§ Miss Ann Widdecombe (Maidstone)
I beg to moveThat leave be given to bring in a Bill to abolish regional health authorities.In seeking leave to introduce the Bill, may I first welcome the comments made by my right hon. Friend the Prime Minister on "Panorama" last night. I am sure that they will bring great relief to the general public, because if the Government are as successful in reviewing the National Health Service as they have been in revising the education system and the economy, there is great hope for the Health Service in the next few years. I thank my right hon. Friend for her remarks.
I propose a modest measure for directing money in the Health Service away from administration and into patient care. I therefore seek leave to introduce a Bill to abolish the regional health authorities. My reasons for doing that are based, first, on the ground of cost. The money would be better spent on patients. Secondly, the functions of the regional health authorities are superfluous, as they could be carried out by district health authorities, by a central board of management, or by central Government. Thirdly, their structure is wrong, as too many disparate interests are grouped together, competing for scarce resources. Fourthly, there is too little accountability.
Theoretically, the regional health authorities are accountable to the Secretary of State, but their powers and budgets are devolved, and very often we hear it said that something must be a purely regional decision. Unlike the Secretary of State, regional health authorities do not have to answer to the public through the ballot box every five years for what they are doing. Furthermore, many of those who sit on regional health authorities have to pass judgment on local situations prevailing in areas with which they are not familiar and which they do not know, whereas district health authorities deal wholly and all the time with what is going on in their own patch, with which they are very familiar.
In 1986, across the country, regional health authorities cost £109 million on administration alone. That figure was given by my right hon. Friend the Minister for Health in answer to a parliamentary question from my hon. Friend the Member for Wokingham (Mr. Redwood). That was £109 million on top of the £317 million that we spend every year on administration costs per district. That represents thousands of nurses' salaries. That represents an opportunity lost for thousands of operations. The Government have always stated, and have more than proved, that they believe that money must be spent at the sharp end of our public services, so that money should be taken from that wholly superfluous tier of administration and put in at the sharp end.
The Bill would allow district authorities to control consultants' contracts. At the moment, the regions issue contracts to consultants and the financial liability for them is passed on to the districts. I know of no commercial analogy which allows one department to issue contracts and another to accept the financial liability.
The Bill would devolve the control of property and land to the districts. At the moment there are considerable numbers of surplus properties and pieces of land throughout the country. There is very little incentive for districts to put their backs into selling that property, 173 because too often the proceeds go back to the regions because they are over certain limits. The districts could develop those properties and that land, or sell them to raise income to help patients, which is what the service should be about. I strongly believe, therefore, that they should have the control, which would mean that they would also have the incentive to make the best use of such assets.
The territorial overview of facilities that would have to be provided, not in every district, but simply between three or four districts, could, I believe, easily be carried out centrally by a fairly minimal and not particularly costly expansion of the existing regional liaison structure within the Department.
There is already provision for the central purchasing of supplies. I believe that this should continue, but that the districts should take over the control of distribution.
It has often been said that 219 districts is a rather large number for any Government Department to deal with, and I have some sympathy with that view. Nevertheless, the Department of the Environment has to deal with several hundred district councils, and the Department of Education and Science is contemplating dealing with a large number of individual schools, which will draw their grants centrally. I therefore think that this requirement could be accommodated by a slight expansion of the regional liaison department.
I do not regard this proposal as any sort of alternative to any other major reorganisation that may be proposed for our health services, nor that on its own it will solve the problems of the National Health Service, but I do believe that at the moment we are spending money that could be better spent, and this would, administratively speaking, be a fairly easy and straightforward way of getting the money for patient care, to pay nurses and to pay for operations.
§ Mr. Nellist
Yes, Mr. Speaker.
The hon. Member for Maidstone (Miss Widdecombe) described this as "a modest measure to drive money away from administration and toward patient care." The abolition of the regional health authority structure in the Health Service would mean an enormous upheaval in the organisation of that service. When the hon. Member says that the cost is £109 million for administration, she is, quite frankly, naive if she believes that if her Bill were to be passed the Government would take that £109 million and put it into patient care or use it to increase the wages of those working in the Health Service. As with all the other changes that have taken place in the past eight or nine years, from redundancies in British Steel, to the abolition of the county council structure, the money saved would go back to the Treasury and end up as tax cuts for the top 5 per cent. of the population.
