§ Mr. Sam Galbraith (Strathkelvin and Bearsden)
I beg to move,That an humble Address be presented to Her Majesty, praying that the National Health Service (Local Health Councils) (Scotland) Regulations 1990 (S.I., 1990, No. 2230), dated 7th November 1990, a copy of which was laid before this House on 9th November, be annulled.A recent article in The Scotsmanwondered why there was no public outcry at the fact that local health councils were allegedly under threat. It is fair to say that letters received by hon. Members on behalf of local health councils have been sent only from members of the councils or their secretaries. That illustrates part of the problem. Local health councils have a low public profile and are seen, quite wrongly, by a large proportion of the public as having no useful role to play in the national health service. Clearly, something needs to be done about their role and functions.
No one is more aware of the problem than the local health councils themselves. That is why for a number of years they have been asking to have their structure and function reviewed. Rather belatedly, the Scottish Office agreed to that, and a review was carried out by Arthur Young Management Consultancy. Unfortunately, it was an unsatisfactory and perfunctory review, which recommended the abolition of local health councils and their replacement by directors of consumer affairs.
Local health councils were clearly under threat, so I met the Association of Scottish Local Health Councils. We discussed the problem and found that the association's view was similar to mine. Therefore, in May 1989 we agreed that I should put some proposals to the Minister. We agreed that the status quo was not acceptable and that 44 councils were too many. We accepted that there should be a reduction and streamlining in the number of councils with the aim of one council per board.
As well as in Orkney and Shetland, there are already single councils in the Borders, in Dumfries and Galloway and more recently, as a result of an amalgamation, there is now a single council in Ayrshire and Arran.
§ Mr. Galbraith
I will just finish this point.
We also agreed that there should be flexibility in the number of councils. Although the aim was to be one per board, for reasons of geography, as in the highlands, or large population, as in Glasgow, there would need to be some flexibility and some boards would have more than one council, but with the ultimate aim of one per board. We also wanted representation from each of the amalgamated areas to be guaranteed in the new councils.
§ Mr. David Marshall
Perhaps I was rather hasty in my intervention. My hon. Friend has clarified part of the point that I wanted to make in relation to the number of health councils in the Greater Glasgow health board area. Does my hon. Friend agree that it is disgraceful to reduce the number of health councils from five to just one, and to reduce the number of people actively participating in the councils from more than 130 to only 15, who will be hand picked by the health board? Is that not outrageous?
§ Mr. Galbraith
I was about to deal with the problem of Glasgow. When the Minister and I met, we agreed that for areas of large population such as Glasgow, one health council would be unsuitable.
§ Mrs. Ray Michie (Argyll and Bute)
If that is what the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) and the Association of Scottish Local Health Councils agreed, I suggest that that body was not properly representing all the local health councils in Scotland. For example, Argyll and Bute strongly opposes abolition. There is no way in which a local health council operating from Paisley or Dumbarton can properly represent a unique area such as Argyll and Bute.
§ Mr. Galbraith
Part of the problem facing local health councils is that they can never speak with one voice. That is one of the reasons for reducing their number. That was agreed with representatives of the Association of Scottish Local Health Councils and, as I have said, I have received no representations from members of the public.
§ Mrs. Michie
I can assure the hon. Gentleman that the letters that I have received are not from local health councils, but from members of the public and community councils all over my constituency.
§ Mr. Galbraith
I have had no such letters, but I am grateful for the hon. Lady's comment.
As I have said, that was the position agreed with the local health councils and their umbrella body. Taking into account geography and population, there are good reasons for having only one health council per board. Is it really necessary, for example, for five separate councils to scrutinise the board's minutes and go through the Scottish Home and Health Department's circulars? I think not.
Most important of all, more than one council means more than one view, and the views expressed are often diametrically opposed. Boards can either ignore the councils' opinion on the basis that they cannot agree, which is often the case, or accept the one that suits them best and use it against other councils. We should therefore be thinking in terms of one council per board.
As a by-product of the reduction in numbers, resources would be freed. All staff could be re-employed and, rather than duplicate the work, could develop and expand their talents. Money would also be available for better accommodation and better sites. Rather than health councils being hidden away in obscure health board premises, they could be housed in shop-front premises in large thoroughfares, where they could be seen by the public and readily available to them.
In May 1989, with the agreement and support of the Association of Scottish Local Health Councils, I had a meeting with the Minister at which I proposed such streamlining. I also put forward proposals for beefing up councils, with shop-front premises and more staff. In addition, I suggested that councils should be consulted earlier by boards in the preparation of their strategy plans. As a result of that meeting, the future of local health councils, which had been under threat, was assured.
The Minister will remember that, at his request, I then submitted my full package to him in writing. The Association of Scottish Local Health Councils was given a copy and it was pleased with the position. It seemed that 411 we were all agreed. I was therefore somewhat surprised when the Minister tried to impose single councils even in the highlands and in Glasgow.
§ Mr. Galbraith
And in other areas, for reasons of geography. Although we had no formal agreement. I felt that the Minister had gone back on our understanding that there would be flexibility and that there would certainly be more than one council in the areas that I have mentioned.
