---

Primary Care Trusts and Ambulance Trusts

With permission, Mr. Speaker, and in the unavoidable absence of my right hon. Friend the Secretary of State, I should like to make a statement on primary care trusts and NHS ambulance trusts. Detailed information for each area has, for the convenience of hon. Members, been placed on the Board since 1 pm. In my right hon. Friend the Secretary of State’s written statement of 18 October 2005, she explained that strategic health authorities had been invited to submit proposals to the Department of Health on how to streamline SHAs and strengthen primary care trusts. Four clear criteria underpinned that exercise: the need to improve health and reduce inequalities; to strengthen the PCTs’ commissioning function; to improve co-ordination with social services through greater coterminosity between PCT and local authority boundaries; and to deliver at least a 15 per cent. reduction in management and administrative costs. In the intervening period, SHAs have consulted local people, staff and clinicians, partners in local government and a range of other local stakeholders on the proposals for SHAs, PCTs and ambulance trusts. Many right hon. and hon. Members on both sides of the House have offered their views and I am very grateful to them. After local consultations, SHAs submitted their reports and recommendations to the Department. An external panel, established to advise Ministers on the proposals, has since met to consider in detail each proposal for PCTs and SHAs. After receiving its advice, we announced on 12 April that the numbers of SHAs would reduce from 28 to 10. Ministers have now considered the recommendations and the panel’s advice on PCTs. I can now inform the House that the number of PCTs will fall from 303 to 152, and that the new organisations will be established on 1 October 2006. The population covered by each PCT will rise from an average of around 165,000 at present to an average of just below 330,000. About70 per cent. of the new PCTs will be coterminous with the boundaries of local authorities with social services responsibilities, which compares with about 44 per cent. of PCTs that are currently coterminous with their local authorities. In some areas, concerns have been expressed that larger PCTs could lose a locality focus and divert resources away from deprived areas or that smaller PCTs could lack commissioning power. We acknowledge those concerns and have sought to strike a careful balance between those conflicting demands. In response, we propose that four general conditions be applied: first, that all PCTs retain and build on partnership arrangements; secondly, that a strong locality focus must be retained and, where necessary, that local structures should be put in place; thirdly, that all PCTs must deliver their share of the 15 per cent. management cost saving, strengthen commissioning and ensure robust management of financial balance and risk; and fourthly, that the new PCTs and SHAs should consider how any further conditions relating to issues that arose during the consultation could be applied. In some areas, the new proposals differ from those suggested by the SHA and the external panel. Having taken into account all the evidence and sought local consensus wherever possible, we have judged that in those circumstances, the alternatives could better satisfy the ““Commissioning a Patient-led NHS”” criteria and have the best possible chance of success. On PCTs as providers of services, let me restate the then Secretary of State’s clear commitment to the House on 25 October 2005. She said that"““district nurses, health visitors and other staff””" delivering clinical services"““will continue to be employed by the PCT unless and until it decides otherwise.””—[Official Report, 25 October 2005; Vol. 438, c. 152.]" Our aim in making these changes is to benefit both patients and taxpayers. Fewer, more strategic PCTs will be better placed to ensure effective commissioning of services for patients, and to support the development of practice-based commissioning among GPs and other primary care staff. Patients will receive the right care and treatment in the right place, and at the right time. The taxpayer will see the release of £250 million worth of savings annually, through the merging of back-office functions and a reduction in administrative costs, for reinvestment in front-line services from 2008-09. That could pay, for example, for roughly 50,000 heart operations or major improvements in services for people with long-term conditions, especially older people. The changes will also build stronger partnerships between the NHS and local government. The reconfiguration of PCTs is the first stage in strengthening the commissioning function. The next stage is a development programme for all PCTs, which will ensure that they are strong, confident organisations fit for driving forward the NHS reforms that we are implementing. On ambulance trust reorganisation, in June 2005 the Government accepted the recommendations set out by Peter Bradley, our national ambulance adviser, in the review entitled ““Taking Healthcare to the Patient: Transforming NHS Ambulance Services””, which set out a vision for ambulance services. In future, they will provide more care in the home and more treatment at the scene, give better advice to patients over the telephone and ensure faster response times to save more lives. The review made it clear that in order to ensure that ambulance trusts have the right strategic capacity, infrastructure and staff to deliver these improvements in patient care, there should in future be fewer, larger ambulance trusts. These changes will enable standards within the new trusts to be levelled up to those of the best. In her written statement of 14 December 2005, my right hon. Friend the then Secretary of State set out our intention to consult and to ensure that the benefits outlined in the ambulance review can be fully realised. Following this consultation, the Secretary of State has now decided that from 1 July 2006, most of the existing 29 NHS ambulance trusts will merge into 12, with separate management arrangements for the Isle of Wight. For now, Staffordshire ambulance service will remain a separate trust, working in partnership with the new West Midlands ambulance service, but will eventually merge at a later date. Feedback from most areas was supportive of our proposals. However, we have decided to address the public’s concern that local responsiveness and flexibility could be lost through having larger trusts by requiring ambulance trusts to ensure that their services are meeting the needs of all localities and populations within their boundaries. Those changes should mean more investment in front-line services as trusts identify savings in back-room functions; improved patient care through providing an opportunity to raise the standard of the service provided by all trusts to the level of the best; better emergency planning, with greater capacity and the capability to respond to major incidents of all kinds; more integrated services; and better career opportunities for staff. Changes of this kind are inevitably difficult. We have not sought to impose a single blueprint on the NHS; instead, we have listened carefully to representations from all Members and from local communities and organisations. Wherever possible, we have responded positively to them. We have one aim above all: to deliver better health care to patients. I commend this statement to the House.