§ The Secretary of State for Scotland (Mr. George Younger)
With permission, Mr. Speaker, I should like to make a statement on changes in the organisation and management of the National Health Service in Scotland.
I received about 400 comments on the consultative document that was published last December, and these have been carefully studied. There is a considerable measure of broad agreement with the view there expressed that the administrative structure of the Service could be simplified.
The reactions also confirmed my own view that no changes should be made in the number of health boards or the areas for which they are responsible. I propose, however, to ask those boards making use of services provided in Edinburgh and Glasgow to form joint consultative committees to secure the coordinated planning and operation of these services.
Opinion was divided on the need for non-statutory districts below area level. Three out of the 10 boards with districts at present agreed that districts could be abolished, and I intend to encourage these boards to take appropriate steps to this end. The other seven boards, for various reasons and with varying degrees of emphasis, indicated that they would prefer to retain a district structure. I intend to pursue this matter further with these seven boards.
The boards generally agreed that as much authority as possible should be delegated to the unit or sector level. I shall ask all boards to make the necessary changes in their arrangements to ensure that this takes place.
It was generally accepted that the professional advisory structure could be simplified, though varying views were expressed on what might be done, and I intend to have further discussions with the principal professional and other interests.
There was a very marked division of opinion on local health councils, from strong support to outright opposition. I am not persuaded that they need be a permanent feature of the NHS in Scotland, 1044 but they are statutory bodies, and any change would require legislation. When there is a prospect of new Health Service legislation I shall decide whether to propose abolition of these councils.
The changes to be made in district organisation and management levels below area will have substantial implications for staff. Proposals to deal with these implications, covering arrangements for filling posts, for staff protection, for premature retirement and for redundancy compensation, are being discussed with the staff side and I hope that a satisfactory agreement can be reached soon.
The implementation of these new arrangements will take some time, but I believe that they will improve efficiency and contribute to the more effective administration of the National Health Service in Scotland.
§ Mr. Millan
Is the Secretary of State aware that his statement was a very thin and unsatisfactory one? Having heard it, we can understand why the Government wanted to slip it through as a written answer and not explain it to the House.
On the general question of the major reform of the National Health Service structure, the right hon. Gentleman knows that he has our support in the view that that is unnecessary, but if the area health boards are to be maintained, as they are at the moment, that will have important implications for districts.
Is the right hon. Gentleman aware that we are suspicious of what he said about districts? Obviously, area health boards with districts want to maintain them. Indeed, for reasons of geography and of population it seems inevitable that districts will have to be retained in many of these area health boards. Otherwise, we shall have unitary authorities with populations, for example, much greater than the Secretary of State for Social Services has in my view rightly decided are necessary for England and Wales. Which are the three boards that have decided that they can abolish their districts? Will the Secretary of State take it that we shall not accept that by administrative fiat the rest of the districts in the other area health boards can be abolished without full and open debate in the House?
What the Secretary of State said about the professional structure was quite 1045 vague. There is some need for change here. Is the right hon. Gentleman aware that what he said is unsatisfactory, because it takes us not a single step further forward?
I should make it clear to the Secretary of State that we are absolutely opposed to the abolition of local health councils. What he said on this aspect was even less satisfactory than what was said for England and Wales, where it has now been agreed that the community health councils—the English and Welsh equivalents—will continue and that there will be a consultation document later about the powers of these councils, their method of appointment, their relations with the statutory health authorities, and so on. That is what we expect for Scotland. It is not simply a question of maintaining or abolishing them. We are willing to consider the way in which local health councils operate, but we are aware that the right hon. Gentleman wants to abolish them and that if he cannot do it right away he wants to erode their powers and responsibilities. The view taken by the Opposition and by the vast majority of patients is that what is required is not an erosion but an increase in the responsibilities of these councils, to make them even more effective representatives of patients in Scotland.
Is the Secretary of State aware that, despite what he said, the fact that he has reached so few firm decisions on reorganisation is bound to lead to uncertainty among the staff and a lowering of morale, which is already low because of the cuts in the National Health Service?
