HC Deb 03 July 1989 vol 156 cc127-34

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Alan Howarth.]

Mr. David Winnick (Walsall, North)

The background to this Adjournment debate is the decision of the Walsall health authority on 27 April this year to submit an expression of interest—that is how recommendations are worded—in what is called self-governing status for two hospitals in my borough: the main hospital, the Manor, and St. Margaret's hospital. Reference was made in the recommendations to a consultation exercise—whatever that means—by the regional health authority, but, at most, that will be of the most limited kind. Who is to be consulted and on what basis? Are medical and non-medical staff of the hospitals concerned to be consulted, or are they to be balloted? How will residents in the borough, the unions and professional associations be consulted?

On 3 May I wrote to the chairman of the Walsall health authority and told him that I remain strongly opposed to the decision. I stated that there was no evidence whatever that any such decision would be in the overall interests of the borough. I added—I hope that the Minister notes this —that there could be no doubt that the large majority of residents are opposed to those hospitals becoming self-governing. I pointed out that if, however, the health authority was determined to press ahead with this matter, it was essential that the residents in the borough were given an opportunity to express their views. I outlined the arrangements that should therefore be made for balloting to take place, with each electoral polling district within each ward being used for residents to express whether they agree with the recommendations of the health authority.

I followed that up with a letter on 18 May to the Secretary of State, enclosing a copy of my letter to the chairman of the health authority and again setting out the arguments for ensuring that ballots are held before there is any opting out, or what the Government describe as self-governing status, for those National Health Service hospitals. I shall return to that in a moment and also to the reply which I received.

The opted-out hospitals will undoubtedly be under immense pressure to specialise in profitable activities and to drop others. It is far less likely that local communities such as mine will be guaranteed a comprehensve package of services. There will also he a financial disincentive for such opted-out hospitals to treat patients who are not covered by a contract from a health authority or a general practitioner under the White Paper proposals described as "Working for Patients"—that is not how I would describe them.

It may be said that that is the typical reaction of the Labour party. People may say, "What do you expect from Labour politicians? 'Hands off the NHS; hands off the existing arrangements'. It is all party propaganda." I make no apologies for the fact that since the Labour Government brought in the National Health Service 41 years ago we have all been completely devoted to the idea. We were devoted to the conception before it was brought in and we have been determined that the National Health Service should survive.

That is not just the opinion of the Labour party, because medical opinion seems to be of the same view. The British Medical Association Council said: The Council believes that the establishment of self-governing hospitals would fragment the service and destroy its comprehensive nature. Patients would no longer have available to them in their own localities a full range of health care facilities, and this would be a cause of great inconvenience to them and to their relatives. The BMA, again in evidence to the Select Committee on Social Services, gave this warning: The considerable experience of such hospitals in the USA shows clearly that there will be pressure to encourage admission of patients that can he treated with financial benefit to the hospital, rather than to admit those patients often the chronic sick whose treatment is likely to lead to little or no financial benefit. I shall quote, too, the views of the joint consultants committee. I very much doubt whether the BMA is dominated by Labour voting doctors. Likewise I have considerable doubt whether the joint consultants committee has an in-built Labour majority. I hope that the Minister will listen to what the committee said: These proposals inevitably change the prime aim of the management of these hospitals, from the provision of adequate care to the community as a whole to the financial success of the hospital. The considerable experience of such hospitals in the USA shows clearly that there will be pressure to encourage admission of patients with conditions that can be treated with financial benefit to the hospital rather than to admit those patients—often the chronic sick—whose treatment is likely to lead to little or no such financial benefit. There does not seem to be much doubt about the medical view of hospitals opting out. The Royal College of Nursing also expressed strong disapproval of any such plans. Locally, Dr. Bradwell Davies, the chairman of the local medical committee in my borough, whose committee represents 180 general practitioners, said that the vast majority of doctors oppose opting out by hospitals. He also made the valid point that they have not been consulted.

Opted-out hospitals will have the right to dispose of assets. The only restriction apparently will be if the Secretary of State believes that it would be against the public interest. The Opposition do not believe that that is much of a guarantee at all.

As there is the possibility that the Minister will consider that opting out is not the right expression to use about this matter, it is interesting to note that on 15 May, when I asked the Minister of State, Department of Health about opting-out hospitals, he did not challenge that description. That is rather like the so-called community charge. Everyone knows that it is a poll tax—even Ministers admit that. The same can be said about hospitals opting out.

