Primary Care Trusts

I am grateful for that contribution. As it happens, I strongly believe that the Government should pilot and trial most things that they implement, but they should see the trials through so that proper conclusions and assessment can be made in the light of experience. So much can be learned by that method. I wish to concentrate my remarks on taking forward the lessons of the report and also focus on the Government’s response to it, which is equally part of the debate. Their response to one of the Committee’s most critical reports—at the time it felt damning—typifies their approach to our NHS: a recital of soundbites and phrases, and saying that throwing a lot of money at the NHS is somehow an immediate answer to criticism. It is incumbent on the Government to look out for a tone that strikes many—I will not be the only one who has heard this opinion expressed in his constituency—as suggesting that an ungrateful nation is failing to thank the Government for throwing money at the NHS. That money has been welcomed, but it is no wonder that the public do not give thanks if the money is not accompanied by the necessary financial and general competence required to ensure that it is best used and deployed. We are in a time of the worst crisis of deficits and job cuts in the NHS in living memory. Another restructuring of PCTs, more or less returning the NHS to the structure that the Government inherited nine years ago on taking office, seems like a monumental lost opportunity. The 100 health authorities were abolished in 1998 and primary care groups formed. They were duly removed in favour of the 303 PCTs, which are now being meddled with and reduced to an indicated 152. The hon. Member for Pudsey (Mr. Truswell) made the important point that the reduction did not seem to carry with it a sense of having been designed with a resonance to his area’s needs or any analysis of what accountability was needed locally. It was a fair and well argued point. There have been nine years of what can fairly be argued to be mismanagement, under a constantly changing cast of Ministers—I do not necessarily consider the Minister himself to be primarily in the frame, although he is currently accountable. The result has been that productivity in the NHS has declined by up to 1.3 per cent. every year. There is a question whether taxpayers, our constituents, are getting genuine value for the vast amounts of money that we have all put in. That money was recently described by Nicholas Timmins of the Financial Times as ““an opportunity squandered.”” The Government have failed to point out that there has been haemorrhaging of staff across the NHS, due to poor financial management. Notably, this week two surgeons at the Oxford Radcliffe hospitals have had to leave their jobs. The Independent reports today that at least 20 NHS trusts are considering making consultants redundant. Money has been haemorrhaged on PFI deals, particularly through the Secretary of State delaying the Barts and The London project and the poor transfer of risk in the Norfolk and Norwich PFI project. Such matters ought to have been highlighted if the Government are genuinely seeking to be accountable for the effect that their expenditure is having on front-line patient care, which is sometimes to diminish it. In emergency care, the Government have severely limited the capacity and quality of out-of-hours provision across the country through their questionable approach to negotiating the GP contract. They are now having to pay to undo some of the problems of that negotiation by directly enhanced services, and they are driving deficits up with overly stringent targets in accident and emergency departments that deliver little clinical benefit to patients. On page 3 of their response, the Government say that the rationale for the changes is to"““commission better services for patients, work more closely with local government, and ensure that we get the best value for money from the system.””" Increasing patient choice and driving up standards will require stronger commissioning—that is something on which we all agree. The Health Committee, however, remained unconvinced that instigating large-scale reform was the best way to retrench commissioning expertise. The Committee rebuked the Government for not strengthening commissioning when it strengthened the provider sector, thereby leading to a market imbalance in the service. The current proposals for practice-based commissioning are looking increasingly unrealisable in totality. There are only meagre benefits—if any—for GPs in holding merely indicative budgets, particularly as the Government are inclined to be sluggish over things. Lord Warner, the Minister, said in another place that he was ““relaxed”” about how quickly practice-based commissioning was implemented. Not only will that not strengthen commissioning sufficiently, but the Government have yet to ensure that we secure best value for money. One of the Health Committee’s sternest criticisms was of the clumsy and cavalier approach that had been taken. In the case of establishing new PCTs as commissioning or provider bodies, it amounted to making policy on the hoof. Under pressure from many people—not only from Conservative and other Opposition Members but from Members on their own side, the Government claim to have clarified matters. However, to use the words of the Select Committee Chairman, it is fair to say that the ““direction of travel”” remains unclear, and that there is still uncertainty around the purpose—let alone the true job expectations—of those who are charged to deliver. According to the Government view on provider status, decisions on local provision will be left to local PCTs. The PCT will decide whether it has to divest itself of provider function. There is a requirement to consult, but no timetable within with that must be done. The Government have said that if PCTs keep provider functions, they will need appropriate clinical governance arrangements, but they have given absolutely no guidelines. Bob Ricketts, the Department of Health director on demand-side reform, has said that commissioning has not worked for 10 years, and that this time it really has to be a success. Leaving aside practice-based commissioning, ““Our health, our care, our say”” gave a greater commissioning role to the Department of Health. Will the Minister provide greater clarity on that point? PCTs have not proved themselves to be adept at commissioning. It must be argued that the rise in sexually transmitted diseases, for instance, is linked to shortfalls in funding for genito-urinary medicine clinics, as PCTs try desperately to claw back money. When I asked my local PCTs about the situation, Central Cheshire Primary Care Trust, which is well managed and has good clinical and management leadership, and which is broadly in balance, replied that it was extremely concerned, but that the programme was on hold until ““prudent fiscal management”” could find"““the necessary investment from savings in other PCT budgets””." Cheshire West Primary Care Trust, one of the disasters of the country, has a turnaround team. My local newspaper has reported that it now has £20 million to make up the terrible shortfall, although there was no mention of the MP who has campaigned about it. There are consultants at the trust, while the people who were meant to do the job are still employed—£20,000 a day is being spent on the consultants while the trust still has £20,000 employment costs for those who should have done the job in the first place. It is an absolute basket case. Constituents are now losing front-line patient services, such as the Parkinson’s nurse specialist, who has gone—the job was cut. That is happening with front-line services, not just with the reorganisation as the background. Nevertheless, Cheshire West would say only that it had established a team to develop strategy. The reduction in the number of child immunisations is another example. It is due to the Government having moved responsibility out to the PCTs under the new GP contract, with cash-strapped PCTs failing to commission immunisation from GPs. If the Government are moving toward practice-based commissioning for the commissioning side of health care, and are also seeking to divest PCTs of their provider functions, what does the Minister actually see as the future of PCTs? That question was raised a moment ago by the spokesman for the Liberal Democrats. Surely those questions should have been answered before yet another restructuring and moral-sapping reorganisation, as it was described by the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) in her fine speech. The reorganisation does little to help close the gap between health and social care. Indeed, this restructuring comes soon after the last one, which was off the back of six others, as has been indicated. The price of raising coterminosity to 80 per cent. is that once again relationships painstakingly built up between the two sectors are rendered worthless, and professionals on both sides are forced to return to square one. We must remember that the Health Committee report says that it will take 18 months for organisations to recover from reorganisation and a further 18 months for any benefits to emerge. That will create uncertainty when, for instance, subtracting the necessary extra investment such as for the important local improvement finance trusts, which rightly want the chance to become the real agents of change and improvement. The Committee report stated:"““There are also well-founded concerns that patient care will suffer as a direct result of the distraction caused by these reforms””." The national infertility awareness campaign is concerned that the PCTs’ implementation of NICE guidelines on infertility will be further delayed by the restructuring—as it is, that implementation is considerably varied. I hope that the Minister will take this opportunity to give a specific commitment on that. I dare say that other Members have received a briefing from the campaign group as well.