---

NHS Reorganisation

I am sure that today’s Conservative Opposition day debate will give some flavour of the rapid structural changes that our national health service will go through in the coming years. The restructuring of primary care trusts has followed a very hasty timetable. That timetable was announced during last July’s parliamentary recess, and the initial consultation period closed on 15 October. That is neither a long time, nor a particularly appropriate time for such consultation to take place. Let us not forget that this is the third restructuring in 10 years, and that it will reduce the number of PCTs from 300 to 100 by this October. Initially, the proposed changes were supposed to coincide with trusts shifting toward a commissioning, rather than provider, role. That led to outcry in this place, and to Adjournment debates initiated by Labour Members. There was also outcry from the 200,000 workers directly employed by PCTs, who suddenly did not know how much longer they would have a job, or who their employer would be. They did not know whether it would continue to be the PCT, or whether it would be a private sector charity or the voluntary sector. Following some rapid rowing back, the Secretary of State adopted a new position whereby PCTs would move to a commissioning role only as and when they decided to. However, the chief executive of the NHS has not formally withdrawn his reference, contained in his initial letter, to the 2008 deadline by which PCTs should move over fully to a commissioning role. I should be very grateful if the Minister clarified that contradiction. There is still a lack of clarity as to the future function of our PCTs. However, the rationale behind the new structure seems clear: it is not a one-size-fits-all approach, but a case of ““any size, so long as it’s bigger””. This approach constitutes a move away from the rationale employed during the previous restructuring of PCTs, which took place only three years ago, whereby greater connection was sought with local communities. Only an ““any size, so long as it’s bigger”” rationale can explain why London’s PCTs are expected to move from a structure that already provides coterminosity with social services to being even bigger beasts, while Cornwall looks set to have its three PCTs reduced to just one. That is indeed a move towards coterminosity, with local authorities providing social services; then again, the existing structures are under review, so the local authorities may in any event change shape. Their future remains in some doubt. As if this dog’s breakfast were not enough, ambulance trusts are also up for reconfiguration. The intention is not to improve services to the public, but to fit the ““any size, so long as it’s bigger”” mantra by reducing the number of ambulance trusts from 31 to 11. Ignoring the principle of not fixing things if they are not broken, it seems that even the best-performing ambulance trusts—such as the Staffordshire trust, which has a three-star rating and is the highest performing trust, according to Government targets—are likely to be merged. As the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) said in her earlier intervention, it is not the size of the trust that determines how well it performs—and is there any point in fixing something that is not broken? Surely the emphasis should be on co-operating and sharing best practice with other trusts, rather than on introducing the concept of contestability, which will put trusts in competition with one another. If the principle is to apply to PCTs and ambulance trusts, SHAs must automatically follow suit, according to the ““any size, so long as it’s bigger”” mantra. They must go through similar upheavals, with the changes to be completed by April 2007.