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NHS: Primary Care Trusts and Ambulance Trusts

My Lords, I too thank the Minister for repeating the Statement made in another place. Since this Government came to power there have been seven reorganisations of the National Health Service. The announcement today marks the eighth and ninth. The NHS could have wanted nothing less. As the noble Earl said, four years ago regional health authorities were abolished. Today’s announcement begs the question of whether the Government were right then to abolish health authorities or whether they are right now to recreate them in a new form. They must have been right at one point and wrong at another. Would the Minister tell us which? Secondly, today’s Statement made much of the anticipated savings of £250 million. Would the noble Lord tell us the evidence for that figure? In January the Health Select Committee, writing on the subject of PCT reorganisation, said that at best it could estimate savings of between £60 million to £100 million. How was that figure of £250 million arrived at and will it be recurrent? Furthermore, can the Minister tell us the anticipated number of redundancies of managers and how will that interplay with the number of frontline staff currently being shed by trusts? The Minister said in the Statement that there would be an achievement of 70 per cent coterminosity with social services. On behalf of my colleagues, I welcome that the Government have in some cases listened and changed their proposals, particularly on coterminosity in some parts of the country. Given that coterminosity of PCTs and social services remains the same in London, and they represent 32 out of 152 trusts, there must be a substantial part of the rest of the country where there is no coterminosity. Given that the numbers of older people—particularly heavy users of ambulance trust and PCT services—live in areas that are not coterminous and given that at the same time social services are having to deliver against a background of 15 per cent cuts and savings, can the Minister say what the Statement means for the future integration of health and social care services? I too wish to make some points on ambulance services. I echo the noble Earl’s feeling that bigger is not necessarily fitter for function, but given that ambulance services are going to be reorganised at the same time as the reorganisation of police forces, can the Minister say what the implications of that would be for co-ordination of emergency work? Furthermore, if ambulance trusts are to cover much wider areas, what is going to happen to people in rural areas? How will this reorganisation ensure that there is equity between those who live in rural areas and those who live in larger urban areas, whose demands on the ambulance service can be particularly high—particularly high at key points such as evenings and weekends? This restructuring is to be implemented by October this year. It is being introduced at a time when practice-based commissioning is being rolled out. It is the structural backdrop to the implementation of the White Paper and is being introduced when there is a great deal of uncertainty in all the different parts of the NHS, such as NHS Direct, which this week announced a whole load of job cuts too. Will the targets that PCTs are supposed to achieve, particularly in things like roll-out of practice-based commissioning, be altered in any way while they try to find their way though what seems inevitably to be a summer of job cuts and a winter of confusion?