NHS Reform and Health Care Professions Bill

Public Bill Committee, 27 November 2001.

Standing Committee A

NHS Reform and Health Care Professions Bill

Oliver Heald (Conservative, North East Hertfordshire)

On a point of order, Mr. Hurst. I welcome you to the Chair. The Opposition look forward to serving under you. We realise that you will be firm but fair. The Bill contains numerous order-making powers, many of which are being drafted—such steps are often taken in circumstances such as these—so that strategic health authorities, patients forums and so on can be established on 1 April 2002. In debating the programme resolution, and in terms of our proceedings as a whole, it would help if the Government could share with us information on any draft regulations that have been prepared and are ready to go. That would enable us to flesh out our debates and to know the exact detail of many of the proposals. Perhaps, Mr. Hurst, you could suggest to the Minister that that would be to the convenience of us all.

Alan Hurst (Labour, Braintree)

That is not a point of order but a matter for debate.

John Hutton (Labour, Barrow and Furness)

I beg to move,

That —

(1) during proceedings on the National Health Service Reform and Health Care Professions Bill the Standing Committee do meet on Tuesdays at half-past Ten o'clock and at half past Four o'clock, and on Thursdays at half-past Nine o'clock and at half-past Two o'clock;

(2) 14 sittings in all shall be allotted to the consideration of the Bill by the Committee;

(3) the proceedings to be taken on the sittings shall be as shown in the second column of the Table below and shall be taken in the order so shown;

(4) the proceedings which under paragraph (3) are to be taken on any sitting shall (so far as not previously concluded) be brought to a conclusion at the time specified in the third column of the Table;

(5) paragraph (3) does not prevent proceedings being taken (in the order shown in the second column of the Table) at any earlier sitting than that provided for under paragraph (3) if previous proceedings have already been concluded.

TABLE

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Will the Minister give way?

John Hutton (Labour, Barrow and Furness)

In a moment.

I hope that members of the Committee will agree that the proposals that we ask them to endorse today are sensible and fair to both sides, and constitute a reasonable way in which to proceed.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

In intervening on the Minister, I wanted the Government Whip also to hear my remark, but he has just left the Room. Has the Minister given any thought to the problem that I raised previously? I am having difficulty tabling an amendment given the clash on Thursday 29 November between the Committee and emergency business in the House, which was brought forward after negotiations were complete on the timetable and members were selected for the Committee. Does he see a way forward that would allow members of the Committee to take part in emergency health business in the House on Thursday afternoon?

John Hutton (Labour, Barrow and Furness)

Whips have an uncanny ability to hear things even when they are not present, so the hon. Gentleman should not worry about my hon. Friend the Member for Poplar and Canning Town (Jim Fitzpatrick).

It is incorrect to say that the Human Reproductive Cloning Bill was introduced before we started discussions on the programme resolution. The Government made clear their intention to introduce that Bill some time ago, and we submitted our proposals on the programme motion to the Opposition last week. Yesterday, in the Programming Sub-Committee, we had an opportunity to discuss these issues, but the hon. Gentleman did not raise this matter. [Interruption.] I stand corrected if he did. On this occasion we must make some difficult choices. It is right that the Committee should meet on Thursday, and members of the Committee must decide how they want to allocate their time. I do not want to advise my hon. Friends not to meet on Thursday, and I am not in a position to help the hon. Gentleman with his predicament. My concern is to make progress with the Bill, and I ask the Committee to support me in that.

Simon Burns (Conservative, West Chelmsford)

As a fellow Essex Member may I add my words of welcome to you, Mr. Hurst. Notwithstanding the recent derogatory remarks of the Secretary of State for Health in the House that caused furore in the county of Essex, I have full confidence in an Essex man in the Chair of this important Committee.

In the Minister's opening comments, he alluded to, and glossed over, the fact that all was not well in last night's Programming Sub-Committee. The Government are seeking to rush the Bill through Committee in the same way that they are rushing their reform of the national health service, which has not been properly prepared for the added responsibilities of primary care trusts and strategic health authorities.

The Bill raises important issues about the future provision of health care in this country, and Government and Opposition members of the Committee would agree that we cannot afford to get it wrong because the danger is that problems will be inflicted on our constituents in the provision of their health care, a point that we have made on numerous occasions inside and outside the House. The abolition of health authorities and their regrouping into strategic health authorities means that 75 per cent. of funding for health care will be devolved to primary care trusts, and that is being done in an over-hasty way that holds serious implications for health care provision. There are several key issues that must be properly and thoroughly discussed in Committee, which will help the Government to avoid mistakes that they may be making in their haste. For the Committee to finish its deliberations by 18 December is too short a period.

During our discussions yesterday, the official Opposition originally wanted six members on the Committee and suggested that we should sit into January so as to have a proper opportunity to discuss in a considered and measured way the important issues concerning strategic health authorities, primary care trusts, quality and, an issue that has not yet been raised but, I assure you, Mr. Hurst, will be raised later during our proceedings, the highly contentious and irresponsible provisions of clause 20. The Government seem hell-bent on resisting any sensible approach and continuing with their ill-thought-out proposals prior to the last general election to abolish community health councils, which provide an independent voice for patients throughout the country.

I am sure that as a constituency Member, Mr. Hurst, you will have received many representations from the excellent mid-Essex community health council and even from its former chairman, who was a Labour district councillor in Braintree, about their opposition to abolition of the councils. We have the impression--we want to discuss it more fully in Committee--that the Government are simply making this pernicious and petty move because they will brook no opposition. If anyone has the temerity to highlight concerns about their actions, they do away with the organisation because it does not fit in with Millbank's script on the image that they want to portray.

To do our work properly and fully, we need more Committee members than the Government have offered and to sit longer so that our discussions are not rushed, but the Government are determined not to accept that. If my information is correct, they informed the official Opposition that we could have four Members on the Committee and that we could sit until 13 December. That was totally unacceptable and we were not prepared to compromise, so the Government returned shortly afterwards and said that they would allow five Members and two extra sittings on Tuesday 18 December. We still believe that that is not long enough, but it would be fruitless to negotiate. The Government are determined to use their majority on the Committee to ensure that they get their own way.

The official Opposition are opposed to the programme resolution for the reasons outlined. We believe that we should have more time and an extra Member on the Committee to help us in the duty of an official Opposition, which is to study, question, probe and monitor legislation. We should ensure that legislation on the most far-reaching reforms to the health service, some say since 1974 and others say since its inception in 1946-48, is properly scrutinised, fine-tuned, improved when improvement is needed and changed if humanly possible. We need the opportunity to try to persuade the Government to think again about those areas that we believe are utterly wrong so that the legislation that goes on to the statute book will improve and enhance the health care provision for our constituents. For those reasons, we cannot support the Government in their programme resolution.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I beg to move, as an amendment to the resolution, after paragraph 5 to add

`(6) provided that Clauses 7 and 8 shall be taken at the morning sitting on Thursday 29th November at half-past Nine o'clock and be concluded by twenty-five minutes past Eleven o'clock.'.

I welcome you to the chair, Mr. Hurst, and both Ministers to the Committee. As the hon. Member for West Chelmsford (Mr. Burns) said, the Bill is important.

Oliver Heald (Conservative, North East Hertfordshire)

On a point of order, Mr. Hurst. Is the amendment in order? A meeting of the Programming Sub-Committee certainly took place last night, and it was a most unsatisfactory affair, but is it in order for an hon. Member to propose an amendment today?

Alan Hurst (Labour, Braintree)

It is in order. I have the amazing power to select or not select amendments when tabled. I have decided to select the amendment, so it is in order.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am grateful to you, Mr. Hurst. I take the opportunity to apologise, if an apology is in order, to the Front-Bench spokesmen for not giving them notice of the amendment. I raised the matter on Thursday afternoon at the Programming Sub-Committee, as I think the hon. Member for West Chelmsford recognises, but it was never adequately resolved. It was raised, however, and the Minister is either mistaken or forgetful in suggesting that it was not.

The Bill requires adequate scrutiny because it makes quite a few changes, not least in clauses 7 and 8, which are two of the many that require scrutiny. However, matters in the House also require adequate scrutiny and when the selection was made for Committee, there was no thought that important primary legislation would come before the House on the afternoon of Thursday 29 November.

There was also a proposal for a debate in the House on the Bristol royal infirmary inquiry and the Kennedy report, which pertain to this Bill. On Second Reading, Ministers said that what they sought to introduce under the Bill dealt with some of those concerns. I had a conversation with the Government Whip and, through what could be considered unusual channels, I was given an indication that whether it was feasible to discuss issues connected to the Kennedy report in Committee at a time when the House would also be substantively debating it for the first time would be seriously considered. I was given a reassurance, which one can only assume was given in good faith, and I accepted it in the same manner.

Then followed a change in business, well after negotiations on the draft timetable were concluded. It was announced only last Thursday that the House would discuss emergency primary legislation, in which many hon. Members including me will have an interest, on the afternoon of Thursday 29 November, when this Committee is also sitting. In private meetings and the Programming Sub-Committee, I have sought flexibility for this Thursday's sitting to enable hon. Members with an interest in the emergency primary legislation to perform their duty of scrutiny in the House as well as in Committee. My amendment should not find disfavour with Conservative Front-Bench spokesmen. I apologise for not having given them a manuscript version of the amendment.

I seek to include in the timetable, while there is still time to table amendments to clauses 7 and 8, a provision allowing us to discuss those clauses during the morning sitting on Thursday 29 November, rather than be forced to miss such an opportunity due to a Second Reading, Report stage and Third Reading in the Chamber on that day. I hope that that finds favour with the Minister, with Government business managers and with the official Opposition. There is a huge amount to debate by 5 o'clock on Thursday and we still have the scope to do that. In the spirit of co-operation, I hope that that might find favour. Clearly, I cannot vote it through by myself without support.

I have some sympathy with Conservative Members' view of the position in which we find ourselves, with large amounts of legislation being rushed through using programme motions. I should put it on the record that I accepted 18 December as a fair end date; I do not want to run with the hounds and the foxes. Nevertheless, given that we were assured that it would be possible to arrange extra sittings before 18 December, the Government should exercise flexibility in relation to the clash of scrutiny that some members of the Committee may face.

Oliver Heald (Conservative, North East Hertfordshire)

The trouble with packing in extra sittings on Monday and Wednesday is that it does not solve the problem that outside bodies that are watching our proceedings and want to help us as the debate matures are unable to do so if we have insufficient time in which to table amendments and new clauses that deal with certain issues in a slightly different way. It is a bastardisation of the system.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am prepared to agree with the hon. Gentleman that it is far better to have an agreed programme than to have to squeeze in extra sittings.

I have no problem with five, six or seven Conservative Members serving on the Committee, and I made no representations against that. However, there is only one of me on my party's Front Bench; my colleague on the health team is serving on the Committee that is considering the Adoption and Children Bill.

I am delighted to welcome the hon. Member for Wyre Forest (Dr. Taylor), who sits as an independent and to whom the business managers who look after the minor parties have been more than willing to give a place. Conservative Members on the Select Committee on Health have done the same. The hon. Gentleman will be torn between Select Committee meetings and sittings of the Committee on Thursday mornings, and I hope that members of the Committee will understand if he sometimes has to be absent from the proceedings in order to do the job of scrutiny in the Select Committee system. As the Minister said, there are great demands on our time, and we will have to exercise judgment, but I hope that the Government majority will show flexibility.

Oliver Heald (Conservative, North East Hertfordshire)

The hon. Member for Oxford, West and Abingdon (Dr. Harris) makes a good point. Some members of the Committee will want to attend the debate on the Human Reproductive Cloning Bill on Thursday afternoon, and it would be convenient to deal with clauses 7 and 8, which are very important, during the morning sitting. We therefore support his amendment.

In terms of the way in which the debate in Committee matures, Oppositions parties are disadvantaged if extra sittings are packed in. Any self-respecting Member can speak at great length on any subject and make an interesting contribution to any part of the debate. However, such contributions are best when they are informed by the views of outside bodies that are concerned about the issues and have practical experience of them. Shortening the Committee's deliberations puts them at a disadvantage, and if extra sittings are packed in there is even less time for them to meet us to talk about the concerns that it is our duty to put forward. It is wrong for the only option always to be, ``Let's pack in some more sittings and keep to our timetable.'' The Government should be more flexible on that.

The Bill is a skeleton, without flesh, a Christmas tree without baubles. [Interruption.] I notice that the Whip enjoyed that one. There are numerous order-making powers in the Bill, as usual, which is the modern trend. To know what is really proposed, we need to see the details of the draft orders, which will be being prepared. No one is nodding, but I am sure that they are. Why should we, as parliamentarians debating the material, not know what is really proposed? We would like to see those details.

The Minister has not jumped at the suggestion that I made at the outset that he should give us all those documents now, saying, ``Oh yes, of course, let's do that.'' That is disappointing because we cannot really tell how long we need until we know the detail. I venture to suggest that if the Minister produced all the draft orders and regulations that are up his sleeve, it might shorten the proceedings. As it is, we will be asking a vast number of questions about exactly what is proposed.

Those are the difficulties that I see, in addition to those that my hon. Friend the Member for West Chelmsford raised. It is sad if a Government cannot meet an Opposition halfway, or at least agree to the approach to Committee business that an Opposition want.

Simon Burns (Conservative, West Chelmsford)

Does my hon. Friend recall that, during the Committee stage of the Health and Social Care Bill earlier this year, the Minister's predecessor, the right hon. Member for Southampton, Itchen (Mr. Denham), was faced with exactly the same problem that my hon. Friend outlines? He listened to the Committee's arguments and in the end became extremely helpful. He made available, where possible, the draft orders so that we were better informed to discuss the contents of the Bill.

Oliver Heald (Conservative, North East Hertfordshire)

My hon. Friend makes a good point. If the Minister and his officials have not prepared the draft orders, when they are thinking of implementing the legislation on 1 April 2002, what a desperate mess they are in.

John Hutton (Labour, Barrow and Furness)

It might be of benefit to the Committee if I try to respond to some of those points now. That might save some Opposition Members from detaining the Committee any further.

When I moved the programme resolution, I had not seen the amendment of the hon. Member for Oxford, West and Abingdon. I am happy to accept it; I think that it is a sensible way to proceed. In future, I am sure that Committees will benefit if some of the phoney rhetoric that we have just heard from the Opposition could be suspended. We hear such talk, claiming that the Government are trying to ramrod their business through and keep Committee members uninformed, every time. That is not our intention, and that is not how I intend to run this Committee.

As a signal of our intention to keep Committee members properly informed, I have produced for them a further explanatory note on the transfer of functions to primary care trusts. I wanted to mention that when debating the clause. It is now on the table for hon. Members to study. We intend throughout to try to keep Committee members fully informed. If we are in a position to share with them any draft regulations ready to be circulated and discussed, we will do so. The hon. Member for West Chelmsford rightly referred to the practices of my predecessor, my right hon. Friend the Member for Southampton, Itchen, and I am pleased to say that, when I am in a position to do the same during the Committee stage, I will.

I have considered the amendment and am happy to accept it as a sensible way of proceeding. I am grateful to him for drawing the issue to the Committee's attention.

Andrew Murrison (Conservative, Westbury)

Many of us are from Essex, either by birth or election: I add my name to that list, and I know that one of my hon. Friends sitting to my right will also do so in due course. Let us hope that that reflects the quality of the Act that ultimately emerges.

I am concerned about the haste with which such an important Bill is being rushed through. As someone who has worked in the NHS, it is dear to my heart. The Bill will fundamentally change the way in which the NHS operates; it is not, by any means, merely tweaking. Therefore, the sort of programme that we have concerns me. The issues need to be adequately exposed; in particular, we need to have the comments of outside bodies.

Only this morning I received a representation from the Local Government Association, and I am sure that many hon. Members have received the same one. Such representations seem to be arriving daily, but I am told that the normal experience is that they usually come in dribs and drabs during the Committee stage. We cannot assume that outside bodies are sufficiently organised to pass their representations to us in good time. They expect Committee stage to last a reasonable length of time so that they can comment as it proceeds. I am rather concerned that supportive outside bodies on which the Committee should rely quite heavily will not have that opportunity.

There are substantial concerns about the Bill, especially as it relates to community health councils—a subject that we shall debate in due course. Somewhat to my surprise, my postbag has been flooded with expressions of concern about community health councils. The strategic health authorities are also causing considerable concern among the general public, although that is largely the result of some misunderstandings about the way they are to be put together.

In short, I urge that we are given more time in which to debate this important Bill. I am sure that the quality of the legislation will be markedly improved as a result.

Amendment agreed to.

Main Question, as amended, put:—

The Committee divided: Ayes 13, Noes 5.

Alan Hurst (Labour, Braintree)

We now move to preliminary business. Copies of the financial resolution that has been tabled are in the Room. I remind members of the Committee to provide adequate notice of amendments. As a general rule my co-Chairman and I do not intend to call starred amendments.

Clause 1 - English health authorities: change of name

Simon Burns (Conservative, West Chelmsford)

I beg to move amendment No. 1, page 1, line 5, leave out from `(1)' to `Health' and insert `From 1st April 2003'.

The first amendment is very straightforward. If accepted by the Government, it would change subsection (1) by saying that the proposed change of name of the health authority would have the knock-on effect of postponing implementation of the wide-ranging changes to 1 April 2003.

In ``Shifting the Balance'' the Government outlined a time scale for changes to PCTs, for the creation of strategic health authorities and for the abolition, in effect, of health authorities in England. According to that document, consultation on the proposed strategic health authorities will last from September to November, and the chairmen and chief executives designate will be appointed in November. That is cutting things fine. One presumes that the consultation period has been established so that the Government can properly analyse, assess and digest the results, but their intention to appoint the chairmen and chief executives in the same month as it ends—should they keep to the proposed time scale—adds to our fears that the measure is being rushed. I genuinely believe that a deadline of November 2001 for designated appointments and one of April 2002 for the establishment of the new strategic health authorities and the disestablishment of existing health authorities leaves too short a time.