I was pleased when the Minister retreated from that position in his response to his hon. Friends on 17 October and made it clear that schemes for more than one council would be considered on their merits, with population figures and geography being taken into account. I therefore ask the Minister to confirm that there will be flexibility in the number of councils, based on geography and population. Surely the Greater Glasgow health board, dealing with a population of about 2 million, needs more than the one council proposed by the board. Will the Minister reject that proposal and ask the board to think again?
Will the Minister also consider the question of premises? It is difficult for the public to contact their local health council when it is lost up a stair in some run-down, far-off hospital. Will the hon. Gentleman ask boards to site their council premises, if not in shop-front premises, at least in a busy thoroughfare where the public can see them and gain easy access to them?
Will the Minister also use the resources freed by the reduction in the number of councils to ensure better staffing of councils, including better secretarial services? If councils are to fulfil their functions properly, they cannot continue with one paid official and limited secretarial services.
§ Mr. Gavin Strang (Edinburgh, East)
Does my lion. Friend agree that it is vital that the staff should be wholly controlled by the council rather than their appointment being dependent on the board? I also put it to my hon. Friend that there is tremendous concern about the proposals in Lothian. I am sure that he intends that, whatever scheme is proceeded with, it should demonstrably have the support of the local communities rather than being cobbled up between the health councils and the boards.
§ Mr. Galbraith
It is important that any scheme should have the support of the local community and not just the support of the local health councils. Does the Minister accept that, if the health boards are to be seen to be independent, it will be necessary for them to appoint their own staff? It is bad enough that members of health councils are appointed by health boards, but when the officials who do much of the up-front work are also appointed by the boards, any semblance of independence disappears.
§ Mr. Menzies Campbell (Fife, North-East)
In his review of the way in which health councils are to be constituted, has the hon. Gentleman given any consideration to the fact that local authorities are no longer permitted to nominate members to health councils? Is that not a defect in the proposals which justifies criticism of the Government?
§ Mr. Galbraith
I do not think that any group should necessarily have a right to place members on a local health 412 council, but nor should anyone be excluded from health councils. However, if a local authority proposes a member for a health board, the board should have good reasons if it turns down the request.
§ Mrs. Margaret Ewing
I should be interested to learn how the hon. Gentleman believes that members of the health councils should be appointed or elected. He has made it clear that he does not believe that the local authorities should be involved in the process, so presumably he is also ruling out the district trades councils. How are people to arrive on those organisations?
§ Mr. Galbraith
My view is that anyone should be able to nominate members for health councils and that no group should be excluded. That is the current position.
§ Mr. Galbraith
By the health board, as is the current position—unless the hon. Lady has a different proposition, in which case I should be interested to hear it.
Mr. Alex Sahnond (Banff and Buchan)
The hon. Gentleman is making the Minister's speech.
§ Mr. Galbraith
I am not, but that is the current position.
The Minister has proposed that the councils should have a membership of 15, but I ask him to think again. Now that there are to be fewer councils, with more work, it seems appropriate to increase the number of members serving on them. To deal with the increased workload, why not allow councils to form sub-committees to which they could co-opt members, which would enable them to have area committees to deal with the specific areas that they look after? That is the system that the Minister is proposing for the health boards. If it is good enough for the health boards, it is surely good enough for the local health councils.
Finally, will the Minister have an early meeting with representatives from the Association of Scottish Local Health Councils? When he discusses this matter with them, he will find that there are a number of areas of agreement and that their views and his own are not so far apart as he might think. It would be nice if at least one change in the NHS could be brought about by consensus and co-operation rather than the usual confrontation.
§ The Minister of State, Scottish Office (Mr. Michael Forsyth)
The hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) appeared almost to have been briefed by the Scottish Office. I agree with many of his points, which is how it should be. In a matter of this kind, it is good that there should be agreement between the parties.
§ Mr. Forsyth
I have, indeed, and I shall try to speak to the brief, as the hon. Gentleman would expect.
Local health councils have existed in Scotland since 1975. Since that time there have been significant changes in how the health service is administered, but the councils' role has largely gone unchanged, despite the abolition in the mid-1980s of the district tier of administration on which many of the councils were based and despite the fact that the original departmental guidance setting up the 413 councils envisaged a review after two or three years. That review was not carried out until the Association of Scottish Local Health Councils came to see me in 1988.
In preparing for this debate, I called for the note of my meeting at that time with the association. Hon. Members will be interested to know that this recorded that the chairman was anxious to see in Scotland a strong independent voice speaking for the consumer and that he was concerned that local health councils were struggling to fulfil their original role and often chose the easy route of highlighting bad news and inefficiencies. I mean no disrespect to the individuals who sit on the councils, many of whom devote a great deal of time and effort to the task, but I suspect that most would associate themselves with that criticism.
§ Mr. Forsyth
The hon. Lady may disagree, but that was the view of the chairman of the Association of Scottish Local Health Councils, who represents the health councils. As the hon. Member for Strathkelvin and Bearsden has said, the 1988 review was carried out by the consultants Arthur Young. It confirmed the general disquiet about the role and performance of councils. It concluded that councils were having only a relatively low impact on decisions of health boards and recommended their abolition. I did not accept that because it seemed too radical a solution. In line with the comments made by the hon. Gentleman, we felt that there was a case for looking at councils and their structure and finding a more explicit role for them.