I take the view that opting out is a halfway house to privatisation. No doubt the Minister will tell me that opted-out hospitals or hospitals with governing status, however he likes to describe them, will remain with the National Health Service. Perhaps they will, in a way, but opting out is a halfway house to privatisation. We all know how the Government could proceed once hospitals opted out of the existing NHS management structure.

The Minister and I will not agree about the pros and cons of opting out. He is here, understandably, to represent the Government's point of view. The decision was made in Cabinet, and a junior Minister—I mean no disrespect to the hon. Gentleman—is here to echo the Government's line. He is not likely to say, "You have a point of view and I shall press it among my ministerial colleagues." We shall clearly not reach agreement on this matter tonight.

Before there is any opting out or self-governing status, whatever description the Minister wants to apply to the proposals, there should be adequate balloting before the matter is taken any further. It is interesting to note that balloting is necessary before schools can opt out. Before the accommodation of council tenants can be bought by private landlords, balloting is necessary. Before a housing action trust can be set up, balloting is now necessary. As we know, the Government were adamant initially that there would not be any balloting for housing action trusts. The Secretary of State remained adamant, even when the other place passed an amendment that required balloting to take place. At the end of the day, however, balloting was accepted.

I received today the Minister's reply to my letter of 18 May. It is dated 30 June. He states: RHAs will give the proposals publicity and seek the views of all interested parties particularly the health authority concerned, staff of the hospital, general practitioners, community health councils and the local community. He adds: We have decided that it would not be sensible for the RHA to organise ballots of staff or any other group with an interest. What does that mean? What sort of a consultation exercise will it be? Do not the Government believe in the same form of democracy in which I believe? I believe in balloting. Let the people decide. I am a democrat. If a decision goes against me, that is most unfortunate to say the least, but for all the reasons that I have outlined I must accept the decision, as I have accepted other decisions. I have no doubt that the Minister has done that in political life when decisions have gone against him. That is the nature of our democracy.

Why should there be no balloting in this instance? Is it really not practicable, or is it because the Government know that if balloting occurred there would be an overwhelming majority against the Government's proposals? The Minister knows that that is so, but he will not concede the point. He knows it as well as I do, otherwise the Government would have no hesitation about balloting.

At a public meeting that was held in the town hall in the borough a few weeks ago there was total opposition to any opting out. No one came from the Conservative party or the doctors to say, "I have a point of view that is in its favour." We would have listened because we are democrats. The meeting was well advertised, publicised and attended and no view was expressed in favour of the Government's case. If the Minister consulted the local district health authority, I think that it would concede to him privately that what I am saying is the truth. Who is frightened of democracy? Who is reluctant to put the issues to those who are concerned?

We will not abandon the campaign. In my borough we will continue to insist that those two hospitals remain within the existing NHS management structure. I hope that there will be similar campaigns throughout the country in defence of the NHS hospitals. I said that I thought of the plans as a halfway house to privatisation. The Government have no real commitment to the NHS. We all know that if, electorally, they could have got away with it, even more damage would have been done— [Interruption.] The hon. Member for Croydon, South (Sir W. Clark) mutters and mumbles, but I doubt whether he has any commitment to the NHS.

The Minister, understandably, will read his prepared speech, but I hope that he will take on board what I have said about democracy and the views of the local community. The overwhelming majority are against his proposals. We shall certainly continue the campaign in Walsall.

10.41 pm
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

I congratulate the hon. Member for Walsall, North (Mr. Winnick) on securing this debate and on presenting his arguments so clearly. It is a pleasure, at this hour of night, to be debating with such a seasoned campaigner, battling as always against common sense and, on this occasion, the tide of history on the reforms of the National Health Service.

During the six months that I have served as a health Minister I have visited many hospitals and spoken to many of those who work in the Health Service. I have seen for myself the great deal of interest in the concept of self-governing hospitals. The Government are convinced that it is an exciting and excellent opportunity for the NHS. I shall be playing my part—not merely reading speeches as the hon. Gentleman implied—in helping to explain to those who work in the NHS and to patients the great value of the Government's proposals.

I am glad to have this opportunity to put on record the considerable achievements of the Walsall district health authority in improving health services for the people of Walsall and the ways in which our White Paper proposals will build on those achievements. The hon. Gentleman did not have time to dwell upon the authority's achievements, nor upon those of the Government during the past 10 years. I hope that he will not mind if I take a few minutes to put those achievements on the record before dealing specifically with his points.

The Government's record since we came to office amply demonstrates our commitment to the National Health Service. We have increased spending by some 40 per cent. in real terms. We are treating more patients each year and we have greatly increased the numbers of doctors and nurses working in the NHS.

