Lords amendment: No. 1, in page 6, line 6, at beginning insert
Subject to subsection (1A) or, as the case may be, subsection (1 B) below
§ The Secretary of State for Health (Mr. Kenneth Clarke)
I beg to move, That this House doth agree with the Lords in the said amendment.
§ Madam Deputy Speaker (Miss Betty Boothroyd)
With this it will be convenient to discuss the following: Lords amendment No. 2 in page 6, line 14, at end insert—
(1 A) In any case where the Secretary of State is considering whether to make an order under subsection (1) above establishing an NHS trust and the hospital, establishment or facility concerned is or is to be situated in England, he shall direct the relevant Regional Health Authority to consult, with respect to the proposal to establish the trust,—
(1B) In any case where the Secretary of State is considering whether to make an order under subsection (1) above establishing an NHS trust and the hospital, establishment or facility concerned is or is to be situated in Wales, he shall consult the relevant Community Health Council and such other persons and bodies as he considers appropriate.
(1C) In subsections (1A) and (1B) above—
- (a) any reference to the relevant Regional Health Authority is a reference to that Authority in whose region the hospital, establishment or other facility concerned is, or is to be, situated; and
- (b) any reference to the relevant Community Health Council is a reference to the Council for the district, or part of the district, in which that hospital, establishment or other facility is, or is to be, situated."
§ Amendment (a) to the proposed Lords amendment in line 6, leave out `consult' and insert ballot'.340
§ Amendment (b) to the proposed Lords amendment in line 13, leave out `consultations' and insert 'ballots'.
Amendment (c) to the proposed Lords amendment in line 13, at end add
'who shall not make an order under subsection (1) above, unless those consultations establish substantial support for an NHS trust among the staff of the hospital, establishment or facility and the local community it serves.'.
§ Amendment (d) to the proposed Lords amendment line 17, leave out `consult' and insert `ballot'.
Amendment (e) to the proposed Lords amendment in line 18, at end add
'and shall not make an Order unless those consultations establish substantial support for an NHS trust among the staff of the hospital, establishment or facility and the local community it serves.'.
§ Lords amendments Nos. 3 to 5 and 40.
Lords amendment No. 41, in clause 30, page 31, line 26, at end insert—
(1A) The Secretary of State shall by regulations provide for such consultation as may be so prescribed to be carried out by a Health Board or the Agency, before he makes an order under subsection (1).
Amendment (a) to the proposed Lords amendment in line 2, leave out from 'regulations' to end of line 5 and insert
direct the relevant Health Board or the Agency to consult, with respect to a proposal to establish a trust:
§ Amendment (b) to the proposed Lords amendment in line 3, leave out 'consultation' and insert 'ballot'.
§ Lords amendments Nos. 42 to 44, 118 to 122, 141 to 145 and 171.
§ Mr. Clarke
The amendments are concerned with the consultation process on the establishment of national health service trusts when our reforms are implemented, beginning in April of next year. In our discussions of the proposed reforms NHS trusts are often referred to as self-governing hospitals. That is a rather simplified description because the NHS units interested in self-governing status as NHS trusts extend beyond hospitals. As far as I am aware, the hospitals interested range from some of the biggest to the smallest. There is also a great deal of interest in NHS units delivering services to mentally ill people and community-based services of one kind or another. There are even two or three ambulance services that are interested in the prospect of having much more control over the way in which their part of the service is run inside the NHS.
This is not the occasion for me to set out again at great length the virtues we see in returning to the NHS much more devolution of responsibility and accountability. That should be given back to those at the sharp end of the service—those people delivering care on the ground—where they have the necessary competence, enthusiasm and ability to discharge those responsibilities properly.
The first NHS trusts will be established in the spring of next year, when leadership will be provided by local people sitting on a board chaired by a leading figure of the locality. That board will comprise executive and 341 non-executive bodies on the smaller corporate-type model that we are advocating for health authorities and trusts under the regime. Those boards will put forward their particular plans for the development of their part of the NHS. Shortly after the Bill receives Royal Assent—I should imagine by the middle of next month—applications to establish NHS trusts will come to me and the regional health authorities from local enthusiasts. They will set out what they think they could do to raise the quality of care to their patients in their part of the NHS if given the necessary autonomy to do so.
