NHS Trusts (Hansard, 3 July 1990)

§ 2. Mr. David Nicholson (Taunton)
To ask the Secretary of State for Health if he will make a statement on progress towards setting up national health service hospital trusts.

§ 3. Mr. Martin M. Brandon-Bravo (Nottingham, South)
To ask the Secretary of State for Health what will be the effect on services to patients in those hospitals which choose to become national health service hospital trusts.

§ 6. Mr. Cecil Franks (Barrow and Furness)
To ask the Secretary of State for Health when he expects the first national health service trusts to be in operation.

§ 7. Mr. Harry Barnes (Derbyshire, North-East)
To ask the Secretary of State for Health how many expressions of interest in the formulation of self-governing hospital trusts have so far been received.

§ 10. Mr. Roger Stott (Wigan)
To ask the Secretary of State for Health what is his Department's latest information on the total expenditure incurred so far on preparation for self-governing hospital trusts.

§ 15. Mr. Ronnie Campbell (Blyth Valley)
To ask the Secretary of State for Health what evidence of the views of community health councils regarding the formation of self-governing hospital trusts is available to his Department.

§ 21. Mr. Robert N. Wareing (Liverpool, West Derby)
To ask the Secretary of State for Health when he last had discussions with the chairman of the Mersey region health authority; if the opting-out of hospitals on Merseyside was discussed; and if he will make a statement.

§ The Secretary of State for Health (Mr. Kenneth Clarke)
With permission, Mr. Speaker, I shall answer these questions together.
On a point of order, I should like to give the House an explanation which Opposition Front Bench Members have requested about the adoption of this procedure. Last night, when I started the final detailed preparation for answering parliamentary questions, I discovered that there were 32 questions on the Order Paper about applications for national health service trust status. Last night there were eight such questions in the first 25. It became quite clear that, if we tried to handle those in the course of ordinary parliamentary questions, first, most hon. Members would not get an adequate reply to their questions—[Interruption.] They are about to get more than adequate replies to any questions that are forthcoming. Secondly, it was also clear that no other subject could sensibly be dealt with during health service questions. For example, we would not have reached the questions on junior doctors' hours and on eye tests which the Opposition regard as important.
I regret that this is an Opposition Supply day because I realise that that has caused some difficulties, but it was obviously for the convenience of the House to handle these questions at this stage.

§ Mr. Robin Cook (Livingston)
Further to that point of order, Mr. Speaker. The Secretary of State, in his apology 860 to the House, conceded that the device that he has adopted has caused offence. He proposes to answer not one question but seven linked together. That is not for the convenience of the House; it is an abuse of the procedures of the House. It is inevitable that that abuse will take time out of the debates on the motions on education and housing, tabled in the Opposition's name—time that was available to the Secretary of State during health questions. He will not remove that offence by making a statement to the House under the guise of giving an answer to questions on the Order Paper. He knows perfectly well that by using such a device to make a statement he is avoiding the need to give the Opposition advance notice of the text, and he is denying the Opposition the right to respond immediately, which is presumably why he has chosen this method of smuggling in a major statement on a controversial issue. Therefore, Mr. Speaker, I invite you to reflect on what additional protection is necessary—

§ Mr. David Shaw (Dover)
This is not a genuine point of order.

§ Mr. Cook
I am addressing my question to Mr. Speaker, if the hon. Gentleman will listen.
What additional protection is necessary to defend the rights of this place against a Government who, despite a majority of more than 100, constantly seek devices to prevent the Opposition from getting a fair hearing in the Chamber?

Several Hon. Members
Further to that point of order—

§ Mr. Speaker
Order. I shall not take any more points of order at this stage. Of course it is up to the Government how they link the questions. I was aware of the decision, and that was why I suggested that the Government consult through the usual channels as to whether this was an appropriate method to deal with the matter.