Walsall district health authority has shared in all those advances and has significantly improved its position as a district that includes some of the most deprived areas in the west midlands region. In the current financial year the district has received an increase of more than £5.5 million in its revenue budget, bringing the total to just under £53 million. That represents a cash increase this year alone of 11.5 per cent. Part of that increase will help to pay for the running costs of the new £20 million Walsall district general hospital which, as the hon. Member will know, was recently completed. That magnificent new hospital, which will admit its first patients in December, will eventually have 289 acute beds, together with an accident and emergency department, operating theatres, a coronary care unit and X-ray rooms.

That is not the only major development in Walsall. Work is due to start as soon as possible on the new Anchor Meadow community hospital, costing more than £9 million. It should be completed by March 1991. We have recently given approval in principle to a new scheme for psychiatric services in the district. That scheme, costing some £8 million, will he carried out in two phases, the first starting later this year. That is a major capital investment programme in anyone's terms. The people of Walsall already have a Health Service of which they can be justifiably proud. The completion of those projects will provide further improvements.

Walsall is to be congratulated on its success in reducing hospital in-patient waiting lists, which were down in March 1989 by nearly 17 per cent. by comparison with the previous year. The reduction in the number of people who have waited for longer than a year is even more dramatic, for it has fallen by more than one third. Those significant achievements are reflected by increased activity rates in almost all specialties. That is a tribute to the skills and professionalism not only of management but of all who work in the Health Service in Walsall.

There is more to proper health care than hospitals—and Walsall's efforts, quite properly, do not end with the provision of hospital services. The district has an admirable record of taking positive and imaginative steps to prevent ill health. In January, I announced that for 1989–90 the Government were allocating to regions a total of £7.8 million for measles, mumps and rubella vaccinations. I drew attention to the excellent local rubella publicity campaign being run in Walsall, which continues to be a great success. There have been about 860,000 vaccinations to date, and the district is well on its way to meeting its target. I hope that the hon. Gentleman agrees that the health authority is doing a great deal to improve the health care—including hospital facilities—that is available to the people of Walsall.

I turn to the hon. Gentleman's specific points. The White Paper "Working for Patients" outlines a number of initiatives to make the Health Service more responsive to the needs of patients by delegating responsibility for managing hospitals as far as possible to local level, and giving general practitioners and patients more choice. Our basic thinking is that hospitals and other NHS units are best run locally by the doctors, nurses and managers who have first-hand local knowledge. Self-governing hospitals will have the freedom to run their own affairs.

Self-governing hospitals will not opt out but will remain fully part of the National Health Service. The hon. Gentleman believes that that is halfway to privatisation and to breaking up the NHS. He is entitled to his belief, but he is wrong. My right hon. Friend the Prime Minister and the Government made it absolutely plain that the Health Service will continue to deliver its services free to patients and be financed largely by taxation and by national insurance contributions.

Each self-governing hospital or unit will have its own trust, which will assume responsibility from the district health authority. In that way they will be able to benefit from the freedoms outlined in the White Paper, to respond to patient needs, to improve the quality of care even more effectively, and to develop a greater sense of local commitment and pride. We stress that self-governing hospitals must continue to meet the needs of patients and the community. They will have delegated freedoms in respect of staff numbers, pay, and capital programmes. Staff transferring to a self-governing hospital will carry over their terms and conditions of service, including pension rights.

The Government fully recognise the importance of maintaining local access to a comprehensive range of health care services. We look to district health authorities to take responsibility for that and for ensuring that contracts are arranged in such a way as to ensure that integration of community and in-patient services is maintained. With the development of self-governing hospitals, and of greater devolution to hospitals that remain under district health authority control, districts will be better able to give attention to those key tasks.

As the hon. Gentleman knows, one of the White Paper's key proposals is that DHAs will have responsibility for the care of all those in their districts and will be purchasers of health care, whereas the hospitals —both self-governing and directly managed—will be the suppliers of health care. The district health authority will be responsible for ensuring that an adequate range of services, including core services, is available in its district.

Mr. Winnick

Obviously the Government have made up their mind to push the White Paper's proposals as much as possible—and it is equally obvious that the consultation exercises and all the rest of it are purely cosmetic. The Minister naturally praises the Government's intentions, but why are the Government so isolated? Leaving aside the objections of the Labour party and the rest, why is medical opinion almost unanimously opposed to the proposals? I read out the views of the BMA, of the JCC, and of the general practitioners in my borough—and I imagine that their view is shared by GPs in the Minister's constituency. If the proposals are so marvellous and will enhance the NHS, why are the general public—let alone the medical profession—far from being persuaded?

