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NHS: Primary Care Trusts and Ambulance Trusts

My Lords, the House will be grateful to the noble Lord for repeating the Statement. In 2001, in the document called Shifting the Balance of Power, the Government announced that 302 PCTs would replace the existing health authorities and that the nine regional offices of the NHS Executive would be abolished in favour of 28 strategic health authorities. The announcement today effectively returns the NHS to a very similar organisational configuration to the one which the Government abolished only three years ago. That fact alone is enough to call the judgment of Ministers and officials into question. The Minister mentions cost savings arising from these mergers, but we all know that reorganisation itself carries a very considerable cost. Can the Minister say what the cost is likely to be in redundancy pay? Is the figure I have read of £320 million an accurate estimate? There is a further issue here. These very far-reaching changes to the structure of PCTs are being made without real clarity on what their functions are supposed to be. Why was it decided to retain the provider role and functions of PCTs when it was initially said by the Government that there was such a compelling case for removing those functions? What is the Government’s endgame in view? Will PCTs be encouraged to divest themselves of their provider functions? If it is to be down to local decision-making, what criteria should govern such decisions as practice-based commissioning develops? Finally on PCTs, I would like to pick the Minister up on two particular matters that he mentioned. He spoke of the need to retain a strong locality focus. How does he propose to do that with these larger structures? And what added benefits does the Minister see for the commissioning of services? As he will remember, commissioning is an issue that we have debated in this House in recent months. Moving to ambulance trusts, I welcome and am relieved by the decision on Staffordshire ambulance service, although its future is still less than clear. But it is not self-evident, despite what the Minister said, that bigger is better in this area. Some of the much smaller trusts which struggle with poorer response times will no doubt welcome a merger and derive a benefit from it, but there is a real issue over whether the creation of ambulance trusts over sometimes very large areas like the greater part of East Anglia will do anything at all for responsiveness and flexibility. Some interesting comments have been published recently on this theme. According to one unnamed chair of an NHS ambulance trust, the former chief executive of the NHS, Sir Nigel Crisp, told him that the changes were driven by the manifesto pledge of the Government to find £250 million of savings in NHS management and administration costs. The chair said that the changes had,"““not been thought through operationally””." The chief executive of Staffordshire Ambulance Trust, Roger Thayne, has condemned the proposed mergers. He has said that there is,"““no evidence that larger ambulance services are anything [other] than more expensive and do not improve performance and save more lives . . . Services serving a population of more than 2 million cost more and save less lives. The worst thing is we don’t know why they’re doing this—but I do know it won’t save more lives””." That was from an article in the Health Service Journal of 22 September last year. Those comments are entirely apposite. It seems to many that what the Government are now doing is primarily cost driven, not outcome driven. Can the Minister say in what respects the reorganisation of ambulance trusts is designed to integrate ambulance services with the other emergency services? How can such integration be possible when in many instances different services are using different communication and co-ordination systems? If you talk to those who work in the NHS, you will hear a number of comments at the moment, but one is heard perhaps more than others about the activities of Government. It is: when will they stop moving the deckchairs and let us get on with it? I suggest that it behoves Ministers to ask themselves that question now.