There are many people in the NHS who will welcome the fact that NHS trust status will give them a much greater control over the day-to-day affairs in their hospitals. There are many who are anxious to get away from the detailed supervision of their affairs undertaken by district health authorities, regional health authorities, my officials and Ministers of whatever party is in power. I believe that a further injection of pride will be given to those local units that take advantage of the opportunity to establish an NHS trust. The staff of those units and all those served by them will have an increased sense of identity with the local hospital—their local part of the NHS—that is such a great feature of the service we are discussing.
The Labour party has throughout bitterly opposed NHS trusts for reasons that have, at times, totally mystified me. Once or twice during our proceedings on the Bill I was struck by the irony of the fact that this particular part of the Bill reverses the policy of the National Health Service Reorganisation Act 1973, introduced by the then Conservative Government. By a further irony I was the Government Whip who ensured that we had a majority when we implemented the 1973 Act which introduced the system of area and regional health authorities. That was done in the teeth of the bitter opposition of the Labour party.
That Act brought to an end the long-standing system of local management of the NHS based on the old hospital management boards and similar arrangements throughout the service. Obviously we are not going back to precisely the way in which the health service was run in its first 25 years. We are introducing much more up-to-date and sensible arrangements that are capable of allowing local decisions. Nevertheless, it is right to go back to a system whereby the NHS, as in its first quarter of a century, brings out the best in local management, enterprise and ideas about how best to deliver care to local patients.
In 1972 the Labour party did not have a clue about why it was opposed to the creation of the health authorities. It firmly committed itself to hand the entire service to local government once it came to power. I remember that the then Opposition spokesman was emphatic about that. The Labour party did not reverse Keith Joseph's reforms, but kept them untouched and untroubled by new ideas from 1974 to 1980. Now the Labour party is dying in the last ditch to defend the rights of the health authorities we created, which were introduced to provide detailed supervision of the day-to-day management of every part of the NHS. The Labour party is defending the right of the district and regional health authorities to second-guess day-to-day management even when we identify local 342 people who want to take responsibility in their hands through an NHS trust. That is what the debate has been about.
The amendments concern the necessary consultation on the establishment of NHS trusts when I receive applications from those promoters who wish to establish such a trust in their area. There is no change of policy behind the amendments and that is why I made a short plea earlier for us not to spend another five and a half hours talking about this, as we did on Report for reasons best known to those who face me in the Chamber.
I have looked up the Second Reading debate when we first presented the Bill to the House. On 7 December 1989 in column 502 of the Official Report I first made it clear that there would be public consultation whenever an application for an NHS trust was made. On 7 December we had the first debate on consultation, ballots, and so on. No doubt the Opposition will rehearse those arguments as we proceed tonight.
In the past few weeks the hon. Member for Livingston (Mr. Cook) has claimed that things have changed since December and that my timetable has slipped. The hon. Gentleman has been whistling in the dark with some enthusiasm in the hope that the introduction of the reforms will be put back. I recommend the hon. Gentleman to read column 505 of the Official Report of 7 December where I first made it clear that the pattern of service in the first year of our reforms would generally reflect the existing pattern of service, because most people wanted to persist with that existing pattern. The opportunities for change will begin in April of next year. Ever since I produced the White Paper and advocated the reforms, I have made it clear that, thereafter, the changes will evolve steadily with everyone learning from experience. They will take advantage of the greater opportunities that the reforms offer to change the service, raise the quality of care and improve the value for money for the taxpayer from the huge sums of money that the Government are not committing to the NHS.
Our response to the repeated concerns that have been expressed in the House and in another place about how the consultation should be run and whether we really meant what we had repeated time and again—that there would be public consultation—was put into the Bill in another place. The amendments collectively ensure that a full process of public consultation will be undertaken.
Returning to what I said a few moments ago about the likely state of progress, if we obtain Royal Assent in the next few days, I shall formally invite applications for NHS trust status. My current expectation is that in the next month the people who believe that they will be ready to form the first NHS trusts in April 1991 will put in their applications. I do not have an exact figure, because it is essentially a matter for local initiatives, but I should expect more than 70 applications from the part of the health service for which I am responsible in England. Thereafter, in accordance with the amendments, the regional health authorities will carry out a process of public consultation with every relevant interest, including the community health councils, that appears on the face of the Bill.