I should like to ask the hon. Member for Maidstone, not today, but at a later stage, to say whether she has approached her colleagues in government to seek ministerial backing for this measure. It seems to me, from a pamphlet from the Adam Smith Institute this month, that once again the Right wing, inside and outside the Tory party, is pushing towards more privatisation in the Health Service. The pamphlet from the Adam Smith Institute said: 174if the Regional Health Authorities arc to be retained at all, which is a matter of debate, they could exist as branch offices of a quasi-independent national board. Alternatively, their staffing levels could be reduced and their operations could be made more flexible by the greater use of contracting rather than in-house expertise.A fortnight ago the hon. Member for Billericay (Mrs. Gorman) started to wave the privatisation flag for the Post Office, and today the flag is being waved by the hon. Member for Maidstone in respect of the Health Service.
As to regional health authorities being "superfluous", there is a clear need for strategic planning, for example, of the siting of regional facilities, whether it be for children's heart operations or for renal dialysis centres. One of the original aims of the regional health authorities when they were established in 1974 was to link each of the 14 authorities with a university medical school and a teaching hospital, primarily to improve the distribution of medical manpower and reduce inequalities between the regions. In the past decade rising unemployment and growing, poverty have militated against any serious work in that direction. In fact, Tory Government decisions, ranging from inadequate nutritional standards in schools, all the way through to mass unemployment, simply mean that more people fall sick. The solution is not one of administration, but is one of finance. That is the core of my opposition to the Bill.
On page 2 of its annual report for 1986–87 on the Health Service in England, the Department of Health and Social Security makes it clear how the regional health authorities fit into the centralised structure of health care. They are part of a centralised, unelected, unaccountable structure in which control is exercised downwards from the Secretary of State through the regional health authorities to the districts themselves. The chairmen and members of the regional health authorities are appointed by the Secretary of State. The regional health authorities then dictate the membership of the district health authorities and, in particular places such as the west midlands, the north-west, Merseyside and the hon. Member for Maidstone's own area of south-east Thames, trade union nominees have been weeded out, and vetoed by regional health authorities for having the temerity to stand against cuts in the Health Service.
In my own region, the west midlands, there were three candidates last year — George Evans for Wolverhampton, Marilyn York for Bromsgrove and Redditch and Raghib Ahsan, who was already a member of the West Birmingham health authority. Two of those three were the only woman and the only ethnic minority candidate proposed for the district health authorities. They were vetoed by the regional health authority as part of the process of weeding out opposition on those bodies. Although Marilyn York gained a position in another health authority, George Evans and Raghib Ahsan were vetoed, as was John Dempsey, a National Union of Public Employees full-time official who was nominated for a regional health authority seat.
I can think of legions of examples which, with the under-funding of the Health Service and draconian methods of management, locally and regionally, have no doubt fuelled the anger of health workers in recent years. No doubt many health workers would have some initial sympathy with the move to abolish regional health authorities. A better response, however, would be to campaign for the democratisation of an expanded Health Service, which should include the present peripheral, 175 privately owned institutions, all the way from abortion clinics to the drug companies themselves. The majority of district and regional health authorities ought to be elected and accountable, with, in turn, a majority of their seats reserved for health workers and other trade unionists. Local authorities should have direct representation so as to represent the interests of the population at large. At some stage of his or her adult life everyone is a consumer of the National Health Service, barring of course the Tory Cabinet.
Clearly, the Government would want some representation to secure a reasonable, even distribution, based on specific regional problems. There should be direct representation from the districts to the regional health authorities. In other words, control and management should extend from the bottom up, with the full involvement of ordinary working people, and not Tory placemen. These proposals are outlined in a private Member's Bill, which I support, which has been brought in by my hon. Friend the Member for Halifax (Mrs. Mahon). I refer in particular to clause 6 of the National Health Service (Improved Provision of Services) Bill.
There can hardly be any family left untouched by the crisis in the National Health Service, which the Prime Minister again refused to admit today. During the past three months I have brought examples before the House from Coventry ranging from delayed heart operations for babies to the proposed closure of one of the city hospitals specialising in geriatric care and, in some cases, to undignified reductions such as the complete curtailment of supplies of incontinence pads. I told the House of a constituent who, before Christmas, was drying out on a radiator used incontinence pads for her elderly mother because of district health authority cuts. The root cause of that is not administration, but the financial cuts imposed by the Government.
