National Health Service Reform and Health Care Professions Bill: Report and Third Reading

Tony Baldry (Banbury): Like almost everyone who has spoken in this debate, I am at something of a loss to explain why CHCs have been abolished. The hon. Member for Oxford, West and Abingdon (Dr. Harris) and I have both had experience of the Oxfordshire CHC. For many years it was led by John Power, the leader of the Labour group on Oxford city council. It was a constructive and critical CHC, irrespective of which party was in office. I still do not understand why it was felt necessary to abolish CHCs.

Mr. Heald: Does my hon. Friend think that the abolition might have had anything to do with "casualty watch", which showed how poor the situation was in accident and emergency departments?

Tony Baldry: I genuinely do not know, but we have never been given a coherent explanation for the abolition. If I was looking for bits of the machinery of government that caused concern, CHCs—especially the Oxfordshire CHC—would not have been high on my list. As Ministers and everybody else would have hoped, Oxfordshire CHC was an effective voice for patients and the community as a whole. It was critical and constructive, and it engaged in the debate.

The most important thing about community health councils, however, was that people could find them. We in the Westminster hothouse may sometimes forget how long it takes for our constituents to adapt to change—and the NHS has experienced an enormous amount of change recently. I suspect that if we asked people in the high streets of our constituencies "What do you know about primary care trusts?" we would find that few had caught up with the change, or would know who was involved in the trusts. Our Oxfordshire health authority has been replaced by five primary care trusts; I suspect that few of my constituents could name the trust currently covering their area.

Stephen Hesford (Wirral, West): Does the hon. Gentleman realise that community health councils were introduced in 1974, while PCTs have existed, broadly, since April this year? He is not really comparing like with like. My experience is the reverse of his: I found that even after nearly 30 years people did not know where their community health council was, and most of those I bumped into did not even know what community health councils were.

Tony Baldry: Perhaps the Oxfordshire CHC was a star, but I suspect that many people in Oxfordshire knew about it. We experienced a number of dramas over the years. There were concerns about the future of hospitals such as the John Radcliffe and the Horton general hospital in my constituency. When public meetings were needed, people were content for the CHC to organise them, knowing that it was objective and independent and would not be party-political or partisan. CHCs dealt in the politics of the possible, carrying out effectively the job with which Parliament had entrusted them.

As I have said, a lot of change is taking place in the NHS and it is sometimes difficult for our constituents to keep up with it. For each primary care trust there will be a patients forum. I must tell the Minister that I do not think that my constituents, or indeed many other people, are desperately gripped by the debate about whether there should be a patients forum or a patients council. I will support those on my Front Bench because I think that the other place has made some good points, but I believe that what people out there really want is stability.

My postbag today contained a newsletter from the primary care network, whose line was simply "Give NHS managers space, time and freedom to deliver". Inside was an article by the hon. Member for Dartford (Dr. Stoate), in which he said that PCTs must be allowed space in which to establish their own priorities.

People do want stability. If there is to be a patients forum for each primary care trust, people must at least know what the trusts are. As I said earlier, Oxfordshire now has five PCTs, one of which—Cherwell Vale—is based in Banbury. When it was set up, with the agreement of all, it included a chunk of Northamptonshire. The reason was simple: as Banbury is a market town, a day's cart ride has historically been involved. That is how it came to be a market town.

For centuries, those in many villages and small towns in the constituency of my hon. Friend the Member for Daventry (Mr. Boswell) have considered Banbury to be their natural market focus. Consequently, general practices in south Northamptonshire have traditionally sent patients to Horton general hospital in my constituency. Indeed, 30 per cent. of the hospital's work comes from Northamptonshire.

Mr. Tim Boswell (Daventry): Will my hon. Friend accept a declaration of interest? I have lived in my constituency, in the far south-west of Northamptonshire, for more than 30 years. Throughout that period I have not only used Horton general as my local hospital, but used a general practice in Banbury. I have crossed the border for primary as well as secondary services.

Tony Baldry: My hon. Friend—who has lived in, worked in and represented his constituency for many years—makes an effective point.