§ Mr. Clarke
I shall give way to the hon. Gentleman, but I stress that the numbers to which I referred relate to England and not to Scotland.
§ Mr. Foulkes
I appreciate that the Secretary of State was talking about the figures for England. However, he will agree that the principles remain the same north and south of the border. The new Ayr hospital is being set up in my constituency and the local health board informs me that there has been an expression of interest in self-governing status. From where does the Secretary of State expect that expression of interest? About whom is he talking and what groups does he expect to come forward with such proposals? If the vast majority of senior doctors and consultants in an area are against NHS trust hospitals, would he consider it viable to go ahead? I am asking not whether it would be acceptable or possible but whether it would be viable.
§ Mr. Clarke
The applications that I am expecting will come from groups of people comprising local clinicians, local nurses, local managers and perhaps local figures such as business people who may have had previous experience of the health service who, as a group, will put forward a proposition for the local NHS trust management of a particular unit. The formal applications will identify who is putting forward the proposals. I expect that most of them will identify the prospective chairmen and the people who would like to be members of the board. Most importantly, the applications will be the documents on which the consultation will be based and will set out proposals of that group for the management of the unit and the development of its services. It will set out the case for saying that that group should manage the unit with NHS trust status rather than continuing with the present direct management by the district health authority in England or the health board in Scotland.
§ Mr. Foulkes
Is the Secretary of State aware that in Ayrshire, and I am sure elsewhere, there was no local spontaneous request for NHS trust status? The only reason anything is happening is that Don Cruikshank, on behalf of the Under-Secretary of State for Scotland, came and stirred things up. The managers of the hospital were promised that they would get phase 2 only if they were to consider trust status. They were then offered free the services of a consultant firm who will put up a package and stimulate interest in it. Interest is being stimulated centrally by the Minister and not locally. The proposal is being strongly opposed locally. It is being imposed from the centre by the Government without any local interest or support whatsoever.
§ Mr. Clarke
I am not responsible for the Ayrshire hospital. I would advise the inhabitants of Ayr to wait and see who is really promoting the reforms and what they say. I cannot gainsay what the hon. Gentleman says, because, as he knows, I do not have direct contact with the health board in Ayr—that is the responsibility of my hon. Friend the Under-Secretary of State for Scotland—but I know from my experience in England that opponents of NHS trusts have been given the most extraordinary descriptions of what is happening. The debate in the country has often 344 been based on wild claims by the Labour party and local trade unions which will be gainsaid in July when real applications and promoters set out their plans. We are putting on the face of the Bill our commitment to consultation on our reforms and the nature of that consultation when we move on to much more sensible discussion.
So far, people keep carrying out ballots among consultants and staff and local authorities organise ballots among members of the public based on daft literature giving daft descriptions of what they say is going on in the hospitals. I shall come on to some of the daft literature in a moment, as most of it is being put out by the hon. Member for Livingston. In July, for the first time people will be putting forward proposals for improving their local hospitals and, as I said on Second Reading, wanting serious local discussion on the issues involved and the future quality of care and access to services for the local residents if NHS trust status was approved and went ahead with a particular collection of promoters.
§ Mr. Thomas Graham (Renfrew, West and Inverclyde)
Does the Minister realise that it has been proposed that the local hospital in Inverclyde should opt out? Why is he frightened of democracy and the right of local people such as the people of Inverclyde to conduct a ballot? There is a demand for a ballot. I thought that a ballot represented the process of democracy. The Conservative party is in government as a result of that process, so it should not be frightened of giving the local people of Inverclyde the right to a ballot to decide whether they want anyone other than the health board to run their hospital.
§ Mr. Clarke
I am grateful to the hon. Members for Renfres, West and Inverclyde (Mr. Graham) and for Carrick, Cumnock and Doon Valley (Mr. Foulkes) for bringing me up to date on the process in Scotland. I am delighted to hear that applications for self-governing status are likely to flood in north of the border and that there is interest in Ayr and Inverclyde. We have no lack of confidence in ballots. I propose to argue yet again the case against reducing serious plans for local health care to semi-political yes/no ballots among selected groups organised by the local Labour party.
