§ Queen's Recommendation having been signified—
§
Motion made, and Question proposed,
That, for the purposes of any Act resulting from the National Health Service and Community Care Bill, it is expedient to authorise the payment out of money provided by Parliament of—
§ Mr. Bob Cryer (Bradford, South)We have a right to raise issues in the House. I am not deterred by the fact that it inconveniences some hon. Members who resort to vile shouts from a sedentary position.
§ Mr. CryerI would point out to the hon. Member for Lancaster (Dame Elaine Kellett-Bowman) that it will actually encourage me.
§ Dame Elaine Kellett-BowmanIt would be so much better if, instead of constantly speaking on money resolutions, the hon. Member for Bradford, South (Mr. Cryer) actually attended and took part in the main body of the debate.
§ Mr. CryerI wish to ask a few brief questions, which are not unreasonable bearing in mind that under the heading
Financial Effects of the Bill,the Bill authorises some £200 million. Therefore, I hope that the Minister will be able to respond.The first financial effect authorised by the money resolution includes an estimated £10.5 million in
remuneration to non-executive members of health authorities and Family Practitioner Service Authorities".As that is a fairly accurate sum, I have no doubt that the Minister will be able to tell the House the average payment to be made in that context.
§ Mr. Dave Nellist (Coventry, South-East)On a point of order, Mr. Speaker. I apologise to you, Mr. Speaker, and to my hon. Friend the Member for Bradford, South (Mr. Cryer) for interrupting, but I wonder whether you could ensure that those Tory Members who want to leave the Chamber do so quietly. I believe that while we have a debate on the money resolution which concerns many millions of pounds, at least we should be able to hear the arguments. I cannot do that because of the Tory rabble.
§ Mr. SpeakerWill hon. Members kindly leave quietly please? Is that better?
§ Mr. NellistMuch better, thank you.
§ Mr. CryerI shall not detain the House too long, but comments made from a sedentary position encourage me 774 to repeat everything again to make sure that the Minister has a thorough understanding of the matter. Therefore, I would discourage hon. Members from so doing.
The second paragraph relates to
The arrangements necessary for establishing contracts for services and setting up NHS trusts".The money resolution refers to loans to NHS trusts. Will the Minister elaborate on that and explain whether grants will be made or whether NHS trusts are to be bribed with loans?The amount of money listed in the paragraph on the financial effects of the Bill is quite considerable—£155 million in a full year. I am sorry that the Minister has not allocated any money for the holding of local ballots so that the people of an area can decide whether there should be an opted-out hospital and an NHS trust in the first place. The Government are keen on ballots for trade unions and virtually everything else.
§ Dame Elaine Kellett-BowmanWill the hon. Gentleman give way on that point?
§ Dame Elaine Kellett-BowmanWe have an hour and a half.
§ Mr. CryerThe debate is limited to 45 minutes, so the hon. Lady is 100 per cent. wrong.
It would be better if the Minister allocated money for a local ballot so that there can be a clear democratic decision on whether an NHS trust is set up.
§ Dame Elaine Kellett-BowmanWill the hon. Gentleman give way on ballots?
§ Mr. CryerThe third paragraph concerns GP practice funds which are quite important, but, as the hon. Lady is piercing my ear drums and making them oscillate rather wildly, I shall give way.
§ Dame Elaine Kellett-BowmanThe hon. Gentleman did not give way when I asked him about ballots. In some specialties 49 per cent. of people being treated in Lancaster come from outside the district. What on earth would the hon. Gentleman regard as the catchment area for that vote?
§ Mr. CryerI am prepared to consider any proposal that the Minister might put forward. The Government have displayed much ingenuity in arranging ballots for trade unions, so I see no reason why they cannot have a shot at defining a catchment area for ballots for hospitals. I should like to see them show some political will to do that. Although they are spending £155 million on what appears to be loan finance to the NHS trusts, there is no provision to allow local people to take their own decisions. By and large, people in Bradford have shown themselves to be overwhelmingly against NHS trusts.
The third paragraph on the financial effects of the Bill says:
There will be additional costs associated with the change in the functions of Regional Health Authorities".That will cost £8 million in a full year, including extra tasks as a result of the introduction of GP practice funds. That significant sum of money will be spent on something that, by and large, GPs have said they are not enthusiastic about because they do not believe that it will strengthen the National Health Service.The fourth paragraph says: 775
Under the GP practice fund scheme … the costs to practices of undertaking work in anticipation of becoming fund holders and in administering these funds will be reimbursed subject to a specified maximum amount.Together with additional computer support, that will cost a total of £15.6 million. That is a lot of money for something about which GPs are not enthusiastic. No doubt the Minister will justify it by saying that it will produce greater efficiency, but these sums are for administrative measures, none of which is of direct benefit to patients. I should like the Minister to say how he foresees that £15.6 million producing greater value for money.The fifth paragraph says that the initial capital cost of the information systems for the management of drug expenditure will cost £9 million,
with ongoing costs thereafter of £3.3 million a year.Is expenditure on drugs in the Health Service so lax that such an amount of money is necessary to provide information about it?The sixth paragraph mentions audit costs and links with the fifth paragraph, because there will be an increase in the cost of auditing of between £12 and £16 million as a result of the transfer of the National Health Service audit function to the Audit Commission. I can see sense in transferring auditing to a central body, but one of the aims of doing so would be to reduce costs rather than increase them. Surely one of the aims of a central audit body would be to obtain economies of scale, expert knowledge and a reservoir or repository of audit knowledge and efficiency, yet it will cost an extra £16 million, which so far has not been explained.
