§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Fallon.]
10.20 pm§ Mr. David Hinchliffe (Wakefield)I propose to raise a number of issues concerning the background to the removal of Sir Jack Smart as chairman of Wakefield district health authority. I should like to make it clear at the outset that I hold no particular brief for Sir Jack. Over a year ago, I called for his resignation as chair of the Wakefield health authority because of his refusal to defend my constituents in Wakefield against the cuts in the National Health Service being pursued by the present Government. Nevertheless, I feel strongly that Sir Jack's sacking in no way solves the serious problems that have arisen in Wakefield health authority.
My specific concern relates to the introduction of cook-chill catering. The Minister will be aware that I have been pressing for an independent public inquiry on this issue since July last year, but to no avail. Lord Skelmersdale, the then joint Parliamentary Under-Secretary of State wrote to me in a letter dated 31 July 1987:
Assessing the costs of the introduction of cook-chill must remain a matter for the individual health authorities concerned acting on the advice of their officers".The Minister is aware from extensive correspondence and meetings with me that Wakefield health authority has stumbled from one financial crisis to another in recent years, with numerous cuts, closures and bed reductions.I remind the Minister that in April 1987, £1.4 million was cut from the revenue budget and in August 1987, a further £1 million package of cuts was brought before the district health authority. We have had a number of examples, of which the Minister is aware, of urgent operations being cancelled—in one instance, for lack of £140,000 revenue to pay for 13 nurses in a neurosurgical unit at Pinderfields hospital. Against that background it should be a matter of deep concern to the Government that, through the most incompetent management advice, a cook-chill system estimated to cost £1 million in capital terms in fact cost £1.5 million and that the anticipated revenue savings of £300,000 per annum from cook-chill turned out to be £400,000 per annum additional revenue expenditure to be taken from a desperately hard-pressed patient care budget.
The central responsibility for the introduction of cook-chill in the Wakefield health authority area rests with Mr. Brian Birchall, the district general manager appointed to the authority in April 1985, folowing the Griffiths management restructuring. Despite the fact that the Stanley Royd inquiry had not reported, he persuaded the Wakefield health authority in July 1985 to confirm a district management team decision to invite Tricon, a food services consultancy firm, to examine the possibility of installing a cook-chill system at Stanley Royd. Tricon's report was presented to the district health authority in February 1986. By a small majority—I was in the minority as a member at the time—approval was given to the district general manager's proposal to establish a districtwide system of cook-chill catering.
It is crucial to my point that one of the objectives outlined in Mr. Birchall's report was 269
to create a viable unit of business as recommended by the latest guidance issued by the DHSS in respect of competitive tendering.That is important in the context of some points I shall be making later.Since that time, Sir Jack Smart has claimed that Mr. Brian Birchall was—to use Sir Jack's words—"foisted" on to the Wakefield health authority as its district general manager and that the authority was "duped" into accepting cook-chill.
Clearly, a number of fundamental errors, which were certainly the responsibility of Mr. Birchall, were made in the introduction of cook-chill in Wakefield. I shall give three specific examples. First, the district health authority's control of infection officer and committee, its consultant microbiologist, Professor Lacey, and most of its clinical staff were not aware of the cook-chill proposals until March 1987, when the catering staff refused to operate the system, on the grounds that it was unsafe. Secondly, I believe that it is an important fact that the proposals brought forward by Mr. Birchall clearly contravened the 1980 DHSS guidelines on cook-chill, with a number of serious errors. Thirdly, numerous additional costs that should have been anticipated were not considered in Mr. Birchall's original report.
In the time available, the subsequent events are far too numerous to mention. The important matter that needs to be dealt with by the Minister is that in the constituency of my hon. Friend the Member for Normanton (Mr. O'Brien), we have a new £1 million cook-chill central production unit which has been stood doing nothing for nearly two years because of the serious errors to which I have drawn attention. I believe those errors are the responsibility primarily of the district general manager. It is important to speculate about the extent of interest charges that must have accrued during the period that this valuable building has been empty, because that will be a drain on our local National Health Service budget.
I believe that the role of the Yorkshire regional health authority has been important in this matter. I should like to ask the Minister a number of specific questions to which it is crucial that she replies this evening.
First, why did the Yorkshire regional health authority invite Mr. Brian Birchall, the general manager of the Wakefield health authority—whose record on cook-chill in that authority was, frankly, a shambles—to chair the regional health authority's catering sub-committee that pressed ahead with the introduction of cook-chill catering throughout the Yorkshire region?
Secondly, why did the regional health authority inquiry, which led to the removal of Sir Jack Smart as the chair of the Wakefield health authority, fail to look at any of the issues—especially cook-chill—that were at the root of the conflict between the Wakefield district's general manager and its chair?