Of the 21 OECD countries, the United Kingdom is 17th on the list — only Spain, Portugal, Greece and New Zealand spend less on health. One of the consequences of that is that for the first time since 1970 the number of deaths of infants between the ages of 28 days and 12 months is rising in England and Wales. The huge problems faced daily by patients, families and Health Service workers are light years away from the Secretary of State for Social Services, who goes into a private hospital at £1,000 a week when he gets ill, and from the Prime Minister, who, in her three periods of illness during her term of office, has used private care on each occasion.
In the past eight years under-funding has totalled £1.5 billion, as estimated by the Select Committee on Social Services. The Government will claim that they spend more money — we heard that again today during Question Time. However, taking into account inflation, the extra cost of drugs and equipment, which the Government estimate to be rising faster than inflation, the Government's estimates of the rising population of the elderly, and the increased sickness, which is due to their policies, it is clear that their 2 per cent. real growth targets are not being met.
In the west midlands, James Ackers, the regional health authority chairman, said that the authority is underfunded by £40 million this year on pay awards alone. The £6–7 million that the authority received before Christmas is pathetically inadequate.
176 The deep and widespread opposition to the Government's cavalier attitude to the Health Service, ranging from the 40,000—signature petition in Coventry against the closure of Whitley hospital, to the half-day strike in the city last November, to the increasingly spontaneous decisions of health workers to step up their action in defence of the Health Service and their own working conditions and wages, was perhaps best evidenced last night in the constituency of the former Secretary of State for Social Services—Sutton Coldfield —when the workers at Goodhope hospital voted that, if the closure proposals for the accident and emergency services at that hospital are not withdrawn, they will occupy and work in the hospital, with the backing of the area consultant, to take out of the hands of this Government the decision whether or not health facilities should be given to working people in our areas.
The responsibility for co-ordinating this action and supporting it around the country now lies, in my view, with the Trades Union Congress, which should bring together the regional action of workers into a one-day national strike against the Government to warn them that it is our Health Service, not theirs. The Bill should be rejected.
§ Question put, pursuant to Standing Order No. 19 ( Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business):—
§ The House divided: Ayes 88, Noes 91.177
|Division No. 153]||[3.48 pm|
|Aitken, Jonathan||Hunter, Andrew|
|Arnold, Jacques (Gravesham)||Irvine, Michael|
|Ashby, David||Irving, Charles|
|Barnes, Mrs Rosie (Greenwich)||Janman, Timothy|
|Beaumont-Dark, Anthony||Jones, Robert B (Herts W)|
|Beggs, Roy||Jopling, Rt Hon Michael|
|Bevan, David Gilroy||Kellett-Bowman, Dame Elaine|
|Boswell, Tim||Kennedy, Charles|
|Bowis, John||Kilfedder, James|
|Brazier, Julian||Kirkwood, Archy|
|Brown, Michael (Brigg & Cl't's)||Lawrence, Ivan|
