§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Clelland.]
10.59 pm
§ Mr. Andrew MacKay (Bracknell)I start by thanking the Speaker, through you, Mr. Deputy Speaker, for ensuring that I could so quickly bring an urgent matter involving my constituency to the attention of the House. I also thank the Under-Secretary for coming to reply to the debate.
It is not very often that a member of the shadow Cabinet who is also a Privy Councillor and has been a Member of Parliament for 20 years introduces an Adjournment debate. By and large, we are fortunate enough to be able to ensure through other channels that our constituents' interests are properly looked after.
I regret to say that in the case of Bracknell primary care group's application for trust status, the disgraceful way in which the application has been handled by Bracknell regional health authority, the cavalier manner in which my letters have received no reply and the way in which the primary care group has been treated by the arrogant Sir William Wells and his colleagues has caused me, unprecedentedly, to write to the Speaker and request this Adjournment debate.
I will say more later about the lack of reasons for the trust status application being refused. First, I shall turn the clock back a few months for the benefit of the Minister. Berkshire health authority, which has been nothing but co-operative throughout, made it clear, as I believe the Minister will confirm, that every primary care group in Berkshire should, if possible, obtain trust status at the same time—in April 2001. There are clear advantages across the county for all primary care groups to move to trust status at once.
Some 10 days ago, the regional health authority informed Slough, Reading, Wokingham and Newbury that they were to obtain trust status next April—but not Bracknell. Bracknell has an excellent reputation and outstanding doctors and health workers. As the Member of Parliament for the constituency for the best part of 18 years, I very rarely receive complaints about primary health care in the borough. The primary care group seemed an ideal candidate for trust status.
An initial vote of general practitioners did not support trust status. For other reasons, many of those voting voted against as a protest. That should not be a reason for the trust application to be turned down. Subsequently, there was a second and much more valid vote, in which only eligible general practitioners voted. As the Minister should be aware, in the first vote, locums and assistants voted, and the whole practice in B infield had to be counted in the Wokingham vote because at that point it had not been transferred to the Bracknell primary care group area, even though Binfield is part of Bracknell Forest borough.
The second vote, for which all GPs were eligible, overwhelmingly supported trust status for the primary care group. In addition to that, all the other stakeholders are, like me, passionately in favour of the trust being set up as soon as possible. I refer to the excellent district nurses, health visitors, district midwives, community physiotherapists and speech therapists. They have all been 285 ignored by an overbearing regional health authority that has consistently neglected Bracknell, and by an arrogant chairman, Sir William Wells, who, I regret to say, does not even bother to reply to letters from Members of Parliament.
The moment that I heard that Bracknell's trust status might not have been granted, I wrote to Sir William on 6 November. That was some time ago. I have not received an acknowledgement, let alone a comprehensive reply. One can understand how upset health workers in my constituency are when their Member of Parliament writes to the regional health chairman, marking the letter urgent, to say that he gathers that the chairman is about to turn down their application for trust status yet grant it to other primary care groups in the county, and to put forward an excellent case for trust status going ahead for Bracknell, only to be completely ignored. There has been no reply whatsoever. That, again, is the arrogant Sir William Wells.
A week later, on 13 November, after the primary care group had been summoned to the regional headquarters and had been told that its application had been turned down, I again wrote to the chairman asking why and complaining that the group had been given no reasons. By now, no one will be surprised to hear that the arrogant Sir William has, to date, not replied to me. He is a public servant, paid for with the hard-earned taxes of my constituents, and I know that the Minister will deeply disapprove of such a cavalier manner.
Let us briefly move on to when the Bracknell primary care group attended upon the regional health authority at its headquarters. No reasons were given for its application being turned down. It was told at the meeting that it was not allowed to take notes. I do not think that, outside the old Soviet Union, many doctors have to attend meetings where they are told by civil servants that they are not allowed to take notes.
A huge document was produced and Bracknell primary care group was told that it contained the reasons for the refusal of its application, that it had five minutes to read the document, but could not take it away and study it. Naturally, in five minutes one cannot get to the bottom of the reasons contained in such a comprehensive document. On 13 November, I asked Sir William Wells to give the reasons. If trust status has been turned down for an excellent primary care group, we have every reason to want to know why.
