Primary Care Trusts

I congratulate my right hon. Friend the Member for Rother Valley (Mr. Barron) on introducing this important Adjournment debate. I also pay tribute to the work of the Select Committee. Its report was very significant in the influence that it had on the reconfiguration process, and the quality of today’s debate has, on the whole, been very high. The starting point for considering why the reconfiguration was deemed necessary is how, in the end, we add most value to patient care. I made the point, as soon as I came into this job in the Department of Health, that everything we do is ultimately about supporting the interaction between the people providing the service on the ground and the people receiving that service—whether it be NHS or social care provision. The Government felt that based on the ever-changing needs of the health service and the necessary reforms that we have started to put in place, the reorganisation of PCTs was essential to further that reform agenda in a positive way that is consistent with our aspirations for excellent patient care. I also believe that in the context of my own responsibilities it is crucial that we achieve an integration of health, social and community care in this country in a way that we have not been able to do previously. That is particularly important in relation to joint commissioning. Therefore, the greater level of coterminosity that has been achieved as a consequence of these change is to be welcomed on the whole. That does not mean that coterminosity has been achieved in every area, but system-wide there is a greater level of coterminosity than has previously been the case. I understand concerns expressed by those who argue that there is too much restructuring and reorganisation, but one has to look at the specific reconfiguration and make a judgment as to whether at this time, in the development of our NHS reform programme, it was the right thing to do. In time—such matters can be proved only over time—the judgment will be that, on the whole, it was the right thing to do. I wish to spend most of my contribution responding directly to the many contributions that hon. Members have made. My right hon. Friend raised an important issue about the question of pensions for staff and reassuring staff in that area. I agree entirely that we need to give greater clarity and greater assurances and produce clear guidance for employers and staff in this respect. It is important and we will be doing that as soon as we possibly can. With regard to the question of savings, we expect—I know that there is a difference of opinion on this and that the Select Committee found a different figure from that of the Department—that there will be a recurrent annual saving of £250 million as a consequence of these changes. The important thing about that is the transferral of those resources to front-line services. The hon. Member for Wyre Forest (Dr. Taylor), who has a tremendous amount of personal knowledge and experience in these areas, asked a number of questions that are worthy of consideration. One of the issues was about publishing the external panel’s response. A number of hon. Members raised this issue. We have published this in the Library only this week in a variety of forms: the external panel advice from Michael O’Higgins to Lord Warner; a table setting out the various decisions that had been made; and the rationale of Ministers’ decisions on PCT configuration. I suggest that the hon. Gentleman consults the Library. He may find that the information is not as complete as he wants it to be and he can come back to me on that point. But, consistent with the commitments that the Minister of State, Department of Health, my hon. Friend the Member for Leigh (Andy Burnham) made when this statement was first made in the House, that information has been placed in the Library this week. The hon. Gentleman also raised, as did other hon. Members, the question of local focus. Of course, we have made it absolutely clear that in terms of practice-based commissioning there will inevitably be a greater level of local focus than there has been historically. We have also made it clear to each PCT that, post-reconfiguration, we expect them to take account of the different localities that form component parts of the trust. They must be sensitive to the distinct needs of those communities—the health inequalities that may exist and the differences that undoubtedly will. It will be partially about us holding those PCTs to account in that respect, but it will also be for local hon. Members to hold PCTs to account and to make sure that those commitments are honoured. The hon. Member for Eddisbury (Mr. O'Brien) raised the question of patient forums and patient involvement in the NHS. Hon. Members are aware that we are due to come forward with some proposals in this area. The hon. Member for Wyre Forest (Dr. Taylor) used the term ““well resourced and independent””, and I hope that when we introduce those proposals we can demonstrate that they are properly resourced, with a significant element of independence to reassure hon. Members. As for the NHS Appointments Commission, as a Minister I would sometimes wonder about its autonomy; however, it has tremendous autonomy. Parliament took that decision for good or for bad. Criteria have been applied for making appointments, and they pay particular regard to ensuring that local appointments reflect local communities. An independent appointments commission, by its very nature, guards fiercely its right to retain its independence. My hon. Friend the Member for Dartford (Dr. Stoate), who speaks with great knowledge about these issues, raised several important points, such as localism and planning blight. He asked whether the reconfigurations cause a period of blight. We have professional people running the organisations, and most of the agenda, which has been in place for a long time, has not changed as a consequence of the reconfiguration proposals. I do not see why there should be significant planning blight as a consequence of the reorganisation, but the proof of the pudding will be in the eating. My hon. Friend was also concerned about professional executive committees. We made it clear that we expect high-quality, high-calibre committees to be elected in every PCT area, so perhaps we can discuss at a later stage how we go about that. My hon. Friend also raised the question about the vital role of community pharmacists in primary care. If I am honest, we have a long way to go towards creating a more central role for them. I suspect that if we looked throughout the country, we would find that there was a patchiness—the new word—in the extent to which PCTs put the role of