The seventh paragraph, on asset registers, caused me some concern. I understand that the introduction of capital charges and the upkeep of asset registers will cost £5.5 million. Does not the Minister think that that will put pressure on authorities to get rid of assets that have a realisable value? Much concern has been expressed in Bradford, because Westwood hospital, which stands in attractive grounds, would be worth much money if it was sold to a speculative builder. It is a hospital for mentally handicapped people, and its staff and the relatives of its patients believe that it would be far better if the grounds were used for developing a village community.
When I raise this point, Ministers say, "That sounds like a reasonable idea, but it is not one of the schemes that is being promoted as an experiment in community care." The hospital provides a potential community. Decanting handicapped people into the community without adequate care provision and resources might result in the erosion of this valuable asset. If mistakes are made and the hospital's grounds are sold, there will be no reserve available to which people can be transferred back. Sometimes people are returned to the community, but there is mutual suspicion by patients and the community. The patients therefore return willingly to places such as Westwood hospital.
I hope that the paragraph reflects an administrative measure to keep a check on what assets the NHS has and to make good use of them and that this is not simply an asset-stripping pressure imposed on the NHS.
§ Mr. Nigel Spearing (Newham, South)My hon. Friend is voicing deep and widely held concerns about these hospitals. We wish to retain those hospitals for the very purposes that he has outlined. Is he aware that in London the realisation of so-called surplus assets, especially by the 776 North East Thames regional health authority, amounts to between 40 and 50 per cent. of the expected capital investment in new hospitals? These amounts have recently been cut because of the drop in the value of land sales.
Would not a transaction such as that described by my hon. Friend place an unenviable pressure on the regional hospital boards—to say nothing of the Secretary of State—to get rid of assets which should be retained for capital investment? That investment should come from the Exchequer, not from land sales which are supposedly surplus but are probably not.
§ Mr. CryerMy hon. Friend makes the very point that I was outlining. There should not be pressure from central Government, saying, "You should realise the assets on the register and sell them at the highest possible price. Speculative builders want to purchase them, so you must sell them as part of your resources to provide community facilities."
Westwood hospital is a precious publicly owned asset. It is situated in grounds that look like college grounds. There are rolling acres. It could be part of an important pilot project. A village community could use the common resources of the hospital, providing a sheltered environment for patients. The patients would not live in the harshness of the community, where they and other members of the community may view each other with mutual hostility. The patients could be encouraged to achieve some independence in a protected environment. That is very much the aim of the patients, the staff and the relatives. Both the relatives and the children in the hospital are growing older, and aging parents are worried at the thought of their children being moved to an area where they do not receive the necessary care and attention because of a lack of resources. That is an important paragraph. I should be grateful if the Minister would assure the House that this village concept will be encouraged rather than scorned.
I greatly welcome the last paragraph on the removal of Crown immunity. Ten years ago, I argued that Crown immunity for all sorts of bodies should be removed. That was viewed as a slightly wild, Left-wing dictator's position. That is certainly not an accusation that can be levelled against the Secretary of State. It is right and proper, and the costs involved are relatively modest in view of the step forward that it represents.
On page xi, the Bill says:
The changes enabling local authorities to make arrangements for the provision of nursing home care … amount to £20 million.Will the Secretary of State give us the basis for the £20 million charge because it seems a rather small sum? The question of community care is important. I hope that the Secretary of State recognises that many people are extremely apprehensive about the resources that will be made available and that £20 million does not seem an adequate sum.
§ The Secretary of State for Health (Mr. Kenneth Clarke)I congratulate the hon. Member for Bradford, South (Mr. Cryer) on his ingenuity in getting into the Health Service debate. Other hon. Members come during the debate, listen to other people and speak before we vote on the principles behind the measure. That does have inconvenient points, such as having to seek to catch your eye, 777 Mr. Deputy Speaker, in competition with other hon. Members. The hon. Member for Bradford, South prefers to steam in some time after we have voted and to speak on the money resolution, although he has raised some valid points. It also saves him from having to read the whole Bill. He always turns up the pages that describe the financial effects of the Bill and works steadily and carefully through them, paragraph by paragraph. I am genuinely in awe of his ingenuity and if there is ever a prospect of the Labour party winning an election, I hope to have a chance to do the same to him some day. Meanwhile, I shall seek to answer his points briefly.