Additionally, and even more sinisterly, some members of the primary care group have been threatened with the fact that it would not be wise to go to their Member of Parliament or to cause trouble—that it would be best to stay quiet; otherwise future applications for trust status would not be granted.
The Bracknell primary care group was then told, under duress, to withdraw its original application because it would be turned down, and, if it was formally turned down, it would affect a future application. That is deeply unsatisfactory. As I suspect the regional health authority will have told the Minister, the application was withdrawn, so there are no problems.
Berkshire health authority has now suggested that there might be a virtual Bracknell primary care trust, whatever that means. It refers to it as a trust in all but name and law. That is a poor alternative; it is not the real thing. It means two upheavals: moving from group to virtual 286 trust and, if successful, in April 2002 to full trust status. No doubt Berkshire health authority, which has been supportive throughout, was trying to be helpful again, but it is not sufficient.
I share the aspirations of the Minister and the Secretary of State, as does my shadow Cabinet colleague, the Opposition health spokesman, my hon. Friend the Member for Woodspring (Dr. Fox), that, wherever possible, trusts are a good thing because they give local people power to decide their own destiny. That is why the Government have rightly encouraged primary care groups to follow hospitals to trust status. Without trust status, the primary care group has to rely on the regional health authority. It is obvious from my comments that we have no confidence in that authority, especially under the chairmanship of the arrogant Sir William Wells.
The position is bad for the morale not only of doctors but of other stakeholders. It also means that for another year or 15 months, an unnecessary tier of bureaucracy will exist and local health workers and doctors will not be able to make their own decisions and continue to provide primary care effectively and efficiently to the benefit of my constituents.
I shall conclude by addressing specific remarks to the Minister. We now depend on her because the application for trust status has been turned down to date. She will realise that we have no faith in the region or Sir William Wells. Will she, as Minister, personally look at the application? I want it to be judged simply on merit. For those with professional expertise, it is inconceivable that other primary care groups in Berkshire have gained trust status while excellent Bracknell has not. We are confident that the Minister will reach the same conclusions if she examines the case on merit.
I should like confirmation from the Minister that it is incompatible with a free and open society, which she and I support, for an application for trust status to be turned down without the provision of reasons, which should be in the public domain. Members of the primary care group do not know the reasons and the Member of Parliament has not been given them. That inevitably casts a slur on everybody; the alternative is that the regional health authority and Sir William Wells have something to hide. Whatever the position, it is deeply unsatisfactory.
We are approaching the end of November; the trusts will be set up in April 2001. It is not too late for Bracknell to receive trust status because other areas in Berkshire to which I referred were granted their status only 10 days ago. I therefore urge the Minister to review the case, publish the reasons for the regional health authority's refusal to allow the application to proceed and, with the Secretary of State, to consider the future of Sir William Wells.
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)I congratulate the right hon. Member for Bracknell (Mr. MacKay) on raising primary health care trusts tonight. Although the main subject of the debate is trust status for the Bracknell primary care group, I need to say a few words about the overall framework in which trusts are developing. I also hope to be able to explain the reasons for the decisions that were made in Bracknell, not least to make it clear that the application was not turned down. It never reached the stage of being put before Ministers. I shall try to place that in context.
287 When we published the national health service plan in July, nobody questioned what was at stake. In many ways, the plan was about reforming the NHS, which had come under attack not only from patients but from within the organisation. People realised that change was necessary. Underfunding hampered the NHS, but so did its operation. The way it was organised to make people wait, the barriers to efficient use of staff, and the chasm between the NHS and social care, all had to be tackled. The NHS needed money, but it also needed change. The NHS plan is about investment and reform, money and modernisation. The money comes at a price; the price is change. The need to change the way the NHS operates is acknowledged in many places, including Berkshire.
We had to consider access to primary care because, during the consultation, the need for more tests, diagnosis and treatment in primary care settings was identified. Proper priority needed to be given to major killer diseases such as cancer and coronary heart disease. We needed to stop postcode rationing for drugs and to secure better access to high-tech equipment. The National Institute for Clinical Excellence has played a significant role in that. However, that change can come about only with the full involvement of everyone in primary care.