§ Dr. John Cunningham (Copeland)
Further to that point of order, Mr. Speaker. I am grateful to you for giving me the opportunity to put on record the fact that this procedure is not acceptable to the Opposition, and we made that clear from the outset. It is clear that, before today was allocated as an Opposition Supply day, the questions were on the Order Paper. In any preview of today's business at Question Time, the Government would have foreseen this difficulty—long before it was known that Tuesday would be an Opposition Supply day. This is a squalid device on the part of the Government's business managers to prevent the effective use of time by the Opposition on a Supply day, and no one should be in any doubt about it.

Several Hon. Members
On a point of order, Mr. Speaker.

§ Mr. Speaker
I am not taking any more points of order on the matter. We must get on.

§ Mr. Kenneth Clarke
The National Health Service and Community Care Act gives me the power to establish NHS trusts, by order, as self-governing units within the national health service. NHS trusts will not opt out of the national health service, and they will continue to provide treatment free of charge, but they will be given substantial freedom to manage their own affairs. In particular, they will be free to determine the terms and conditions of service of the staff 861 they employ, to acquire, own and dispose of assets, to borrow money and to retain surpluses. We intend that trusts should use their powers to improve the quality of the health care which they provide and to respond more effectively to the needs of general practitioners and NHS patients.
We intend that the first NHS trusts should become operational on 1 April 1991, and I have now invited formal applications. Units will be able to apply for trust status at any time, but those units intending to become trusts from 1 April will wish to submit their applications as soon as possible.
One hundred and ninety nine NHS units have expressed interest in NHS trust status. They represent a wide range of units—single hospitals, groups of hospitals and non-hospital facilities. I understand that about 60 to 70 of the units which have expressed interest—

§ Mr. Frank Haynes (Ashfield)
On a point of order, Mr. Speaker. This is not good enough. This is a statement.

§ Mr. Speaker
Order. May I remind the House that it is not for me to say—

§ Mr. Haynes
It is for you.

§ Mr. Speaker
Order. Hon. Members must reflect, if they are concerned about protecting the Opposition's time, that a statement would take much longer than questions answered together—[Interruption.]

Several Hon. Members
On a point of order, Mr. Speaker.

§ Mr. Speaker
Order. I will take the points of order provided that hon. Members reflect on the fact that they take time out of the Opposition's Supply day. Mr. Haynes.

§ Mr. Haynes
On a point of order, Mr. Speaker. This is shameful and you are allowing it to go on. It is time that you put your foot down because the Government are running all over us. They did it last night and you did not do anything about that. They introduced amendments—

§ Mr. Speaker
Sit down. How on earth can the hon. Gentleman make that charge about last night? I was not in the Chair last night.

§ Mr. Haynes
But you knew about it.

Several Hon. Members
rose—

§ Mr. Speaker
Order. Will the hon. Gentleman withdraw that dastardly charge against me? I was not even here.

§ Mr. Haynes
I accept that you were not in the Chair, Mr. Speaker, but I still say that you knew what was going on last night. You always know what is going on in this place, and you know what is going on today, but you have not done a damn thing about it.

§ Mr. Speaker
I hope that the House will reflect quietly on this. This is an Opposition Supply day. [Interruption.] It is up to the Government to decide whether to make a statement or to answer questions at the end of Question Time. A statement would probably take half an hour and questions taken together after Question Time would take about 15 minutes. The House can decide what it wants to do.

§ Mr. Kenneth Clarke
Further to that point of order, Mr. Speaker. I am in the middle of attempting to answer, in effect, 32 parliamentary questions. The answer is therefore undoubtedly lengthy, but all the points that I am covering relate to the questions on the Order Paper. If the Labour party prefers to get excited about procedural matters rather than matters of substance, it is free to do so. If it is worried about wasting its Supply day, it has the simple remedy of not asking any supplementary questions.

Several Hon. Members
rose—

§ Mr. Speaker
Order. We are clearly in difficulty over this, but if it would help the House the Secretary of State can make his answer and I will treat it as a statement. If it will help the House, I will do that.