We believe that payment for non-executive members is right, although we expect to make very modest payments, such as those that would be made to the non-executive director of a substantial board in the private sector. Nowadays, membership of a health authority or, in future, an NHS trust is not a minor matter of public service which people can take on for an hour or two a week, for which they can be quite unremunerated and in which they can expect to have some fairly honorific duties. The turnover of district health authorities can be £50 million or £80 million a year and such authorities are involved in crucial decisions about the use of assets and the development of services in their locality. To pay such members nothing would mean that the people making the appointment would have to go to a restricted group of the population. We are talking not about a full-time salary, but a small honorarium, which is now appropriate and compensates in part for the attendance allowance monies that are paid to councilors—
§ Mr. Nellistrose—
§ Mr. ClarkeI believe that the hon. Member for Coventry, South-East (Mr. Nellist) wants to ask me about that.
§ Mr. NellistThat thought had occurred to me. Will the Secretary of State tell us how small the honorarium will be? Many local authorities' budgets are handled by people who receive a pittance for their attendance. Those budgets may run to many hundreds of millions of pounds. Does this reflect a change in Government thinking? The Department of the Environment still says that it does not intend to pay decent allowances to councillors, whereas the Secretary of State for Health appears to be saying that large sums will go to non-executive members. Can he give us some figures?
§ Mr. ClarkeI know some local authority members who appear to regard their local authority work as their sole source of income and make a full-time job of it. Admittedly, that tends to happen in councils in which large numbers of committees are formed and in which committees sit almost daily, so causing almost daily attendance. I do not contemplate any sum that we pay using this power would enable anybody to regard the membership of a health authority as a full-time source of income. People may devote many hours a week to it and on some regional health authorities some of the members are, in practice, full time. I was thinking of a few thousand pounds only to mark the fact that this is no longer an honorific or titular post.
778 The next paragraph on page x refers to the sum of £155 million, which is the best estimate we can make of the initial cost of strengthening the management of the National Health Service in a variety of ways, such as the establishment of contracts for services, the setting up of NHS trusts and the general strengthening of management at all levels. I am sure that the sum will justify itself when one reflects that we are talking about the management of a service which gets through £28 billion each year at present. Financial and personnel management are not up to the strengths that one would expect of an organisation of this size. I am sure that the costs will be outweighed by improvements in the operation of the service and by the improved value for money that the strengthening of management should produce.
The next point the hon. Gentleman raised was about the additional costs of family practitioner service authorities. They do not arise solely from the Bill; in recent years we have changed the role of the old family practitioner committees. They play an important part in managing the contracts of the GPs, opticians, dentists and pharmacists in their locality. As they are staffed at present, they exist only to pay the cheques to doctors, so some strengthening of the service is required to enable them to carry out their new duties properly.
The amount spent on the GP practice fund scheme will depend on the number of participating practices. This is a modest investment for a part of the Bill that will prove popular with the GPs who take advantage of it, and with the patients in the affected practices. It is a great breakthrough for general practice that the more go-ahead GPs will have the chance to control the use of resources in their areas for the benefit of their patients in a way that has not been permitted them before.
The cost of the information systems for drug expenditure, at £9 million, is splendid value for money when one contemplates the huge expenditure of the Health Service on drugs. Despite all our discussions on drugs from time to time, every hon. Member agrees that it is worth seeing what we can do to avoid wasteful and unnecessary spending on drugs, as long as we ensure that the money goes back into the Health Service, as the Government intend that it will. Only the hon. Member for Peckham (Ms. Harman) still believes that our proposals might involve cash limits on GPs' prescriptions of drugs—she is the last survivor of an ever dwindling band. Everybody else welcomes the proposal.
Audit costs are also modest, given that they will extend value-for-money audit of the huge sums that we spend. Asset registers are concerned with ensuring that proper regard is paid to capital costs when determining value for money in the NHS. They will not have much bearing on longstanding policy on the disposal of surplus land which might occur in the case of Westwood hospital. When examining the best way of developing services, those responsible in the health authorities will not just go for capital-intensive solutions all the time—because they get a grant of capital, they can disregard the cost compared with the revenue they must seek. They will make the best judgments, taking account of the cost of the capital and comparing it with the revenue costs that might be incurred by other methods. That is a sensible accounting change.
This might result in some hospitals being retained for longer. In future, authorities will determine how to make better use of their premises, instead of always thinking in terms of great new capital building.
779 I am glad that the hon. Member for Bradford, South and I agree completely about Crown immunity. We are moving towards abolishing it altogether. All hon. Members agree that there is no place for the continuation of Crown immunity in the NHS, and no reason why health authorities should not be liable to the same controls—
§ Mr. NellistWhat about this place?
§ Mr. ClarkeThis is not the time to give my opinion on the House of Commons having taken on responsibility for its own affairs some time ago. We have enough difficulties trying to improve the management of the NHS; improving the management of the House would be a labour of Hercules on which I have no intention of embarking.
§ Mr. ClarkeI hope that I have dealt with most of the hon. Gentleman's points. I am grateful to him for drawing attention to these important financial matters. I trust that he will now allow us to vote on the money resolution in the same way as we did on the Bill.
§ Mr. Deputy Speaker (Sir Paul Dean)Order. I do not think that the Minister is giving way.
§ Question put and agreed to.
§
Resolved,
That, for the purposes of any Act resulting from the National Health Service and Community Care Bill, it is expedient to authorise the payment out of money provided by Parliament of—