§ Mr. David Marshall
Does the Minister accept that not all the health councils are members of the Association of Scottish Local Health Councils? If what he has just said is the opinion of that association, I am surprised if it has any health councils in its membership because the sentiments he expressed were not those of many Opposition Members.
§ Mr. Forsyth
They were broadly representative of the view among health councils then. That was certainly what the independent councils established. Everybody knows that the health councils have not played the role anticipated for them in the 1974 legislation. My hon. Friend the Member for Dumfries (Sir H. Monro), who was responsible for piloting the legislation through the House, has expressed doubts about the role and functions of the health councils following the introduction of the legislation. The promise made then to carry out a review was not kept, and the councils were left on the sidelines, and they felt that.
It was the only meeting I can recall in the Scottish Office at which an organisation's representatives have asked us to abolish them or give the organisation a proper role. We decided to go for the latter course. Clearly, health councils have a role to play. They are ideally placed to offer local comment on proposals for health services in their districts and, by undertaking visits to hospitals and units, can help to ensure that services are kept up to scratch. They also provide a useful source of advice to patients with complaints about the service that they receive. However, all of that has to be seen to operate in an environment in which the health boards' role is changing.
§ Mr. Jim Sillars (Glasgow, Govan)
The Minister emphasised the local aspect of local health councils. He cannot by any stretch of the imagination describe the city of Glasgow as one locality. Does he not accept that one of the reasons for anxiety in the city of Glasgow is that the Greater Glasgow health board is made up of people who do not come from the major districts for which hospitals have to provide? It contains no one from Easterhouse, Castlemilk or Govan. If he is to reduce the number of boards from 130 to 13, he will effectively cut out the vast majority of the citizens from any critical contact they have with the health service.
§ Mr. Forsyth
The hon. Gentleman must recognise that the health councils' role is not to be representational in a geographic sense, but to represent the patients' interests. To do that effectively, the health council must be composed of able people, properly resourced and backed up in an organisation that can talk to the health board on equal terms. The Greater Glasgow health board is substantial and, in order for patients to be effectively represented, we need a strong, properly resourced, health council. That is why the strategy has been to encourage the boards to put forward proposals that look towards single health councils rather than a proliferation.
The hon. Gentleman will know that the Government have been attacked for seeking to weaken health councils. If we really wanted to do so and to make them ineffective, we would have proposed a proliferation of health councils that were not properly serviced or resourced, which would have taken us back to the original position after the 1974 legislation.
§ Mr. James Wallace (Orkney and Shetland)
The Minister said that he believes that health councils should be properly resourced. I agree with that as a general proposition. Does he agree that one of the most important resources for a health council to enable it to carry out its functions is that of information? Why do not the regulations provide that health councils should be able to exact information from hospital trusts and not simply from the national health service and local health boards?
§ Mr. Forsyth
The hon. Gentleman is being extremely unfair because the regulations provide a basis for the health councils to obtain information from the boards. The hon. Gentleman will appreciate that NHS trusts, which he opposes and of which we as yet have no examples in Scotland—but we will have——
§ Mr. Forsyth
If the hon. Member does not think that there will be any NHS trusts, it is odd that his colleague asked that question. The hon. Gentleman will know that NHS trusts will operate under contract to the board, and any information about the provision of service will be provided by the board, and the board will be responsible for the standard of service. There is no contradiction in that.
§ Dr. Godman
That is kind of the Minister. In this new era of flexibility in ministerial decision making, may I ask 415 the hon. Gentleman to reconsider what appears to be his proposed option for a single health council for the Argyll and Clyde health board area? That board has asked for two councils on the basis of representations made by its four local health councils.
§ Mr. Forsyth
There seems to be some confusion about this. The regulations show that it is up to the health boards to put forward schemes. I have not seen the scheme to be put forward by Argyll and Clyde. The Government have taken the view that single health councils, properly resourced and serviced, are the way forward for representing effectively the wishes of the patients. However, it is open to boards to put forward schemes. Grampian health board, for instance, has put forward a scheme for one health council for the whole of Grampian region. Other boards may put forward other schemes, and they will be considered solely on their merits. I cannot anticipate what decisions will be taken before I have seen the schemes.
§ Mr. Forsyth
I have said that I have given way for the last time.
Increasingly we shall look to the boards to determine the health needs of those in their areas and to purchase—whether from their own units or NHS trusts—services commensurate with that need. In drawing up their strategies and monitoring the services provided, they will be looking for constructive advice from health councils. A multitude of councils, as at present, thinly resourced and largely unco-ordinated in their efforts is not the best way of providing that advice—in fact, quite the reverse. What we need are strong councils capable of talking to boards on a one-to-one basis.
§ Mr. Menzies Campbell
The hon. Gentleman said a moment ago that he could not pre-judge any proposals that health boards might make to him on the constitution of the health councils in their areas. Earlier this year he issued a circular in which he instructed health boards to ensure that they submitted schemes for only one health council in each health board's area. Does he now accept that that circular was in that respect ultra vires in relation to the principal legislation and in relation to the terms of regulation 3?