Finally, we shall expect a full debate before any final decisions are taken, first, because it is now absolutely clear from the meeting that the right hon. Gentleman had last Friday with the chairmen of the area health boards that there are to be real cuts in the NHS in Scotland this year, despite all the obfuscation that we have had from the Secretary of State about this matter over the past few months and, secondly, because on the last occasion on which we debated this matter—9 June—we had an extraordinarily inaccurate and appallingly ignorant statement by the Under-Secretary of State who deals with health and social service matters about the present structure of the NHS in Scotland, which has given rise to considerable resentment in Health Services circles there.
§ Mr. Younger
I do not agree with what the right hon. Gentleman said at the end of his remarks. It does not seem to have any relationship to the statement.
I was not sure what the right hon. Gentleman was complaining about at the beginning of his questions. He seemed to agree that no major changes were required in the National Health Service in Scotland but to complain that there were no major changes in the statement. With respect, he cannot have it both ways.
The three boards that consider that they can do without their districts are Fife, Ayr and Arran and Forth Valley. I shall discuss this matter with the rest of the boards and hope to reach agreement on the most useful and right thing to do in each case.
I was not sure whether the right hon. Gentleman was suggesting that I should have imposed a new arrangement on the professional structure without having proper discussions with those concerned. That is not my way of doing things. I shall have full discussions with all concerned before deciding what should be done.
I do not share the right hon. Gentleman's view on local health councils. It is well known what local health councils do and how they do it. If they wish to carry out further studies into how they could do it better, or to change what they do, it is up to them to do it, but there is no point in laying on an expensive inquiry from the centre to decide that when everybody knows what they do. As I said, some people consider that they should be abolished, whereas others feel strongly that they should be retained. I shall stick to what I said in my statement about that matter.
I regret that there must be some feeling of uncertainty among the staff, but there will be full consultations as quickly as possible, so that all may know where they stand.
It will be for my right hon. Friend the Leader of the House to decide whether there should be a debate. I would welcome a debate at any time that it could be arranged, so that we might discuss the financial side of the NHS in Scotland. As the right hon. Gentleman knows, in the budgets put forward for this year sums 1047 of money were given that would involve a small element of growth in real terms. But inflation that takes place during the year reduces the cash available. In that respect the Health Service is in a situation not different from that of everyone else in the country.
§ Mr. Grimond
Will the Secretary of State confirm—as I understand is the case—that there will be no difference in the medical arrangements for the Islands? Secondly, since the whole of the exercise that the Secretary of State proposes must presumably be directed at economies, in both staff and the money spent upon staff and the administrative side of the service, what estimate has he made of the economies that will result if his proposals go through?
§ Mr. Younger
On the second point, it is too early to say how much saving of money or manpower can be made. I am anxious to proceed in a way that produces agreement with the boards on the most effective way of doing this, but we think that there should be considerable savings in money as well as greater efficiency, which is the main point of the changes.
It is not proposed that any changes should be made in the Islands, but I shall be discussing with them what changes, if any, they can make to become more efficient.
§ Mr. Sproat
Will my right hon. Friend accept that anything that he does to get rid of a whole batch of bureaucrats will be widely welcomed throughout Scotland? Does he agree that in recent years one of the greatest scandals in Scottish hospitals has been the explosive growth of administrators at the cost of medical staff, and that there is a continuing and vital need to cut back on administrators and to concentrate scarce resources on medical staff, where they are really needed?
§ Mr. Younger
I appreciate what my hon. Friend says. It is my impression that the vast majority of people who work in the Health Service agree that the Service can only gain the more efficient they become and that there is no help to anyone in having people doing jobs that are not strictly necessary.
§ Dr. M. S. Miller
Will the right hon. Gentleman answer three short questions? First, does he have plans for any kind of restructuring of the primary care sector? I have in mind, mainly, the family doctor aspect, which is a key area in the Health Service.
