had an interesting exchange about why some of the strategic health authorities appeared to come to conclusions that were different from the widespread community view. There was an interesting exchange about the reasons for that and some suggestion that it was the result of looking to the future, or perhaps empire-building. I have a slightly different theory, which is that the power of the acute trusts has been underestimated. There is a close working relationship between the strategic health authorities and the big hospital trusts. I know perfectly well that my local hospital trust did not want to deal with lots of small PCTs. Its life would be easier if it were dealing with a smaller number of commissioners. It had a very loud voice, so when we went to see the strategic health authority, it made it clear that the acute trusts’ preference for fewer commissioners was weighing strongly with it. That is one reason why the health authorities were saying something different to what the communities were saying. Again, it is a case of the unelected being very powerful: in this case, the chief executives of the acute trusts had a big say.