§ Mr. Forsyth
I have replied to the hon. and learned Gentleman's letters and answered the question put to me by my hon. Friend the Member for Tayside, North (Mr. Walker). The hon. and learned Gentleman understands the position perfectly well. The boards can put forward schemes that we will consider on their merits. The Government's view is that representation of the interests of the patients and making the consumers' voice heard in the health service are best served by single councils, properly resourced.
This is not only the Government's view. A number of boards have favoured this course. For example, Orkney and Shetland and Borders——
§ Mr. Forsyth
Indeed. Orkney and Shetland and Borders, all represented by Liberal Members of Parliament, have always had a single council. Until 1980, Dumfries and Galloway had four councils, but at the 416 suggestion of the councils the number was reduced to one. Last year a similar step was taken in Ayrshire and Arran, which previously had two councils.
On this matter I am happy to acknowledge that wisdom is not confined to Members on the Government side of the House. The hon. Member for Strathkelvin and Bearsden has given his blessing to the principle of one council per board area, although he reserved his position in respect of Glasgow and Highland when he came to see me.
The Association of Scottish Local Health Councils is also on record as favouring single councils. A resolution at its 1989 annual general meeting, passed by 24 votes to three with two abstentions, supported the proposals forA body at health board level, properly resourced and staffed independent of the Health Board and required to manage and deploy it resources at local level across the Health Board area in accordance with the NHS principles of equity and access".The association has since made much of the qualification in the resolution that there should be area organisations.
It stated:the area level organisation may as part of its remit establish at local level bodies adequately staffed and funded with due regard to geographical and population distribution".The association seems to be advocating the possibility of an additional tier of council.
I understand that an experiment in The Borders, which the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) will know all about and which was established by the council there, has not proved successful as a result of the difficulty of appointing representative members. However, I recognise that there may be occasions when councils will wish to establish ad hoc groups to give advice on the position in a particular local area. Nothing in the regulations precludes that.
The regulations provide the framework within which the councils will operate. They cover the submission of schemes by boards, the functions of councils and the related requirements of boards to consult and provide relevant information. They allow for councils to visit NHS premises and make provision for staffing, accommodation and finance. The regulations allow for existing councils to remain until the new councils are established.
This new framework for local health councils has to be seen in the context of the important changes now being introduced into the health service. These will ensure that the needs of patients are at the very heart of health service priorities. Strong and effective councils, with members solely appointed on merit, have an important role to play as consumer watchdogs. We simply cannot afford to allow the old, ineffective arrangements to continue. What is needed are new councils fully able to meet the challenges of an invigorated national health scheme. The regulations provide the way forward.
§ Mr. John Home Robertson (East Lothian)
The regulations need to be seen in the context of the drastic changes that are taking place in the national health service in Scotland. Those changes are nowhere more evident than in Lothian region. I fully accept the Minister's statement that, if we have to make a choice between funding a consumer representative organisation, a consultative committee such as a local health council and patient care, there is no doubt about the decision that people would make. They would want to spend their money on patient care.
417 At a time of such drastic changes, especially in areas such as my constituency, there is a need for an effective consumer voice so that patients and their families can make their views known to those who make the decisions—the Minister and the health boards. As the Minister knows, I am acutely concerned about what is happening to the national health service in my constituency. It has been sorely hit by the package of cuts that have been imposed by Lothian health board, partly as a consequence of bad management by that board, and partly because of underfunding by the Scottish Office.
As a result of those cuts, our one geriatric hospital is to be closed and replaced by a private unit in Roodlands hospital in Haddington. The cuts also mean that we are to lose our local accident and emergency and casualty service.
The Minister and Lothian health board assured me that a casualty service would continue to be maintained at Roodlands hospital. However, last week I discovered that the Scottish ambulance service was instructed that all casualties in my constituency were to be taken to hospitals in Edinburgh because there was no effective casualty service left in Haddington.
Against such a backdrop, it is vital that patients are effectively represented in the debates that are going on about the future of the services that are vital to patients and their families. East Lothian health council has rather distinct interests from those of other parts of the Lothian region. There are obvious differences between what happens in East Lothian, West Lothian and Midlothian and in the city of Edinburgh. Even the Minister should be able to grasp that.
There must be some way in which opinion in an area like mine can be focused. The management of the national health service is ludicrously incestuous. The service is run on behalf of the Minister by the health boards that he appoints directly. He is accountable to no one. He certainly is not accountable to the electorate of Scotland, and the health board is accountable only to him.
At present, 80,000 people in my constituency are represented by one individual on Lothian health board. I am sure that it is pure coincidence that that person was appointed shortly after he lost his seat as a Conservative councillor for Dunbar on East Lothian district council. Perhaps that appointment was a consolation prize. The Minister told us that that person was appointed purely on merit.
It is now suggested that one local health council should cover the whole of Lothian. Again, East Lothian would probably have only one representative nominated by that health board. That is no way in which to organise consumer or patient representation.
Clearly, the valuable services of the local health council should be maintained. I understand that, as a compromise, East Lothian local health council has suggested that it would be happy to work with the neighbouring local health authority in Midlothian, where there is an understandable community of interest. However, to lump East Lothian as a nominally local health council in with the rest of the Lothian region does not make sense.