§ Mr. Clarke
It is not insulting. The hon. Gentleman was not here for the speech of the hon. Member for Livingston, who made it quite clear what his approaches will be when local enthusiasts put forward proposals next month for self-governing status. Was he interested in the quality of care? Was he interested in the health service? Did he want to have discussions about the details of its management? He said:
We shall treat every consultation on opt out as though it were a by-election.The Labour party has taken that approach to health reforms for the past 12 months. So far it has not produced one serious proposition to reform or improve the national health service. The Labour party's policy could be written on the back of a postage stamp. I regret that, since we first brought forward our proposals, the Labour party has joined some of the professional trade unions, as well as the TUC affiliates, in inventing ridiculous scare stories which they can exploit locally to win votes for the Labour party. I warn the Opposition that, if their reaction to local doctors, nurses, managers and people committed to the 345 health service putting forward proposals is to run around behind front organisations such as Save our Hospitals, Health Emergency and other groups, trying to terrify patients into voting for the Labour party against illusory fears, it will rebound on them very badly.
§ Mr. Clarke
I shall give way in a second.
The National Association of Health Authorities—an association of health authorities in England and Wales—is in favour of our reforms.
Opposition Members will recall the Vale of Glamorgan by-election which they won by making a great deal of health service reforms. It was quite clear in Glamorgan that at that early stage, the Labour candidate and those helping him had persuaded the public in Glamorgan that our health reforms meant that they would have to pay for their treatment. That sort of by-election campaign is distasteful and discredits the Labour party. It should not repeat it on the consultation process on the NHS trust. I have my hands on a document that makes it quite clear that it intends to repeat that scurrilous behaviour.
§ Mr. David Winnick (Walsall, North)
Is the Secretary of State aware that, given his position, he is quite right to be cautious and wary of balloting or any form of democracy, rather like the leaders of the old eastern Europe countries? Is he aware that in my borough, where the Manor hospital is on the list, there was a household referendum organised by the council with questions approved by the health authority that is keen—at least the full-time administrator and Tory chairman are keen—on opting out? That authority agreed that the questions were fair. In the referendum, 78 per cent. said that they were opposed and 17 per cent. were in favour. Given those figures, is it not clear that the reason the Secretary of State does not want balloting is because he knows very well that he would lose by a landslide majority?
§ Mr. Clarke
As I said on 7 December, we shall have public consultation when we have the local plans and sensible local discussion. The eventual decision must wait for production of those plans so that their quality can be evaluated. In Walsall and elsewhere, the Labour party has jumped the gun before the proposals have been made so that it can describe them as it likes. Some Labour local councils have money coming out of their ears because of the community charge that they have levied. They have spent much of their charge money on political propaganda and telling the local population that their hospitals are under great threat. They then carry out ballots on the issue. Money has been wasted on political propaganda by elected councillors in places such as Redditch and Walsall.
The National and Local Government Officers Association is pouring money into groups such as Health Emergency and Save Our Hospitals a long time before anybody knows what is proposed for local hospitals. That is what lies behind those ridiculous ballots. That may be repeated—we have been promised that it will in the summer. I think that there will be a proper process of public consulation. The public are concerned about their health service. Sensible people will read the documents and discover what is proposed. I hope that they will make 346 proposals about what they would like to see in the service. The Labour party's campaigning will be seen as irrelevant and something that tries to exploit fear.
The Labour party thinks that this is all about a by-election and wants to reduce the issue to the organisation of local ballots. When the health service was first set up by my great predecessor, Nye Bevan, it was a controversial change. No ballot of any kind was organised in 1948. In the 1945 general election both parties were committed to the national health service, but setting it up was controversial—doctors voted 9:1 against Nye Bevan and his suggested contract. Quite rightly, he took no notice of the 9:1 ballot because he discussed the matter seriously in the House and got his majority. In the intervening 40 years, no Government have ever thought it sensible to organise a ballot, among whatever electorate, on the details of the management and financing of local hospitals.