Secondly, what plans does the right hon. Gentleman have to encourage doctors and nurses who left clinical practice to do administrative work during the last reorganisation to go back in to clinical work, where they ought to be?
Thirdly, will the right hon. Gentleman continue to encourage consultants in the NHS—as they are doing at present in Scotland—to stay 100 per cent. within the NHS?
§ Mr. Younger
Those are three very important questions. I think that the best answer that I can give—as they all affect future policy on the Health Service—is that there is a great deal of work going on in relation to those matters, and in the autumn I hope to be able to make further statements about future policy. Certainly this would cover such matters as restructuring in the primary care sector and what we can do to encourage those who have left the profession of medicine for administrative jobs to go back there. I shall certainly be giving attention to that matter.
§ Mr. Henderson
Is my right hon. Friend proposing any improvements in the ambulance service? Is he aware that there are shortages of psychiatric and geriatric nurses in many areas? Has he any proposals for short training for local people, where there are establishments for elderly or mentally ill people, so that this shortage can be met without detracting from the major professionalism of professional nurses?
§ Mr. Younger
There are no immediate plans for any major changes in the ambulance service, which has been going through some reorganisation recently, but that is something that we keep under review all the time. As for the qualification for psychiatric and geriatric nurses, we look at ways of making it more attractive to people to come into these sectors of nursing, but there is no short cut to having highly skilled and qualified people doing this work. We have to bear that in mind.
§ Mr. Douglas
In view of the Prime Minister's assertions about voluntarism, will the Secretary of State endeavour to justify how he can have a Sword of Damocles hanging over the local health councils?
§ Mr. Younger
I did not quite pick up the first half of what the hon. Gentleman asked. However, I do not consider this to be the sort of Sword of Damocles that would in any way interfere with what local health councils are doing. They must know perfectly well that they have to give satisfaction to the public in what they do, and I am sure that they will continue to do that, and they will have support from me in doing that while they still exist.
§ Mr. McQuarrie
When he is discussing the future of the National Health Service in Scotland, will my right hon. Friend bear in mind the serious need that there should be no further closures of hospitals in rural areas, or any loss of medical practices in those rural areas? Additionally, when making appointments to health boards, will he consider giving greater consideration to people of experience in local authorities and the medical profession?
§ Mr. Younger
I am grateful to my hon. Friend. I appreciate his close interest in the question of the provision of medical services in rural areas, which is a very important matter. It is also a difficult matter. I cannot give my hon. Friend an undertaking that there will be no further closures but I can undertake that any closures that are brought to my attention will be looked into very carefully with a view to trying to maintain the best possible service for the people in the area but bearing in mind the fact that sometimes some services are extremely costly and can result in an undue drain on resources for other Health Service purposes in the area.
As for appointments to boards, the principal criterion that I always follow is to find the best person for the job. I shall certainly bear in mind what my hon. Friend rightly says about the importance of getting medical people and local authority people involved.
§ Mr. Buchan
Does the Secretary of State agree that he has created, if anything, more uncertainty and confusion by 1050 this statement? It is almost worse than having no statement at all. Cannot he just tell us now that districts will stay where districts are wanted? Secondly, will he remove—I repeat the term—the Sword of Damocles that he has now hung over local councils, which, after all, are doing voluntary work and which have been thrown into uncertainty? How shall we get a response from them with the kind of statement that we have had today?
§ Mr. Younger
I should have thought that the hon. Gentleman would agree with me that it is in the interests of the Health Service and everyone who works in it that the best use should be made of the limited funds that we shall be able to afford for it. If some area health boards think that they can do without districts it is surely right to let them do without districts. For the others, I intend to discuss matters with them, so as to be certain that we look at every possible way in which we may be able to save money or staff in reducing districts in some or all of those cases.
I do not agree with the hon. Gentleman about the health councils. If they are feeling in any way as he describes, they have the remedy in their own hands, which is to demonstrate to everyone that they really are the useful bodies that some people think they are.