We need accountability in the national health service, particularly when the Government are inflicting such drastic cuts on health services in areas like mine. My constituents need to be represented. I appreciate that the 418 regulations make it possible for there to be more than one local health council in health board areas. I hope that that will be the case.
§ 11.2 pm
§ Mr. Mick Buchanan-Smith (Kincardine and Deeside)
I was slightly alarmed earlier because, after our previous debate this evening, I thought that we were gradually moving towards a consensus between the two Front Benches. That may have been unfashionable in recent years, but I do not find it wholly unwelcome in politics in Britain. However, my newly-fanned fires of enthusiasm were slightly dampened when the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) agreed with my hon. Friend the Minister. I began to think that perhaps this move to consensus was not so good as I had first thought. It filled me with alarm and has made me rather more diffident about what I am going to say than might otherwise have been the case.
While I believe that the local health councils should be subject to review and reorganised from time to time, and I welcome the review, I have several reservations about the consequences of that review. If the argument was that as the councils no longer served a purpose, they should be removed, that would have been the end of the matter. However, the fact that an area is to retain one health council must make us anxious about whether the council will be representative of the consumers of the health service in the areas covered by the health boards. If the principle is that we should retain a health council, we must consider whether the proposal offers representation in its area.
That is why I see grounds for rationalising and reducing the number of health councils. As my hon. Friend the Minister said, areas like Dumfries have willingly and voluntarily reduced their numbers. That reflects the local view.
I have genuine concern about wide geographic areas. It is appropriate that in Grampian, for example, there should be only one board, and I agree that there could be some rationalisation. I have advocated to the board that there should be one health council for Aberdeen, one for what I would describe broadly as north Grampian and one for south Grampian. I represent a constituency which stretches from Braemar, on the eastern edge of the Cairngorms, to within a mile of the centre of Aberdeen, at Duthie Park, where it adjoins the constituency of the hon. Member for Aberdeen, South (Mr. Doran), and the interests of my constituents in those two places are entirely different. I feel sometimes that I represent two constituencies in a parliamentary sense.
Those who live in Kincorth or Garthdee, for example, have an interest in the health board quite different from that of those who live in Braemar. I am sure that my hon. Friend the Minister of State will be sensitive to that. My constituents in Kincorth and Garthdee were not much interested when at Upper Deeside and Torphins we were fighting to retain the local maternity hospital, which was a worthwhile cause and a battle in which the local health council played a sensible and constructive part. In the same way, I am sure that the hon. Member for Moray (Mrs. Ewing) will appreciate that my constituents at St. Cyrus, at the south end of my constituency immediately 419 north of Montrose, do not have a great deal in common with those living at Elgin, up on the Moray firth. They are separated by many miles.
§ Mrs. Margaret Ewing
With the hon. Member for Gordon (Mr. Bruce), the right hon. Gentleman and I have worked together on various health matters which have affected us generally in the Grampian region. Does he agree that it has been recommended by the five existing health councils in Grampian that there should he a minimum of three councils, an arrangement which would take account of the two rural geographic areas and Aberdeen? They are not saying that they should fight one another. When the Minister of State talks about flexibility, the views of the existing councils should be taken into account.
§ Mr. Buchanan-Smith
The hon. Lady makes a relevant point. If the existing health councils had decided to fight for the status quo, I would have found less credibility in their argument. Instead, they have said that it is important to ensure that health councils are representative in a geographic sense of the areas that they cover.
I was grateful to my hon. Friend the Minister of State when he said that health boards can have more than one council if they wish. That was encouraging. However, the Grampian health board said, "No, I am sorry, but we are going to have only one council." I am disappointed that the board did not take advantage of the latitude that it was offered. I think that there would have been a better set-up if it had done so.
I have been in correspondence with the Grampian health board and it has shown some sensitivity in responding to me, as it may have done to other hon. Members who represent constituencies in the region. Et has stated that the membership of the council will be related primarily to geographic areas and secondly to population. That is a step forward, and one that I welcome.
I hope that my hon. Friend the Minister of State will try to persuade the health boards, and especially the Grampian board, that if they are to have only one council they should try to provide that within that structure there are nominated sub-committees which are representative of different areas. In that way, there would be some sense of identification of an area. There would be a local sub-committee with which a local community could identify when it wished to submit views representative of a certain area. With sub-committees, local communities would be able to make submissions in the knowledge that there was a definite voice for their area within the council. In that way local views and problems could be aired and examined.
That final recommendation is second best to what I would want. I hope that my hon. Friend the Minister will consider my recommendation and press it on those health boards which have decided to have only one health council.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
I endorse the points made by the right hon. Member for Kincardine and Deeside (Mr. Buchanan-Smith) about the position in Grampian—which is itself somewhat peculiar as it is the health board that is part of the problem. That is not often the case in other areas.
420 The House should commend the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) for tabling the prayer. It is an important debate. We must sincerely commend him also for the genuine work and interest that he has put into the matter. There was a real worry that health councils would be abolished. He contributed greatly towards positively resolving that question. However, his remarks this evening have shown that he has a wholly west-coast, central industrial belt perspective. I am surprised that his party sources did not tell him earlier that he was on the wrong lines for the revision of the role and function of the health councils. It is commendable that he has so positively contributed to the debate, but his recommendations are inappropriate and wrong, certainly for the areas that I and other hon. Members represent.