Let us take the example of a medium-sized firm in the constituency of the hon. Member for Walsall, North (Mr. Winnick). Locks and chains are no longer made in Walsall, but let us imagine any modern and thriving town. No one would believe that changes in the management of a local firm should be the subject of a ballot organised by Walsall council, subject to leafleting by local trade unions. Whatever products are made in Walsall, I dare say that they are less important than the services given by the national health service. There are few things more important than the health care given to our population by the national health service. Therefore, we should have the highest standards of management, efficiency and value for money in the NHS. We should not reduce its management to a political circus for the benefit of Opposition Members who want to fight by-elections on the back of it.
§ Mr. Derek Fatchett (Leeds, Central)
I have heard the Secretary of State make that argument before, and I have never found him convincing. I remember the Secretary of State in one of his previous roles in the Government—as Secretary of State for Employment—advocating the extension of ballots in connection with trade unions and industrial relations. He seems to cut his cloth conveniently according to which job he holds. The Secretary of State says that management issues should not be subject to ballots. He also says that key social and political issues should not be subject to ballots when they affect important services such as the national health service. How does he square that with the way he voted on opt-out schools, where a ballot must take place on the management of the school and a resource that is of great importance socially —of equal importance to the national health service? Is it just that the Secretary of State finds it convenient to cut his cloth in one direction for the health service, because he knows that he will lose the ballot, and in another direction on opt-out schools?
§ Mr. Clarke
I am glad that I eventually persuaded Opposition Members with my arguments on trade union ballots. I remember that they were against them, said that scabs would interfere with the proper running of trade unions, and restrict their right to take industrial action against whoever they pleased. With teeth clenched and holding back their wilder colleagues, Labour Members now say how much they welcome the introduction of ballots for trade unions, so that strikes can be organised only with the consent of union members. I hope to 347 persuade the hon. Gentleman with my arguments today. We have just agreed to debate these amendments for eight hours—I know that we are covering some familiar ground.
Education involves a tightly knit group of users. We are not talking about ballots of staff alone. It is not just the teachers who make the decisions, because they do not own the school. We do not run workers' co-operatives in education or health. But there is a defined group of people at any one time—a set number of pupils—who receive the service. They are the only ones directly receiving the service and their parents are the ones who are offered a vote on education.
In the health service there is hardly any unit or hospital where the catchment area is so predictable. We do not have hospitals that serve only the people who live in the same borough and do not take people fom outside. Plainly, the staff are not a group of people who can decide about management because the hospital does not belong to them. With the greatest respect to consultants—who are probably the key staff and deliver the service—the hospital does not belong to them. Consultants are always described as though they are some sort of amorphous, block body. There is a huge difference between consultant orthopaedic surgeons who have beds and admit patients, consultants who may be academics with contracts, anaesthetists and radiographers. Consultants are not a set body of people with one collective set of interests and views.
The public served by a hospital come from anywhere. If any of us were to be ill tomorrow in this Chamber we probably would not have the first idea to which hospital we would be admitted. Therefore, there is no electorate among whom we could organise the ballot. The health service is such a giant organisation and so complex that it is not patronising to say that scarcely any member of the public understands how it is managed and financed. One problem is that it is such a chaotic system that not everyone inside it knows how it is managed and financed.
The idea that the document proposing how it should be run in future should be based on some electors who answer a simple yes/no question about the development of services in their district, guided as they will be by the sort of rubbish put out by the Labour party in leaflets while consultation is being carried out, is bad. It would be irresponsible to run a great national service such as the NHS in that way. The Labour party is irresponsible and has no ideas for the service. Its members see this as an opportunity to make mischief and win votes by terrifying old people about the service that they are likely to get.
§ Mr. Alun Michael (Cardiff, South and Penarth)
The Secretary of State appears not to have learnt the lesson of the Vale of Glamorgan by-election when there was a thorough discussion about the health service and the nature of the health service that people want. Our excellent candidate, and people such as my hon. Friend the Member for Livingston (Mr. Cook) and others who thoroughly debated the health service, received a positive response and people responded positively to our proposals for the health service. As we seem to be educating the Secretary of State about what is happening outside England, let me bring him up to date on the position in South Glamorgan. At present, the South Glamorgan health authority is scrabbling for cuts worth £7.2 million—
§ Madam Deputy Speaker
Order. The hon. Gentleman is intervening. Whatever else we do in this Chamber, we do not fight by-elections all over again.