Thirdly, why has the regional health authority failed to respond to or contradict any of the detailed evidence concerning costings of cook-chill in Wakefield that was presented to its inquiry by the Wakefield health authority's former consultant microbiologist, Professor Richard Lacey?
Fourthly, why, after refusing to give additional money to the Pinderfields neurosurgery unit, and saying that Wakefield health authority should spend its share of the 1987 non-recurring revenue grant on cook-chill, did the regional health authority take the unprecedented step of 270 making a grant of £350,000 to the Wakefield health authority for the introduction of cook-chill earlier this year?
Fifthly, why, after all the grave doubts about the suitability of cook-chill for hospital catering in general, and then clear evidence of the huge cost of implementing cook-chill which would result in diversions of funds from patient care, has the regional health authority pressed ahead with the decision to implement cook-chill across the region?
§ Mrs. Alice Mahon (Halifax)Is my hon. Friend aware that for some months I have been trying to discover which members sat on the sub-committee that took the decision that the new general hospital in Halifax would not have a production kitchen but would, in fact, have a cook-chill reception unit, and thereby allow privatisation to enter by the back door? I have made numerous requests. both to the regional health authority and to the Minister, and this week I received from the Minister a rude reply to my request for the names of the members of that sub-committee. The constituents in Halifax think that there is something amiss. They smell a rat. I wonder whether my hon. Friend is aware of that and will take that matter on board.
§ Mr. HinchliffeWith respect to my hon. Friend, I have been sniffing those rats a little longer than she has. I hope that the Minister will respond to my hon. Friend, because the issues that she has raised about cook-chill in Halifax directly concern the people in Wakefield to whom I have referred.
The answers to the points that I have raised about the Yorkshire regional health authority lie in the crucial importance of cook-chill to companies tendering for National Health Service catering. It is a fact that private catering companies much prefer to mass-produce food from cook-chill units. They are happy to sit back and see vast amounts of public money, which should be spent on patient care, being used to install the facilities and equipment that they need so that they can move in and make a killing. Every year in the Yorkshire region, 10 million meals are produced—there is one hell of a killing to be made. Huge profits can be had; that is why this is such a ball game for the catering companies.
In Wakefield and the Yorkshire region, there are strong suspicions that certain parties to the issue are putting their commercial interests and concerns before the interests of NHS patients. That is the crux of the matter.
Two specific people should be mentioned in terms of Wakefield. Given the clear enthusiasm of the Yorkshire regional health authority for cook-chill, the business interests of the chair of that authority, Mr. Brian Askew, are of direct relevance. He is a director of the Sam Smith brewery in Tadcaster, which, of course, has recently developed significant catering interests.
The second person, to whom I have already referred and who has done more than most to promote cook-chill vigorously in Yorkshire, is Mr. Brian Birchall. Prior to coming to Wakefield his business background was at senior level with United Biscuits. That company has a large number of important catering subsidiaries.
§ Mr. Derek Fatchett (Leeds, Central)It also has friends in the Tory party.
§ Mr. HinchliffeYes, it is close to the Tory party.
271 It is important to note that United Biscuits has recently opened a chilled food division based on South Humberside. Obviously, that division will be ideally placed to tender for the provision of cook-chill meals to hospitals throughout the Yorkshire region.
It is my sincere belief and the belief of many people in my area—people who have been silenced on this issue as the result of legal threats by Mr. Birchall—that Mr. Birchall has done a job, not for the NHS or the people of Wakefield, but for contacts within private industry who stand to gain substantially from his efforts on cook-chill. No doubt he also stands to gain because, at the end of his general manager contract, he will be ideally placed to obtain an extremely lucrative position advising private caterers about providing catering for the NHS.
The Minister may say that I am putting two and two together on the latter points that I have raised and making five. If that is her belief, she has a clear course of action open to her—to look at my allegations and the scandalous misuse of NHS resources in paving the way for privatised catering. The Minister can act, as a matter of urgency, by setting up a full public inquiry into this affair, including the role of the regional health authority. If she fails to do this, people will draw their own conclusions.
§ Mr. Deputy Speaker (Sir Paul Dean)Does the hon. Member have permission to intervene?
§ Mr. O'BrienYes, Sir. I wish to speak in support of my hon. Friend the Member for Wakefield (Mr. Hinchliffe) because the headquarters and the kitchen that has been built, but which is not in use, are in my constituency and service several hospitals in both the Wakefield and Normanton constituencies.
In my opinion, and in the opinion of many of my constituents, the situation that has developed in the management of Wakefield health authority leaves a lot to be desired. That situation appears to be deteriorating, and has deteriorated during the past few months. Constituents have complained to me that a whole ward has been disturbed at 11 o'clock at night in order to admit some patients by removing others from the ward. That demonstrates the acute shortages of accommodation and of effective management in Wakefield health authority.
