§ 14. Mr. Malcolm Bruce
To ask the Secretary of State for Scotland when he expects to announce the Scottish hospitals opting for self-governing trust status.
§ Mr. Michael Forsyth
An announcement will be made as and when the procedures laid down for trust applications have been completed.
§ Mr. Bruce
Does the Minister accept that there is growing disquiet about the way in which the possibility of self-governing hospitals is being presented in Scotland? There is no evidence that the hospitals, the health service, the patients, the public or the staff want them, but they are being presented almost as a fait accompli.
Will the Minister assure us that, unlike the practice in England, if any such proposals come forward the public, the patients and the staff in the hospital and the catchment area affected will be consulted and their opinions taken fully into account? The people of Aberdeen and Grampian do not want self-governing hospitals forced upon them against their wishes.
§ Mr. Forsyth
The hon. Gentleman is mistaken on two counts. First, he is mistaken in his suggestion that proposals are coming from anyone other than the consultants and the management. For example, the proposals for the Foresterhill hospital in Aberdeen have come from the consultants and the management, but they have not yet decided whether to submit them to the Scottish Office.
Secondly, the hon. Gentleman is mistaken about consultations in England, just as he is mistaken about consultations in Scotland. All proposals for self-governing status are subject to consultation by the health boards. That has been clearly laid down. I commend to the hon. Gentleman the paper that we have published on the procedures for NHS trusts, which spells that out clearly.
§ Mr. McKelvey
Is the Minister aware that on 8 December a meeting was held in Kilmarnock city centre at which a poll was taken—it was a proper poll, as advised by MORI—on the opt-out proposals? Some 1,700 people voted, of whom 95.2 per cent. said that they would prefer the hospitals in their areas to remain within the ambit of the Ayrshire and Arran health boards. Only 3.7 per cent. were in favour of opting out, and there were two spoilt papers, representing 0.9 per cent. of the vote. Will the hon. Gentleman take that result into consideration if there are any applications from hospitals in Ayrshire to opt out?
§ Mr. Forsyth
I would not take seriously a poll conducted on a proposal that has not yet been made, when people were not aware of the details. If the hon. Gentleman is accurate with regard to the questions asked, I should be even more cynical about the results. Hospitals which apply for self-governing status will not be opting out of the NHS. They will remain part of the NHS and they will remain under contract to the health boards. They will remain subject to scrutiny of their performance by the health boards.
If the hon. Gentleman were to conduct a poll asking whether people favoured more decisions being taken by local management at local level and whether they favoured resources being determined by those most involved in the provision of services, he might get a different answer.
§ Mr. Buchanan-Smith
Whatever the merits or demerits of hospitals opting for their own management within the NHS under trust status, does my hon. Friend acknowledge that the position is very different in areas of high population, where there are a number of separate hospitals, compared with an area such as Aberdeen where there is a highly integrated hospital service based on the Foresterhill site? Does my hon. Friend agree that that creates different circumstances and may I have his undertaking that that aspect will be taken into account if proposals are put forward?
§ Mr. Forsyth
My right hon. Friend will be aware that Foresterhill is an example of a hospital which was created and brought into being by the community. It was initiated through the efforts of the community. Self-governing hospitals are about recreating the possibility for communities to be involved in the management and organisation of their hospitals. I am not surprised that Foresterhill has shown great interest in the opportunities that the Government are making available.
§ Mr. Galbraith
The Minister's response exacerbates our worries, both about consultation and about links with the local community. The reality is that opted-out, self-governing hospitals will be run from the centre—the Scottish Office will decide the priorities and processes by diktat.
The Minister's response about consultation in Kilmarnock highlighted the problem. What will be the consultation on opting out? Will it include the community, the trade unions, the churches, the regional councils and the district councils? Whose views will be taken into account and what weight will be given to them? In reality, will not the decision be made by a small clique on the health board and rubber-stamped by the Scottish Office?
§ Mr. Forsyth
The hon. Gentleman may go on saying that self-governing hospitals will be run by the Scottish Office, but that simply is not true. They will be independent trusts operating under contract with the health boards and subject to the Secretary of State's direction only if they fail to meet particular standards of patient care. The hon. Gentleman knows full well the position on consultation. Any proposals for self-governing status will be subject to consultation; trade unions, churches, the community and anyone else who wishes to comment will have an opportunity to do so.
I do not wish to embarrass the hon. Gentleman, but he himself has put forward some interesting ideas for the independent management of out-patient clinics and the 285 devolution of management to local level. Painful though it may be, he should therefore acknowledge that the proposals for self-governing status are very much in line with the thinking that he himself advances, even if he cannot bring himself to congratulate the Government on them. We look forward to the conversion that the Labour party underwent in relation to school boards being repeated with regard to NHS trusts.