§ Chris GraylingTo ask the Secretary of State for Health what structural reorganisations have taken place in the NHS since 1997; and what estimate he has made of the total cost to the NHS of structural reorganisation programmes since 1997.[59093]
§ Mr. HuttonWe have abolished the internal market and devolved decision making in the National Health Service to the frontline. We have reduced the number of service commissioners from approximately 3,600 in 1997 to approximately 300 in 2002.
The intention to replace general practitioner (GP) fundholding with primary care groups (PCGs) and primary care trusts (PCTs) was announced in the New NHS: Modern and Dependable as was the intention to reduce the number of health authorities (HAs) with the responsibility for commissioning services being delegated to PCGs and PCTs. This policy was reinforced by the NHS Plan and Shifting the Balance of Power. As a result of the new NHS Reform and Health Care Professions Act, the new health authorities will become strategic health authorities, and the changes to health authorities and PCTs under Shifting the Balance of Power will be in place from 1 October 2002.
The number of NHS trusts has reduced through a series of locally led mergers and demergers with a number of community trusts merging with PCTs.
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The table shows the change in numbers of organisations and different levels of responsibilities within the NHS since 1 April 1997. Service Commissioners Service Commisioners Providers Service Providers 1 April 2000 99 459 17 326 1 October 2000 95 434 40 326 1 April 2001 95 239 239 318 1 April 2002 28 (note 1) 1 303 274 Note 1:
In practice, commissioning of services has been delegated from HAs to PCTs. HAs will become StHAs in October 2002, subject to the NHS Reform and Health Professions Bill.
The establishment of primary care groups was funded using monies released by the abolition of GP fundholding. The previous Government had set aside an annual budget of £180 million to run fundholding. We have used those monies both to set up PCGs and to improve services to patients. Approximately £150 million additional monies was used following the establishment of PCGs. Approximately £63 million of central funding has been made available to support the establishment of primary care trusts.
The New NHS: Modern and Dependable contained a commitment to deliver £1 billion management costs savings over five years (1997–98 to 2001–02), including £100 million in the first year. The changes as a result of Shifting the Balance of Power will release £100 million savings from reducing bureaucracy and this will be placed in a transitional fund in 2002–03 and 2003–04 and used to fund childcare facilities for NHS staff.