With that in mind, the purpose of the amendment is twofold. First, it is designed to find out whether the Government are indeed keeping to the time scale outlined in ``Shifting the Balance'', what progress they are making in terms of the April 2002 target date, the way in which interested parties responded to the consultation process, and what consideration the Government have given to those responses. Apart from probing, the amendment has a second and more defined purpose, which is to advise the Government to think again about rushing in, and to accept the amendment so that strategic health authorities will not be set up until a year this April.

If the amendment were accepted, there would be a knock-on effect on consistency, clarity and the way in which the system works. I appreciate that the Government have put together a package and that therefore many elements rely on others. If the introduction of SHAs is postponed for 12 months to April 2003, it is logical to postpone changes to the functions and establishment of 100 per cent. of PCTs. They come as a package, and the one cannot work without the other. I accept, therefore, that however innocuous and helpful to the Government the amendment might be, it would have a wide-ranging knock-on effect on the first five clauses.

I urge the Minister not to reject the amendment out of hand. As I have said, it is intended to be helpful. It is not the Minister's intention to introduce botched or rushed legislation; he, like any other hon. Member—or, in his case, right hon. Member—wants the best possible legislation. On that basis, I anticipate his appreciating the fact that we are doing the Government a service by tabling an amendment that errs on the side of caution to ensure that there is no headlong rush that will cause considerable confusion and might destabilise the position.

There are approximately 104 health authorities in England and Wales. When the SHAs are set up, they will reduce dramatically the number of bodies at what is, for all intents and purposes, the health authority level of the NHS: fewer SHAs will cover larger areas and populations. In the context of the Government's aims, I understand the logic of their proposals. However, health authorities are currently the purchasers of health care for our constituents.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Language is important. The Government have done little to change the so-called internal market, but they have changed the language. We no longer talk about purchasing; instead, we talk about commissioning. I fear that I am on the hon. Gentleman's side when I say that the change is only a change of language; it is not the sort of change that it was purported to be.

Simon Burns (Conservative, West Chelmsford)

I am grateful to the hon. Gentleman. I appreciate that language is important. I was trying to be realistic about what is happening, rather than fall into the Millbank spin. He will appreciate that language will become more important if the Secretary of State has his way and brings back the internal market, about which Government Members have been so rude for the past few years. However, I digress.

Health authorities, which have been localised to cover smaller areas than the proposed SHAs, will be abolished in the next four or five months if the proposed time scale is kept to—and it will be. Many of their functions will be transferred down to PCTs, which will cause a problem because at least 130 primary care groups have not even applied for PCT status. There will be a headlong rush if the Government are to have all the PCTs in place before the 1 April 2002 deadline. Everyone knows that when structures change—especially when significant additional responsibilities and functions are placed on those structures—there is great uncertainty and a sense of feeling the way forward. Do Government want such a situation to arise? Do they fully appreciate the implications of what they are doing within their proposed time scale?

SHAs will be discussed in detail in connection with later amendments. They, too, will be finding their way in the early stages following their creation. I suspect--the Minister may be able to enlighten us--that there is conflict in several areas: for example, have the SHAs' geographical areas been resolved satisfactorily? I presume not, because that is one of the matters that the consultation process is to examine. Stories are beginning to circulate of people in some parts of the country being confused about why their geographical area is to have only one or two strategic health authorities whereas another area, perhaps in the same region but geographically separate, is to have significantly more SHAs covering its population.

Staffing will need to be arranged. It is fair that the Government have time scales for appointing chairmen and chief executives designate, but SHAs will need other staff. Their full role will need to be sorted out and the way in which the Government want them to fulfil their functions will have to be made clear. We must also examine the functions that the health authorities have had, in particular the handling of health service funding, which is to pass from the SHAs to the PCTs. I suspect that that will raise many problems if care is not taken, mainly because the new bodies will lack experience.

I urge the Minister to say more about the progress of the consultations and the time scale between now and 1 April 2002, especially the crucial issue of whether there will be enough time to have in place bodies that are fully competent and capable of fulfilling their functions on 1 April 2002. They might not have enough time to prepare.

Richard Taylor (Independent, Wyre Forest)

I am pleased to be here because it is important to have an Independent Member on a Committee such as this one. I am speaking not as one who has a political background, but for patients and the professions. I support the amendment because as soon as we have strategic health authorities, we must have primary care trusts. I am very concerned that only a few PCTs have been formed so far; although they may be ready to go, I am sure that those that are still PCGs will not be ready, bearing in mind the extra services that they will have to take on which were previously county-wide. In my county, Worcestershire, two of the three groups are still PCGs and have no idea of how they will take on the extra responsibilities.

I strongly support the amendment. It was because I do not wish to delay the Bill that I did not vote against the programme motion.

Oliver Heald (Conservative, North East Hertfordshire)

I am following the hon. Gentleman's speech closely. Does he agree that it is extraordinary that some PCTS still have no idea what their budgets will be next year?

Richard Taylor (Independent, Wyre Forest)

To picking up that point briefly, my own PCT knows that it will get 75 per cent., but it badly wants to know 75 per cent. of what.

I support the amendment. I am in favour of much of the Bill, but the changes could be introduced more slowly to give some PCTs the option to start under the old health authorities so that primary care groups have a little more time to get ready.

John Baron (Conservative, Billericay)

I, too, support the amendment. It is easy for members of the Committee to make political points, but the Bill must be properly thought through because it will introduce fundamental changes to the workings of the NHS.

I want to highlight some early findings of the British Medical Association and other bodies that have suggested that we should take more time to consider the Bill. The general feeling in the medical profession is that it is being rushed through: for example, at a meeting in the west midlands a couple of weeks ago, senior health, local government and business representatives reached a consensus that the planned configuration of strategic health authorities and regions will be too large and diffuse to engage effectively with primary care trusts and local authorities.

John Hutton (Labour, Barrow and Furness)

As I understand it, the hon. Gentleman is saying that the strategic health authorities will be too large, but he will be aware that Conservative Front Benchers have tabled an amendment suggesting that they should be larger still. Will he support that amendment?

John Baron (Conservative, Billericay)

My point is that there has not been enough clear and joined-up thinking about the responsibilities of SHAs in terms of their communication and relationship with PCTs. That leaves open many questions that people in the medical profession cannot answer: for example, how will conflicts be resolved? The BMA has noted that PCTs will be accountable for their performance to SHAs through individual performance agreements. That is fairly straightforward. However, SHAs will also be expected to manage the performance of PCTs across organisational boundaries and to broker solutions if necessary. The BMA has questioned how conflicts between SHAs will be resolved—although they will be accountable to the Secretary of State.

The BMA is concerned, as are we, that neither the Bill nor the document on shifting the balance of power within the NHS allocates responsibility for safeguarding or fostering academic activity. Unless such provision is made, benefits to the health service, including clinical service and education, will be lost. Moreover, the decline in recruitment and retention in academic medicine will continue.

The BMA has pointed out that it is unclear whether the responsibility for co-ordinating and collaborating on the provision of tertiary services will lie with SHAs or with the new regional directors of health and social care. I hope that that will be made clear in the course of the Committee's proceedings. The Bill does not make it clear to those who have to operate at the coalface how such issues are to be resolved. We need to give it more careful consideration and delay its implementation until it is suitably amended.

I have another concern, which has already been touched on by other hon. Members. Although PCTs are not directly linked to SHAs, there is a strong connection with the operation of the NHS at the coalface. My concern is that PCTs are not ready for the responsibilities that they will be taking on from next April. From visits to the two PCTs covered by my constituency, I know that they feel that, organisationally, they are a little behind the curve. I know that some PCTs are already up and running, but the fact remains that there will be quite a rush into mergers between PCTs and PCGs, whether that is wanted or not.

PCTs are taking on responsibilities for which some of them—not all, but a good number—are not fully prepared. I think that I am right in saying that one in seven of existing PCTs do not have a finance director. That is crucially important because there will be a major shift of resources to PCTs: 75 per cent. of total NHS spending will eventually end up in their hands. If the management and organisational structure is not in place by next April, there will be major problems in delivering the services that our electorate want.

The Government have supported the survey carried out by the National Primary Care Research and Development Centre in collaboration with the King's Fund. It suggests that there are many doubts about some PCTs' abilities to absorb the pace of reform. Professor David Wilkin, the project director, has said that the pace of change has been dictated by Government timetables rather than by a

``process of learning and building on experience''.

That point is crucial. We are rushing into something and we need more time to consider it, not only within the House. We must delay the implementation of the legislation or there will be real problems at a time when the real crisis in the NHS—increasing waiting lists and poor care at the point of delivery—is not being confronted, at least not by the Bill as it stands. We should be addressing that, rather than carrying out a fundamental restructuring that no one in the health service or the medical professions wants.

Andy Burnham (Labour/Co-operative, Leigh)

The hon. Gentleman says that no one in the health service wants the changes. Why did most major health organisations welcome the Bill's measures in the briefings that they sent for Second Reading?

John Baron (Conservative, Billericay)

At the moment, because the Bill is being rushed through so quickly, we are getting a response from a wide sector in the NHS and from medical bodies generally. We are getting conflicting messages from that, because no one has had time truly to consider the implications. Various reports commissioned by bodies such as the King's Fund or the National Primary Care Research and Development Centre say that the Bill is being rushed through. No doubt, the Government will find voices that say that it is not, but the bottom line is that many working in the NHS think that it is.

Andy Burnham (Labour/Co-operative, Leigh)

Did the hon. Gentleman read the briefing prepared for Second Reading by the King's Fund? It welcomes the Bill and endorses the proposals in it.

John Baron (Conservative, Billericay)

I respectfully point out that that welcome contained many provisos. Many dissenting voices suggested concerns at the way in which the Bill is being rushed through. One could refer to the findings in many other surveys. The BMA, which is working at the coal face, thinks that there are real concerns with it.

Oliver Heald (Conservative, North East Hertfordshire)

Something such as a PCT is a very good idea, but not if it is micromanaged by the Health Secretary, has 408 targets and is rushed through. Does my hon. Friend agree that there are ideas in the Bill that can be welcomed, but that the trouble is that it is half-baked?

John Baron (Conservative, Billericay)

I agree with my hon. Friend. The idea that PCTs will decentralise is wrong. If more moneys are being made available and PCTs are allowed to use them as they see fit, that would be decentralising. However, the problem is that targets will accompany extra finance. If those are not met, money will be withdrawn and not made available. This is a further micromanagement of the NHS and not a decentralising measure at all.

Although some may welcome certain parts of the Bill because they believe that it is decentralising, the detail shows that that is far from the case. That is why we need more time to consider the Bill in this place, and to delay implementation. Many in the health profession have severe reservations about the Bill and we need to delay implementation to ensure that patients do not suffer unduly.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

As I said on Second Reading, I oppose this structural change because it misses the point about the challenges facing the health service. The Government seek to make structural change partly for the sake of seeming to be doing something. I have plenty to say about that, but I will reserve my comments to the debate on clause stand part. I will not respond to all the points, some of which were valid and some of which I would challenge.

I will address my remarks to the time scale. The Government seek to bring about structural change to create a flurry of activity that disguises the failings of the health service and shifts the debate and blame away from them. On the radio on Sunday evening, we heard a clue to Government thinking when the right hon. Member for Norwich, South (Mr. Clarke), the Minister without portfolio, made it clear that he accepted that the health service was not in a much better shape than when his Government came to power four years ago, and that they were running out of time to deliver an improved health service, or even the perception of an improved health service, before the next election. When we see such a rushed time scale from the Government, we must bear in mind that that lack of time will dominate their thinking on a time scale for change.

Simon Burns (Conservative, West Chelmsford)

I am sure that the hon. Gentleman would not want to misrepresent the right hon. Member for Norwich, South. That Minister said, rather surprisingly for a member of a Government controlled by spin, that in certain areas the health service was worse under his Government than under the previous one.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Yes, I remember that being said. I think that the take-home message is that, on average, the health service is no better. The health service was failing when the Government came to power. They have not only failed to deliver substantive change so far, but have raised expectations of being able to deliver while foolishly sticking to spending plans, which have previously failed the health service, for more than two years.

Alan Hurst (Labour, Braintree)

Order. The amendments are narrowly drawn and we are slipping into a Second Reading debate.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Thank you, Mr. Hurst. I could offer the old excuse of being led astray, but I shall not dare.

The Government's proposal for a timetable to make changes by next April is predicated on a hope that structural change will deliver. However, I see no evidence of such structural change if the Government continue to retain so much control and responsibility, and they will continue to deserve much of the blame or praise for what happens. That will do nothing to bring about improved delivery. I suspect that the Government would prefer a time scale in which the changes are introduced by April 2003, but they know that that leaves the changes little time to bed in and would cause additional chaos to that caused in the interim, when new structures are being introduced to under-prepared bodies, hard-pressed managers and health care professionals. They know that they could not run that risk so close to the next election.

Gareth Thomas (Labour, Clwyd West)

We are debating an amendment on the timing of the implementation of these changes. Does the hon. Gentleman accept that there has been extensive consultation with regard to the broad thrust of the Government's policy? He need only remind himself that the Government have published several consultation papers over a long period of time, such as ``The NHS Plan: A plan for investment, A plan for reform'' in July 2000, and ``Shifting the Balance''. Unlike the official Opposition, his party has Members from Wales. Although there are several Essex Members on the Opposition Benches, there are none from Wales. Furthermore, the National Assembly for Wales produced a paper called ``Improving Health in Wales—Structural Change in the NHS in Wales''; there has been extensive consultation.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am grateful to the hon. Gentleman for raising that point, but consultation papers do not work if they do not mention the relevant changes. The Library's paper on the NHS plan, which is as good a summary as I have seen, states:

``The Plan itself did not promise significant structural change in the roles of NHS institutions''.

Indeed, many organisations that signed up to the NHS plan did not realise, although they should have done, that that did not assure them of the stability they needed to deliver its challenging and sometimes worthwhile plans, proposals and targets. People were lulled into a false sense of security by the promise that, finally, after years of change, there would be stability in the NHS, which would allow it to start delivering for patients and to get on with other areas of the Government's policy, such as the quality agenda. Those organisations were wrong because less than a year after the publication of the NHS plan, which one should have thought would set out structural changes, the Secretary of State issued a press release—a speech went with it—on 25 April, saying that the plan was to be changed, and that this change was going to be brought in quickly.

The Government have had to consult quickly on the structures. Are they finding that they must rush important matters? According to their timetable, it is clear that they have not finished the consultation on the boundaries of SHAs. However, they propose to appoint chairs designate and chief executives designate to bodies for which the boundaries have not been set. Many chairs designate will be seeking to demonstrate in the appointment process that they have local knowledge of clinical networks and partnership issues. Can the Minister reassure me that the Government will not shortlist such positions until their boundaries are settled? If they do so, they will jump the gun, and will discriminate unfairly against applicants whose strength is their knowledge of the local area, or, as it will be called, the strategic area, the boundaries of which have not been set.

The Minister must also respond to the allegation that the unseemly rush in which managers, who are beset by performance targets—many of which are political and distort clinical priorities—that they are hard pressed to deliver have to apply for different jobs within the structure. That cannot be a healthy situation, and although I understand that it is a consequence of change—one cannot oppose all change on that basis—to do so in such a rushed way will cause significant problems at a challenging time. We know that morale is poor.

Oliver Heald (Conservative, North East Hertfordshire)

When one transfers a function, one tends to discuss it as though it were inanimate. We are discussing taking away the person who knows everything about, for example, the assessment of need, the planning and securing of health services and the improvement of health in a particular area, and possibly giving someone else the job. Does the Minister agree that the timing must be right in those circumstances, otherwise situations may arise where vital management issues are simply not being addressed?

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Yes, I concur with that. The point that I want to make is that our most experienced managers are the ones on whom we rely to make some sense out of the balance between patient needs and political needs. Those managers are sorely tried at the moment. Many of the best managers will say, ``Up with this we will not put''—continuous change, continuous blame and the prospect of continuous shifting of that blame, with the myth that 75 per cent of the power is being dissolved locally, when, as Conservative Front-Bench spokesmen put so well on Second Reading, that the opposite is the case.

The combination of the rush and the Government's apparent desire and need to shift the blame on to managers and clinicians will have a dramatic effect on the ability to retain managers, many of whom are effective given the under-resourcing.

I am opposed to the whole proposal, so I am not putting forward amendments to make a proposal to which I am wholly opposed any better or worse, but I have some sympathy with the thoughts behind this amendment. Will the Government jump the gun in terms of appointing or shortlisting chairs designate to strategic health authorities where boundaries have not yet been agreed?

Andrew Murrison (Conservative, Westbury)

The litmus test for whether the Government are proceeding at too rapid a rate, is how far we are ahead with the appointment of chairs to the strategic health authorities. Perhaps the Minister might like to comment on that. If we are behind the curve, it may show that we are moving too rapidly and that we need more time.

The human aspect that has been alluded to is important, and has perhaps been overlooked in all of this. We are talking about people who have a huge amount of skill and experience as chairs, as members of the general public, and as officers within the national health service, seeing their career's being fundamentally altered by all of this. The way that this will work in practice, is that people will see SHAs as the bodies to which they aspire and PCTs as something to go for in the event that they are unsuccessful in becoming chief executives or chairs of strategic health authorities. Many people will be a need to get the timing right. I can tell the Minister that there is a huge amount of confusion at the moment about those who aspire to chairman roles and those who aspire to be chief executives, and how that time is actually going to pan out.

My chief concern about the timing is due to the palpable confusion in the minds of those among the general public who take an interest in these things. Constituents suggest that there is a very real confusion about the role of PCTs and the role of strategic health authorities. There is concern over the boundaries, and more particularly, about the division of responsibility between the two bodies. We must accept that the Government have got their communication wrong with this matter. It might be very prudent for the Government to think about extending the timetable, which will at least give them some time to get their message across.

There are very real concerns among the general public about how strategic health authorities will affect the treatment that patients receive, and the referral patterns in clinical networks. I am in no way an apologist for the Government, but I have spent some time over the past several days reassuring constituents that strategic health authorities will not affect, as far as I am able to tell, the pattern of referral that they might expect. A great deal of that has to do with changes to the proposed boundaries in my particular constituency.