We have already allocated some £54.5 million to primary care groups and trusts this year to kick-start the expansion of primary care services, and further investment will follow. It is important that those funds be used strategically to develop new services and improve access to primary care. However, although primary care will receive earmarked funds, those are not the only funds that will affect how services are delivered. More than £20 billion has been devolved to primary care groups and trusts, to commission services. That money must be used responsibly.
The creation of primary care groups was a vital step in the biggest devolution of power and decision making ever seen in the NHS. It brought together doctors, nurses, community nurses, health visitors and local people and put them in the driving seat in deciding how local patients would be looked after and treated. We have set up a central programme of support and development to help to manage the transition, because the cultures of corporation and management that have developed over the past 50 years were and are variable.
For starters—this is extremely close to my heart because I have information technology responsibilities—we have provided some £50 million to help all PCGs to improve their IT infrastructure and data management, so that all the partners in the system can communicate effectively. The national primary care development team was set up to ensure that all PCGs have access to expert advice and support. We expected each group not to reinvent the wheel, but to learn from good practice.
We have issued guidance to ensure that all PCGs have organisational development plans in place that are relevant to their needs. That has already made a real difference to patients, and I shall give examples from the right hon. Gentleman's constituency. He has acknowledged that good work is going on in Bracknell. All those involved show great commitment, and we recognise that. Bracknell has an exercise referral scheme; the Bracknell assessment and rehabilitation team offers rehabilitation packages; waiting 288 times for physiotherapy services have been reduced by three to six weeks, and additional physiotherapy has been provided in the community; and an innovative project on access to primary care for people with learning disabilities has been developed with the centre for community development.
In addition, general practices in Bracknell are participating in a primary care collaborative, which brings practitioners together to develop simple but effective improvements in the way that services are provided. The collaborative is considering access to GPs and nurses and to secondary care and coronary heart disease facilities.
Such examples of good practice have been achieved by ensuring better working across boundaries and the development of robust links between primary and secondary care. That, with a more effective direction of resources, was meant improved services for patients in Bracknell.
The development of primary care groups into primary care trusts provides an unparalleled opportunity. It will allow local health professionals to control budgets that will enable them to shape hospital and community services for patients in their area and to invest in improving the primary and community services provided by doctors, nurses and other local professionals. I am grateful to the right hon. Gentleman for not falling into a trap into which I occasionally fall—I am always quickly told off when I talk about doctors and nurses alone. He acknowledged that more than 60 per cent. of those who work in the NHS are not doctors or nurses but support staff who are part of the chain of care. They are extremely important, and I assure him that we recognise their contribution.
Trusts can develop services more integrated between general practice, community services and social services, and can give patients better access to health care by identifying which services most need developing. Above all, decision making must be brought closer to patients and must be shaped by the professionals who most often meet patients' needs. Nationally, some 40 PCTs are up and running, and more than 130 PCGs have expressed an interest in becoming PCTs from 1 April 2001—which leads me to the concerns raised by the right hon. Gentleman.
Bracknell was one of the PCGs hoping to take the step to PCT status in 2001. Its application was part of a wider plan in Berkshire to move, on a whole-system basis, to six PCTs, which would be broadly coterminous with the unitary authorities, by April 2001.
There is no such thing as a blueprint for PCT applications. Certain criteria must be met, and we have specified four basic criteria. The first involves a vision: applicants must be able to demonstrate their need to become a PCT, and also demonstrate what will be achieved as a result. The second relates to support: applicants must show that their applications have received local support from all stakeholders.
I was disturbed by the right hon. Gentleman's perception of the way in which the first and second ballots went. I hope that, as we move on—and I shall go on to explain how we can move on very positively—any such issues will be resolved, and it will be made clear who is involved. For instance, all general practitioners are involved.
Thirdly, applicants will need to show competence with regard to clinical leadership, management capacity, technical systems and skills enabling them to manage 289 large budgets and provide community services. Fourthly, they must be able to ensure that there will be no detrimental impact on other services, or service providers, within the health system involved.
Unfortunately, the Bracknell PCT application did not meet all those criteria. More work is needed to consolidate and realise the plans outlined in the application, and to ensure that the PCT is fit for its purpose. The PCG and the health authority were fully aware of the concerns raised by the NHS executive about their plans, and worked hard to address them. However, it was not possible to complete all the necessary work in time to establish a PCT safely next April. That is unfortunate, but the needs of the patient must always come first.
