Healthcare

Lord Rea Excerpts

Thursday 28th October 2010 Lords Chamber

[Lord Rea]

My Lords, I will use my four-minute slot to talk about the role of health professionals—one of the aspects mentioned in the noble Lord’s Motion. I am a former cog in the NHS machine, so I have some knowledge of working there. When my noble friend Lord Darzi spoke of increasing the involvement of clinicians in NHS decision-making about three years ago, he was thinking of drawing on their experience of the realities of front-line medicine and surgery. Now what is proposed is the greater involvement, especially of GPs, in the complex process of commissioning care. This requires many skills which are outside the training and interest of the majority of practising doctors. It is true that many PCTs are not up to speed and we have heard that some of them are remote.

The final report of the Health Committee of the previous Government said that PCTs,

“employ large numbers of staff, but”,

too many are not of the required calibre. It went on to say that PCTs need to become, “better at collecting data”—for example, on the needs of their population—and at analysing them. That is not a very flattering remark, but are these weaknesses enough to justify closing down all PCTs and replacing them with GP-led consortia, with all the upheaval and chaos—not to mention expense—which is caused by such a major reorganisation? I think not, because the skills in which the Select Committee found PCTs to be weak are not skills possessed by the average practising GP, whose training lies in assessing and treating the health problems of individual patients and families.

Of course, some have developed a wider outlook and are interested in public health and preventive medicine, and some have considerable entrepreneurial skills, as the department knows well, but these are a minority. The expertise needed properly to commission healthcare for a given area includes an ability to assess the health needs of whole populations, not simply those on GP practice lists, as well as managerial and planning skills—the very skills which the Select Committee found wanting in many PCTs. GP consortia are likely to have the same or greater shortcomings, even if they re-employ all the most expert staff now working for PCTs because of the disruption of working relationships which will follow the abolition of the PCTs. Also, staff with these skills are those whom the newly empowered directors of public health—which, with provisos, I greatly welcome—working with local authorities, will require to assist them in their enhanced new role in local government, so there will be competition for staff with the appropriate training and expertise.

As the noble Lord, Lord Hunt, said, independent consultants and healthcare firms are waiting to step in to fill the breach—at a price, of course. Sometimes one wonders whether this was the main purpose of the whole exercise. Perhaps it is too much to hope that the Government might think again considering the very hostile reception that this proposal has received from nearly all health professionals and health think tanks, including the King’s Fund. In the final seconds of my speech, may I ask the noble Earl whether he can assure us that the newly empowered directors of public health, who will be working with local councils, will be fully funded, that this funding will be protected and that they will also have a statutory role in their work with local government?