There is a very real need to get the message across to those people that the NHS is changing rapidly. We have heard the right hon. Member for Norwich, South reflect upon the way in which the NHS has changed for the worse over the past several years. We are rethinking the notion of ``24 hours to save the NHS'', are we not? However, we need to take time. The Bill will implement changes, and although I do not think that they will alter the health outputs that patients will enjoy, it is still important, especially for those working in the NHS—a deeply demoralised group of people—that we calm down, and take our time in considering the Bill. That is why I have voiced my profound concern at the pace at which things are going.

Oliver Heald (Conservative, North East Hertfordshire)

I have one or two points. When Sir Humphrey said to the Minister that something was a courageous decision, the implication was that it was a pretty stupid thing to do. The Royal College of Nursing has described the timetable for the changes as ``ambitious''. I suggest that a similar message is inherent there. To pick up on the point made by the hon. Member for Leigh (Andy Burnham), there are things that individual bodies will welcome in such a Bill, but all the briefings that I have seen raise concerns on a wide range of issues in it.

The Opposition have always said that a PCT, as an idea, is a good basis that could be built on. However, last year, or in 1999, when the Bill that set up PCTs was being passed, the Minister promised that they would not be forced on anyone and could evolve through the patient care group process. What has happened since to make matters so urgent that PCTs are now to be forced on all areas of the country, whether they are ready or not, on 1 April 2002? We think, although the Minister might think this cynical, that it is because there has since been a bad winter and the Prime Minister has promised the unrealistic target—or so it looks, on the proposals that have been made—of getting British health spending up to the European average, which would mean an extra £35 billion a year. This, therefore, is the alibi; organisational change.

The health press, whose writers are almost certainly not Conservatives, echoes those concerns; for example, in the Health Service Journal, an impartial magazine. The magazine believes that we are seeing alibi-building that is unhelpful, disruptive, mistaken and that will slow down the implementation of the NHS plan. It contains articles in which former senior officials from the Department of Health say that the process is extremely unhelpful. The RCN says that the timetable is ambitious.

The hon. Member for Oxford, West and Abingdon expressed concern about how the change will affect management functions. That is an important point. All over the country, there are individuals whose responsibility is the assessment of need, planning, securing health services and improving health. Those individuals work in health authorities, although some of them have transferred to primary care trusts. They provide the important management functions essential to the Government's delivery of the NHS plan.

What are those people doing at the moment? Are they concentrating on delivering the NHS plan? Perhaps the Minister can tell us, but I suspect that at the moment, they are writing their curriculum vitae, because they all need a job. They do not know whether they will be moving to a particular PCT or SHA, or to another region. Many managers in the NHS have pointed out that those people are key to the process of delivering the Government's ambitions and are being disrupted by the change.

Is the system ready for the change? The second national tracker survey of primary care groups and trusts carried out by the National Primary Care Research and Development Centre, in collaboration with the King's Fund and supported by the Department of Health, says that what is needed is not extra resources, but managers with the right skills and experience coming through the system. Although managers from trusts and health authorities can be taken on, they do not necessarily have the requisite primary care skills. As has been said, many of the finance staff are not yet in place.

Clearly there is a political imperative to push this through quickly to provide the alibi for performance in the NHS, but does the Minister really think that the SHAs and PCTs are ready for it to happen on 1 April 2002? In many cases, the necessary staff are not in place and they do not know what their budgets will be. It is a mess in the making. For us to ask for an extra 12 months is not a big deal. It was not prompted by political considerations, but by people who are out there trying to do the job saying that they are not ready. Will the Minister bend on this issue?

John Hutton (Labour, Barrow and Furness)

I am always happy to bend in the hon. Gentleman's general direction, but, sadly, not on this occasion. The hon. Member for West Chelmsford said that he was afraid that I would reject the amendment out of hand. I will ask my hon. Friends to reject it, but not out of hand, as we have looked at it carefully and listened to Opposition Members. I was left in some doubt about whether the hon. Gentleman wanted to press it to a vote. He described it as a probing amendment, but his hon. Friend the. Member for North-East Hertfordshire made rather more of it. What is its status?

Simon Burns (Conservative, West Chelmsford)

The Minister is again showing, as he showed last night, that he is not fully listening. The amendment is two-pronged; it is partly a probing amendment, but there is also a real intent behind it. The probing element addressed the lack of knowledge of what is going on in terms of consultation and the time scale between now and April, and the second element addressed the fact that the measure is rushed. My speech was structured around both those points.

John Hutton (Labour, Barrow and Furness)

It was a very cleverly structured speech, then. [Interruption.] I am trying to be kind and generous to the hon. Gentleman; I am sure that that will do him no end of good on his own side of the House. He clearly wants to press the amendment to a vote. I shall urge my hon. Friends to reject it, for reasons that I shall explain in a moment.The hon. Gentleman and the hon. Member for Oxford, West and Abingdon performed a rather disappointing and predictable double act. Conservative Members are increasingly opposed to any extra investment in the health service—

Simon Burns (Conservative, West Chelmsford)

No, we are not.

John Hutton (Labour, Barrow and Furness)

It is obvious. The hon. Gentleman has clearly not been reading the recent speeches of his right hon. Friend the shadow Chancellor, nor those of the Leader of the Opposition, who have talked about reducing the share of public expenditure to 35 per cent.

Simon Burns (Conservative, West Chelmsford)

Rubbish.

John Hutton (Labour, Barrow and Furness)

It is rubbish, but it is coming from the Opposition, not the Government.

As my right hon. Friend the Secretary of State said on Second Reading, the Liberal Democrats are opposed to any type of reform in the NHS, even successful reform, that will decentralise and devolve power. They are arch-conservatives in that sense.

Hon. Members expressed several concerns about the whole process. The hon. Member for West Chelmsford referred to the appointment process for chairs and chief executives. No chair or chief executive has yet been appointed to any of the organisations. The advertisements for the chief executive posts that we placed in September made it clear that they would be filled in December and January. It would not be right to pre-empt the consultation's conclusions on strategic health authority boundaries, so we have looked again at the matter and made it clear to those within the field—and, as I understood it, others—that the appointments would not pre-empt the conclusions of discussions relating to ``Shifting the Balance''. I hope that I have reassured hon. Members that it is not our intention to anticipate those conclusions.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I do recall that change being made, and I should have made it clear that my main concern was whether shortlisting took place and entry closed before the boundaries were established and full consultation in respect of ``Shifting the Balance'' had finished.

John Hutton (Labour, Barrow and Furness)

I will get back to the hon. Gentleman on that point. I cannot say for certain that no shortlisting has taken place. I do know that applications are being sifted, and I shall try to confirm later today whether there has been any shortlisting.

I should reiterate that it is not our intention to pre-empt in any way the outcome of consultation on what the boundaries should be. There were some 99 health authorities in England, but there will be about 28 strategic health authorities, although no final decision has been taken in that regard. As we have said on many occasions, that is in our view the right way to deal with change in the NHS, and the best way to motivate and encourage innovation and enterprise on the part of front-line staff.

Oliver Heald (Conservative, North East Hertfordshire)

The Minister is giving some very helpful information. When considering the number and size of strategic health authorities, will he be prepared to accept population sizes greater than the 1.5 million guideline? As I understand it, he proposes to accept greater sizes in the north.

John Hutton (Labour, Barrow and Furness)

The figure is a guideline; there is no statutory basis for constructing such a limit. According to a later amendment, the hon. Gentleman's party wants to create a statutory limit of 2 million. These issues are subject to consultation and we want to take into account the views of local people. The hon. Gentleman will be aware that, in approximate terms, we are trying to form one larger strategic health authority from four existing health authorities. We think that that constitutes the right shape, balance and size.

It is important for Opposition Members to keep in mind a point of which the Conservative party had some experience when in government. Organisational change in the NHS is always resisted. There are always voices saying that we should not change, that we are going too fast, that there should be change in other areas and so on. It is clear that we must think very carefully about all these matters and listen to what the NHS and the public say about such changes, and that is what we are trying to do. However, it is deeply disappointing to hear Opposition Members say that we should keep our heads in a bucket of extremely cold water and resist any sense of the urgent need for change. I find such attitudes very discouraging.

Of course, we must continue to make the case for change and to emphasise why it is important for the NHS, and that is what we are doing. We are definitely not talking about change for change's sake. I agree with the hon. Member for Westbury (Dr. Murrison) that, in that regard, there is a sense of history. He would expect me to say that that is an exaggerated description of some of the reforms implemented by the previous Administration, but I believe that view to be right. The internal market was a shambles that burdened the NHS with tiers of bureaucracy that led people to send bills and chase invoices throughout the service. With great respect to the hon. Gentleman, and given that he worked in the NHS during those years, I cannot believe that he considers that those reforms were sensible, helped the NHS in any material way or added to its efficiency.

Oliver Heald (Conservative, North East Hertfordshire)

What is the difference between paying, purchasing and commissioning?

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman knows perfectly well that we are not introducing the internal market that the Conservative party inflicted on the NHS with precious little support from anyone within it.

I have one caveat and cautionary note for Conservative Members. They are rediscovering their enthusiasm for public services, but they will not convince anyone in the country at large who remembers the enthusiasm shown by the previous Conservative Adminstration for public services. We are unlikely to accept any lectures from Conservative Members on that subject.

The hon. Member for Billericay (Mr. Baron) made a very good speech by reading the BMA's briefing. The association obviously has a friend in the hon. Gentleman.

Simon Burns (Conservative, West Chelmsford)

What is wrong with the BMA?

John Hutton (Labour, Barrow and Furness)

There is nothing wrong with the BMA, which comes to Richmond house regularly. When the Conservative party was in office, the BMA was not allowed into Richmond house. Tory Ministers stopped talking to the BMA because they were so fed up with their criticisms of Tory policies. Now, the Tories have discovered a new enthusiasm for the views of the BMA.

Simon Burns (Conservative, West Chelmsford)

Rubbish.

John Hutton (Labour, Barrow and Furness)

That sums up today's modern Conservatives.

The hon. Member for Billericay is lending his support to the BMA today, but previous Conservative Members have not been prepared to do that regularly in the past. As with other Conservative Members, he disputed whether the reforms would decentralise the NHS. It is the view of the BMA that they are radical decentralising measures, and I was surprised that he did not refer to the association's comments.

John Baron (Conservative, Billericay)

I have two points to make. The earlier comment that we oppose reform in the NHS is completely wrong. We are saying today that both the NHS and we in the House need more time in which to consider the reforms and implement them. Those at the coal face who must implement the reforms have severe reservations that we are rushing them through too quickly. The purpose of the amendment is to ask for one year's delay in the hope that that will give those who must implement the reforms more time. There is a real danger that a good number of primary care trusts--it is difficult to quantify how many--simply will not be ready for the deadline of 1 April 2002 because of the management and structural issues entailed.

Alan Hurst (Labour, Braintree)

Order. Interventions should be brief and to the point.

John Baron (Conservative, Billericay)

I apologise, Mr. Hurst. On the BMA, there is no harm in raising the concerns of the BMA and there is justification for doing so. That does not necessarily mean that we are endorsing those concerns. The point is that the BMA is raising legitimate issues and it would be wrong if they were not brought to the attention of the Committee. They should not be dismissed out of hand as irrelevant.

Alan Hurst (Labour, Braintree)

Order.

John Hutton (Labour, Barrow and Furness)

Thank you, Mr. Hurst. The hon. Gentleman makes a fair point; I am not disputing his right to raise the concerns that the BMA has expressed. I am simply saying that there is a Cassandra quality to his and other Conservative Members' comments.

Oliver Heald (Conservative, North East Hertfordshire)

Will the Minister give way?

John Hutton (Labour, Barrow and Furness)

No, I will not.

The comments of the hon. Member for Billericay diminish the substance and quality of the argument that he is trying to make to the Committee. He cannot have his cake and eat it. That is a luxury of Oppositions and that is what he is trying to do.

Conservative Members have also expressed concern about the number of primary care trusts that have been established. The hon. Member for West Chelmsford implied that very few had been established and were likely to meet the deadline of April 2002.

Simon Burns (Conservative, West Chelmsford)

I said that I understood that 130 PCGs had not prepared fully or applied for PCT status.

John Hutton (Labour, Barrow and Furness)

Unfortunately, the hon. Gentleman is wrong about that and I shall correct his arithmetic. Some 164 PCTs were established by April 2001 and a further 23 from the current round are likely to be approved soon; 23 of the remaining PCGs have been approved for establishment from April 2002; 20 have been approved but have not yet received notification of approval, which will happen shortly; 98 have submitted proposals for approval and are likely to be approved during December and January. Only 11 PCGs are still consulting and we expect all to be constituted as PCTs by April 2002. That has always been the deadline that we and others in the service have worked towards.

Another theme of the comments made by Conservative Members is decentralisation. I have great sympathy with some of the points that have been made. It is impossible to run a service as complex and diverse as the NHS from Richmond house. That is the Government's view and we have been working to find a successful method of devolving and decentralising power, of which this is the most obviously clear example. It is not true to say that the proposals have suddenly emerged during the past few months. Reference has been made to the NHS plan, and my hon. Friend the Member for Clwyd, West (Gareth Thomas) referred to it and to the equivalent document produced by the National Assembly for Wales.

The hon. Member for Westbury, who referred to those concerns, should refresh his memory and go back a little further in time. The 1997 White Paper ``The new NHS'' refers in paragraph 3.17 to some of the reforms that we wanted to make to health authorities, including making them leaner with no direct commissioning responsibilities. Those are precisely the proposals that we are implementing in the Bill. They have a longer ancestry than he and other Conservative Members are prepared to give credence to.

Andrew Murrison (Conservative, Westbury)

The point is that Governments may put such proposals in White Papers until they are blue in the face, but if they do not get them across to the general public they have failed. My constituents believe that the Government are manifestly failing at the moment because there is so much confusion, even among those who take a passing interest in arcane NHS structures, about how things are going and, more particularly, the effect that they will have on them and their ability to access health care.

John Hutton (Labour, Barrow and Furness)

I accept that that is the hon. Gentleman's view, but it is not mine. It is unlikely that I would ever accept the hon. Gentleman's view about the success or otherwise of the reforms that we are making to the NHS.

Simon Burns (Conservative, West Chelmsford)

Will the Minister clarify a point arising from what he said? If I heard him correctly, he said that he expected all PCTs to be in place by October next year. The strategic health authorities will come into effect on 1 April next and the health authorities are abolished. Will those areas that still have PCGs but are awaiting approval to be PCTs by October be able to fulfil the role of a PCT in advance of becoming one?

John Hutton (Labour, Barrow and Furness)

No. The hon. Gentleman's problem is that he has not fully understood the time scale for making the changes. It is true that we intend to use existing powers to reorganise existing health authorities by 1 April 2002, but it is obvious that the legislation will not be in place by then. There is no prospect of that and we do not envisage being able to implement the legislation until October next year. The reforms will become operational from then onwards and fully operational from April 2003. That is the time scale that we envisage and there seems to have been some misunderstanding about that on the Conservative Benches.

The argument about decentralisation is important and underpins what we are trying to do in this part of the Bill. There is always some political knockabout surrounding centralisation and decentralisation and whether a measure is a devolved one or not. It is a legitimate and important argument, but the data is always tortured until it confesses and the statistics can be used to prove one case or another.

Conservatives may not be aware that during the last year of the Conservative Government, the Secretary of State for Health issued 298 central directions to the national health service. Last year, my right hon. Friend the Secretary of State issued 22 such directions. Most fair-minded people will consider those two figures and decide who were the centralisers and which party wanted to direct and manage the NHS centrally. With the greatest respect to the hon. Member for West Chelmsford, they would not reach his conclusion, based on those figures.

John Baron (Conservative, Billericay)

On the question whether we are centralising or decentralising—I hope that we will not get into party dogma on this—the Government argument is that the Bill is decentralising because, suddenly, PCTs will be spending about 75 per cent. of the resources available to the NHS. If PCTs had a large element of freedom in terms of how they spent the money, one could agree that that would be a decentralising measure. However, the fact remains that although 75 per cent. of expenditure will be devolved, strict targets and performance criteria will be set from the centre. If these are not met, money could be withdrawn. How can that be described as a decentralising measure? Surely it is micromanagement.

John Hutton (Labour, Barrow and Furness)

No, it certainly is not micromanagement. It is the proper role of Government, who are accountable to the House, to set the overall standards and framework within which they expect public money to be used in the NHS; the alternative is a free-for-all, and I cannot believe that the hon. Member for Billericay and his hon. Friends support that. There must be a proper balance. I find it genuinely surprising that the hon. Gentleman takes the view that it is not a proper role for Government to determine the overall resources available to the service and to indicate the targets, results and performance to be achieved with the money.

John Baron (Conservative, Billericay)

The Minister misunderstands. I am not saying that there is no role for Government in running the NHS or that the Government should not provide basic safety nets and guidelines for providing the service at the coal face. However, the Government are arguing that the Bill is decentralising when clearly it is not. The Secretary of State will set microtargets, performance targets and criteria for a swathe of areas, and money will be withdrawn if those are not met. That is micromanagement. There is a role for Government and it is a question of getting the balance right, but they have gone too far in centralising, rather than decentralising.

John Hutton (Labour, Barrow and Furness)

I hear the hon. Gentleman's arguments, but they do not accord with the facts; that is the problem. We are not withdrawing money from anyone, so he can forget about that.

John Baron (Conservative, Billericay)

Even if the authorities do meet performance targets?

John Hutton (Labour, Barrow and Furness)

We are steadily increasing the resources available to the NHS. The performance assessment framework will work in a different way. Everyone will benefit from the fund. Does the hon. Gentleman not think that it is right that we set targets for the key areas of access to health care services and waiting times? Is that not a responsible role for the Government?

My understanding of the hon. Gentleman's election manifesto was that his party was committed to setting such waiting time guarantees. I am genuinely puzzled by the hon. Gentleman's argument. I accept that he can argue about the balance, but surely he cannot argue about the role of the Secretary of State in the matter. It is not true that we see the Secretary of State's role as guaranteeing a safety net for the NHS; that would be an inappropriate view of the relationship that we want to develop and maintain.