|Butler, Chris||Lloyd, Sir Ian (Havant)|
|Carrington, Matthew||McCrindle, Robert|
|Cartwright, John||McNair-Wilson, M. (Newbury)|
|Clark, Dr Michael (Rochford)||Mans, Keith|
|Clark, Sir W. (Croydon S)||Marlow, Tony|
|Coombs, Anthony (Wyre F'rest)||Martin, David (Portsmouth S)|
|Coombs, Simon (Swindon)||Michie, Mrs Ray (Arg'l & Bute)|
|Davis, David (Boothferry)||Moss, Malcolm|
|Day, Stephen||Neale, Gerrard|
|Dover, Den||Page, Richard|
|Evans, David (Welwyn Hatf'd)||Pattie, Rt Hon Sir Geoffrey|
|Fearn, Ronald||Redwood, John|
|Field, Barry (Isle of Wight)||Rost, Peter|
|Fookes, Miss Janet||Rowe, Andrew|
|Forth, Eric||Shaw, David (Dover)|
|French, Douglas||Shaw, Sir Michael (Scarb)|
|Gill, Christopher||Shephard, Mrs G. (Norfolk SW)|
|Glyn, Dr Alan||Steel, Rt Hon David|
|Goodson-Wickes, Dr Charles||Stern, Michael|
|Gow, Ian||Summerson, Hugo|
|Greenway, Harry (Ealing N)||Taylor, John M (Solihull)|
|Hamilton, Neil (Tatton)||Taylor, Matthew (Truro)|
|Hargreaves, Ken (Hyndburn)||Thorne, Neil|
|Harris, David||Thornton, Malcolm|
|Haselhurst, Alan||Townsend, Cyril D. (B'heath)|
|Hayes, Jerry||Tredinnick, David|
|Heddle, John||Vaughan, Sir Gerard|
|Hicks, Mrs Maureen (Wolv' NE)||Walker, A. Cecil (Belfast N)|
|Holt, Richard||Walker, Bill (T'side North)|
|Howell, Rt Hon David (G'dford)||Warren, Kenneth|
|Howells, Geraint||Watts, John|
|Hughes, Robert G. (Harrow W)||Wells, Bowen|
|Widdecombe, Miss Ann||Tellers for the Ayes:|
|Wiggin, Jerry||Mr. Nicholas Bennett and|
|Mr. Simon Burns.|
|Abbott, Ms Diane||Kirkhope, Timothy|
|Anderson, Donald||Lamond, James|
|Ashley, Rt Hon Jack||Leadbitter, Ted|
|Ashton, Joe||Lloyd, Tony (Stretford)|
|Banks, Tony (Newham NW)||Loyden, Eddie|
|Barnes, Harry (Derbyshire NE)||McAllion, John|
|Barron, Kevin||McAvoy, Tom|
|Benn, Rt Hon Tony||McCartney, Ian|
|Boateng, Paul||McKay, Allen (Penistone)|
|Boyes, Roland||Madden, Max|
|Buchan, Norman||Mahon, Mrs Alice|
|Campbell, Ron (Blyth Valley)||Maxton, John|
|Campbell-Savours, D. N.||Maxwell-Hyslop, Robin|
|Carttiss, Michael||Meacher, Michael|
|Clarke, Tom (Monklands W)||Meale, Alan|
|Clay, Bob||Michie, Bill (Sheffield Heeley)|
|Clelland, David||Moonie, Dr Lewis|
|Corbett, Robin||Mullin, Chris|
|Corbyn, Jeremy||Nellist, Dave|
|Crowther, Stan||O'Neill, Martin|
|Cryer, Bob||Patchett, Terry|
|Dalyell, Tarn||Pike, Peter|
|Darling, Alastair||Primarolo, Ms Dawn|
|Doran, Frank||Radice, Giles|
|Evans, John (St Helens N)||Richardson, Ms Jo|
|Faulds, Andrew||Robertson, George|
|Favell, Tony||Ross, Ernie (Dundee W)|
|Fields, Terry (L'pool B G'n)||Sedgemore, Brian|
|Fisher, Mark||Sheldon, Rt Hon Robert|
|Flannery, Martin||Shore, Rt Hon Peter|
|Flynn, Paul||Short, Clare|
|Foot, Rt Hon Michael||Skinner, Dennis|
|Fyfe, Mrs Maria||Soley, Clive|
|Garrett, John (Norwich South)||Spearing, Nigel|
|George, Bruce||Steinberg, Gerald|
|Grant, Bernie (Tottenham)||Strang, Gavin|
|Griffiths, Win (Bridgend)||Taylor, Mrs Ann (Dewsbury)|
|Haynes, Frank||Thomas, Dafydd Elis|
|Heffer, Eric S.||Welsh, Michael (Doncaster N)|
|Hinchliffe, David||Williams, Alan W. (Carm'then)|
|Home Robertson, John||Wilson, Brian|
|Hood, James||Winnick, David|
|Hoyle, Doug||Worthington, Anthony|
|Hughes, John (Coventry NE)|
|Hughes, Robert (Aberdeen N)||Tellers for the Noes:|
|Jones, Ieuan (Ynys Môn)||Mr. Harry Cohen and|
|Jones, Martyn (Clwyd S W)||Mr. Pat Wall.|
|Kaufman, Rt Hon Gerald|
§ Question accordingly negatived.