§ Mr. William Hamilton
Is the Minister aware that one of the shortcomings of the Health Service is a lack of democratic control? In so far as local health councils fulfil that need, however inadequately, it is very important that they should be preserved and that their powers should be strengthened. Does the Minister recognise that his statement will be widely interpreted—certainly on the Opposition Benches, and, I guess, outside the House—as a determination on his part, despite the will of the people, to abolish both the districts and the councils at a local level—bodies that provide, however inadequately, for the consumer interest?
Does the Minister recognise that his statement, combined with the provisions 1051 of the Health Services Bill, is an indication that the Government are determined to smash the principle on which the Health Service was originally created? Is not this a determination to cut the cost of the Service and to rely increasingly on the private sector, where the depth of one's purse determines the quality of the service that one gets?
§ Mr. Younger
This is a sign that the Government are committed to trying to spend the public's money in the best possible way to provide the best possible Health Service. I should have thought that the hon. Gentleman would warmly support that. As for the local health councils, I think that the hon Gentleman has got that matter wrong, too. Whatever else they are, they are certainly not democratic. They are appointed, in just the same way as health boards are appointed. They are no more and no less democratic than the boards. If the hon. Gentleman wants democracy in the Health Service, he will have to make them directly elected or something like that, but I do not think that that is suggested by anyone.
§ Mr. Allan Stewart
Is my right hon. Friend aware that his decision not to take a simple blanket view of the case for or against districts will be widely welcomed, because the fact is that conditions vary enormously between different areas of Scotland?
§ Mr. Younger
My hon. Friend is absolutely right in that. Governments who decide that everyone has to be treated in exactly the same way sometimes make mistakes. I am prepared to consider each of these cases on its merits and to try to do the best possible thing for each area.
§ Mr. Cook
Does the Secretary of State accept that his statement is far less significant than the statement that he made outside Parliament on Friday, to the effect that health boards would not get the resources that they need to meet inflation? Is he aware that Lothian health 1052 board does not fill nursing vacancies now? If so, why does he continue to pretend that his cuts will not affect the quality of patient care?
§ Mr. Younger
The chairmen of the health boards came to see me about financial problems on Friday. I told them that the whole public sector must play its part and cut public expenditure to a level that the nation can afford. The only difference about the National Health Service is that it has been greatly helped, because it has had more generous budgets than other public sector bodies. As for cash limits, once the budgets have been laid out the position of the NHS is the same as that of everybody else. Inflation during the year reduces the amount available for expenditure. Not only health boards but businesses, families and all other persons are in the same position.
§ Mr. Younger
I know that this subject is particularly important in my hon. Friend's area. In many areas of Scotland rural health services play an important part in the community. We shall bear that in mind.
§ Mr. Dalyell
I should like to refer to the question raised by my hon. Friend the Member for Dunfermline (Mr. Douglas) about the Sword of Damocles. In answer to the question of my hon. Friend the Member for Renfrewshire, West (Mr. Buchan) about area health councils, the Secretary of State said that some people thought that they were useful bodies. Is the Secretary of State among those people?
§ Mr. Younger
I sought to record that although the majority of representations that we have received are in favour of maintaining local health councils, a substantial number think that they should be abolished. I believe that this issue should be looked at with them and with the area health boards to ensure that we have got the right answer before we legislate. That is the right way to proceed.
§ Mr. Myles
Further to the question raised by my hon. Friend the Member for Aberdeenshire, East (McQuarrie), will my right hon. Friend encourage area health boards, especially the area health board in my area, to improve their public relations? Will he discourage them from continuing their plans for centralisation? In my area, it is not centralisation, because everything is being taken to one corner.
§ Mr. Younger
I shall draw the attention of all health boards to the need to improve public relations. I know that my hon. Friend will be pleased to know that one of the main aims of reorganising the National Health Service is to bring decision-making further down towards the hospital level. That is desirable, particularly in those areas where districts are being removed.