The hon. Member for Billericay is wrong in his analysis. There is no doubt, certainly in the BMA's view, that this is a radical decentralising measure that will affect the NHS for a long time to come; it is the hon. Gentleman's prerogative to disagree with that view. If he, like me, believes in devolving power, he will see that this is the only sensible way to organise a service as large and complex as the NHS and that it is reasonable to go down that road.

Oliver Heald (Conservative, North East Hertfordshire)

Under the Bill, 58 powers of the Secretary of State are gained, retained or enhanced. It is true that if some of the powers were implemented in a light regulatory mode, that would be better than if they were heavily prescriptive. Does the Minister agree that it is vital that he allows the Committee to see all the draft orders?

John Hutton (Labour, Barrow and Furness)

I said earlier that I would do that if the orders were ready.

Oliver Heald (Conservative, North East Hertfordshire)

Will the Minister give way?

John Hutton (Labour, Barrow and Furness)

No, I have answered the hon. Gentleman's question.

Oliver Heald (Conservative, North East Hertfordshire)

On a point of order, Mr. Hurst. Clause 1 has at least seven order-making powers and schedule 1 has numerous powers. The Minister has agreed to allow the orders to be seen. If any of them are ready, should he not give them to us so that we can debate them?

Alan Hurst (Labour, Braintree)

That is not a point of order but a matter for debate.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman and I are both lawyers, so we are used to such arguments; it is our trade. The orders are not ready because they have not been drafted. Had they been drafted, they would have been shared with the Committee.

Returning to the substance of the amendment, we have had a wide-ranging debate about the nature of the proposals, their implications for the NHS and their relationship with PCTs, a point on which I agree with the hon. Member for North-East Hertfordshire. It will be important for PCTs to get maximum managerial support as they take on their new roles and responsibilities. The Government have set out our intentions on many occasions. The national primary care development team, under Dr. Barbara Hakin—an outstandingly successful PCT chief executive in Bradford—is helping other chief executives and PCTs to take on their new responsibilities and address the significant challenges that they face.

The hon. Gentleman said that the RCN's description of these proposals was ``ambitious''; they are ambitious because we are ambitious for the NHS.

Oliver Heald (Conservative, North East Hertfordshire)

I was referring to the timetable.

John Hutton (Labour, Barrow and Furness)

It is an ambitious timetable, which leads us to the argument that is fundamental to the amendment tabled by the hon. Member for West Chelmsford. I said earlier that all organisational change meets with some opposition. That is the nature of organisations. Notwithstanding the points made by Opposition Members, there is a strong argument that having identified the changes that must be made, it is better to get on and implement them. The danger with his proposals is that they carry an additional suggestion of delay.

Simon Burns (Conservative, West Chelmsford)

Of six months.

John Hutton (Labour, Barrow and Furness)

Yes, but we could use that six months for another purpose. It is a challenging timetable, but it is achievable. We are on target to get the PCTs, which will be up and running by October 2002, through the system. Having looked at the argument and having heard what the hon. Gentleman has to say, the Committee must decide—given that we indicated the nature of the changes in 1997, developed specific proposals, made a significant start towards achieving results throughout the service and began the reorganisation that these changes will bring through—whether we should say to the NHS and the public at large, ``We need to get these changes in place.''

In the circumstances, the delay that the hon. Member for West Chelmsford proposes would not be helpful. It would serve no purpose other than to cause delay in the way in which he has described. We have a comprehensive system of support arrangements in place to ensure that PCTs will be able to discharge their new responsibilities, and we are currently consulting with the public and the NHS on the boundaries of the SHAs. This is an occasion for us to say that it is time to get on and do the work; that is what I shall ask my hon. Friends to do if the hon. Gentleman pushes his amendment to a Division.

Simon Burns (Conservative, West Chelmsford)

I have listened very carefully to the Minister's comments, and I was genuinely grateful for some information that he supplied. He fleshed out our understanding and knowledge of how the clause will work, fulfilling the probing role of the amendment. One or two things that he said have concerned and slightly confused me, although I shall not pursue them in great detail.

The Minister said that the proposals were both challenging and ambitious. Given the time scale, are the Government being over-ambitious? This debate has in no way reduced my fears that the policy is being rushed and, whatever he may say, my hon. Friends and I are not alone in thinking that. There was concern, which he helpfully cleared up, that the structures would be put in place on 1 April 2002, but some PCGs would not become PCTs until October 2002.

The Minister said, if I understood his comments correctly, that the reforms would not come into operation until October 2002, when all PCTs would be in place. In one way, that is reassuring, and it has certainly clarified the situation. However, that also makes our amendment even more reasonable. Until the Minister gave that clarification, I was asking the Government to give the NHS another 12 months in which to complete preparations so that there would not be a rush that would cause confusion. Following his helpful clarification, I am asking for only six months. I do not regard that as delay or procrastination. I regard that as a commonsense way in which to help the NHS to help those involved and, ironically, to help the Government to get their reforms right, and up and running, in the most effective and efficient way.

When one seeks to be helpful, it is not unreasonable to push an amendment to a Division. I am convinced that when the Government look back on the full year of 2002-2003, they will wish that they had taken our advice and given themselves a breathing space of six months in which better to lay the system's foundations.

Question put, That the amendment be made:—

The Committee divided: Ayes 6, Noes 10.

Oliver Heald (Conservative, North East Hertfordshire)

I beg to move amendment No. 2, in page 1, line 6, leave out `Strategic' and insert `Area'.

Alan Hurst (Labour, Braintree)

With this we may discuss the following amendments: No. 3, in page 1, line 11, leave out `Strategic' and insert `Area'.

No. 4, in page 1, line 14, leave out `Strategic' and insert `Area'.

No. 5, in page 2, line 2, leave out `Strategic' and insert `Area'.

No. 6, in page 2, line 8, leave out `Strategic' and insert `Area'.

No. 7, in page 2, line 9, leave out `Strategic' and insert `Area'.

No. 8, in page 2, line 16, leave out `Strategic' and insert `Area'.

No. 9, in page 2, line 18, leave out `Strategic' and insert `Area'.

No. 10, in page 2, line 19, leave out `Strategic' and insert `Area'.

No. 11, in page 2, line 20, leave out `Strategic' and insert `Area'.

No. 12, in page 2, line 23, leave out `Strategic' and insert `Area'.

No. 13, in page 2, line 27, leave out `Strategic' and insert `Area'.

No. 14, in clause 3, page 3, line 11, leave out `Strategic' and insert `Area'.

No. 15, in clause 3, page 3, line 12, leave out `Strategic' and insert `Area'.

No. 16, in clause 3, page 3, line 15, leave out `Strategic' and insert `Area'.

No. 17, in clause 3, page 3, line 16, leave out `Strategic' and insert `Area'.

No. 18, in clause 3, page 3, line 19, leave out `Strategic' and insert `Area'.

No. 19, in clause 3, page 3, line 27, leave out `Strategic' and insert `Area'.

No. 20, in schedule 1, page 44, line 6, leave out `Strategic' and insert `Area'.

No. 21, in schedule 1, page 44, line 8, leave out `Strategic' and insert `Area'.

No. 22, in schedule 1, page 44, line 12, leave out `Strategic' and insert `Area'.

No. 23, in schedule 1, page 44, line 14, leave out `Strategic' and insert `Area'.

No. 24, in schedule 1, page 44, line 17, leave out `Strategic' and insert `Area'.

No. 25, in schedule 1, page 44, line 19, leave out `Strategic' and insert `Area'.

No. 26, in schedule 1, page 44, line 21, leave out `Strategic' and insert `Area'.

No. 27, in schedule 1, page 44, line 24, leave out `Strategic' and insert `Area'.

No. 28, in schedule 1, page 44, line 27, leave out `Strategic' and insert `Area'.

No. 29, in schedule 1, page 44, line 29, leave out `Strategic' and insert `Area'.

No. 30, in schedule 1, page 44, line 31, leave out `Strategic' and insert `Area'.

No. 31, in schedule 1, page 44, line 35, leave out `Strategic' and insert `Area'.

No. 32, in schedule 1, page 44, line 37, leave out `Strategic' and insert `Area'.

No. 33, in schedule 1, page 45, line 2, leave out `Strategic' and insert `Area'.

No. 34, in schedule 1, page 45, line 6, leave out `Strategic' and insert `Area'.

No. 35, in schedule 1, page 45, line 8, leave out `Strategic' and insert `Area'.

No. 36, in schedule 1, page 45, line 10, leave out `Strategic' and insert `Area'.

No. 37, in schedule 1, page 45, line 13, leave out `Strategic' and insert `Area'.

No. 38, in schedule 1, page 45, line 14, leave out `Strategic' and insert `Area'.

No. 39, in schedule 1, page 45, line 18, leave out `Strategic' and insert `Area'.

No. 40, in schedule 1, page 45, line 20, leave out `Strategic' and insert `Area'.

No. 41, in schedule 1, page 45, line 22, leave out `Strategic' and insert `Area'.

No. 42, in schedule 1, page 45, line 25, leave out `Strategic' and insert `Area'.

No. 43, in schedule 1, page 45, line 28, leave out `Strategic' and insert `Area'.

No. 44, in schedule 1, page 45, line 30, leave out `Strategic' and insert `Area'.

No. 45, in schedule 1, page 45, line 34, leave out `Strategic' and insert `Area'.

No. 46, in schedule 1, page 45, line 36, leave out `Strategic' and insert `Area'.

No. 47, in schedule 1, page 45, line 39, leave out `Strategic' and insert `Area'.

No. 48, in schedule 1, page 45, line 41, leave out `Strategic' and insert `Area'.

No. 49, in schedule 1, page 45, line 44, leave out `Strategic' and insert `Area'.

No. 50, in schedule 1, page 46, line 1, leave out `Strategic' and insert `Area'.

No. 51, in schedule 1, page 46, line 4, leave out `Strategic' and insert `Area'.

No. 52, in schedule 1, page 46, line 7, leave out `Strategic' and insert `Area'.

No. 53, in schedule 1, page 46, line 10, leave out `Strategic' and insert `Area'.

No. 54, in schedule 1, page 46, line 13, leave out `Strategic' and insert `Area'.

No. 55, in schedule 1, page 46, line 15, leave out `Strategic' and insert `Area'.

No. 56, in schedule 1, page 46, line 18, leave out `Strategic' and insert `Area'.

No. 57, in schedule 1, page 46, line 19, leave out `Strategic' and insert `Area'.

No. 58, in schedule 1, page 46, line 22, leave out `Strategic' and insert `Area'.

No. 59, in schedule 1, page 46, line 24, leave out `Strategic' and insert `Area'.

No. 60, in schedule 1, page 46, line 27, leave out `Strategic' and insert `Area'.

No. 61, in schedule 1, page 46, line 29, leave out `Strategic' and insert `Area'.

No. 62, in schedule 1, page 46, line 32, leave out `Strategic' and insert `Area'.

No. 63, in schedule 1, page 46, line 33, leave out `Strategic' and insert `Area'.

No. 64, in schedule 1, page 46, line 36, leave out `Strategic' and insert `Area'.

No. 65, in schedule 1, page 46, line 38, leave out `Strategic' and insert `Area'.

No. 66, in schedule 1, page 46, line 40, leave out `Strategic' and insert `Area'.

No. 67, in schedule 1, page 46, line 44, leave out `Strategic' and insert `Area'.

No. 68, in schedule 1, page 47, line 2, leave out `Strategic' and insert `Area'.

No. 69, in schedule 1, page 47, line 5, leave out `Strategic' and insert `Area'.

No. 70, in schedule 1, page 47, line 7, leave out `Strategic' and insert `Area'.

No. 71, in schedule 1, page 47, line 9, leave out `Strategic' and insert `Area'.

No. 72, in schedule 1, page 47, line 15, leave out `Strategic' and insert `Area'.

No. 73, in schedule 1, page 47, line 17, leave out `Strategic' and insert `Area'.

No. 74, in schedule 1, page 47, line 20, leave out `Strategic' and insert `Area'.

No. 75, in schedule 1, page 47, line 23, leave out `Strategic' and insert `Area'.

No. 76, in schedule 1, page 47, line 26, leave out `Strategic' and insert `Area'.

No. 77, in schedule 1, page 47, line 29, leave out `Strategic' and insert `Area'.

No. 78, in schedule 1, page 47, line 33, leave out `Strategic' and insert `Area'.

No. 79, in schedule 1, page 47, line 35, leave out `Strategic' and insert `Area'.

No. 80, in schedule 1, page 47, line 37, leave out `Strategic' and insert `Area'.

No. 81, in schedule 1, page 47, line 40, leave out `Strategic' and insert `Area'.

No. 82, in schedule 1, page 47, line 43, leave out `Strategic' and insert `Area'.

Oliver Heald (Conservative, North East Hertfordshire)

All the amendments are to the same effect. They would change the name of strategic health authorities to area health authorities. Their purpose is not simply to concentrate on the name, but to ascertain whether such authorities are properly designated as strategic. We want to examine the functions that the Government intend for them, and whether it is right to describe those functions as strategic. We might go further and ask whether those bodies have a role to play.

As I understand it, the Government propose to reallocate responsibilities in the NHS so that PCTs will become the bodies that assess need, plan for it and commission services, and as such will be the main budget-holders; I do not use the word ``purchaser'', of course. There are to be about 30 new health authorities, covering about 1.5 million residents each, although I have heard that, in certain areas, the Government are prepared to accept far larger numbers of residents.

Will the Minister explain why it is necessary to have strategic health authorities and what is strategic about them? The research paper says that they will provide

``support to PCTs and NHS trusts to help them . . . improve the quality of the services they provide through their `clinical governance' arrangements''.

What does that actually mean? The paper goes on to refer to developing

``appropriate links with patients and the public as a whole, to ensure that services become genuinely patient-centred''.

We seem to be developing a massive structure of overarching and underlapping bodies to do what the community health councils used to do. Is it really necessary to have another set of bodies developing links and ensuring that patients have a role? Can the Minister justify the claim that those bodies are genuinely strategic?

The research paper says that SHAs will

``play a part in the wider public health agenda so that they contribute to general strategies to promote good health''.

What does that involve? Does the Minister really believe that a strategic role is called for? If so, how will the system operate in terms of the relationship between SHAs and PCTs?

The BMA asserts that the new structures should include a role for public health doctors. Does the Minister intend the high-level appointment of a public health doctor in each area? Would that be part of improving the quality of services within a clinical governance arrangement? I do not think so. Would it assist in developing a link with patients? Probably not. However, it might play a part in the wider public health agenda. Is part of the strategic purpose of SHAs the appointment of public health doctors? The BMA thinks that that is important. It says:

``The BMA is concerned that with such flexibility of appointment to these key public health posts at PCT and SHA level, potentially some areas of the country may be without the expertise of a public health doctor.''

The Royal National Institute for the Blind has commented on the role of sight loss and eye health promotion. Will the Minister explain whether that is a strategic issue that plays a part in the wider public health agenda, or is it the kind of thing that PCTs will deal with? Will he also respond to the RNIB's observation that the NHS and local authorities should work more closely to ensure effective service delivery in terms of sight loss and eye health promotion?

In other words, what does it all mean? [Interruption.] I ask that not in an entirely philosophical sense; I was hoping instead that the Minister might give a little detail and explain what the strategy is, why we need strategic health authorities, and why they should be called that rather than area health authorities.

John Hutton (Labour, Barrow and Furness)

I am encouraged to have an opportunity so soon in our debate to respond to the points raised by the hon. Gentleman. On noticing page after page of amendments, I thought that we would be discussing them for some time. I am grateful to him for spelling out that his amendments are essentially probing and that he is simply trying to establish what the function of these bodies should be.

The hon. Gentleman asked several questions about the public health function, which the hon. Member for Westbury also mentioned on Second Reading. Both hon. Gentlemen are rightly concerned about where the public health function will go and whether the reforms will weaken it, but in my view they will strengthen its delivery in the NHS. Given the present climate, that is one of the most important things that we must get right. All hon. Members and their constituents are aware of the growing menace of international terrorism and of the role of public health specialists in helping the NHS to cope with it effectively. I shall return to that subject in a moment, but I should first make it clear that the proposed reforms will not diminish the important role of public health in the NHS; indeed, I very much hope that they will strengthen it.

The rather quixotic desire was expressed for a seminar on the activities of SHAs, but ``Shifting the Balance'' and other documents provided for the Committee offer an almost exhaustive description of their role and functions. First and foremost, SHAs will have the key performance management role across the NHS. If the hon. Member for North-East Hertfordshire has talked to people in the NHS, he will know that the regional offices are too far away from the front line to carry out that role in the way that many in the service would like.

Again, this is an area in which we must make a judgment call. The Bill and the background documents show that the performance management function must be effective, but not too distant or bureaucratic, and the function must be close enough to the front line to ensure that genuine performance management responsibilities can be discharged, without creating for the sake of it—this is perhaps the hon. Gentleman's worry—another tier of bureaucracy in the NHS. Such a further tier is not what we are proposing.

The hon. Gentleman also referred to other responsibilities of the strategic health authorities, particularly their leading strategic development of services and ensuring that all parts of the NHS work together effectively. In a sense, that issue touches on another that was raised by the hon. Member for Billericay when we considered a previous group of amendments. We need a devolved NHS where as many resources and as much control and responsibility as possible are given to the front line, but where the back office functions—for want of a better expression—are properly identified and supporting arrangements established. That is a sensible balance, and although the line is perhaps not drawn in a place with which the hon. Gentleman is happy, there will certainly be significantly fewer authorities than the current 90-odd area health authorities in England to which he referred.

Oliver Heald (Conservative, North East Hertfordshire)

A lot of people say that all that the Government are doing is moving deckchairs. At the moment, there are two basic tiers—regional directors and health authorities—but we will end up with three: PCTs and SHAs, both of which have a health authority role, and regional directors. There will be a lot more PCTs than there ever were health authorities, so we will end up with more bodies. Is that really necessary?

