Primary Care Trusts

I would say to the hon. Gentleman that we give the PCT a significant amount of resource. We give them a major amount of autonomy. Yes, it also has priorities and targets that are set by Government. However, as I understand it the situation is that a five-year-old child is in pain. If it is as clear as the hon. Gentleman has reported it during the debate, he is right to pursue the question of whether that child’s treatment could not be provided in a more accelerated way. That is all that I can say to the hon. Gentleman. I cannot comment on whether the PCT and management’s view, that that is a question of priorities, is a reasonable one. All I can say to the hon. Gentleman is that in any weighing of priorities the pain of a five-year-old child should be given significant weight. However, I cannot go any further than that. I have probably gone too far as it is. My hon. Friend, the Member for Pudsey (Mr. Truswell) is obviously frustrated, to say the least, about some of the changes that have been made in his area and some of the ways that they have been approached. He expressed support for some of the innovative services that have been provided in recent times and concern that they may be detrimentally affected by those changes. All I will say to my hon. Friend is that it is important, not to debate decisions that have already been made, but to ensure that the new structure delivers in the way that the Government intended. I am happy to engage in a constant dialogue with hon. Members, including my hon. Friend, to make sure that any fears or concerns that they have will not be borne out. That is not the end of the matter. One of the matters that is legitimate in the debate is for right hon. and hon. Members to play a role in holding their local PCTs and other health organisations to account on the way that services are delivered at a local level. That need not be in a formal way, but it is an entirely proper part of a Member of the House’s responsibilities to ensure that local delivery organisations meet the needs of their constituents, and, if they do not, to bring that to the attention of the management of those organisations and, ultimately, to that of Ministers. The significant thrust of what the hon. Member for Northavon (Steve Webb) was saying was that consultations were sometimes of a sham nature. He said that I looked disapproving at that statement. I did not actually. My experience of consultations, across the board in all services, is that sometimes managers issue consultation documents—not just in the health service, but across the piece—and they know exactly the decision that they have already made. They know the outcome that they want. The consultation is there to justify the decision that they have already made. Any hon. Member who would not acknowledge having had such an experience at one stage or another, in one consultation or another, would not be living in the real world. Such consultation is not acceptable, and should not be, to the Government or to locally or nationally elected representatives. I do not think that the hon. Gentleman can describe the consultation as a sham. There is a lot of evidence that major listening took place. The evidence is in the changes that were made as a consequence of the listening. If the consultation were a sham and the Government wanted to drive the changes through on a one-size-fits-all basis, as we have been accused of, we would not necessarily have listened and we would not have made changes, so I do not think that that was entirely fair. The hon. Gentleman talked about decisions being made locally. That was a big thrust of his argument. The strategic health authorities of course oversaw all of the consultations, not the Department of Health at a national level. However, there comes a point when there has to be some level of arbitration or mediation in making final judgments. Significant differences of opinion are always going to have to have an ultimate arbiter or mediator who comes up with a solution. That solution will not always be acceptable, either to local people or to other stakeholders. In some way there will always have to be somebody who makes a decision. There were very disparate and diverse views as to the best way forward. Obviously the Government have to create a mechanism to arbitrate and mediate in such circumstance. Turning to the contribution of the hon. Member for Eddisbury, the argument that the Conservative Opposition tend to throw at the Government is that all we have done is to throw lots of money at the health service and as a consequence have not seen real improvements. Frankly, that is disingenuous. First of all, we have always made the case for reform alongside investment. That has been the mantra from day one in the way that we have sought to improve our health and social care services. Secondly, it is disingenuous to pretend that there has not been tangible improvement in many of our front-line services as a consequence of the Government’s investment and reform programme. I believe that many members of the public—it is not a question of an ungrateful nation—would acknowledge that. The hon. Gentleman described the financial challenges of the year as the worst crisis in the NHS’s history, but I would say that the worst crisis in the NHS’s history developed during 1979 to 1997. One of the primary reasons why the Major Government were thrown out of office to the extent that they were was because of the public belief that the health service had been so starved of resources, particularly during the latter years of the Major Government. The Conservative party paid the political price. That was a real crisis. I remember the bed-blocking stories every year—year after year. They were almost accepted as an inevitable part of what was happening in the national health service. One only needs to remember from a professional point of view, as well as from a patient point of view, the reality of those years. The hon. Gentleman also raised questions about commissioning. I agree entirely with his belief in the centrality and importance of getting the commissioning right. The question is not just of commissioning at a practice level within the NHS, but also about how we can integrate commissioning in social and community care, as well as those commissioning functions currently under the national health service. The hon. Gentleman also raised the question of health inequalities and making sure that, under the new configuration, we do not neglect or allow to become invisible again some of the most deprived and disadvantaged communities. In my view we have to make sure that post-reconfiguration we continue to target resources on those most disadvantaged, in areas where health inequalities are at their starkest. The hon. Gentleman also raised the question of the NICE guidelines on infertility. I know there is a fear among some of the organisations involved, but I do not believe that the reconfiguration per se will be a problem for the NICE guidelines. I want to reiterate that we do not believe that the reconfiguration of primary care trusts should lead to that situation—