Mr. Freeman

The hon. Gentleman may cite the BMA's views, but that does not mean that his arguments are right.

I turn to the subjects of consultation and ballots and to the other matters that the hon. Gentleman specifically raised.

The chief executive of the National Health Service management board invited initial expressions of interest in the proposals for self-government to be sent to regional health authorities by 31 May. Of the 179 expressions of interest 19 came from West Midlands region, including one from the Manor hospital and one from St. Margaret's hospital in Walsall. Expressions of interest are just that: they do not carry any commitment to proceed with an application. Indeed, it would be unrealistic to expect them to do so until they have fuller information. We are very encouraged by the level of interest that people from all parts of the NHS are showing in our proposals.

We have recently published further guidance on the establishment and operation of self-governing hospitals. A national conference on self-governing hospitals, attended by more than 400 people from the NHS, was held in London on 20 June, and we are following it up with a series of eight regional conferences around the country. The first was held in Birmingham on 22 June. I hope that those who attended, including those from the units in Walsall that had expressed an interest, found it interesting and informative. Sponsors of expressions of interest will want to consider the new information in detail, and to discuss the implications with their staff and district and regional health authorities before deciding whether to proceed with an application.

When people decide to proceed with firm applications they will be asked to complete an application document. Regional health authorities will give firm applications local publicity and seek the view of those with an interest, particularly the health authorities concerned, staff at the hospital, general practitioners, community health councils and the local community. Each application will need to he subject to careful consultation, given the complicated service, management and financial implications involved. The Secretary of State will consider any responses, together with any comments on them from the regional health authority, alongside the application. The timing will depend on the passage of the necessary legislation.

The hon. Gentleman asked why there should not be a ballot. We are not changing the terms and conditions of staff employed in the Health Service. This is not a closure, nor is a hospital leaving the Health Service; it is a delegation of powers and responsibilities by the Secretary of State to a hospital trust. We do not consider, therefore, that a ballot is either necessary or practical. To what constituency would the ballot apply? As the hon. Gentleman knows, patients—including Manor hospital patients—come from outside his district, and it is not possible or feasible to define the constituency precisely, as can be done with a school or housing estate.

The final decision on applications will rest with the Secretary of State. As explained in the White Paper, he will expect applications for self-government to demonstrate first adequate managerial skills and capacity to run the hospital as a self-governing unit, and second the involvement of senior professional staff in management of the hospital. He will also need to be satisfied that the proposal is consistent with maximum choice for patients and GPs, that the proposed unit would be financially viable, and that self-governing status is not being sought as an alternative to closure.

The process is not a race, and hospitals will become self-governing only when they are ready. It is too early to comment on the prospects for particular hospitals at this stage. An application for self-governing status will take time and commitment to prepare, but it provides the opportunity for hospitals to address the implications of self-government and to build up their capacity to run their own affairs effectively so that their hospital is ready, when self-governing status has been achieved, to apply their new freedoms to the benefit of patients and the local community.

Mr. Winnick

The Minister argues that ballots are not necessary because the hospitals are to remain in the NHS. Why, then, the consultation? Clearly the Government accept that consultation is necessary, although we believe that it would be a cosmetic exercise. What sort of consultation will take place with the local community? If the Minister's argument holds water—that the local community should not really be involved, because the hospital caters for a wider element—why do both the letter and the Minister's speech refer to the local communities being consulted?

Mr. Freeman

I think that, on reflection, the hon. Gentleman will agree that there is a distinction between a change in organisation structure in the Health Service—where consultation is necessary and the Secretary of State intends that it should take place—and a fundamental change in NHS structure, involving, for instance, privatisation or breaking up the NHS. That is not intended, but in such circumstances it would clearly be appropriate to consult the electorate democratically. In this reorganisation of the Health Service, management authority is being devolved by the Secretary of State from regions and district to self-governing trusts. They remain within the Health Service. The Secretary of State envisages that those who are most directly involved, including the staff who work in the hospitals and certainly the community health council, will be invited to offer their views. As the hon. Gentleman knows, those views are expressed by community health councils when there is the prospect of a closure. The community health council will be asked to give its views about the devolvement of management responsibility and the Secretary of State will certainly take into account those views.

We expect some applicants to wish to take advantage of the new proposals as early as possible. They will aim to achieve self government by April 1991, the earliest sensible date, subject to the passage of the necessary legislation through this House and another place. Others will be ready later.

I hope that these comments will help Walsall and other authorities in England carefully and thoroughly to review the prospects for the exciting challenge of self government.

Question put and agreed to.

Adjourned accordingly at five minutes to Eleven o'clock.