John Hutton (Labour, Barrow and Furness)

As I understand it, the hon. Gentleman's amendment would leave us with exactly the structure that I have just proposed—it would simply brand the bodies with a different name.

Oliver Heald (Conservative, North East Hertfordshire)

That is why it is a probing amendment.

John Hutton (Labour, Barrow and Furness)

On this occasion, I do not feel particularly probed by the hon. Gentleman. Perhaps he will do better with later amendments. I accept that he wants a better and fuller description of the rationale behind the changes, but it is only fair to point out that the amendment would result in exactly the structure that we are proposing.

The fundamental change relates to the functions of health authorities and SHAs—that is the core of ``Shifting the Balance''. On reading the Bill, it is obvious that some health authority functions will remain in a different place in the NHS firmament, but most will move to PCTs. As we have made clear in numerous arguments on Second Reading and elsewhere, that is the right way to achieve our principal objective of finding a new and different system that properly confers responsibility and thereby grants the freedom to be innovative and enterprising. Those should be the hallmarks of a modern, dynamic public service. We must give those powers and opportunities to the people on the front line who actually make a difference, know their communities well and understand where the problems and pressure points are in the system, so that they have the tools to do the job more effectively.

It is important to call strategic health authorities by that name because it emphasises that their function should differ from that of the area health authorities to which the hon. Gentleman wants to revert. We should remember that area health authorities were commissioning bodies. Strategic health authorities will have a completely different role.

Oliver Heald (Conservative, North East Hertfordshire)

No one is suggesting that we go back.

John Hutton (Labour, Barrow and Furness)

That is what the hon. Gentleman is suggesting—he is proposing that we establish area health authorities rather than strategic health authorities.

Oliver Heald (Conservative, North East Hertfordshire)

No I am not.

John Hutton (Labour, Barrow and Furness)

With the greatest of respect, that is precisely what the amendment proposes. Most people in the NHS remember what area health authorities used to do, as will the hon. Member for Westbury, who is very fond of old NHS structures but has no fondness for the new ones. It would serve no purpose to allow confusion about the new health authority. The Bill needs to make crystal-clear the concept of a strategic responsibility and role, and that is what it will do in relation to the functions that strategic health authorities will discharge.

I have talked a lot about striking a balance, and it is important to make such matters clear. The system must devolve, decentralise, innovate and encourage change at a local level, but it must also be effectively managed, so that two parts do not do opposite things and thereby create the free-for-all that was characteristic of some of the hon. Gentleman's party's early reforms. Such a free-for-all does not enhance care or encourage the co-operation between different parts of the NHS that is so important if it is to be efficient and effective and to do what our constituents want: to improve access and quality of care, and make the best use of the resources at our disposal.

The challenge for us all, which we have tried to take on through these reforms, is to get right the balance between devolving and decentralising—that is what we want to do—and ensuring that the all parts of the service can work together closely, still plan sensibly for the future and secure the results that we all desire.

I have looked at the past functions of the area health authorities to which the hon. Gentleman's amendment harks back, and set out the obvious responsibilities of the strategic health authorities, and there is no obvious comparison between the two. The strategic functions of the new health authorities will be clearer and more defined. As I have said, under our proposals the new strategic health authorities will take a step backwards from service planning and commissioning. They will lead strategic development of local health services, and performance-manage PCTs and NHS trusts.

The hon. Member for Westbury made a point about public health, which also came up on Second Reading. I apologise to him because I did not get a chance to respond fully to his points then. Should the day ever dawn when he has the chance to wind up debates, he will know how difficult it can be to respond fully to all the points made by hon. Members. I did not intend him any discourtesy in not dealing fully with his points about public health.

We plan that every PCT will have a director of public health and an appropriate support team. Those directors will be board-level appointments, which is an important step forward. They will focus their activity on local neighbourhoods and communities, and on programmes to improve health and reduce inequalities. We want them to play a powerful role in forging partnerships with, and influencing, all local agencies to ensure the widest possible participation in health and the health care agenda. That generation of directors of public health will be from a variety of backgrounds, not only medical as at present.

The new strategic health authorities established by the NHS reforms will also need a doctor with appropriate strategic management skills. The SHAs will also have responsibility for the performance management of the public health function of primary care trusts. It makes absolute sense for public health doctors to fulfil that role. A successful SHA will lead and performance-manage that area to ensure that each organisation for which it is responsible has vibrant clinical governance arrangements and powerful, effective clinical networks.

I do not think that there is a substantive argument behind the amendment.

Oliver Heald (Conservative, North East Hertfordshire)

Is the Minister saying that an SHA will have a public health doctor but that a PCT might not, although it could?

John Hutton (Labour, Barrow and Furness)

PCTs will have a public health function and a public health director. That will not necessarily be a doctor, but a consultant for public health, rather like the present arrangements.

Oliver Heald (Conservative, North East Hertfordshire)

As the Minister knows, the BMA is interested in the matter. SHAs will always have a public health doctor and PCTs will have a public health function, but not necessarily a doctor.

John Hutton (Labour, Barrow and Furness)

Yes, that is broadly how we see the reforms working. We do not want to compromise, or affect the quality of, the public health function as it is discharged by the NHS. That is not on our agenda.

I do not think that there is much else for me to say about these amendments, other than that there are an awful lot of them. I am grateful that the hon. Gentleman has not felt the need to discuss each of them, and I hope that I have not provoked him into doing so. I do not think that they constitute a sensible way forward.

Oliver Heald (Conservative, North East Hertfordshire)

Perhaps the Minister will comment on the point raised by the Royal National Institute for the Blind. It has briefed all Committee members about its concern that there should be proper local arrangements between local authorities and the NHS to ensure effective service delivery. Can I tempt him to say whether that would be an SHA role where it concerns the improvement of quality, or a PCT role?

John Hutton (Labour, Barrow and Furness)

It would be both. Primary care trusts will be able to enjoy the fruits of some of the earlier legislative changes that we made to promote closer working, such as section 31 arrangements under the Health Act 1999 and the care trusts provisions of the Health and Social Care Act 2001. The strategic health authority will have an overall role in making sure that progress is being made in that important area.

Oliver Heald (Conservative, North East Hertfordshire)

That is very helpful.

It was not our intention to see the area health authority rise like a phoenix from the grave. If anything, the area health authority role is far more akin to what PCTs will do. I was not going back that far; I simply wanted to discuss whether the strategic health authorities were strategic and had a role and function. I am not very satisfied with the Minister's reply, partly because the details of the functions of SHAs will be set out in an order made by the Secretary of State under the negative procedure that will never be discussed by the House in detail.

John Hutton (Labour, Barrow and Furness)

I remind the hon. Gentleman that we have followed the pattern that was set by the National Health Service Act 1977, where the legislation requires the establishment of the health authorities, but the functions are left to the Secretary of State to determine. We are following that pattern and it will be open to Opposition Members to call for a debate on the proposals if they are concerned in future.

Oliver Heald (Conservative, North East Hertfordshire)

The last time I looked, there were 2,000 negative orders, 30 of which were debated, despite the fact that many hundreds were requested for debate. This Government are a bit worse than we were but, none the less, it is not the tradition to debate negative orders even if the Opposition want to debate them.

The Minister is right that, between 1974 and 1979, many Acts were introduced on the basis that they had wide order-making powers; they were Christmas trees without baubles or skeletons without flesh. One could not tell the details of what would happen as a result of an Act of Parliament. Some people may think that that was a bad trend, but it has been followed; now, much detail is not covered by the Bill, but by orders.

One suspects that layers of bureaucracy are being added, so it is a pity not to be able to see what the functions of the SHAs will be. They will be dealt with by order. We cannot get down to the detail, or see whether the authorities will be doing anything worthwhile. The amendments are probing, but I will not press them.

Andrew Murrison (Conservative, Westbury)

I am grateful to the Minister for suggesting that I might be able to remember area health authorities. I can just about cast my mind back to 1974 when those authorities were rearranged, together with district health authorities and regional health authorities, and there is a sense of de''ja vu as we reinvent those structures. That might be fine were they to serve a useful function, but SHAs are looking fairly bankrupt.

PCTs are taking the best and leaving the rest. Although I am grateful for the Minister's views on where the public health function will lie, and reassured that public health consultants will find a role in SHAs, I am concerned that they are a bolt-on to the SHAs to bolster them up. I am pleased to hear that directors of public health will be attached to PCTs and, although I am doctor, I am pleased that directors do not necessarily have to be medically qualified. In the amendment, the Minister did not mention consultants in communicable disease control, so will he mention where CCDCs will sit? I expect that they will sit on SHAs.

We have not yet defined ``strategic''. Words are important; they mean what they say. We need to explore why the Government require the insertion of the word ``strategic''. Why will they be strategic authorities, rather than straight health authorities? We also need to know why 1.5 million has been chosen as a proper figure for a population served by each SHA. Presumably, it is linked with the notion of being strategic.

We must explore the need for tertiary centres in SHAs because I understand that one of the key planks in being strategic is that one has access to a tertiary centre. That appears to be the case under most of the proposals for boundaries, but there are several signal exceptions—for example, the SHA that it is proposed will be made up of Somerset and Dorset. It stretches the imagination to suppose that that SHA will have a tertiary centre, so there appear to be a few disconnects in the thoughts that are going into this, which gives me added concern about the notion of being strategic. If the authorities are to be strategic, they need to be uniformly strategic. The signs are that that is not happening.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman has asked two further questions and it would be appropriate to respond briefly now, rather than to write to him later. He has asked about the arrangements for communicable disease controls and where the CCDCs will be located —at PCT level or strategic health authority level. That is an issue that we are considering. The chief medical officer is advising the Government about that, and we expect to receive his recommendations by the end of the year.

The hon. Gentleman also asked about tertiary centres and specialist commissioning. We are trying to draw a line between NHS bodies with commissioning responsibilities—PCTs—and those without, including the SHAs. The securing of specialist services will be the responsibility of PCTs, working together in collaborative and cooperative ways. It will be the responsibility of the SHA to ensure that satisfactory arrangements are in place to ensure that that process is working. For the next financial year, the current regional specialist commissioning groups will continue to exist, making sure that PCTs can build up the capacity effectively to discharge that function, with clear responsibility to ensure that there is a planned transition and to develop the PCT capacity to commission those services from 2003 onwards.

Oliver Heald (Conservative, North East Hertfordshire)

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Simon Burns (Conservative, West Chelmsford)

I beg to move amendment No. 84, in page 2, line 3, at end insert

`provided that such area has an adult population of more than 2 million people.'.

I say from the outset, to avoid any confusion, that this is a probing amendment. In the absence of any draft regulations, I seek to tease out from the Minister some more information on the nuts and bolts of the SHAs.

The Minister will be aware that subsections (2), (3), (4) and (5) are also subject to amendments at a later stage, which have been selected, so we will have the opportunity to debate other aspects of SHAs, but the Government have included in the Bill the power to establish SHAs for England, without specifying, for a variety of eminently reasonable reasons, their detailed intentions.

The figure of 1.5 million has been bandied around as the average population that the Government anticipate an SHA will cover. Staff from the North Essex health authority seem to be working on the basis of one SHA for Essex, which would in effect be a merger of the North Essex and South Essex health authorities, giving a population of about 1.5 million. Our amendment refers to an adult population of 2 million, so, clearly, if the Government were to accept it—as I have said, it is a probing amendment—the figure would be higher because it excludes children and young people under the age of 18.

We know from the Bill that there cannot be cross-border SHAs between England and Wales. For various reasons, I think that that is a wise decision, and an inevitable one for the Government. Interestingly, under clause 1(4)(b), the Secretary of State may, by order,

``abolish a Strategic Health Authority''.

I would like press the Minister on that. If he has a belt and braces approach to the Bill, he will get any eventuality into the legislation. I assume that that provision is there so that if a future Government wanted to re-organise the structure of SHAs by merging some into larger units, they would have the powers without having to revert to primary, or even secondary, legislation. Can the Minister confirm that that assessment is correct?

That raises a problem, depending on the population basis. If the level is 1.5 million, and if the Government rigidly stick to that throughout the country, any abolitions or mergers of SHAs—I presume that, in most cases, abolition of an SHA would be to enable a merger—could establish very large organisations. Those could be vulnerable to the accusation of potential detachment from the area that they seek to serve strategically because they cover too large a geographic area.

Alternatively, that provision might be in the Bill because the Government, for various reasons, wanted some areas to have SHAs covering more than 1.5 million people, if that were their average guideline figure. With experience and hindsight they might want to make an SHA larger because it was too small to fulfil Ministers' and the Department's original intentions.

I am not saying that 2 million adults, with however many children there might be, is an ideal figure, or that 1.5 million is right or wrong. From the only experience I have—on the ground in Essex—that figure seems more or less sensible, as it reflects the county boundary and keeps local roots for the body. However, will the Minister share with the Committee more information about his and the Department's thinking on the shape, form and size of SHAs in England?

Oliver Heald (Conservative, North East Hertfordshire)

Does my hon. Friend agree that it would be useful if the Minister explained what latitude there is on that point, and to what extent he is prepared to allow for higher figures? In a big city, it might be useful to have a much higher figure than 1.5 million people.

Simon Burns (Conservative, West Chelmsford)

I hope that the Minister will answer my hon. Friend's point and explain what factors will be taken into account in determining—

It being One o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at half-past Four o'clock.

Standing Committee A

Clause 1 - English Health Authorities: change of name

Ann Widdecombe (Conservative, Maidstone and The Weald)

Before I ask Mr. Burns to conclude his comments, I remind members of the Committee that all mobiles and pagers should be set on silent, or should not be on at all.

Simon Burns (Conservative, West Chelmsford)

May I be the first, Miss Widdecombe, to say what a pleasure it is to have you as co-Chairperson of our proceedings?

As I was saying when we adjourned for lunch, amendment No. 84 is purely a probing amendment by which we are seeking to find out more about the Minister's views on the composition of the strategic health authorities in terms of the average number of people that each will represent, and to tease out of him more information about how he thinks that SHAs will work.

Andrew Murrison (Conservative, Westbury)

It is a fairly fundamental law of physics that large bodies tend to consume small ones, and one of my concerns about SHAs relates to their size. As far as we are able to tell, they will be of diverse size. One of the stringencies placed upon those deciding on their boundaries is that the authorities should relate to a tertiary centre, such as a major teaching centre or major hospital. My own area of the south-west provides an example of where the proposals fall well short of that. The minnow that is Somerset and Dorset—I mean that in the nicest possible way—relates at best to Taunton, which is not a major centre. That will leave Devon and Cornwall looking towards the Peninsula medical school and Plymouth, which is a major tertiary centre. The remaining area of Avon, Gloucestershire and Wiltshire will look towards Bristol royal infirmary and the Bristol teaching hospitals.

That creates real instability. It is likely that there will be some mergers as time goes by. In the south-west, the three SHAs will probably reduce to two, with Somerset and Dorset being split between the SHA for the far west and Avon, Gloucestershire and Wiltshire. Such changes bring more uncertainty for those who work in the service. We should be able to anticipate that to ensure from the outset that SHAs can plan for the long term in a period of some stability. Members of the Committee have commented on the importance of stability in the national health service, which has undergone almost perpetual change since 1974. This is one area where the Government can give a steer by offering the prospect of stability at SHA level.

Of course, reducing the number of SHAs in the south-west from three to two and repeating that across the country would strip out a layer of bureaucracy and associated costs, as well as giving many of them much more cogency. I urge the Minister to think in terms of reducing the number of SHAs, perhaps by increasing the numbers of people that they will serve.

Richard Taylor (Independent, Wyre Forest)

I was delighted that in the letter from the Secretary of State for Health that was circulated with the White Paper, ``Shifting the Balance'', he emphasised that consultation would take place according to boundaries. Natural geographical boundaries for health care seem to be the most sensible way of deciding the constituent members of strategic health authorities. Will the Minister confirm that the authorities will not be rigidly bound by numbers, whether too small or too great, but that the natural geographical boundaries, whether they have tertiary centres or not, will be used?

I have a natural geographical area in my part of the country that has long been known as West Mercia, which is an example of an ideal grouping without a tertiary centre. I make a plea for geographical boundaries and not boundaries based on absolute numbers.

John Baron (Conservative, Billericay)

Will the Minister consider another issue concerning the boundaries of strategic health authorities pertaining to existing clinical networks? The Government have stated that SHAs would be coterminous with an aggregate of local authorities and that the boundaries would not cut across Government office boundaries. That is fine, but existing clinical networks do not always align with local or central government boundaries. Securing delivery of health care must be the overriding determining factor when resolving difficulties, so consideration must be given to the role of the clinical networks. I hope that the Minister will forgive me if I refer to the BMA again, but it suggested that an appropriate solution might be to manage any lack of coterminosity at the new regional director of health and social care level instead of with the 28 SHAs to ensure that such decisions are taken at the appropriate strategic level. That would give weight to existing clinical network boundaries instead of historical administrative boundaries, which are largely based on geographical features. Will the Minister consider that point, because existing clinical networks are important to the overall functioning of health services at local level?

Oliver Heald (Conservative, North East Hertfordshire)

I join in the welcome to you, Miss Widdecombe, as our co-Chairman.

I want to add one or two points to those of my hon. Friend the Member for West Chelmsford (Mr. Burns). To have a guideline of 1.5 million residents as the basic unit for a strategic health authority is acceptable, although we could argue about what the number of residents should be. However, some flexibility is required from the Minister if it is to work well. My understanding is that, in some city areas, it is proposed that strategic health authorities should be much larger than 1.5 million residents. I should be grateful if the Minister would tell us whether that is right and give us some idea of the scale of difference that is acceptable to the Government.

In my area, it has been suggested at regional level that Hertfordshire should be combined with Bedfordshire to achieve a unit of approximately 1.5 million; a similar size to Essex, to which my hon. Friend the Member for West Chelmsford referred. That is a convenient way of dealing with the matter and would meet some of the clinical networks, but if there were no constraint in terms of having to use local government units to build strategic health authorities, or by the 1.5 million figure, some of the other issues could be considered. For example, to the east of the county, many patients go to Addenbrooke's hospital in Cambridge. Further down the east side of the county, many residents go to Harlow in Essex for hospital treatment. To the south of the county, Mount Vernon is the cancer centre, as the Minister knows, and many of its patients come from north London.