§ Mr. Robin Cook
I am obliged for that suggestion, Mr. Speaker. Of course it is implicit in what you have just said that what the House is now hearing is not an answer to parliamentary questions but a statement. The Secretary of State has already been speaking for more than two minutes—

§ Mr. David Shaw
What is wrong with that?

§ Mr. Cook
That is a question that the hon. Gentleman must address to his Secretary of State because the Secretary of State is well aware that this is a matter of major interest to the House on which, had he wished to make a lengthy statement, he could have arranged to do so. As you will be aware, Mr. Speaker, the procedure for making statements contains within it certain protections for the rights of the Opposition, one of which is that the Opposition receive advance notice of the text that the Secretary of State is to share with the House. The device that you are proposing, which is to treat the statement as a statement, while recognising the reality of what the Secretary of State is up to, does not contain that protection of the rights of the Opposition.
I therefore submit to you, Mr. Speaker, that since it would appear that you are now persuaded that what we are hearing is not a parliamentary answer but a statement, the appropriate thing to do would be to invite the Secretary of State to take away his statement, to return with it—[HON. MEMBERS: "No."] I am addressing my remarks to the Chair, not to Conservative Members. I am sorry, Mr. Speaker, but some Conservative Members appear to think that they are the Speaker and so are answering my question.
Would not the appropriate course be to invite the Secretary of State to come back tomorrow with a statement which will protect the Opposition's right to see the text in advance and enable the House to proceed with the important debates in Opposition time on Opposition motions?

Several Hon. Members
rose—

§ Mr. Speaker
Order. I am on my feet.
Clearly the House is in difficulty on this matter. It appears that communications between the usual channels have broken down, which is a serious matter. When I heard about the matter at lunch time, I understood that the usual channels had come to an agreement on it. Those hon. Members whose questions are on the Order Paper today have a right to have their questions answered. If communications between the usual channels have broken down on whether to have a statement or to have 863 supplementary questions, we should hear—[HON. MEMBERS: "Why?"] Because they have a right to put their questions.
We should hear now what the Secretary of State has to say. I will call those hon. Members and then we shall move immediately to the Opposition's Supply day.

Several Hon. Members
rose—

§ Mr. Speaker
Order. I have a very long list of hon. Members who wish to participate in the debate, and it will be difficult for me to call them all.

§ Mr. Nicholas Winterton (Macclesfield)
On a point of order, Mr. Speaker.

§ Mr. Speaker
Order. I hope that it will be helpful.

§ Mr. Winterton
I am sure that it will be helpful, and I am seeking your advice and guidance, Mr. Speaker.
Many hon. Members who have been in the House for a few years are aware that quite a number of questions on a particular subject can be tabled to a Department on any one day. From what has happened today, are we to understand that if six, seven or eight questions are tabled on one subject to a specific Minister, the Government of the day can adopt the procedure that they have adopted today, which is to make a statement in all but name and therefore deny the Opposition the opportunity of having knowledge of what is to be said?

Several Hon. Members
rose—

§ Mr. Speaker
Order. Hon. Members must allow me to answer. It is in order to pursue such a procedure under our rules, as they stand at the moment, although it is unusual to answer quite so many questions. That is why I suggested that the matter should be agreed through the usual channels, and a resolution reached that would be to the convenience to both sides of the House. I must ask the Secretary of State to continue.

§ Mr. Kenneth Clarke
I will—

§ Mr. Wareing
On a point of order, Mr. Speaker.

§ Mr. Speaker
Order. I will take it later. The hon. Gentleman must sit down.