§ Mr. Clarke
As the hon. Gentleman knows, I am not responsible for the South Glamorgan health authority. Welsh Question Time would be a better place to raise such matters.
Let me move on to the kind of consultation that we envisage. I have described what I want.
§ Mr. Tony Favell (Stockport)
I have not had the advantage of listening to the Committee's deliberations. As my right hon. and learned Friend knows, I am a simple fellow and I should like a simple answer to a simple question. Will the patient be better off with a self-governing hospital or with the great bureaucratic trail which, in Stockport, for example, goes from the hospital to the Stockport district health authority to the North West regional health authority to the Elephant and Castle to the Treasury and then all the way back down the trail?
§ Mr. Clarke
My hon. Friend's question makes it clear potentially where the answer lies if the NHS trust is well judged and the right local people have the right local plans. The first part of his beguilingly simple question is the key for all members of the public. When I, as Secretary of State, look at applications for NHS trusts, I shall make the final decision on the basis that he suggests in the first part of his intervention: is a self-governing trust likely to improve the service to the public and will it be in the interests of the NHS to have that degree of local freedom? I hope that we shall then have non-political, serious, local discussion involving those who work in the service, those who are served by it and anyone who has a sensible proposition to put forward.
The Labour party will apparently join in that three-month public consultation. It does not always join in. Often it joins in behind the shield of organisations with names such as Hospital Alert, Health Emergency and Save Our Hospitals, into which the public's community charge has been tipped. The BMA is also promising a great campaign. The BMA and the Labour party ran a pretty silly campaign last summer and they appear to be saying that they will run the same one this year.
The Labour party's document "A question of trust" contains its manifesto for opt-out ballots. Yet again, it shows that all these months in it is still proposing to go round this summer putting out exactly the same myths. I have never used the phrase "opting out" to describe the proposals, because it does not describe them. The hon. Member for Livingston and his hon. Friends continually talk about hospitals opting out of the NHS. The hon. Gentleman has the courtesy to agree that that is his case. He is not on the stumps now; he is in the House of Commons. He knows that nothing will leave the NHS. NHS trust status has nothing to do with a hospital leaving the NHS. It is local management within the NHS and it is utterly untrue for him to sit there rah-rahing in words that he uses on the platform, saying that such hospitals will be leaving the NHS.
The treatement will be free. I have already mentioned the Vale of Glamorgan by-election where electors were clearly told that they would have to pay for treatment. 349 That has all been repeated in the document. It uses weasel words. Anyone reading about the opt-out ballots that the Labour party is running will see the headingTreatment will not be accessible".I will not read what follows, but there is nothing that describes the reforms which remotely justifies that statement. Then it says of treatment,It will not be free.That is an utterly disgraceful assertion.
The Labour party has pressed for public consultation and the amendments, which it will not vote against, give the public the consultation that it has demanded, but its response is to issue guidance which will result in anyone following it not telling the truth when he tries to get Walsall council or some other band of idiots to hold a local ballot and get a negative answer.
§ Mr. Robin Cook (Livingston)
The Secretary of State takes exception to the term "opt out", but he will confirm that, after he has made an order, such hospitals will be run by a board of directors which will own the property and have full legal title to it with the freedom to sell such part of the property as it chooses. That board of directors will hire and fire everybody employed in the hospital and be responsible for balancing the hospital's books by trading in services and being responsible for raising every penny by selling the services. That board of directors has the freedom to go to the City of London and borrow on the private market. Under the Bill, the board of directors has the freedom to make profits and retain profits year to year. There is no material particular in the ownership and structure of such hospitals which differs from any Nuffield or BUPA hospital.