The context of the debate is important. The whole structure and management machinery of the national health service has been recast. The lines of authority, the centres of decision making and the whole process of setting priorities are fundamentally changing. There are new conflicts within the new system. They are real and acute and they will be difficult to address. There will be ministerial political direction together with the direction of the new chief executive. There will be a general manager at local level and there will be health board members, and especially non-executive members. All of them will have to try to make the best judgment possible in new and very different circumstances.
That process worries me because it can be much more easily politically manipulated than the old consensual system. I am not saying that the old system was perfect but simply that any Government—not just the incumbent Government—will have immensely increased powers in manipulating the way that the management structure works. Health boards have a new set of pressures and priorities within which they must work. The difficulties that they face will be made worse because the system can be more politically manipulated.
It is more important than ever that the local health councils are independent, that they have adequate resources and that they have a real and meaningful standing in the local community, in the health boards and in St. Andrews house. There must be a proper recognition of their function and their role. They are the only statutory representatives of the public in the new system, and they are supposed to be separate from the management process. To succeed, they must be given adequate resources and genuine access to the new decision-making process. They need a proper place in the hierarchy.
Two major and connected issues arise from the regulations—first, the number of local health councils in each board area, a matter which has already been referred to, and, secondly, the ability of local health councils to decide what is best for their area.
§ Mr. Kirkwood
If the hon. Gentleman will forgive me, I do not want to take up more time than I have to.
The regulations are, on the face of it, flexible enough to get the number of local health councils right and for them to have the ability to decide what is best for them. It is what is in the Minister's mind that is causing the uncertainty and concern. He has given a clear signal that he wants one local health council per board, he has decided 421 on 15 members, and he is not prepared to consider any district or sub-committee structure. The Minister is pointing at the Opposition Front Bench, but I am not responsible for the Opposition's policy on this. We have our own point of view.
We must make it clear to the Minister that one local health council per board area is unacceptable. My hon. and learned Friend the Member for Fife, North-East (Mr. Campbell) eloquently made the point that the Government's circular was ultra vires, and other hon. Members have referred to that, too. The fact that local health councils have no powers of co-option is to be deplored. The boards have been given the power of co-option. My local health council has, as the Minister said, experimented with district sub-committees and co-opting people. It is keen to continue to co-opt people on specific issues and in specific localities as is necessary. The Minister says that it can, but the impression that it has received is that the Minister has set his face against that. It is regrettable that the regulations refer to a joint responsibility with health boards for appointing staff, and that compromises the independence of councils in an unacceptable way.
There is a cogent legal reason for voting against the regulations. As hon. Members will know, the Joint Committee on Statutory Instruments has made three or four points about the validity of the orders. In its opinion, regulations 9, 11 and 12 are potentially outwith the Government's powers and appear to make an unexpected use of the powers conferred by the National Health Service (Scotland) Act 1978. If those turn out to be defects, they are far reaching.
The Committee questions whether the Government have power to require health boards to comment on reports produced by local health councils, whether there is a valid power to require health boards to provide local health councils with staff, accommodation and other facilities. It said that it could find no powers specifically available. Thirdly, regulation 4 empowers each local health council to keep under review the operation of the health service in its district, excluding NHS trusts, as was referred to by my hon. Friend the Member for Orkney and Shetland (Mr. Wallace).
The House has not been able to study those points in depth because the report has not yet been published. But the Minister did not say a word about those potential defects. I hope that he will do so when he replies.
The Minister has a choice. He can create a strong consumer voice in the NHS, but he can do that only if he gives the new local health councils independence and strength and the resources that they need. If he does not do that, he will effectively stifle public scrutiny. He apparently wants to reduce the number of councils, retain control of their membership and diminish their role. It looks suspiciously like an attempt to sideline local health councils and limit their ability to represent the best interests of patients so that the Government are not embarrassed. It is not too late for him to think again, but it will be too bad for patients if he does not.
§ Mr. Frank Doran (Aberdeen, South)
I follow the remarks of the right hon. Member for Kincardine and Deeside (Mr. Buchanan-Smith), because Grampian region has a broad geographical spread of urban and rural areas, and I strongly support the right hon. Gentleman's remarks in that regard.
What does the Minister mean when he talks of a strong voice for the consumer and strong, adequately-resourced health councils? From the regulations, it appears that the whole process will be in the hands of the health board. We know already of Grampian health board's decision to hear only one voice, and that it has ignored the local community's proposal that more voices are required properly to represent the views of consumers.
Over and above that, the regulations have an ideological bent that should not be ignored. [Laughter.] The Minister laughs, but I want to raise two matters of particular concern. The Joint Committee on Statutory Instruments pointed out that the regulations contain no requirement for opted-out trusts to provide information.