§ Mr. Clarke
I will accept your ruling, Mr. Speaker, and resume. I gather that we are now in a mixture of answering questions and making a statement. Of course it would have been possible to make a statement, but the effect of that would have been to take more time out of the Opposition's Supply day. It would also have deprived the hon. Members who have tabled questions of a reply to them.
Some 199 NHS units have expressed an interest in NHS trust status. They represent a wide range of units, single hospitals, groups of hospitals and non-hospital facilities. I understand that about 60 or 70 of the units that have expressed an interest in trust status are likely to submit applications in the first wave. The first three applications from Mersey region were handed to my hon. Friend the Under-Secretary of State for Health yesterday. When applications are submitted, I shall direct regional health authorities to have public consultations on the applications and to report the results to me.

§ Mr. Martin Flannery (Sheffield, Hillsborough)
Why should we put up with this sharp practice? It is disgraceful.

§ Mr. Wareing
rose—

§ Mr. Speaker
Order. The hon. Gentleman must sit down.

§ Mr. Clarke
Regional health authorities will decide who should be consulted, taking account of the facilities offered by the proposed trusts and the patients served. However, we made it clear that those consulted should include the health authorities and family health service authorities concerned, staff of the proposed trusts, general practitioners and the local public. I shall decide whether to accept applications on the basis of consideration of the application documents, comments received by regional health authorities in local consultation and any other relevant information. No group will have a veto over my decision, which will be based on my assessment of whether, in the light of all relevant factors, NHS trust status for a particular unit will benefit NHS patients in that locality. We have made it clear that the cost of implementation of the NHS review will not be met from—[Interruption.]

§ Mr. Speaker
Order. This is absolutely intolerable and more bad behaviour on the part of the hon. Members concerned. They know the situation perfectly well. The Secretary of State must be allowed to finish his statement. [Interruption.] I know that it is not a statement, but has the right hon. and learned Gentleman finished his remarks?

§ Mr. Clarke
The establishment of NHS trusts will represent a major step in improving the quality of care available to NHS patients, and I welcome the enthusiasm with which groups of managers and clinicians have been working on preparing their applications.

Several Hon. Members
rose—

§ Mr. Speaker
Order. That was a very long answer.

§ Mr. Wareing
You allowed it.

§ Mr. Speaker
Allowed? The hon. Member knows perfectly well that my position has been made clear. The Government have a right under our existing rules to do what they have done. It is for the usual channels to consult on this matter. That they have broken down is very serious, but it is not my responsibility. The hon. Member is a member of the Whips Office, and he should know.

§ Mr. David Nicholson
I thank my right hon. and learned Friend for that comprehensive reply. Does he acknowledge that these reforms must be justified by the assurance of better services to patients? In particular, will he confirm that one of the advantages of the reforms will be that NHS trusts will be free from interference from such people as Chris Wright, known as "the prat in the hat"? He is a former parliamentary Labour candidate and a Labour appointee to Croydon health authority, who is under a life ban from Crystal Palace football club and was one of the ring leaders of the hooliganism in Sardinia last month.

§ Mr. Speaker
Order. Just because there has been a very long statement, hon. Members must not abuse the House by asking very long questions, because that is just as bad.

§ Mr. Clarke
If Mr. Wright had succeeded in his aim of being elected as a Labour Member of Parliament, he 865 would have felt quite at home in the demonstrations that we have just seen of Labour's approach to matters of consultation on NHS trust status.

§ Mr. Andrew Faulds (Warley, East)
On a point of order, Mr. Speaker.

§ Mr. Clarke
I agree with my hon. Friend that the only basis for judging applications for national health status, self-governing status or any other reforms is whether or not they are likely to lead—[Interruption.]

§ Mr. Speaker
Order. I must warn the House that the next action I shall take will be to suspend the sitting until right hon. and hon. Members have calmed down. That will take even more time out of the Opposition Supply day. Therefore. I am reluctant to do that.

§ Mr. Brandon-Bravo
If I am right in believing that the services provided by trust hospitals will be effectively by contract with the district health authority acting on behalf of the national health authority, and if, on advice—for example, from their own medical or surgical faculties—such hospitals want to provide additional services such as heart surgery, as they wanted to do in Nottingham but were denied by the regional health authority, will they have that kind of independence?