If the Secretary of State is so confident that the statements in that document are weasel words which cannot convince anybody, why is he so afraid to let the local people decide? Does he not understand that the arguments that he has been advancing for the past half an hour are precisely the same arguments that Wellington used against the Reform Act 1832—that elections were too complex, that they could not be reduced to simple decisions and that people were not sophisticated enough to understand the issues? Why does he not have the courage to put his policies to the decision of the electorate?
§ Mr. Clarke
The hon. Gentleman repeats on the Floor of the House the kind of nonsense that he puts about outside and—here I congratulate him—without the trace of a smile or a flicker of his beard, although he must know that the NHS trusts that we are talking about bear not the slightest resemblance in any serious particular to a BUPA, Nuffield or any other private hospital. The land for which they are responsible will remain NHS land. Local NHS managers will be empowered, as local managers are now, to sell up to certain limits, but above a low limit they will require the consent of the Secretary of State before they dispose of land. The patients will be NHS patients, not paying a bean for the service, receiving it free.
Contrary to another untruthful statement in the document, the staff will all be NHS employees. They will be public servants receiving public service pensions. They may agree with their local management to vary from the national pay rates in the NHS, but they will be NHS staff. The board will not have any shares in anything, because there will not be any private capital. No profit will be made. Nothing will be distributed to anybody. It will not be a commercial undertaking.
350 The hon. Gentleman makes my case by getting up and giving us a fantasy vision of an NHS trust as some kind of private hospital when he knows, or should know after hundreds of hours of debate, that what he has just described is nonsense and a travesty of our descriptions of how to run the NHS better with the right local promoters.
§ Mr. Andrew Rowe (Mid-Kent)
Will my right hon and learned Friend confirm that there have been informal discussions with one of my local district health authorities about the real possibility that the whole district might become self-governing, which clearly demonstrates the rubbish being talked by Opposition Members?
§ Mr. Clarke
I am grateful to my hon. Friend. Many people in the service are enthusiastic. We have always promised full public consultation on proposals. The amendments put in statutory form the public consultation that we promised, and they should have allayed all the serious fears. There are no serious fears on the Opposition Benches; there is mere political opportunism that if Labour Members misdescribe the proposals enough they might win a few votes for the Labour party in the course of the public consultation process. That will be irrelevant to the public consultation process. There will be a serious discussion about how best to improve the local health service.
I invite the House to agree with the Lords in the relevant amendments to ensure that public consultation has a statutory foundation and that we can put our repeated promises into effect.
§ Ms. Harriet Harman (Peckham)
If the Secretary of State is as confident as he seems to be that these proposals are minor, technical, managerial matters which seem to be engendering a new breed of people whom he describes as local enthusiasts, why does he not agree with our amendments? Why does he not agree that there should be a ballot, or that after consultations have been held a hospital should opt out only if there is support for it to do so?
When the right hon. and learned Gentleman talks about not taking seriously local people's views about whether their hospital should opt out, he underplays the importance of opting out, implying that it is a minor, technical change. Yet elsewhere he stresses that the creation of opted-out hospitals is one of the key proposals, and so it is. That is why people want, and are entitled to, a say in whether their local hospitals opt out of the local national health service. Our amendments, which the Secretary of State will oppose—
§ Ms. Harman
I shall give way later; I want to develop my argument.
Our amendments would give people at local level the right to stop their local hospital opting out of the local NHS by a decision of the Secretary of State. Under the Bill, all hospitals will be forced to compete for patients in the internal market—[HON. MEMBERS: "And why not?"] Patients will lose choice because the quality of care will suffer as hospitals cut corners, competing to win contracts by reducing their costs. The internal market will affect all hospitals—
§ Ms. Harman
351 Opted-out hospitals are to be the leading edge of the internal market. They are to be the market leaders, as the Secretary of State would describe them in his salesman's jargon.
To play this role, opted-out hospitals are to be cut loose from their local communities. No longer will they be directly managed by the local district health authority; no longer will they be an integrated part of local hospital and community services. There has been much talk of the freedom that will be bestowed on opted-out hospitals—the freedom to drop uncompetitive services if they are expensive and do not bring in enough revenue, for instance. These will be services such as those provided for the long-term chronically ill, geriatric patients and the mentally ill.