I heard the Minister's earlier explanation, but I am well aware that one of the Scottish Office's favourite targets is Aberdeen royal infirmary. It provides a whole range of acute services, and it serves not only the city of Aberdeen and Grampian region but Orkney and Shetland, and some parts of the highlands and islands. If trust status is conferred on that hospital, the voice of the local health council—the consumer organisation—will be neutered. Its role will be diminished, because it will have no locus in respect of that particular hospital.
Paragraph 6 of the 1974 regulations, which this new measure will replace, imposed a duty on the health board to provide information, with no qualification except in relation to confidential information relating to patients or staff. The new regulations introduce a new area of confidentiality in respect ofinformation in respect of which any rule of commercial confidentiality applies.Again, that aspect is one from which local health councils will be excluded.
The whole ethos and direction of the health service is changing, and new economic and financial factors are being introduced into hospital management. The whole basis on which the health service was founded is being altered, and in this instance commercial contracts for the cleaning, pharmaceutical and laboratory services that we know will be in the pipeline if a Conservative Government remain in power will be excluded from investigation by local health councils.
I repeat my original question: what does the Minister mean when he talks of a strong local voice for the consumer, when the consumer will be denied representation in the vital areas that I mentioned?
§ Mr. Bill Walker (Tayside, North)
Unusually, I find myself in agreement with the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith), who made an accurate assessment and judgment of the situation. I am happy to support his remarks.
I represent a large rural constituency that forms a significant part of Tayside health board area. To me, it is nonsense to suggest that the people in the eastern end of my constituency, which is to the east of Forfar, understand 423 the feelings and actions of people in Glen Lyon or Drumochter. It is even more unrealistic to expect that in an area the size of Tayside.
The practical solution is the one on offer. It is that there should be one properly funded and adequately staffed health council per health board. If we attempt to do anything else, some areas will feel that they are not properly represented.
§ Mr. Forsyth
I shall try to deal quickly with the points made in the debate in the short time that is left.
I was not aware of the position in respect of the casualty department that the hon. Member for East Lothian (Mr. Home Robertson) raised, and I shall certainly look into that. However, his stance on health councils was different from that taken by members of the Opposition Front Bench.
My right hon. Friend the Member for Kincardine and Deeside (Mr. Buchanan-Smith) said that he was disappointed by the decision that Grampian health board has taken. He might wish to reflect that the health board reached that conclusion, I am sure, because it felt that it had a health council which would take advantage of the resources available to it. The point about ad hoc committees, which he and the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) mentioned, is important. There is nothing in these regulations to prevent health councils from establishing ad hoc committees for a particular purpose. The decisions will remain with the health councils. Nor is there anything to prevent health boards appointing members to health councils, for which they will have to advertise and invite bodies to submit nominations, looking at the geographical spread and taking it into account, as my right hon. Friend said that Grampian would do.
The hon. Member for Roxburgh and Berwickshire also asked about comments made by the Joint Committee on Statutory Instruments. As always, we are extremely grateful for the careful scrutiny of these matters which the Joint Committee carries out.
The hon. Gentleman will find that regulations 9, 11 and 12 are virtually identical to regulations 8, 10 and 11, which have been in existence since 1975, I believe. On his comment about the Secretary of State retaining control of membership, my right hon. Friend will not appoint members of health councils. They will be appointed by the health boards, having taken nominations from representative organisations and from members of the public.
The hon. Member for Aberdeen, South (Mr. Doran) found an ideological bent in these regulations. I am sure that if that were so, the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) would not have supported them to the extent that he has.
If Forresterhill becomes an NHS trust, it will be responsible to the Grampian health board, under contract, and the health council will still be able to obtain the information that they require.
§ Mrs. Maria Fyfe (Glasgow, Maryhill)
Could the hon. Gentleman explain why he thinks that it automatically follows that one health council is an appropriate number for the Glasgow area when the general consensus among hon. Members representing Glasgow is that three is a reasonable number? What makes one health council better than three?
§ Mr. Forsyth
I know that the hon. Member has had differences of view with the Greater Glasgow health board. It is a large and powerful organisation. The consumer voice—the health council—needs to be a powerful and properly resourced organisation. If there are three such councils, the resources available to fund them will be divided in three. It is a matter for the judgment of the Greater Glasgow health board what conclusion it reaches as to the best way forward. It may, like Grampian, decide that it is better to have one council. It is a matter of judgment. When the hon. Member for Strathkelvin and Bearsden came to see me some time ago, he argued that perhaps there was a case for having two councils—Glasgow, North and Glasgow, South. Whatever proposals come to us from the Greater Glasgow health board, from Argyll and Clyde, or any other health board, we shall examine them on their merits. When considering proposals, and reaching a judgment about them, we shall want to take account of the views that have been expressed in the debate, which have been fairly clear. It is a matter not simply of quantity, but of quality.
§ Mr. Robert Maclennan (Caithness and Sutherland)
The Highland health board's proposal for eight councils makes sense in terms of the geography of the area and also in terms of patients, because most of their problems stern from the geography.
§ Mr. Forsyth
The hon. Gentleman must not tempt me into making a judgment in advance, or his hon. and learned Friend the Member for Fife, North-East (Mr. Campbell) will accuse me of being ultra vires. The highlands are very adequately represented by his own efforts in respect of their health needs. They manage with three Members of Parliament. The hon. Gentleman is not arguing that there should be eight Members of Parliament; he would be the first to quarrel with me if I suggested otherwise.
