Primary Care Trusts

That is an elegant characterisation; if only I believed that the process was as carefully worked out as that. The hon. Gentleman has highlighted the sense that, throughout this experience of reforming PCTs, the Government have been making it up as they go along—abolishing county-wide health authorities, but replacing them three years later with merged PCTs that cover the same area and do similar things. I find that the most worrying aspect of all. To have a 10-year NHS plan, with strategic direction that sets out where we are going so that everyone knows where they stand and can plan on that basis, is an excellent idea, but to produce an NHS plan for 10 years in 2000 but then to rewrite the whole thing every six months seems to be the opposite of what we want. A number of hon. Members have mentioned the importance of continuity. An hon. Member briefs a PCT about an issue and gets to the point of something being about to happen, but then the PCT disappears and the whole thing has to start again. We need continuity and stability—not stick in the mud-ness or dinosaur-ness, if I may use those words—rather than constant turmoil. The hon. Member for Wyre Forest (Dr. Taylor) quite properly pointed out the so-called distraction effect on managers. I am so pleased that the day after the Minister made the announcement, my local PCT chief executive could get on with planning health services for south Gloucestershire, instead of wondering whether she would have a job in six months or having to organise the winding down of the organisation. I cannot believe that what is happening is a rational way to proceed. The hon. Gentleman talked about consultation and the statutory duty to consult on such changes. I am sure that he is right factually, but for the Department of Health to write and say, ““We don’t need to consult,”” is the wrong way round. Surely one would wish the Department’s instincts to lead it to say, ““We want to consult.”” It should not say, ““No, it’s all right, we don’t have to—we’re just going to get on with it.”” The Department should want to hear what people say before it makes decisions. The default position should be for the Department to consult unless there is a pretty good reason not to, but so seldom do things happen that way. The hon. Gentleman mentioned Professor Ashton. Nobody could say that his resignation was politically motivated or a party political gesture, because he expressed political sympathy for the governing party of the day and wanted to enter into politics. However, he also highlighted the constant reorganisation and its debilitating effect on health services. The hon. Member for Dartford (Dr. Stoate) mentioned PCT planning blight, which is a helpful phrase. He also flagged up the idea of directly elected members of PCT boards, which I am interested in, but then said that perhaps we could work with the foundation trust board model. I have to say that the foundation trust board model is a complete farce, with small numbers of people, often self-appointed, notionally representing huge numbers of people. I have come across plenty of governors and members of such bodies—I do not think that they are called boards—whom the foundation trust often sees as its cheerleaders. The trust is often a commercial organisation trying to get business and succeed, and wants those people not to hold it to account but to go out and promote it. That is a very different role, so I am not sure that the foundation trust precedent is a happy one. Foundation trust governance came about because the Government do not trust local government and therefore invented a proxy for local accountability, which has not worked. The hon. Member for Southend, West (Mr. Amess), who has just rejoined us, asked to be remembered for something. I assure him that he will be remembered; or rather—he knows what I am going to say—that his smile will be remembered. It was his smile in 1992 that brought me into politics. His joy at what had happened in Basildon did not, it would be fair to say, coincide with my feelings. I decided at that point that a political career was necessary and I am grateful to him for that. The hon. Gentleman raised an interesting question: what happens when a PCT is created that straddles local authority boundaries, such as county boundaries and unitary authority boundaries? By the sound of it, what happens is a dog’s breakfast. Probably influenced by experience in my area, I am a great believer in coterminosity wherever possible. The idea of creating something that is not truly local, but not coterminous either, horrifies me, as does the thought of how the joint working will take place in the set-up that the hon. Gentleman described. What is proposed does not look like a sustainable long-term solution, so I would not be astonished if the Essex PCTs ended up being reorganised again, which I suspect horrifies him as much as everybody else. The hon. Member for Staffordshire, Moorlands was absolutely right to highlight the impact on public health of all these changes, as it has been a neglected area. Several hon. Members made that point. The hon. Member for Wellingborough (Mr. Bone) was right repeatedly to stress the importance of local accountability. That is where I come in on this whole issue. We are talking about the public’s national health service. We are not only consumers who shop around, whose voice in health care provision should be exercised only when we are ill. We are citizens who pay our taxes and who should have a say, as citizens, in the way that our health service is structured. The phrase ““sham consultation”” was used by the hon. Member for Southend, West and others, and it was interesting that the Minister appeared to be genuinely puzzled by it, as if such things do not happen. Now he is looking at me with a puzzled expression. [Interruption.] Perhaps I misunderstood him. However, there is widespread public dismay about the consultation. I said the other day that never have so many people been consulted about so much to no effect. There is a sense that we are either not talked to at all or that, when they do talk to us, people do not listen to what we say. Record amounts of consultation go on. I spoke to the Secretary of State about a local issue on my patch, and she said that there had been citizens’ juries. Yes, there had been citizens’ juries in one bit of the patch that wanted one thing, and they got what they wanted, but the other bit of the patch was not asked and did not get what it wanted. The critical point about consultation is that it needs to happen before the decision is made. That might sound blindingly obvious, but it would be nice if it happened. It needs to happen early, while people still have open minds. If people consult when they already know the answer, it just spreads cynicism. We need to consult when minds are still open, when issues are still there to be addressed, when the contribution of the public as citizens can still add something. We do not need consultation that is a rubber stamp or a process that generates disillusionment. The consultation on changes to primary care trusts has been a case study in how not to do it. I hope that the Minister has listened to Members across the House this afternoon and that future changes will be made in a genuinely consultative, local and accountable way.