Once established, PCTs face a huge agenda: expanding the provision of services, integrating services transferred from community trusts with existing primary care services, developing the essential commissioning role, putting in place new clinical governance and quality regimes, and undertaking financial and human resources management on a considerable scale. It is important for them to be ready to take on the task. A PCT in Bracknell would not have been ready by April 2001, and it was felt that it would be irresponsible to let the application proceed.
This is important. It was not that the application was turned down; it was that the negotiations to let it proceed never reached the stage at which it would be put before Ministers.
It is vital for the new PCT to have local support, and the application did not demonstrate the existence of broad local support in Bracknell. I hope that all stakeholders will use the time available to make their support much plainer.
The issue was raised with both the PCG and the health authority in the summer, but only limited progress has been made in the resolution of issues of concern. Let me give a broad example, based on my examination of various other applications and the number of local meetings that have been held. I understand that only 11 have been held in the Bracknell area. I would expect at least 20 to be held. Perhaps, in the right hon. Gentleman's view, his community feels it is working so well that it does not need to demonstrate that; but we need to see evidence of broad local support.
The health authority and the PCG will need to build on the support that they already have over the coming months. I understand that they will be visiting GP practices and working with other professionals to explain the benefits of PCT status. In view of all the work still required to develop robust actions plans and to foster local support, the PCG and the health authority agreed with the regional office that it would be better to withdraw the current application.
The PCG and the health authority will now work to improve the weaknesses identified, and aim to re-submit the application next spring. If the revised application meets the necessary criteria, the new PCT will be established in the autumn and will be ready to go live in April 2002.
No doubt the right hon. Gentleman is wondering what his constituents will suffer as a result of the delay. Let me emphasise that the quality of care received by patients in Bracknell, and indeed in Berkshire as a whole, will not be affected by the plans.
The additional period of development is to ensure that patient care is of a high standard when the PCT assumes its responsibility. Any other course of action would have 290 been foolish. Good quality service will continue to be provided in the interim. The health authority has already decided to maintain the existing community trust in east Berkshire for a further year for that purpose. In addition, the PCG will be bolstered by a project director to lead and to support further development of services.
I note the right hon. Gentleman's concern that there may be a financial loss to the new PCTs in that period of development. He said that all the other PCGs in his area turning into PCTs may have an adverse effect on Bracknell, but I assure him that it will not. PCGs and PCTs receive their resources from the health authority, based on a weighted capitation formula. That will not be affected by the transfer of services later than originally planned.
I make it clear that the further development that the PCG requires before the transition to PCT status is not a reflection of the efforts to date by the staff of the PCG. It is a case of being realistic. I put it on record that the commitment of those who have worked on that so far is fully recognised. There has been much good work, but the local support has not been shown sufficiently. I hope that we can remedy that. Perhaps the debate will help us all to mobilise that support.
We must recognise the task that faces the PCG before the transition can be made. We would not be helping either staff or the people of Bracknell if the change went ahead prematurely. Promising work has already been done. I will expect the health authority to give the chief executive and other PCG staff further support to build on that.
Primary care trusts are central to delivering our vision of the new modern NHS. They will ensure that the right services are available at the right time, in the right location for the right patients.
I note the right hon. Gentleman's specific questions. I cannot look at the application as a Minister; it never proceeded as far as the ministerial decision stage. I certainly undertake—he will have no doubt about it—that I will watch developments in Bracknell carefully and ensure that we come to a position whereby the application can be brought forward.
I was slightly disturbed that the right hon. Gentleman had the perception that people were trying to keep something secret. I know that aspiring PCTs have meetings with the regional office before they submit the application. Those meetings are supposed to be in confidence because it is prior to the application. I understand that some people may not have felt bound by the confidence, but, again, I will take a close look. It is to no one's benefit if ill feelings arise in an area. If that can be resolved, I will look into it.
I fully recognise that the right hon. Gentleman looks forward to his constituents benefiting from PCT status. When the necessary action has been taken, they will. If we can engage the stakeholders more closely on the ground, they will be in a position to take the application forward. Then I will look at it with keen interest, and with greater knowledge of what has been happening on the ground than I had before the debate. Therefore, I am grateful to him for raising the matter. I hope that I have dealt with his questions.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes past Eleven o'clock.