I believe that the regulations provide the health boards with an opportunity to establish a proper "patient voice" for the first time. We shall, of course, look at them in the light of experience, as always.
§ Question put:—
§ The House divided: Ayes 24, Noes 121.425
|Division No. 22]||[11.29 pm|
|Alton, David||Kennedy, Charles|
|Barnes, Harry (Derbyshire NE)||Kirkwood, Archy|
|Beggs, Roy||Macdonald, Calum A.|
|Brown, Ron (Edinburgh Leith)||Maclennan, Robert|
|Bruce, Malcolm (Gordon)||Marshall, David (Shettleston)|
|Campbell, Menzies (Fife NE)||Salmond, Alex|
|Carlile, Alex (Mont'g)||Sillars, Jim|
|Cryer, Bob||Skinner, Dennis|
|Dalyell, Tam||Steel, Rt Hon Sir David|
|Godman, Dr Norman A.||Wallace, James|
|Home Robertson, John||Tellers for the Ayes:|
|Howells, Geraint||Mrs. Margaret Ewing, and Mrs. Ray Mitchie.|
|Hughes, Simon (Southwark)|
|Aspinwall, Jack||Carrington, Matthew|
|Baker, Nicholas (Dorset N)||Carttiss, Michael|
|Bevan, David Gilroy||Cash, William|
|Boswell, Tim||Channon, Rt Hon Paul|
|Bowden, Gerald (Dulwich)||Chapman, Sydney|
|Bright, Graham||Chope, Christopher|
|Brown, Michael (Brigg & Cl't's)||Clark, Dr Michael (Rochford)|
|Buchanan-Smith, Rt Hon Alick||Coombs, Simon (Swindon)|
|Cope, Rt Hon John||Mills, lain|
|Cran, James||Mitchell, Andrew (Gedling)|
|Currie, Mrs Edwina||Mitchell, Sir David|
|Davies, Q. (Stamf'd & Spald'g)||Morris, M (N'hampton S)|
|Davis, David (Boothferry)||Morrison, Sir Charles|
|Day, Stephen||Moss, Malcolm|
|Devlin, Tim||Moynihan, Hon Colin|
|Douglas-Hamilton, Lord James||Neale, Gerrard|
|Dover, Den||Neubert, Michael|
|Dunn, Bob||Nicholls, Patrick|
|Dykes, Hugh||Nicholson, David (Taunton)|
|Fallon, Michael||Norris, Steve|
|Forman, Nigel||Oppenheim, Phillip|
|Forsyth, Michael (Stirling)||Paice, James|
|Forth, Eric||Patnick, Irvine|
|Franks, Cecil||Porter, David (Waveney)|
|Freeman, Roger||Portillo, Michael|
|French, Douglas||Powell, William (Corby)|
|Goodlad, Alastair||Raffan, Keith|
|Green way, John (Ryedale)||Rhodes James, Robert|
|Gregory, Conal||Riddick, Graham|
|Griffiths, Peter (Portsmouth N)||Ryder, Richard|
|Grist, Ian||Sackville, Hon Tom|
|Hague, William||Sayeed, Jonathan|
|Hannam, John||Shepherd, Colin (Hereford)|
|Hargreaves, A. (B'ham H'll Gr')||Sims, Roger|
|Hargreaves, Ken (Hyndburn)||Smith, Tim (Beaconsfield)|
|Harris, David||Stanbrook, Ivor|
|Hayes, Jerry||Stern, Michael|
|Hayward, Robert||Stevens, Lewis|
|Hicks, Robert (Cornwall SE)||Stewart, Andy (Sherwood)|
|Hind, Kenneth||Summerson, Hugo|
|Hunter, Andrew||Taylor, Ian (Esher)|
|Irvine, Michael||Taylor, John M (Solihull)|
|Jack, Michael||Thompson, D. (Calder Valley)|
|Jackson, Robert||Thurnham, Peter|
|Janman, Tim||Tracey, Richard|
|Johnson Smith, Sir Geoffrey||Trippier, David|
|Jones, Gwilym (Cardiff N)||Twinn, Dr Ian|
|Jones, Robert B (Herts W)||Walden, George|
|King, Roger (B'ham N'thfield)||Walker, Bill (Tside North)|
|Knapman, Roger||Waller, Gary|
|Knight, Greg (Derby North)||Wardle, Charles (Bexhill)|
|Knowles, Michael||Wells, Bowen|
|Lang, Ian||Widdecombe, Ann|
|Lester, Jim (Broxtowe)||Wilkinson, John|
|Macfarlane, Sir Neil||Winterton, Mrs Ann|
|MacGregor, Rt Hon John||Winterton, Nicholas|
|Maclean, David||Wood, Timothy|
|McLoughlin, Patrick||Yeo, Tim|
|Mawhinney, Dr Brian||Tellers for the Noes:|
|Maxwell-Hyslop, Robin||Mr. Neil Hamilton and Mr. Timothy Kirkhope.|
|Meyer, Sir Anthony|
|Miller, Sir Hal|
§ Question accordingly negatived.