Everyone at regional level, and everyone else involved, is doing their best to come up with a solution for a strategic authority that will work. Will the Minister explain why the figure should be 1.5 million, because a larger number would give greater flexibility?

What is the thinking on having coterminosity with local government areas? Would that be convenient where social services and the NHS were working together? Does the Minister hope that there will be joint working with mental health services? If that is necessary, what is his response to the submission by the Democratic Health Network, a body set up by the Local Government Information Unit? It states that

``the Government has given no clear rationale for the number of the proposed new SHAs. We would wish to see much closer working between health and local government at both regional and sub-regional level. It will not be helpful that the proposed new SHAs will not be co-terminous with other government regional or sub-regional structures.''

The Minister will know that I am not a great one for regions. However, the network has 100 members from local government; it is a body with a voice. It has asked that question. Will he respond to it? This is not something that I would favour, but it is the Opposition's job to put forward submissions when bodies of importance issue them.

The Democratic Health Network goes on to say:

``If the main role of Strategic Health Authorities is performance management, we do not understand why up to 30 SHAs are necessary and why they cannot be made co-terminous with the English regions . . . which would make it much easier to co-ordinate regional health policy with other areas of regional policy and with political and administrative structures at regional level.''

One can see what it means. The Minister accepts that in parts of the country where there are cities and great urban areas, there should be larger SHAs that fit in with the sub-regional pattern.

I should like the Minister to explain whether this is a patchwork with big SHAs on the one hand and little ones on the other. What is the meaning of the guidance figure of 1.5 million? It obviously means something in Hertfordshire because that region has said that 1.5 million is an important guideline. If something totally different is happening in the west midlands or Yorkshire, how will he reconcile the one with the other? Will the Minister give us a clearer picture of what is going on?

John Hutton (Labour, Barrow and Furness)

May I say how pleased we are to see you in the Chair, Miss Widdecombe? My Front-Bench colleagues and I would rather you were in the Chair than on the Opposition Front Bench.

Oliver Heald (Conservative, North East Hertfordshire)

Does the Minister accept that I would always be happy to vacate this slot should my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) want to return to the fray?

John Hutton (Labour, Barrow and Furness)

You would rule me out of order if I started to argue the merits or otherwise of appointments to the Opposition Front Bench, Miss Widdecombe. I do not intend to go there, and I notice you no longer intend to go there either.

The debate on amendment No. 84 has raised two questions. First, where do we draw the lines in relation to the boundaries of SHAs? The hon. Members for Wyre Forest (Dr. Taylor) and for Billericay (Mr. Baron) have referred to that matter. Secondly, what criteria do we use to draw the lines? The hon. Member for North-East Hertfordshire will be aware from his experience as a Minister that such lines are difficult things to get right. We are putting the structures in place; they are our creation. However, drawing precise boundaries and lines across the map of England is necessarily complicated, and raises issues such as those that the hon. Member for Westbury (Dr. Murrison) mentioned about local perceptions of where boundaries are, and what affinities local people feel with the communities around them.

Opposition Members ask me where we are drawing the lines; we are consulting on that. I hope that all Opposition Members will want to add their views to the consultation process that we have initiated, and some have already. I am sure that the hon. Member for Wyre Forest has, because he is that sort of man. It is up to hon. Members, if they feel concern about such issues, to input into the consultation process. That is the melting pot out of which final decisions come.

The criteria to which Opposition Members have referred—the existence of clinical networks, the importance of coterminosity with local authority boundaries and the issue of regional office boundaries—are important in making decisions about where the boundaries of SHAs should be fixed.

The reference in the consultation document to a guideline population basis of 1.5 million people—not simply adults, to which the amendment refers, but including children—is also important. Of course we need flexibility in such areas when coming to sensible decisions and, wherever we can, we will refer to the weight of local opinion that emerges through the consultation exercise.

We will not make final decisions through an arbitrary approach to those criteria, but the amendment would force us into doing that. We have issued a document referring to the criteria, and I will return in a minute to Opposition Members' concerns about those criteria. The hon. Member for North-East Hertfordshire said that we need flexibility to make the proposals work well. His amendment, by design, removes from the Bill the flexibility that he wants to ensure is a principle underpinning the decision-making process about the boundaries of SHAs. I accept that the amendment was designed to illuminate and inform the debate, but we must look at the proposed words. I have to tell my hon. Friends that it would be a mistake to go down that road.

Important issues have surfaced, such as observing coterminosity with local authority boundaries wherever we can. The amendment would compromise our ability to do that. I am sure that it is obvious to hon. Members that we want coterminosity because health and social care, the two key pillars of our care system, have developed historically as two separate tribes that do not always work well together. We see the consequences of that in various areas in the NHS. Delayed discharge is the obvious example; another is the problem in accessing mental health services. NHS and social care providers need to work together as closely as possible there because mental health lends itself to such a solution. People with mental health problems have a high degree of dependence on social care services. If the NHS is to do its job properly in delivering effective care, those two great pillars of the welfare society must work more closely together.

The principle of coterminosity between the boundaries of SHAs and those of local authorities fits with the strategic development of services that we want to see. That would be difficult to achieve if the boundaries of SHAs cut a big swathe across the boundaries of social service authorities, so that the same social service authority provided services to a range of PCTs in different SHAs. That would not be the sort of strategic development and coherence that we want, and that SHAs are intended to facilitate and promote.

The argument, as in earlier debates, comes down to how we juggle the various criteria, which most hon. Members recognise as important, in a framework that does not twist the Secretary of State's arm, forcing him to make decisions on arbitrary criteria in the Bill that he has no power to waive. If one takes that to its logical conclusion, the difficulty would be presented in stark terms; the hon. Gentleman's amendment would not allow the Secretary of State to constitute an area with a population two short of 2 million as an area that could have a SHA. With respect to the hon. Gentleman, that does not make sense and would contradict the principle of flexibility that I am sure we share.

I was asked a number of pertinent questions about the guideline of 1.5 million in the consultation exercise. The document makes it clear that we have attempted to provide flexibly. He asked me for a guide for the range of populations that could come within the boundaries of a single SHA. It is clear in the proposal for Durham and Tees valley in the north east that if Ministers decided to set up an SHA there, the population that would be served would be 1.2 million.

Another example is in the east midlands. The proposed boundaries for mid-Trent would include Lincolnshire, north and southern Derbyshire, north Nottinghamshire and Nottingham, making a substantial population of nearly 2.7 million. It is obvious that, in ``Shifting the Balance''—and with the consultation under way—there is flexibility over the size of populations that need to be served and serviced by the SHAs. That reflects the important point made by hon. Members about the importance of clinical networks, and the point about tertiary centres made by the hon. Member for Westbury.

We are trying to juggle a number of criteria, which we have set out clearly. We have made no secret about the criteria that we intend to use. We want the proposals to command as much support as possible from the local communities that they will serve. Opposing views are forming part of the consultation process and they will be drawn to Ministers' attention as important arbiters of local opinion. As many hon. Members recognise, we then need to make the judgment of Solomon and are unlikely to be able to keep 100 per cent. of people happy. However, the criteria will be transparent and powerfully informed by the strength of local support for the proposals. Ministers will try to approach the task flexibly with a clear view of the end game. That is not a monstrosity of bureaucracy that cuts across obvious boundaries, but a new system for the NHS that complements the framework of the responsibilities on local authorities and regional officers of government.

John Baron (Conservative, Billericay)

I welcome what the Minister says and ask him to consider how we manage the lack of coterminosity. Any boundary that we draw will probably alienate one small section, but the bottom line is how one manages the lack of coterminosity. When it comes to the boundaries of clinical networks, the answer is to manage that lack at the new regional director of health and social care level, rather than at the SHA level. That would provide one step back to oversee the true strategic approach to managing that matter.

John Hutton (Labour, Barrow and Furness)

That is one suggestion, on which I will reflect. However, the consultation exercise, which ends on Friday, is for communities in the NHS, local authorities and the public at large to help us to get the decisions right now. It is important to get coterminosity with local authority boundaries right and to reach decisions that will reflect the natural referral patterns around clinical networks, to which the hon. Member for Billericay referred.

By definition, any organisational change throws up the possibility of upheaval. We want to minimise that disturbance, while getting the basics of decisions right. We will consider the hon. Gentleman's comments, but the role of the regional directors is further away in the back office than he might imagine. It may be helpful to him and other hon. Members if I set out my thoughts in writing.

The amendment has been designed to extract further comments from me on the nature of the boundaries for SHAs. However, the problem with the amendment—as, I am sure, the hon. Gentleman understands—is that if it were to be included in the Bill, it would necessarily require us to run a different consultation exercise. Given all that he and his hon. Friends have said today about not delaying the process unnecessarily and unreasonably—

Simon Burns (Conservative, West Chelmsford)

Not rushing it. [Interruption.]

Ann Widdecombe (Conservative, Maidstone and The Weald)

Order.

John Hutton (Labour, Barrow and Furness)

Thank you, Miss Widdecombe. I need protection from the bad boys on the Opposition Front Bench who sometimes misbehave. It is clear that the amendment tabled by the hon. Member for North-East Hertfordshire would strike out the present consultation exercise and require us to start again. I have explained the timetable by which we are currently operating. We intend that the changes will come through in October 2002 and take full effect from April 2003, but the amendment would make it harder to stick to that. The hon. Gentleman might not agree with that timetable—that is his prerogative—but, from my point of view, the amendment would delay progress of the reforms that we want to see.

Oliver Heald (Conservative, North East Hertfordshire)

I have two points to take up with the Minister, which I raised during my short contribution. The first concerns the regional aspect. If Hertfordshire and Bedfordshire were placed together, they would constitute a sub-regional group because they are a quadrant of the region. I forget the precise name—perhaps it is the western quadrant—but I note that an expert sitting not far from the Minister may be about to tell him the answer. According to Government thinking, will such sub-regional structures form the basis of the strategic health authorities? Is there a regional aspect to the matter? As the Minister will recall, the Democratic Health Network is keen to have such an aspect, as it clearly would be a good thing from its point of view.

Secondly, the Minister will recall intervening when the point was made that people in the west midlands are concerned that the strategic health authority might prove too large. What area and population will the west midlands authority cover? Will it be a large authority such as that for mid-Trent, to which he referred, with well in excess of 2 million people?

John Hutton (Labour, Barrow and Furness)

I do not have in front of me details on the proposals for the west midlands, but as our debate progresses I might be able to get that information. However, the ``Shifting the Balance'' consultation document made it clear that in establishing the two principles that we intend to follow, we will not allow the boundaries of strategic health authorities to cross Government Office boundaries. That is an important point, and further than that I am not sure I can go today. In a sense, the hon. Gentleman and his hon. Friends are asking me to announce decisions on certain strategic health authority boundaries. I cannot do so because consultation has not finished and it would be wrong for a Minister to pre-empt that process.

Simon Burns (Conservative, West Chelmsford)

May I seek clarification on something that the Minister said to my hon. Friend the Member for North-East Hertfordshire a moment ago, so that we do not get totally confused? In an earlier debate, the Minister said that, in effect, all PCTs would be in place by October 2002, when the system comes into effect. However, about three minutes ago—just before my hon. Friend's intervention—I think he said that although PCTs will be in place by October 2002, they will take full effect from April 2003. Assuming that I heard him correctly, I find that confusing.

John Hutton (Labour, Barrow and Furness)

I do not want ever to confuse the hon. Gentleman. I was referring to the first full financial year in which the arrangements will take place, which, obviously, is April 2003. The basis for the measures will not come into operation until October 2002, which is the half way point. I repeat that I was referring to the first full financial year.

Perhaps I am wrong, but I hope that my comments have been of some value to hon. Members who have raised these concerns. The amendment is completely unworkable and unacceptable. It would build rigidities into a system that, as the hon. Member for West Chelmsford himself has said, has a paramount need for flexibility. I urge my hon. Friends to reject it.

Simon Burns (Conservative, West Chelmsford)

You were not here, Miss Widdecombe, when, at the beginning of my remarks, I made it plain to the Minister that these were probing amendments, and, to be fair to him, he has fully acknowledged that fact. We are grateful for the further information that he has made available.

I should be the first to agree with the Minister that if the amendment were to be agreed to tonight, it would place any future Secretary of State, regardless of their political complexion, in a straitjacket. I sympathise with the Minister's comments that if one were two people short of 2 million, one would not be able to set up a SHA, which clearly would be ludicrous. That was not our intention in so far as we used the amendments as a vehicle to probe him, a process that proved illuminating and enlightening. In light of his response, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Ann Widdecombe (Conservative, Maidstone and The Weald)

Before we come to amendment No. 85, for the convenience of the Committee I should say that having examined the scope of the amendments and clause 1, I am not minded to have a stand part debate on clause 1. I am therefore happy for members of the Committee to go a little wide in the course of the debates on the following two amendments. That is not a general invitation.

Oliver Heald (Conservative, North East Hertfordshire)

I beg to move amendment No. 85, in page 2, line 7, at end insert—

`(c) A Strategic Health Authority shall only be established under paragraph (a) above provided that there has been consultation with general practitioners, nurses and other health professionals in that area.'.

Ann Widdecombe (Conservative, Maidstone and The Weald)

With this we may discuss the following amendments: No. 86 in page 2, line 7, at end insert—

`(cc) A Health Authority shall only be established under paragraph (b) above provided that there has been consultation with general practitioners, nurses and other health professionals in that area.'.

No. 87, in page 2, line 14, at end insert—

`and such an order shall only be made following consultation with health professionals, local authorities and other interested parties in that area as to the name proposed.'.

No. 88, in page 2, line 21, at end insert—

`and such an order shall only be made following consultation with health professionals, local authorities and other interested parties in that area as to the name proposed.'.

Oliver Heald (Conservative, North East Hertfordshire)

The amendments are designed to ensure that there would be consultation with general practitioners, nurses and other health professionals in the area concerned before the establishment of a SHA, or a health authority in Wales. The Minister has already said that there has been consultation with the public concerning the general concept, and that consultation, which is due to be completed shortly, is continuing on the boundaries of SHAs. The decision on the boundaries will be made in December of this year.

The proposed provision is designed not to duplicate that process, but to allow wider consultation on the establishment of a SHA. It would allow issues such as the impact of the changes on local implementation of the NHS plan, and other practical matters, to be dealt with on the basis that local practitioners can bring their common sense and experience of events in their area to bear on the decision. If a SHA was not ready for implementation, or if it would damage patient care to implement a SHA, it need not go ahead. The Government would know the worst and be able to react to it.

Worries are being widely voiced about whether the changes are for the best, and there is a long article about the subject in this month's Health Service Journal. The article cites commentators who take the view that the effect of these changes will be negative, and it points out that there seems to be an irresistible urge for Ministers to put their stamp on the NHS, often to political time scales that do not fit with time scales that would effect substantial and good-quality change in the system. The article quotes a professor of health economics at York university, Alan Maynard, who describes structural re-organisation as

``a wonderful substitute for change . . . It's displacement activity, a whole lot of smoke with everybody doing an awful lot, but nothing that creates change at all. You change the name, you change the sign on the door—what difference does that make to the service? Implementing real change is perhaps a 10-year enterprise . . . reorganisation distracts everybody—but does concentrate people's minds on the bottom line, which is `Am I going to have a job tomorrow?'''

Managers should be worrying about how to implement the NHS plan and other improvements.

The article quotes other people, such as Dr. Charles Webster, the author of the official history of the NHS, who states:

``I think the majority of reorganisational changes are done as a surrogate for spending more money.'' A battery of criticisms is being levied.

Simon Burns (Conservative, West Chelmsford)

Does my hon. Friend agree that, given the problems within the health service, with our constituents facing longer waiting time, problems with accident and emergency services and having to wait on trolleys, the Secretary of State for Health is confusing activity with action?

Oliver Heald (Conservative, North East Hertfordshire)

I am sure that that is right. The general flavour of the remarks that managers are making in the health service is that because the Prime Minister's promise to increase the spending on health up to the European average, which would involve spending, on one view, £35 billion a year more than we are at the moment, is unrealisable, we are having yet another reorganisation, and there is a developing cynicism out there.

The former head of press and publicity at the Department of Health, a man who has worked under Conservative and Labour administrations, has put it this way:

``I think they are in danger of disappearing up their own fundament.''

Simon Burns (Conservative, West Chelmsford)

Who is that?

Ann Widdecombe (Conservative, Maidstone and The Weald)

Order.

Oliver Heald (Conservative, North East Hertfordshire)

I should tell the Committee that it was Romola Christopherson.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman has changed Romola Christopherson's gender. She is a woman.

Oliver Heald (Conservative, North East Hertfordshire)

In that case, her comments carry even more weight. The Minister would no doubt agree that we should not suggest that her views are in anyway less important because of that. If anything, her experience working over all those years for both Governments gives her a unique position from which to comment.

Simon Burns (Conservative, West Chelmsford)

Unless Romola Christopherson has changed her position recently, I think that she now works in the press department at No. 10. She certainly went from the Department of Health to No. 10, which may be the cause of some of the problems between the Department of Health and No. 10 at the moment.

Oliver Heald (Conservative, North East Hertfordshire)

There obviously are problems, but I rather doubt whether they are the result of Ms Christopherson going there. It does say in the article that she has retired from the civil service, so it may well be that she is no longer working at No. 10, if she did previously.

The article also states:

``David Hunter, professor of health policy and management at Durham University, is concerned that `we don't seem to have learnt anything from the mistakes we made then . . . What is even more worrying is that at times of other changes, at least one or two parts of the system have been stable. This time, it's everything that's changing. It looks like a recipe for disaster.'''

Mr. Hunter makes the point, which I do not think has been made so far in this Committee, that about three years ago, the Secretary of State for Health at that time, the rt. hon. Member for Holborn and St. Pancras (Mr. Dobson), said:

``The last thing we want is a big bang reform''

of the NHS. Yet, here we are three years later having yet another reorganisation of the health service. It is hard to understand why the Government are taking this approach.

