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Primary Care Trusts and Ambulance Trusts

Indeed, it does say it here, because that is what I wrote. First, let us look at ambulance trusts. Peter Bradley’s review concluded that there should be fewer of them, but that they should be larger, yet no evidence for that major change was contained in the report, or made available since. Ministers then decided to reduce the number of strategic health authorities to align with their obsession with regions, notwithstanding the electorate’s rejection of the idea in the north-east. With sleight of hand, Ministers have used the reorganisation as an excuse to reduce the number of trusts to 12, and then they have ducked the flak by suggesting that that was Peter Bradley’s idea and recommendation all along. Will the Minister therefore undertake to place in the Library of the House any evidence that relates specifically to claims that creating large trusts will lead to improvements in patient care? How does the reorganisation achieve closer integration of all the emergency services? Will the Minister explain how a north-west regional ambulance service will integrate better with the newly merged Merseyside and Cheshire police force—a merger that will be carried out in the teeth of maximum hostility and objection? How will it integrate better with contingency planning in Cheshire, or with the Cheshire fire service’s move to sub-regional control rooms? Will the Minister comment on proposals to reduce control room numbers by co-aligning them with the police and fire services? The House should bear it in mind that in Warwickshire, for example, the fire service responds to some 3,000 emergency calls a year, whereas the ambulance services respond to some 100,000. Who is co-ordinating the reorganisation across Government? Co-ordinated is the last thing that it is—perhaps the Deputy Prime Minister has been devoting his time to this matter recently. It is shambolic, inconsistent centralising by an arrogant Government who claim to listen but who choose not to hear the views of those who work on the front line and who know best. The official consultation on ambulance trusts lasted from the middle of September last year to near the end of March this year, yet the NHS appointments commission sent out letters on 30 January—in the middle of the consultation period—asking for nominations for men and women to chair the new NHS ambulance trusts. The question arises—was not the decision therefore a foregone conclusion? I have had a letter from Roger Moore, the chief executive of the appointments commission, in which he stated that the recruitment began"““at the request of the Department of Health””." I am pleased that concerted work by MPs across Staffordshire and by the shadow health team, supported by huge amounts of work by the people of the county, has caused Ministers to backtrack on axing Staffordshire ambulance service for up to two years. That 24-month period was set out in the handout on the Board in the Members’ Lobby, but not in the statement. That is a classic fudge, as it puts Staffordshire ambulance trust in the departure lounge. However, will the Minister give the House an assurance that unless the west midlands service is brought up to the standard of Staffordshire there will be no hint of a merger, whether in two years or beyond? Given today’s statement, any right-thinking person is entitled to regard the Government’s consultation as a sham. Constant change will undermine what has already been achieved; for example, by turning round the East Anglian ambulance trust. The Buckinghamshire and Northamptonshire service is about to complete the process of splitting; now they will have to go through the upheaval of being merged again. We are not against the restructuring of PCTs per se—[Hon. Members: ““Ah.””] The Under-Secretary of State for Health, the hon. Member for Bury, South suggests that the whole statement was about PCTs; clearly he was not listening, as much of it dealt with ambulance trusts. On PCTs, as distinct from ambulance trusts, we are not opposed to restructuring, but we have always said that future functions need to be defined before such restructuring takes place. In 2002, the Department of Health abolished the 11 regional offices of the former NHS executive and about 100 health authorities. Today, the Government are bringing back that map. Has the Minister estimated the cost of that U-turn, which takes us back to the position four years ago? He may talk of the Secretary of State’s clear commitment in October 2005 about the functions of PCTs, yet three months before that the DOH was equally clear, in ““Commissioning a patient-led NHS””, when it called for PCTs to become"““patient-led and commissioning-led organisations with their role in provision reduced to a minimum””" by 2008. The Secretary of State backtracked on that commitment, without reassessing whether the proposed structures would be fit for purpose. Now, no one is clear. As the Health Committee said in January, when it attacked the Government’s indecision,"““we are appalled at the continuing lack of clarity about whether or not PCTs will eventually divest themselves of provider functions.””" The Department of Health’s NHS operating framework for 2006-07, published on 26 January, offered little further clarity, stating:"““Where PCTs do continue to provide services, they will need to put in place clear governance procedures that ensure that there is no undue influence from the provider side on commissioning decisions.””" Will the Minister detail how 15 per cent. management cost savings can be made when the Government are calling for each PCT to have two sets of managers—one for commissioning and one for direct services? The problem for the Minister is that all this restructuring has gone on without putting in place the necessary precondition for its having a realistic chance of success: defining the future functions of PCTs. Will the Minister tell us how many PCTs are predicted to be direct providers of services in two years’ time? New organisations can hardly be expected to deliver unless and until they have clarity of purpose. In his statement the Minister said that in some cases the new proposals differ from those suggested by the strategic health authorities and the external panel. Will he tell the House how many PCTs the expert panel proposed should be created overall; and will he publish in full the panel’s advice so that we can see to what extent the Government arrived at different decisions and the implications of the variations? The Government seem only now to be waking up to the cost of the reconfiguration and the redundancies that go with it. Can the Minister confirm that the estimated cost of this latest round of NHS reconfiguration, which will merely take us back to where we were four years ago, will be £320 million? Will he also confirm that at £250 million—the figure he gave in his statement—the savings will be less than the cost? Is he confident even of that amount, or was the Health Committee right when it said that savings of between £60 million and £135 million were nearer the mark? Are those estimates gross or net, given the cost of the redundancies that will be inevitable to deliver on that Government promise? What is the time scale? The House is entitled to have that crucial information in a year when the Government’s financial control of, and credibility with, the NHS is shot to pieces and the NHS is in confusion and plunged into at least 10 months of uncertainty and chaos at PCT level. This is no way to run an NHS.