community pharmacists at the centre of their planning and commissioning. I agree that we should think far more seriously about it. I am not sure to which international travels my old friend, the hon. Member for Southend, West (Mr. Amess) was referring; he has a better memory than I. He referred to political shenanigans and the meaninglessness of consultation, too, and I must say to him and to other hon. Members who have made that point, that when the first letter was issued there was a case for saying that a number of things could have been done differently. I would be the first to acknowledge that. I guess I can, because I was not part of the team at the time. However, many changes were made as a consequence of listening to the Committee and to Members. They demonstrate that the Government have listened and taken seriously the views of people on the ground, who are democratically accountable and understand the needs of their communities, when health service managers and bureaucrats have not acted in accordance with local needs and preferences. The Government can be proud of being not too proud—sometimes Governments are—to say where it was appropriate to make changes to the original proposals. I accept that not all hon. Members are satisfied, but in many cases, those changes were made. Based even on today’s debate, there is considerable evidence that those changes were not made on a party political basis, because people of all political persuasions have today been able to point to changes that were made as a consequence of their representations on behalf of their constituents. It is disingenuous of the hon. Gentleman to say that there was no listening process and that somehow there were political shenanigans. I shall leave it to my hon. Friends to determine whether they like the phrase ““truly socialist Bill””. I imagine that many of my hon. Friends would be pleased if that title were attributed to a health Bill. The hon. Gentleman is right when he says that it is very important in the context of reorganisation and restructuring that we reassure front-line staff. It is disingenuous when talking about organisational change to suggest that staff will not be anxious and insecure. They will be. Good management and good leadership are about managing that process on a local level. Again, the word ““patchiness”” springs to mind. There are excellent examples of organisations that manage change and deal with the insecurities and anxieties of the people who work there. There are other examples in which the concerns of staff are not taken nearly seriously enough. That has consequences for morale and in other areas. It is about good management. On the question of the PCT’s continued role as a service provider, we have made it clear that we expect PCTs to continue providing services but that they have the right to consider bringing into the market new providers that may be in a better position to provide those services in a more responsive and high-quality way. There will be no edict or instruction from Government to PCTs to stop providing services, but we need to focus on the best shared outcomes that we can achieve for local populations, and that might sometimes mean bringing in other providers that have not historically been involved. I spent my entire working life before coming to this place in the voluntary sector. The voluntary sector could do things in terms of responsiveness to user and carer need that statutory services frankly could not and cannot do. It is not a new concept or phenomenon, but it must not be ideologically driven. It must be about shared outcomes and high quality and responsive services. My hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) felt that despite some of her early frustrations the Government had listened. She also made a point about the centrality of area commissioning, which is one of my responsibilities in a sense. We have not sorted commissioning of health and social care in this country. We need an integrated approach and commissioners who are willing to get their hands dirty by getting close to users and carers as they make decisions about the nature of the services that should be commissioned. Being a commissioner in a modern health service in a social care setting is a skill. Maybe we need to do a lot more thinking about the kind of support and development that we offer to people who end up in commissioning roles in such organisations, because the nature of the commissioning can often determine the quality and responsiveness of NHS and social care. I agree with my hon. Friend about the importance of public health. The Government will continue to stress PCTs’ responsibility for focusing on public health. We want to see a continued shift where appropriate from hospital care to community care and primary care. In some areas that is more advanced than in others, but it is important that we keep our eye on the ball and ensure that we are spending more money, time and energy on preventive support than on reacting when we could have done better in the first place. I pay tribute to my hon. Friend’s parent-led Sure Start scheme, an example of an innovative local project that is making a difference, probably more than anything because it is parent-led. On the question of staff training and primary care, I agree entirely with her that staff training and development are important. I do not have any figures to hand, but if she wishes me to write to her on the issue, I shall be happy to do so. I want to reassure the hon. Member for Wellingborough (Mr. Bone) on the question of community hospitals. He is right. The Government are committed to a new and exciting role for community hospitals, and I hope that that will help him in his discussions with his PCT. Just because the management arrangements have changed does not mean, if we are talking about reflecting and meeting the needs of local communities, that the commitment to community hospitals should change. I hasten to add from the Department of Health that it is not for me to dictate to the PCTs the nature of the projects that they should support. [Interruption.] I will give way to the hon. Member for Eddisbury in a moment. The hon. Member for Wellingborough raised the question of the five-year-old child. It would be wrong for me to comment on an individual case, but it is slightly contradictory that Ministers are asked to make judgments about individual cases at that level when we have devolved resources to the PCTs and asked them to make decisions about priorities. I do not know the level of pain that that child is in right now. That should be important in determining the decision-making process. However, I cannot intervene directly in that individual case.