The Royal College of Nursing also has concerns that there should be a proper balance on the boards of the strategic health authorities, a point that it has made quite forcefully. Would the Minister be happy to see that happen? Clearly, the nursing profession has a particularly important role in that area.

The amendment proposes consultation before action. Does the Minister agree that, instead of airy-fairy consultation on broad principles, or simply looking at boundaries, what is really needed is to ask practitioners on the ground whether their area is suited to the changes? If they think not, let us not have a SHA and all the changes there, or let us leave it until the area is ready. As the Minister knows, we have always accepted that PCTs are a good basis on which to go forward provided that they are properly organised, have the staff that they need, and have had their budgets sorted out with everyone ready to start. The concern is that SHAs could end up being strategic about organisations that are not really strong enough to take the burdens that will be placed on them. I look forward to the Minister's comments on the amendments.

Andrew Murrison (Conservative, Westbury)

We have yet to discuss the position of academic medicine in the proposed changes. Academics have been highly critical of the Bill, and with good reason. They are not mentioned in it very much. If SHAs have a role, I should have thought that it would be heavily tied in with academic medicine. We have talked about the different sizes of SHAs and how they might link with tertiary centres. Tertiary centres are intertwined with academic medicine, and I am concerned that insufficient weight is being given to such links. That is certainly suggested by the different sizes that the Minister has implied will come out of the consultation process. If proper tertiary centres are not part of a particular strategic health authority, it will lack an academic focus.

We have progressed in recent years. Academic medicine is no longer solely the prerogative of teaching centres, but, nevertheless, there has been a drift back towards large centres in recent years. Funders seem to be more impressed by large centres, a situation that is likely to continue. Referring from convenience to the south-west, the minnow SHA covering Somerset and Dorset would lack such a tertiary centre, and a proper focus of academic medicine. I am concerned that academics' views and worries about being sidelined are not being properly registered. I hope that the Minister will bear in mind the needs of academic medicine in this country. If SHAs have a role—some doubt is emerging about that—promoting academic medicine in their areas might be it.

Richard Taylor (Independent, Wyre Forest)

The amendments place me uncomfortably on the horns of a dilemma. This week's Health Service Journal tells us that there is an absolute plethora of consultations. They are running at the rate of about one a week. Much as I want to see meaningful consultation, as alluded to by the amendments, it is difficult to square that with the current tremendous rate of consultation. Consultation is getting into bad repute because it is so often on a preferred option, and that option often succeeds. I believe that there were 32 consultations last year. Can the Minister tell me, now or at a later date, how many of those had a preferred option, and how many of them overturned that option? It would be reassuring if we could sometimes see that consultation was meaningful and overturned the preferred option, which may not be the best one.

Amendments Nos. 87 and 88 mention consultation with

``local authorities and other interested parties''.

Something that we risk losing with the abolition of community health councils is their role as statutory consultees. Will they be replaced with other statutory consultees?

Andy Burnham (Labour/Co-operative, Leigh)

The setting up of SHAs is an extremely important step. They will play an important role in working across an entire region to raise the general standard of health and to tackle the fundamental problems, such as health inequalities, that were bequeathed to us by the Conservative Government. For example, they will play a key part in consultations with regional development agencies.

The problem with the amendments is not their principle, but the fact that they are too narrowly drawn in focusing first on NHS staff and health professionals and, secondly, on the name proposed for the SHA rather than more widely on its boundaries. That does not reflect current practice in the health service, where there is wide consultation not only within the profession, but across community, local and voluntary groups. There may be a case for enshrining that good principle in legislation.

Perhaps the Government might consider amendments that, instead of focusing too narrowly on health professionals, would require consultation with the range of bodies that are affected by the creation of SHAs.

Simon Burns (Conservative, West Chelmsford)

That was an interesting speech. The hon. Member for Leigh (Andy Burnham) gives the distinct impression that he supports the idea of consultation, but thinks that the trouble with the amendments moved by my hon. Friend the Member for North-East Hertfordshire is that their scope is too narrow in terms of who would be consulted. I assume that he has conceded the principle of the amendments but thinks that their scope should be widened. Carrying that to its logical conclusion, if we pressed them to a Division he would support us with the proviso that, if they were accepted, he would try to amend them on Report to widen their scope so that they were 100 per cent. consistent with his views.

Andy Burnham (Labour/Co-operative, Leigh)

The real problem with the amendments is that they do not reflect current practice in the NHS and in Richmond house. They are far too narrowly focused on health professionals and NHS staff. The hon. Gentleman cannot have been listening when I said that SHAs will have an impact far beyond the NHS, especially in terms of regional government and regional development agencies. I do not support the amendments, but I do not think that the Minister would have a problem with them in principle.

Simon Burns (Conservative, West Chelmsford)

I am most grateful to the hon. Gentleman. I had forgotten that he is sitting next to a Government Whip, so no doubt he had to put it on the record that he had overstepped the mark and was heavily backtracking to remain within the bounds of the controls.

My hon. Friend the Member for North-East Hertfordshire has moved some important amendments today and, unlike the hon. Member for Leigh, he is right because it is crucial that when an important new structure with the vital role, as the Government keep telling us, of the strategic overview of health care provision throughout the country is set up, there should be consultation within the local community. Perhaps, as the hon. Gentleman said, we have been a little modest in suggesting who the consultations should be with. Perhaps the amendments are right in principle and would enhance and improve the Bill, but need to be considered further at a later stage to ensure that we have not missed out any people or organisations that should be included in the consultation process. I presume that the Minister will also be sympathetic to the amendments, even if he believes, like his hon. Friend, that they are a little narrow in suggesting who should be consulted.

There is a similar precedent for consultation. At the beginning of the debate, Miss Widdecombe, you kindly said that we could go slightly wide of the amendments, but I assure you that I do not seek to test your patience and I shall watch you very carefully so as not to overstep the bounds. I am trying to explain that there is a precedent. During the proceedings of the Health Act 1999, Miss Widdecombe, you were the shadow Secretary of State for Health and leading for the Opposition. You will be familiar with the fact that when the Government set up the PCTs they were anxious that they should emerge as voluntary organisations after full consultation with the local community. We are setting up new groups or structures within the health service and there is a precedent for the SHAs--the original powers taken by the Government to set up the PCTs and PCGs in 1999. I am sure that you will remember, Miss Widdecombe, that the then Minister of State, ironically, Standing Committee A, during the afternoon--there are many similarities that I hope will keep me in order--on 27 April 1999, said:

``Given some of the comments that have been made, it is important to emphasise that we do not intend a headlong rush''--

We have heard a lot about headlong rushes today, particularly this morning--

``to be made into PCTs and that it is not a part of our agenda to impose PCTs on the national health service.''

This is my point:

``We want measured and voluntary change, and progression to trust status that is driven locally and based on local views. Full and proper consultation must therefore always occur before a PCT is established, and due consideration should be given to the views of a full range of local stakeholders.''--—[Official Report, Standing Committee A, 27 April 1999; c. 252.]

The then Minister, like the hon. Member for Leigh, had a broader vision of the bigger picture than I have, and that is my fault. The hon. Gentleman's criticism is that our amendments are too narrow, and I accept that. I plead guilty.

Oliver Heald (Conservative, North East Hertfordshire)

It is only right that I should plead guilty, because I drafted the amendments. Does my hon. Friend agree that the reason for choosing those particular stakeholders was because the Royal College of Nursing had said that it was worried about the time scale envisaged for the proposals, which talked about new organisations. It was concerned that the programme was ambitious and the BMA—the doctors—said much the same. It used the words ``ambitious timetable''. Those concerns came to us, but I accept that I may have drafted the amendment too narrowly.

Simon Burns (Conservative, West Chelmsford)

My hon. Friend is right to draw attention to those important views from outside bodies whose members are working day after day in the health service and who have a far greater comprehension of what is going on than any politician.

Although the Minister was referring to PCTs, the precedent exists and we strongly believe, as does the hon. Member for Leigh in a wider way, that the same criteria for consultation, discussion and consent should apply to the SHAs before they are established. Given the power of our arguments, I hope that the Minister would be prepared to accept the pleading from his hon. Friend, and from us, and agree to the amendments as a halfway house, or building block, that can be improved on, enhanced and expanded by the Government on Report. The Government could use their majority to ensure that we improve the Bill in such a fashion.

John Hutton (Labour, Barrow and Furness)

This has been a useful debate and I thank all hon. Members who have taken part. The hon. Member for West Chelmsford asked me to take into account the arguments of my hon. Friend the Member for Leigh, which I am prepared to do because he made a good case with good arguments. I should also say that I am grateful for that, just in case, with the Whip sitting next to him, I cause any problems, but I am not trying to encourage other hon. Friends. I want to put what I am saying on record because I do not want to be disingenuous to the hon. Member for North-East Hertfordshire who moved the amendment.

My hon. Friend is right. The architecture of the Bill includes a duty on the Secretary of State to set up SHAs, so we must be clear that the Bill will require him to do that anyway. He is right about the principle of consultation and the argument must take place in that context. We believe, and I hope that the Committee will endorse the view, that it should be a statutory duty to set them up. We could not pull the rug from under the Secretary of State and say that they cannot be set up under certain circumstances. The proposals are coherent.

SHAs should cover every part of England, but I accept the point made by my hon. Friend that the National Health Service Act 1977, or any other subsequent piece of legislation, which the Conservative had 20 years to change and amend, does not require consultation on the establishment of health authorities, and it never has done. Currently, the Secretary of State is required to establish health authorities under statute. My hon. Friend is right to draw attention to the fact that previous Governments, as well as this one, have operated the practice of consulting the public, professions in the NHS and groups outside on proposals to change the boundaries of health authorities; mergers are an example. We are in the middle of consultation now about the establishment of the new SHAs.

I could not accept the suggestion of the hon. Member for West Chelmsford that we should consult on the principle of establishing SHAs because we believe that that should be covered by an express duty on the Secretary of State. As suggested by my hon. Friend the Member for Leigh, there is scope for considering consultation processes under the Bill in respect of changing the name of health authorities and the boundaries and mergers of SHAs. I am prepared to reflect further on that and consider amendments on Report if necessary. The principle, to which my hon. Friend referred, is important and I am happy to consider it further.

I am prepared to reconsider how the proposals will affect SHAs in England, but I cannot accept the amendments as they would apply to Wales, for two reasons. First, those are devolved matters. This House has given responsibility for them to the National Assembly for Wales, and we should respect that devolution settlement, not seek to fetter the Assembly's powers in that way.

Secondly, more practically and perhaps importantly, the health authorities in Wales will be abolished by 2003 anyway. There seems little point in establishing such consultative proposals for bodies that will be scrapped in Wales in 18 months' time. With that caveat, and bearing in mind my hon. Friend's request to look at boundary changes and name changes, I can tell the hon. Member for North-East Hertfordshire that we will reflect further on the matter and table an amendment, if possible, on Report. I hope that, in that spirit, he will not press the amendment.

Oliver Heald (Conservative, North East Hertfordshire)

The Minister's approach has been constructive. I join him in congratulating the hon. Member for Leigh. His viewpoint met us halfway and encouraged the Minister to move further as well.

The Minister has not gone the whole distance, as we would like him to. He says that he will consider placing consultation requirements in the Bill, which is welcome, and he mentioned consultation on names and boundaries. However, he did not agree to consultation on practical matters such as whether an SHA could deal locally with robust arrangements that were ready to be put in place, or whether the timing was right. Many concerns expressed have been on such matters as insufficient staff for PCTs and arrangements not being fully in place, as we have discussed, for a start in October or even in April 2003.

I should like to press the Minister further. Is he simply agreeing to consultation on names and boundaries with the wider group of people mentioned by the hon. Member for Leigh, or is he prepared to consider consultation on some of the more practical issues that I raised about whether local arrangements are ready for the changes to be implemented, whether staffing of PCTs is sorted out and so on? In other words, is he prepared to find out from doctors, nurses and local people whether the proposals can, practically, be implemented?

John Hutton (Labour, Barrow and Furness)

I have probably gone as far as I can today in giving commitments to the Committee to re-examine the proposals. I shall certainly reflect on what the hon. Gentleman has said, but I repeat the point that I made at the outset: there will, I hope, be a statutory duty to establish SHAs, and I would treat with extreme caution any proposal from the hon. Gentleman that that should somehow be subject to caveats, or made conditional upon another range of circumstances. The Secretary of State will have to be satisfied that the SHAs are capable of delivering the functions that he has in mind for them. That is his responsibility, and he must discharge it. I have gone as far as I can on areas where we can look at amendments to the Bill.

Oliver Heald (Conservative, North East Hertfordshire)

We have seen some progress on the amendments, so, in that spirit, it would be right for me to withdraw them. I hope that the Minister will consider what the BMA and the RCN have said. Obviously, if the representative bodies of the two main health professions combine to say that they are worried about the time scale for arrangements being enforced, that is a matter for concern. We hoped that this consultation process would be a way, not of second-guessing the Minister, but of ensuring that local services do not collapse, with inadequate management, causing a deterioration and the delay of much of the progress that we hope to see during the coming years. I hope that the Minister will think further on the matter; he has said that he probably will. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Simon Burns (Conservative, West Chelmsford)

I beg to move amendment No. 90, in page 2, line 33, at end insert—

`(2A) Subsection 126(1) of the 1977 Act is amended by the insertion after the word ``Parliament'' of the words ``; save that no statutory instrument shall be made under section 8 above unless a draft of the instrument has been laid before, and approved by resolution of, each House of Parliament.''.'.

The amendment is very straightforward. As is patently obvious, we are seeking to reverse secondary legislation procedures that will set up SHAs. Unless I am mistaken, there are 58 separate order-making powers—[Interruption.] My hon. Friend the Member for North-East Hertfordshire tells me that it is slightly less than 58, but, in any event, the vast majority of the considerable number of order-making powers in this legislation are negative procedures.

At this point, I will offer to do a deal with the Minister. I will not mention issues that some of his right hon. Friends may have supported in 1983 or in 1987 if he agrees not to offer the bog-standard ministerial response that the Opposition did not do things in the way that I am suggesting when in government. Life has moved on and people have changed their views on certain issues. I shall explain why I have changed my views on the Bill after the Minister has intervened.

John Hutton (Labour, Barrow and Furness)

Why is the hon. Gentleman so reluctant to talk about the record of his party in government? He is right to say that life has moved on; he is sitting on the Opposition Benches and we are sitting on the Government Benches.

Simon Burns (Conservative, West Chelmsford)

I shall not digress, except to say that I was not talking about the Conservative Government. I said that I would do a deal with the Minister; unless he advances the hackneyed argument that most Ministers advance these days, I will not remind him that his right hon. Friend the Prime Minister fought the 1983 general election on CND's platform of withdrawal from Europe.

Ann Widdecombe (Conservative, Maidstone and The Weald)

Order. CND has no relevance whatever to amendment No. 90, which is concerned with procedures for draft instruments.

Simon Burns (Conservative, West Chelmsford)

I am extremely grateful for that guidance, Miss Widdecombe, because it helps me make the point that life has moved on and that issue is no longer relevant. I hope that the Minister will not offer the hackneyed arguments to which I have referred, but will instead advance an intellectually coherent argument against the amendment—I am sure that he does not accept it—based on reasons why the negative, rather than the affirmative, resolution should be used.

You have graciously and kindly said, Miss Widdecombe, that our debate can go slightly wider, but I shall be careful not to abuse your generosity. As you would have realised had you been here this morning, and as anyone who has studied the clause will realise, it sets up an important new or reformed structure in our health care system. We have argued time and again this morning and this afternoon—I can assure the Minister that we will do so again in respect of clause 2—that the Government are rushing far too quickly into imposing the new structure on the health service. In a spirit of helpfulness, we are urging a more cautious approach that ensures that proper foundations exist on which to build their aims. One way to do that is to accept the amendment, which would reverse the onus to enact secondary legislation through the negative procedure.

This morning, my hon. Friend the Member for North-East Hertfordshire pointed out to the Minister that in one particular Session, there were more than 2,000 negative resolution statutory instruments, of which only 30 or 31 were debated in Parliament. Putting legislation into the negative format gives the Government carte blanche. The way in which the system works in terms of secondary legislation means that it is extremely difficult to find parliamentary time for such matters, especially if the Government are determined to restrict and hamper the Opposition's ability to express an opposing view in Parliament.

It is important for democracy, and it is important for the NHS, that we have affirmative procedures, in which case the order setting up the SHAs would have to be debated in both Houses of Parliament. There would be an opportunity for Members, and those in another place, to scrutinise line by line, as we are doing to the Bill, a far-reaching proposal, which would ensure that the Government have got it right. Even at that late stage, they would have the opportunity to advise or warn the Government if they discovered that there were faults and flaws in their proposals. Once the Government recognised the strength of the case, they would have the opportunity to rectify the problem before inflicting a flawed piece of legislation onto the NHS.

Peter Atkinson (Conservative, Hexham)

My hon. Friend points out an important aspect of the Bill. In clause 1, the Secretary of State is taking substantial powers to

``vary the area of a Strategic Health authority . . . abolish a Strategic Health authority . . . establish a new Strategic Health Authority''.

If that were done against the will of local people there would be an enormous argument. If, for example, the Secretary of State decided that Chelmsford should be welded into east London, many of my hon. Friend's constituents would become angry. That could be imposed without representation being made unless the Secretary of State was to accept a prayer against that resolution. That is wholly undemocratic.

Simon Burns (Conservative, West Chelmsford)

My hon. Friend is right, and he anticipates a point that I was seeking to move onto during the course of my remarks. Clause 1 contains substantial powers for the Secretary of State, and he can exercise those powers notwithstanding the Minister's generous concession during our debate on the last group of amendments. It would be a step forward if, on Report, the Minister were to come up with proposals that were acceptable to the House, and they were embodied in the Bill; what a paradox.