§ Mr. Clarke
Those hospitals, like all other hospitals—

§ Mr. Faulds
On a point of order, Mr. Speaker.

§ Mr. Speaker
I will take points of order afterwards.

§ Mr. Faulds
On a point of order.

§ Mr. Speaker
Order. I am not taking points of order now, and I will not be bullied by the hon. Member for Warley, East (Mr. Faulds).

§ Mr. Faulds
This is quite disgraceful.

§ Mr. Speaker
Order. I order the hon. Member to resume his seat.

§ Mr. Faulds
On a point of order, Mr. Speaker. I am not having this.

§ Mr. Speaker
Mr. Harry Barnes.—[Interruption.] Order. I suspend the sitting for 10 minutes until this matter is sorted out. This is an intolerable breakdown of the usual channels. I ask them immediately to get together to sort out this matter.

§ Mr. Speaker
I understand that the usual channels have now had an opportunity to discuss the matter. The Government have applied to make a statement about it tomorrow. Of course I shall ensure that those hon. Members listed on the Order Paper for linked questions today will be called on that statement. It is now in the best interests of the House that we move on.

§ Mr. Robin Cook
May I briefly welcome—

§ Mr. Dick Douglas (Dunfermline, West)
On a point of order—

§ Mr. Speaker
The hon. Gentleman may be seeking to make a point of order, but I did not call him.

§ Mr. Douglas
Why are you always—

§ Mr. Speaker
I did not call the hon. Gentleman. Please sit down.

§ Mr. Cook
May I welcome your statement, Mr. Speaker, which provides a sensible way of proceeding this afternoon? This exchange, and the outcome, represent an important defence of the rights of this place.

§ Mr. Douglas
I trust, Mr. Speaker, that the unfortunate precedent that you tried to establish of making an answer to a question a quasi statement—

§ Mr. Speaker
I must ask the hon. Gentleman to sit down, please, while I explain to him what happened. It is not for me to grant leave to answer questions at the end of Question Time or even statements; that is entirely for the Government. At lunch time, when I heard about the large number of questions to be answered at the end of Question Time, I immediately sought to discover whether it had been agreed between the usual channels. I was assured, after some negotiations, that it had been arranged. As I understand it, that information was incorrect; but it is nothing to do with me.

§ Mr. Douglas
During the interchange subsequent to the Secretary of State trying to give an answer to a question, you, Mr. Speaker, with great respect, indicated that you were going to take answers to questions as a quasi statement. I trust that we start de novo and that what you said is expunged from any scintilla of precedent of the House.

§ Mr. Speaker
I was merely seeking to be helpful to the House. I am not part of the usual channels; perhaps it is a pity that I am not. I was trying to see how it might be possible to get on with the business.

§ Mr. Faulds
I am most regretful that I had to cross swords so noisily with you, Mr. Speaker, but may I say in defence of you that it is quite clear from what has transpired that you were misled by the Government into thinking that there was an agreement when there was no agreement between the two parties? The proceedings went ahead because of the usual deceitfulness of Ministers.

§ Mr. Speaker
Order. I was not misled; I was perhaps misinformed.

§ Mr. Kenneth Clarke
It is fair to say that you, Mr. Speaker, and the House were let down by the fact that the usual channels did not function as well as they should have done. That involves all of us; there were distinct misunderstandings on both sides. It was only just before 2.30 pm when I was warned that there was any doubt about this procedure, and I thought that I would resolve it by the first explanation that I gave. Plainly, that was a mistake and we all proceeded on mutual misunderstanding. The usual channels have now worked very well by restoring order and allowing a statement to be made in the usual way tomorrow.

§ Dr. Cunningham
This place operates by consent and can operate in no other way. When consent and agreement are trampled on by a Government determined to impose their will on the House regardless—[Interruption.]—oh, yes, regardless of whether there is agreement, breakdowns 867 occur. I hope that we can now proceed with the business and deal with this important matter in the appropriate way with a statement tomorrow.