The primary care trusts that the forums will represent "went live" on 1 April 2001, but only began active life on 1 April this year with the demise of the Oxfordshire health authority. They were shadowing the authority for years. As I have said, Cherwell Vale primary care trust stretches into Northamptonshire. Members can imagine my amazement on seeing a letter from the chief executive of the Northamptonshire strategic health authority. Incidentally, if few people know which PCT represents them, I suspect that almost no one—and this goes for many Members of Parliament—understands what strategic health authorities do.

One thing strategic health authorities clearly want to do is reorganise PCTs. On 10 April, less than a fortnight after Cherwell Vale went live, David Sissling, chief executive of the Northamptonshire strategic health authority, wrote to the chief executive of the Thames Valley health authority saying:

"We recently discussed a possible adjustment to the boundaries of Cherwell Vale PCT and Daventry and South Northamptonshire PCTs. This would enable an alignment with the boundaries of Northamptonshire and Oxfordshire and of course the new health authorities.

I have discussed the proposal with a"—

listen to the next word—

"limited number of colleagues including the Chief Executive of Daventry and South Northamptonshire PCT. On the basis of these discussions I can formally confirm our strong support for a reconfiguration."

No one in the PCT was consulted. No patients or general practitioners were consulted. Members of Parliament were not even given the courtesy, then or since, of being told about the possible configuration of PCTs, just 10 days after they had come into being.

Tony Baldry rose—

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. Before the hon. Gentleman follows that line too far, let me say that the debate seems to be straying somewhat from the main point of the amendment.

Tony Baldry: We are focusing on patients forums, Mr. Deputy Speaker. Important questions are who will be on those forums, and what geographical areas they will represent. People in south Northamptonshire need to know which forum to go to, and they can know that only if they know which is their PCT. As I have said, they need some stability. For instance, people living in Chipping Norton, in the constituency of my hon. Friend the Member for Witney (Mr. Cameron), need to know which PCT represents them.

One of the most important concerns of the forums, however, will be the viability and vitality of their local general hospitals. The only logical reason for the Northamptonshire strategic health authority to want to take patients away from the Cherwell Vale PCT is that it wants to refer them to hospitals in Northamptonshire—which will undermine the viability and vitality of Horton general.At present, Oxfordshire has five primary care trusts; each one will, under the Government's proposals, have a patients forum. They came into being after considerable consultation between general practitioners, everyone involved in the national health service and all the stakeholders. Doubtless they had to have ministerial approval. It was agreed that there would be five of them. They have chief executives, boards and chairman—all the paraphernalia of a primary care trust. The Government are asking us to vote tonight for a patients forum for each of those PCTs.

Similarly, as soon as the primary care trusts took up their effective duties on 1 April, the chief executive of the Thames Valley strategic health authority tried to bludgeon the five to become three. Not surprisingly, the smallest of these, the North East Oxfordshire primary care trust based in Bicester in my constituency is somewhat concerned. The chairmen of at least two of the primary care trusts said:

"We 'went live' 1st April 2001, i.e. 13 months ago, and are all now engaging fully and constructively with patient groups, local agencies and health professionals, including our GPs. We are certain that to close down our 5 trusts in order to create 3 new ones will very significantly disrupt and damage the ever improving quality of provision for our patients."

That was written by the chairmen of the North East Oxfordshire and the Cherwell Vale primary care trusts.

It is irrelevant to my constituents whether they have patients forums or patients councils. They want stability; people working in the NHS want stability; GPs want stability. The Government have set boundaries for primary care trusts—let us keep to them, at least until 2005, for heaven's sake. At least let there be natural evolution. The Government should not set up primary care trusts on 1 April 2002 and seek to change the boundaries radically, without consulting anyone, by 10 April. What kind of precedent is that for patient or consumer involvement? Ministers talk about involving the wider community. If the national health service does not even have the courtesy to involve Members of Parliament, what hope is there of involving the wider community?

The Government will win the vote tonight because they will dragoon all their members into their Division Lobby, except for those who have been expelled to Siberia for the occasion. However, this debate is irrelevant if Ministers cannot accept and understand that, above all, the NHS needs some stability for the next two or three years so that everyone involved can understand what is happening. Simply rewriting the geographical boundaries will benefit no one. I hope that the Minister will intervene with the chief executives of the various strategic health authorities who seem to have nothing better to do than try to rewrite the boundaries of primary care trusts.