The Minister is in a conciliatory mood today, and he has listened to my arguments and those of my hon. Friend the Member for North-East Hertfordshire and the hon. Member for Leigh. He has seen that there is reason to look further, and he may come forward with amendments on Report. It is unusual for the Government to concede a point in Committee to the Opposition, and it is very unusual for a Government Back Bencher to contribute to the debate. However, when such a Back Bencher hits the jackpot and comes up with an idea that the Minister thinks is worthy, that is a bonus, so it must have merit.

The Minister could go away and return with a set of proposals that, for the sake of argument, we might find acceptable. If they were then included in the Bill, the Minister will have increased the powers of consultation on a number of issues that are vital to local people, communities and organisations that are directly affected or which have an interest in strategic health authorities and health care in their region.

That would be a step forward, but the contradiction is that the powers in the same Bill allow the Secretary of State to ride roughshod over the results of any local consultation carried out in good faith if he is not minded to accept the advice or the views that are thrown up during the consultation process. That seems extraordinary. We must be consistent; the consistent approach, given the Minister's earlier statement, is that the Secretary of State should be held to account.

The affirmative resolution procedure could be described as consultation because a Committee of Members of Parliament—reflecting all views and parties, and able to be consulted—have the opportunity to contribute to the debate and decide whether to vote for the order to become law so that the SHAs can be established as the Secretary of State has specified. Alternatively, it could be thrown out--a statutory instrument cannot be amended--and the Secretary of State could be told to look at the matter again because he has got it wrong or is acting in contradiction of the views of local people following the consultation. He could then start again from scratch and return to the matter in the House and in another place.

Oliver Heald (Conservative, North East Hertfordshire)

Does my hon. Friend agree that the section 60 power in the Health Act 1999, which provides wide order-making powers in health matters, has recently been used successfully to allow consultation and the views of those who are not Members of Parliament to be heard? The draft Nursing and Midwifery Order and the draft Health Professions Order were considered yesterday and representatives of the nursing profession, the midwifery profession, health visitors and so on with particular views were able to express them and to lobby Members of Parliament. The same applied to chiropodists and podiatrists who were unhappy with aspects of the Health Professions Order. If such bodies have concerns, it is better, when the time comes for a decision to be made, if they can make representations. The Royal College of Nursing and the BMA both have worries, so would that not be the best approach?

Simon Burns (Conservative, West Chelmsford)

Again, my hon. Friend is absolutely right and I hope that the Minister was listening carefully to the powerful way in which he made his case. It is important that not only Members of Parliament, but outside organisations connected with health care and the national health service have the opportunity to input their views on the proposals in draft legislation, whether primary or secondary legislation. It is equally important that they believe that their views have been considered and given a fair chance. If the Government do not agree with their views, and if both Houses of Parliament do not share those views, it is only right that the orders should go on to the statute book. However, there must be that power to determine whether the Government are right. I warn the Minister that this is the first of several debates about this issue, because most of the order-making powers in the Bill are subject to the negative resolution procedure and most deal with important matters. I hope that he will think carefully about that.

Peter Atkinson (Conservative, Hexham)

It has suddenly occurred to me that my hon. Friend's advice to the Minister is not in the best interests of the Opposition. Most Members of Parliament know that once they interfere in local politics, they are likely to get their hands bitten hard. In this case, the Secretary of State will become a referee between several warring factions who think that boundaries should be somewhere other than where he has decided. Ultimately he will have to adjudicate, thereby becoming deeply unpopular. If he followed my hon. Friend's advice, he would at least avoid some of that flak.

Simon Burns (Conservative, West Chelmsford)

I fully understand my hon. Friend's point and would not want to be a Secretary of State placed in the position that he describes. However, I am afraid that, on this occasion, I cannot agree with my hon. Friend. Democracy, proper consultation and the opportunity fully to debate and consider legislation is more important than the situation in which an individual Secretary of State might find himself.

Too much legislation, especially secondary legislation, is going through the House on the nod. That does a disservice not only to the bodies and organisations that are directly affected by it, but to the working of this place. It also builds up the frustration of interested parties whose lives are affected either by the work that they do in those organisations or through the representative role that they play. Many organisations feel that they are being ignored, bypassed and sidelined on issues that are crucial to many people.

In the light of that, I hope that the Minister will have an open mind and be prepared to think again. I leave him with one thought. When Labour in opposition between 1992 and 1997, many of his colleagues who were then on the Front Bench—I am ashamed to say that I do not remember if he was one of them—made the same speech in Committee against my Government that I have made today against his Government. They spoke passionately and with conviction and belief, but they were frustrated. The Minister must know what we are going through, and I hope that he will want to try to stop that ping-pong effect between the Government and the Opposition.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

First, I apologise for my late arrival in this afternoon's sitting. I said this morning that as I believe that the whole clause is fatally flawed I do not have much to say about amendments that seek to make it better. I was surprised to find that there is some compromise in the air regarding consultation. I was also surprised, but delighted, to see you in the Chair, Miss Widdecombe. I remember the times that we spent debating the Health Act 1999, sometimes with the Minister. That is where I learned how to deal with Standing Committees. If I perform badly, it will not be a reflection on what I learned from you, Miss Widdecombe. I enjoyed the experience a great deal.

I am somewhat hampered, in that I understand that there may not be a stand part debate. I do not argue with your decision on that, Miss Widdecombe, but I regret it because we have not had an opportunity to debate the fundamental problem—the abolition of health authorities and the creation of larger beasts called strategic health authorities—that none of the amendments tackle. In so far as I am in order, I will attempt to make a few remarks on the order-making powers during discussion on the amendment.

Simon Burns (Conservative, West Chelmsford)

The hon. Gentleman has been a member of the Committee since its inception. If he does not feel that any amendments deal with the fundamental issue to which he refers, why has he not tabled amendments to deal with it?

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The amendment that I would like to table is one that deletes clause 1. I can support that principle by voting against clause 1 on the stand part vote, so amendments are not required. I made that clear earlier, and I am sorry that the hon. Gentleman did not understand my point. I make it again now. We can have long debates about improving something that is fatally flawed, but it is important to come down to the nub.

Oliver Heald (Conservative, North East Hertfordshire)

On a point of order, Miss Widdecombe. As one or two hon. Members were not present when you made your ruling, it may be convenient for the Committee if you confirmed that you would allow considerable latitude in the discussion of the amendments.

Ann Widdecombe (Conservative, Maidstone and The Weald)

I am not sure whether my words were ``considerable latitude''. I said that, having examined the scope of the amendments and the clause, I was not minded to allow a stand part debate and that, in the light of that, I was prepared to allow discussion to go slightly wide. I stressed that that was not a general invitation to discuss anything and everything. If the hon. Member for Oxford, West and Abingdon wishes to make remarks that are slightly wide, that will be in order.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am extremely grateful to you, Miss Widdecombe, and to the hon. Gentleman, for that clarification. On Second Reading I made several remarks that I would otherwise have made in a stand part debate, and I do not intend to take up the Committee's time by repeating them. I should be grateful if you would bring me to order should I step beyond the latitude that you have so kindly and wisely granted.

I agree with the principle that it is correct when scrutinising legislation to ensure that the Government are not taking the easy path with the negative procedure for statutory instruments. When we discuss other order-making powers in the Bill, there will be occasion to raise that. The remarks of the hon. Member for West Chelmsford are reasonable in general, but this is not the order-making power upon which to go to war over negative and affirmative resolutions. If every change that was conceived had to go to a Standing Committee, we would spend much time looking at minutiae and miss the bigger picture, and that would, to a certain extent, play into the Government's hands.

The wider picture is yet another example of the continual upheaval in the health service, with the loss by local health authorities of their strategic functions to a much larger body with which local people will find it hard to identify. Although there will be coterminosity, in that we are told that an SHA's wider boundaries will not cross the boundaries of the local authority or the regional office, there will still be a loss, certainly for counties, when, for example, the Oxfordshire health authority that people know so well and sometimes love—or sometimes hate—is removed. It cannot be replaced, even with greater consultation over SHAs and PCTs.

Any gain is lost if the clause is passed, so I do not think that asking for affirmative resolutions when boundary changes occur is especially helpful. There will always be arguments about what the boundaries and the name of the SHA should be. In the end, the Government have to make a decision, and will, presumably, be indirectly held to account for it.

As the Government are taking broad powers to make changes, it is appropriate to question why the Government want to devolve responsibilities to PCTs, which for all their localness, do not have the same understanding of and identity with local communities that health authorities have. Health authorities are population-based groups, whereas PCTs, by definition, cover those people on the list of GPs in the area. While they may be smaller than health authorities, they lose a lot in terms of accountability.

In the areas that I know of, the names of the PCTs do not necessarily follow those of natural communities. The Government will have difficulties naming SHAs under some of the powers that the amendment is discussing, when trying to identify natural communities.

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman is not right in what he said about primary care trusts. PCTs come in various shapes and sizes. For example, the PCT that covers my constituency is coterminous with the previous boundaries of the health authority.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The concept of the boundary of the PCT is a curious one. As I understand it, the people served by the PCT are those who fall within the ambit of the primary health care services in that area. Indeed, one of the arguments for the establishment of the PCT was the focus that the Government want to give to primary care to have a greater role in commissioning outwith health authorities. Health authorities cover geographically defined areas, and there will be some significant overlap in population terms between PCTs, simply because they are at the boundaries of conurbations. I do not know whether the Minister —

John Hutton (Labour, Barrow and Furness)

The hon. Gentleman is right on that point, but he is wrong in assuming that there is no possibility of coterminosity between PCTs and health authority boundaries. Often there will be. Some PCTs are set up on the same boundaries as health authorities.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Presumably they have seen the virtue of that conterminosity with the commissioning population. Therefore, if commissioning is the key—certainly some of the functions of the commissioning and overseeing of services—I would prefer to see that done and supervised on a population-based approach.

John Hutton (Labour, Barrow and Furness)

Once again the hon. Gentleman has missed one important factor—the PCTs are established following local consultation. I accept his point about the boundaries sometimes being a mysterious process, but whatever the boundaries are, they are informed by the strength of local opinion, particularly with the GPs and in primary care.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

There would be more merit in that argument as a total rebuttal if the formation of PCTs was an option that local populations could choose following consultation. But the Bill, and specifically the next clause—which I will not deal with now—does make that compulsory, and therefore less of a consultative issue.

It is relevant to the discussion to ask the Minister for clarification on a matter that he raised earlier, which we could not discuss then. He provided a clarification note about the functions currently conferred on health authorities and transferred under the Bill in the main to PCTs and, in one example, to SHAs, with regard to which he has an order-making power, which we are discussing here.

Personal medical services and personal dental services will be transferred to SHAs because, as the Government explain in their note, technical and legal barriers prevent the direct conferral of all PMS and PDS functions to PCTs in the Bill because the National Health Service (Primary Care) Act 1997 requires a distinction between the commissioner and the provider of PMS and PDS pilots. I understand that. I was concerned about the loss of the purchaser-provider split when PCTs were going to be doing the providing, as well as the commissioning and running themselves.

Does the Minister think that there is an argument for ensuring that more of those services, particularly the management of family health services and general medical services, might have been transferred to a SHA rather than to a PCT, where there will be a concern that it is the people against whom there may be complaints and general issues of performance who are in charge of managing that performance.

John Hutton (Labour, Barrow and Furness)

It is important that those services should be as close to the front line as possible. That is why we have taken the decision on the point he mentions. Personal medical services are particularly difficult because some PMS pilots are directly provided for by PCTs and it is important to respect the commissioner-provider divide. That is regulated under clause 4, so I am sure that we will have an opportunity to discuss it later.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

On that basis, I shall not pursue it any further now.

On Second Reading, I raised the question of the public health function. Concerns have been raised and while there is certain support for the concept of moving the public health function from local health authorities to PCTs, concern has also been raised about the loss of expertise and people through that change, and the loss of a strategic overview because SHAs will be much larger and will have a rival in the shape of a more local director of public health. How will the Minister ensure that we do not lose the effective public health function? I hope that he will accept that it has been performed well at health authority level so far. In respect of infectious disease control and other matters, the regimes are tried and tested at that level. It would be unfortunate if, despite gaining the benefits that the Minister claims for this move, the public health function was lost. There is a question over whether sufficient specialist expertise exists in public health to provide the function under multiple PCTs, rather than under a single health authority.

I am grateful for your patience, Miss Widdecombe, in allowing me to stray beyond the exact boundaries of the amendment. I shall seek a Division at least on clause 1 stand part and, because of our concern about change for the sake of it and appearing active to hide failure to deliver, my party cannot support what amounts to vandalism of the health service.

John Hutton (Labour, Barrow and Furness)

I will reply to some of the points made by the hon. Member for Oxford, West and Abingdon (Dr. Harris) shortly. On public health, he may have missed my earlier attempt to clarify those points. I hope that he will not take offence, but I will send him a copy of my earlier remarks rather than attempt to repeat them. There may be video too, but he would not want to watch that.

On both sides of the Committee, there must be a sense of deja vu about these debates. The hon. Member for West Chelmsford is probably right to say that in opposition my colleagues have tabled similar amendments to those tabled today. During every Bill for which I have ever had responsibility in Committee, amendments have been tabled that seek to do broadly what the hon. Gentleman has tried to do.

I say to the Committee, and particularly to the hon. Member for West Chelmsford—he dealt with similar arguments as a Minister—that my job is to strike the right balance between order-making powers that should be subject to affirmative procedures because of the issues that they raise and those issues that can be dealt with by negative procedures. It is legitimate for hon. Members to disagree with that, but it would wrong for the hon. Gentleman to imply that because I have made a decision on such powers my motive is to sideline Parliament or ignore the parliamentary process to get what I want in a back-handed way. That would not be true.

I have always tried to discharge that aspect of my responsibility to the best of my ability. I recognise the responsibilities that we have to Parliament, to the House and to the democratic process, which we all hold dear. I do not appreciate the hon. Gentleman's suggestion that these clauses have been cobbled together in a deliberate attempt to sideline Parliament because that is not the case.

However, I welcome the hon. Gentleman's new-found role as guardian of the constitution, and he performed it well. It is also appropriate for us to point out what he rightly described as some inconsistencies. This is not all one-way traffic and although he might like a polite veil to be drawn over the record of the Administration in which he served, I am not prepared to do that.

In the context of these debates, it is necessary to compare and contrast. It is perfectly reasonable for me to make the point that if the hon. Gentleman were standing in my shoes—admittedly, it would be a different Bill—I doubt whether he would have drawn the line between affirmative and negative resolutions in any place other than where this Bill has drawn it. It is a question of balance and judgment, and Ministers are accountable in that regard. If the hon. Gentleman were to have ministerial responsibility again, I very much doubt whether his conversion would be translated into action such as that proposed in the amendment.

I should draw the hon. Gentleman's attention to one other point about the amendment that explains why I am unable to accept it. As I understand it, it would require that affirmative resolution procedures be followed in relation to any order to vary the establishment orders, including any order that transfers staff, property, rights or liabilities under this provision. The Opposition Whip, the hon. Member for Hexham (Mr. Atkinson), is present, as is the Government Whip, my hon. Friend the Member for Poplar and Canning Town (Jim Fitzpatrick), and it is incumbent on us as Members of the House to consider whether it is a sensible use of our time to make such matters subject to the affirmative resolution procedure. As the hon. Member for Oxford, West and Abingdon rightly said, this is not a die in the ditch issue, and I am sure that in his heart of hearts the hon. Member for West Chelmsford probably realises that. On this occasion, he has chosen the wrong issue about which to make such points.

There is a sense of ritual familiarity about these arguments, and I do not dispute the passion with which the hon. Gentleman holds his views on the constitutional propriety of this or any other point that he has made, but this was the wrong issue to which to address his concerns. As I have said, the clause deals with the negative resolution procedure in a sensible way and I hope that my hon. Friends will support that view and reject the amendment.

Simon Burns (Conservative, West Chelmsford)

I have listened to the Minister's comments and, naturally, I am disappointed. I thought that, like a number of sinners, he might feel that he could repent, but it is clear that he is not prepared to do so on this occasion. Regrettably, therefore, this is a missed opportunity. I am being in no way derogatory, but the Minister seemed a little sensitive to the apparent suggestion that he was seeking to sideline Parliament. I might so accuse a number of his colleagues, but I would not aim that accusation against him on a personal basis.

John Hutton (Labour, Barrow and Furness)

I did not assume that the hon. Gentleman was making personal comments.

Simon Burns (Conservative, West Chelmsford)

I am grateful to the Minister for that reassurance. Although I am disappointed that he is not prepared to accept the amendment, I do not wish to press it to a Division at this stage. I should like first to read the official record, reflect on what the Minister has said and consider our position.

Amendment, by leave, withdrawn.

The Chairman, being of the opinion that the principle of the clause and any matters arising thereon had been adequately discussed in the course of debate on the amendments proposed thereto, forthwith put the Question, pursuant to Standing Orders Nos. 68 and 69, That the clause stand part of the Bill:—

The Committee divided: Ayes 9, Noes 6.

Schedule 1 - English Health Authorities: change of name

John Hutton (Labour, Barrow and Furness)

I beg to move amendment No. 95, in page 47, line 5, at end insert—

``In section 125 (protection of members and officers of authorities), before paragraph (a) there is inserted—

`(za) a Strategic Health Authority;'.''.

Ann Widdecombe (Conservative, Maidstone and The Weald)

With this it will be convenient to take Government amendment No. 96.

John Hutton (Labour, Barrow and Furness)

I acknowledge that the amendments are extensive, but they are technical and minor. They simply tidy up loose ends to ensure that references to health authorities in a wide variety of statutes are fully reflected in the Bill. I can assure the Committee that they raise no substantive policy issues.

Simon Burns (Conservative, West Chelmsford)

I am grateful to the Minister for his explanation. I am not a lawyer, but it seems even to me that the amendments are heavily technical. I have one question. Why have they been tabled now rather than being included in the Bill when it was published? Is it simply because some events have moved on, creating a new need, or was there an error at the time, leaving them genuinely forgotten? Such things often happen in the drafting of legislation.

John Hutton (Labour, Barrow and Furness)

I am sure that the hon. Gentleman does not expect me to say that they were forgotten.

Simon Burns (Conservative, West Chelmsford)

They could have been.

The rest of the debate is in Hansard.