Furthermore, the inquiry that was held at the behest of the regional health authority was nothing more than a kangaroo court because, when members of Wakefield district health authority were invited to give evidence which was heard by the committee—evidence which made allegations against the former chairman of Wakefield health authority, Sir Jack Smart—the people giving evidence were never identified and the person about whom the allegations were made was never given the opportunity to reply to those allegations.
I ask the Minister: where else but in Wakefield, where else but under the management of the Wakefield district health authority and where else but in the Yorkshire region under the chairmanship of Brian Askew, can such things occur?
An undemocratic inquiry was being held because the managements of Wakefield health authority and of the 272 regional health authority wanted to remove a member of the Labour party from the position of chairman of the district health authority—indeed, the last remaining chairman of a district health authority who was a member of the Labour party. One must assume that the whole situation is politically motivated.
The inquiry was totally against natural justice and against the democratic procedures that we cherish so dearly in this House. If the Minister is to be fair to those procedures, to the Health Service and to the people who use the services of Wakefield district health authority, the present situation cannot be left unchanged. A kangaroo court was held to dismiss the chairman. People gave evidence and remained anonymous. That is reminiscent of South Africa, where people give evidence facelessly behind locked doors. Here, that evidence has been used against the people who are administering the health authority.
If the Minister thinks that all that is rubbish, why does she not accept the suggestion of my hon. Friend the Member for Wakefield and conduct an inquiry into what is happening in Wakefield? That is the only way in which we can have a clear approach to this matter.
I turn now to the issue of cook-chill. There is room for further investigation there, because when the appointment of Tricon was originally vetted by the then administrator, Mr. Pritchard, the total cost was less than £8,000. However, when the district general manager was appointed, the cost increased to £49,400, without any invitation for tenders and without approval by the health authority on the question whether the increased expenditure was justifiable. The district general manager took that decision to increase expenditure to nearly £50,000. After that commitment, the health authority had to approve it.
I appeal to the Minister not to allow this to continue. Until we have some clarification, it will go on for a long time. It is important to clear the matter up, and the Minister should make that her responsibility.
§ The Parliamentary Under-Secretary of State for Health (Mrs. Edwina Currie)Let me start by offering the usual courtesies and congratulating the hon. Member for Wakefield (Mr. Hinchliffe) on winning the ballot. I know that he tries to take an interest in the health of his constituents, which is probably amply demonstrated by the fact that in the current Session of Parliament he has tabled 115 questions on health-related matters and thus kept Ministers well aware of his existence. He was a member of the health authority before the last election, and participated in much of the discussion leading up to the sort of decision with which the authority is now faced. The hon. Gentleman and his hon. Friend the Member for Pontefract and Castleford (Mr. Lofthouse) asked to see me last September to discuss health matters relating to their constituencies, and I believe that we had a very useful meeting.
This evening's debate takes place against a background of significant increases in National Health Service funding. This is now the country's second largest programme of expenditure, after social security. Last year the 1987–88 financial year—the nation spent over £21 billion on the NHS. This year, spending in the United Kingdom is expected to top £23.6 billion. The Secretary of State's announcements at Brighton recently bring the total 273 amount to he made available for nurses' pay this year to nearly £1 billion, and the total amount spent on the Health Service is over £2 billion more than last year's figure.
As for the Yorkshire regional health authority, back in 1982–83 its gross revenue spend was under £600 million. By last year it had risen to £817 million—a cash increase of 40 per cent. and a real-terms increase of 11 per cent. For this year its initial revenue allocation is a further increase to £889 million. Taking into account additional money for nurses' pay, £330 million spent by the family practitioner services and the result of its own efforts such as income generation and land sales, spending in the Yorkshire region in 1988–89 will top £1,219 million, the largest amount ever spent on health in Yorkshire. It involves more staff, better hospitals, more equipment and—most of all more patient care. I am looking to see whether the hon. Member for Wakefield is nodding but he is not. He probably does not believe me, but I must tell him that it is true.
I visited the Yorkshire region on 23 September and saw the new Dewsbury general hospital, recently completed at a cost of £18 million. We broke the ground for phase 3 and the new psychiatric wing there, costing a further £4 million. That is far better than any Labour Government has ever been able to do for the people of Dewsbury and the surrounding area. We took part in the formal opening of the Yorkshire Heartbeat programme, which will probably do as much to improve the health of local people as almost all the rest of the Health Service's activity put together.
Wakefield health authority's funding has also increased. Its initial cash allocation for 1988–89 is now over £50 million. On top of that, a considerable extra amount will come its way as a result of the clinical grading review and other items—for example, £61,000 from the waiting list money for this year for gynaecology.
The hon. Gentleman has not referred to the plans—of which is he probably aware, although they are still at an early stage—to spend £14 million on improving services in Wakefield on the site of Pinderfields hospital. Among other things, it will enable the centralisation of the maternity service on the main hospital site, thus providing a much enhanced quality of care. Wakefield has been looking after the hon. Gentleman's lady constituents far better than used to be the case. I hope that he recognises that.
