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NHS: Primary Care Trusts and Ambulance Trusts

My Lords, there is quite a lot there to respond to. I will do my best to give coherent responses to the points made by the noble Earl, Lord Howe, and the noble Baroness, Lady Barker. Both raised the issue of redundancy. The £250 million is a conservative estimate of the savings likely to be made—a mixture of staff and non-staff savings, including real estate issues. When people study the changes more closely, they will see that there is a lot of emphasis on sharing back-office services and, in some cases, sharing management systems and doing joint commissioning, too. Some of these provide scope—confidently, we think—for £250 million, which will be a recurring saving. It is worth bearing in mind that the redundancies are a one-off payment to secure those recurring savings. We confidently predict that we will get four-year savings in 2008-09 and these will go, as I said when repeating the Statement, on front-line services. These will help particularly with areas around long-term conditions and some front-line services in acute services. On removing provider functions from PCTs, the Secretary of State, Patricia Hewitt, has made clear on a number of occasions—as have I—that we have no intention of requiring PCTs to divest themselves of their provider functions. However, the trusts will need to continue to ensure that the provider services in their area are fit for purpose. That is why we will be going through, as I said in the Statement, a process of ensuring their fitness for purpose, so that they can ensure that the right services are in place to meet the needs of all the people in their communities, including those in the areas of greatest deprivation, some of whom need new providers and alternative providers to be in place. Coterminosity was welcomed by the noble Baroness, Lady Barker. We have significantly increased coterminosity with social services through these changes. That was a big issue in the public consultation, which led to the White Paper. People want their services to be integrated. It was not possible to achieve 100 per cent coterminosity. We listened carefully to what local stakeholders said and we have adapted some of the proposals to meet those concerns. There is a balance to be struck in some parts of the country between coterminosity and meeting the needs of health inequalities—also having bodies in place that carry a great deal of public confidence. There is not a lot of point in going through an exercise where more than 12,000 people turn up at public meetings to debate and many more write in with their views, and not listen to those views—particularly where front-line staff such as GPs express their views on the most suitable configuration at a particular local level. I hear what both noble Lords say about big not necessarily being beautiful in relation to ambulance trusts. I note the welcome of the noble Earl, Lord Howe, for the arrangements in Staffordshire. We listened to the advice that was given to us by our National Ambulance Adviser, as I made clear in the Statement. Peter Bradley consulted with a considerable stakeholder group before he fashioned the advice in the report mentioned in the Statement. His views were not the same as those of Roger Thane of Staffordshire—who, let me remind the noble Earl, has resigned and is no longer the chief executive of Staffordshire. Mr Thane has his views—he is entitled to them—but they are not the views expressed by our National Ambulance Adviser and are not necessarily the views which are shared by a large number of people in the ambulance service. We think it is essential to listen to that advice because it makes clear that a number of trusts need to be larger in order to provide the infrastructure and the capability to cope with the changing needs placed on our ambulance service. As to rural areas, these proposals will not change front-line services or where ambulance stations are located. There is nothing in the proposals which will require any ambulance trust to change its ambulance stations. Of course, over time, in all places, ambulance stations occasionally have to change because populations have the inconvenient habit of changing and people move to different parts of the country, but there is nothing in the proposals which in any way disadvantages rural areas. I have tried to deal with most of the points raised. I refute absolutely whatever is attributed to Sir Nigel Crisp in regard to changes driven by the manifesto. It is very clear that we need to strengthen the commissioning function in PCTs. The introduction of practice-based commissioning—which I can confirm we are still aiming to have in place across the country by the end of this year—changes the dynamic; it tends to push in the direction of larger PCTs and more combinations of PCTs because of the functions being carried out in the commissioning sector by GPs.