I am sure the hon. Gentleman knows that over the past five years the number of in-patients treated in Wakefield has increased by 23 per cent., the number of out-patient attendances has increased by over 16,000 to over 140,000 per annum, and the number of day cases per annum has doubled. The waiting list is not only under control, but a great deal better than the England average, and it is a commendable reflection on what has been going on there.
Let me turn to the dismissal of Sir Jack Smart. The hon. Gentleman said that his sacking in no way resolved the matters facing Wakefield health authority. I wrote down what he said. How right he is. That was the only sensible comment that the hon. Gentleman made. The removal from office of Sir Jack Smart cannot come as any surprise to those familiar with the long and unhappy saga surrounding Wakefield health authority. He was dismissed from the chairmanship of the health authority on 3 October because for him to continue in office would not have been in the best interests of the Health Service in that district. The decision was based not solely on the regional 274 health authority inquiry, but on a wide range of considerations over a considerable period. The hon. Gentleman may recall that a motion of no confidence was passed against Sir Jack Smart by his own health authority while he was in the chair. That situation could not continue.
I speak of Sir Jack in sadness rather than anger for he has given many years of sturdy public service to the Health Service and elsewhere. The members of Wakefield health authority, who carry collective responsibility, should not seek to fix the blame on one man. What patients there need is leadership and decisions taken in the interests of patients, not in a factional or partisan mode. The behaviour of some people on the authority has been a disgrace and is probably best put behind them.
The health authority is now faced with a large group of decisions which it is required to take, not least about cook-chill, Snapethorpe hospital, the appalling levels of heart disease and the high rate of measles and other preventable diseases. Ministers now hope that the authority will get on with those matters and put its troubles behind it.
I remind the hon. Member for Normanton (Mr. O'Brien), who spoke so eloquently in favour of Sir Jack Smart, that it was his hon. Friend the Member for Wakefield who, according to the Wakefield Express of 4 September 1987, wrote to Sir Jack urging him to resign, saying:
I have to express my total lack of confidence in your chairmanship.Labour Members may like to discuss that between themselves. We are now proceeding with the careful consideration of the appointment of the new chairman and hope to make an announcement shortly. Ministers are satisfied that correct procedures have been followed in the dismissal of Sir Jack, and there will be no further inquiries.The previous vice-chairman has also given us good service. His term of office came to an end on 30 September, and we would like to put on record our thanks for his many years of service. Health authority members will have an opportunity to elect his successor at a meeting on Friday 28 October, and we hope that they will get on with that, too.
Opposition Members know that Yorkshire regional health authority established a group of acknowledged experts to advise on the safe introduction of cook-chill. I have here the group's report, which was published on 30 September 1987. It confirmed the safety and value of cook-chill in general and concluded that Wakefield's proposals were satisfactory, subject to some further work. Wakefield health authority got on and did that further work and produced a revised policy which satisfied the expert group. This includes the regeneration of food at ward level. Its implementation was agreed on 29 July when additional capital funds of £350,000 were provided by the regional health authority.
Our view has always been that issues to do with cook-chill are essentially local ones for local managers to sort out and we expect them to get on with it. [Interruption.] By "them" I mean the health authority, not just the district manager or a single individual. The efforts made tonight to pillory individuals are a disgrace. To cast those slurs on individuals in this Chamber is an abuse of parliamentary privilege and I would have thought that it was against all the principles of Socialism.
275 The Wakefield health authority, in its paper to its own authority, says that it anticipates savings of at least £200,000 a year. The main effect will be a reduction in the number of posts needed to operate catering, a reduction in the amount of overtime, and so on. That, of course, will affect members of NUPE.
What the hon. Members for Wakefield and for Halifax (Mrs. Mahon) forgot to tell the House in their allegations about the interests of other people outside, who cannot respond, is that they are supported by NUPE. On that sort of basis I would have expected them to say that those who have paid their election expenses are concerned about their jobs. That is a legitimate concern, but it also reflects on the important fact that the health authority will have a substantial additional sum a year to spend on patients. In the end, we are here to look after patients, not the full-time 276 officials of NUPE, COHSE and one or two other unions.
A prominent Health Service publication likened events in Wakefield to a Health Service soap opera—"Dallas" without the sex. This was a sad event. Ultimately, it is our responsibility to all involved to ask them to examine and readjust their motives and attitudes and to give the Wakefield district health authority a fresh start, for the sake of those who have been largely forgotten in all this and barely mentioned by Opposition Members in their tirade against good and honourable men and women in Wakefield. We have to think about the patients and patient care, and that is what I propose to do.
§ The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at ten minutes to Eleven o'clock.