Opted-out hospitals will have the freedom to divert services to private patients—[HON. MEMBERS: "Not true.] I suggest that hon. Members read the Bill, because I am basing my comments on it.
Opted-out hospitals will have the freedom to divert services to private patients to stoke up their income. They will have the freedom to bid for contracts and perhaps draw in patients from other district health authorities by offering waiting times so as as to get bigger contracts from neighbouring health authorities.
§ Mr. Jerry Hayes (Harlow)
Would the hon. Lady be kind enough to be straightforward and tell us precisely where in the Bill all her allegations or even the suggestion of those allegations come from? She knows very well that what she has just said is wholly inaccurate, because district health authorities—and, if need be, the Secretary of State—will be able to intervene if there are local eccentricities of the kind that she suggests.
§ Ms. Harman
In Committee we proposed amendments on all these points which would have prevented opted-out hospitals being cut loose from their local communities, and the hon. Member for Harlow (Mr. Hayes) among others, voted against them. We proposed amendments that would guarantee local access to core services for the elderly, for children and for psychiatric patients, but they were voted down. We tried to put safeguards in the Bill, but the Conservatives voted them down—
§ Ms. Harman
I shall carry on for a bit.
It has been suggested that opted-out hospitals will have the freedom to bring in patients from Europe. The location of St. Thomas's hospital at the channel tunnel terminal is seen as a wonderful opportunity to provide services to patients from Europe. But that is not how people living near St. Thomas's, who want to use the hospital see it. They know that they will lose. When opted-out hospitals exercise their muscle in the market place, local people will be the losers. If they are unfortunate enough to need one of the services that have been dropped as uncompetitive, they will no longer be able to turn to their local hospital —they will have to go elsewhere. The so-called guarantee of local access to certain key services described as core services, which had pride of place in the White Paper, has no place in the Bill.
§ Ms. Harman
Local people have no guaranteed right to those core services in an opted-out hospital. In Committee, the Government voted down our attempts to guarantee local access.
§ Ms. Harman
The hon. Gentleman was there; he knows that they voted down our guarantees of local access to services for children, the elderly and the mentally ill—
§ Ms. Harman
I have already given way once to the hon. Gentleman, and I know that he will seek to catch the Chair's eye later.
If private patients prove more lucrative than local NHS contracts—[Interruption.] I hope that the hon. Member for Harlow will listen to what I am saying. He seems to be getting agitated.
If private patients prove more lucrative than local NHS contract patients, local people will lose out to patients under contract from BUPA, to which the opted-out hospital could be selling its services—or the French equivalent might even come first. If a neighbouring consortium of district health authorities which had formed themselves into a purchasing consortium wanted to place a large contract for a large throughput of patients, to win that contract an opted-out hospital could agree terms which gave patients under that contract preference over patients from the local district health authority. There is nothing in the Bill to stop that. There is no reason why opted-out hospitals should not act in that way as they will no longer be part of the local health authority. That is the whole point of opting out.
§ Mr. Kenneth Clarke
Perhaps I may reassure the hon. Lady. The only proposals in the service for consortia of district health authorities for purchasing purposes are coming from district health authorities which contain self-governing units. Local district health authorities would put together what is usually called their purchasing roles—I prefer "planning roles"—to put themselves in a stronger position to stipulate the quality and sort of care that they want from the self-governing hospital in their territory.
§ Ms. Harman
The Secretary of State does not understand how his internal market will work. Consortia of local district health authorities coming together to increase their purchasing power need not buy contracts only from their locally managed hospitals or even from their local opted-out hospitals. They could buy contracts with other local opted-out hospitals. The right hon. and learned Gentleman's argument does not, therefore, negate what I have said. The situation is exactly as I have described it: large purchasers can arrange contracts with opted-out hospitals in such a way that people coming under the contract offered by the consortium of district health authorities would receive care in preference to local people.
Opted-out hospitals will not look to their local communities because the chairman will be appointed by the Secretary of State. The Secretary of State's appointees in the regional health authority will appoint the non-executive directors. The chairman and non-executive directors—direct or indirect appointees of the Secretary of State—will appoint the non-executive directors, so the 353 focus will be on the Secretary of State, not on the local community. That is why local people whose hospitals are targeted for opting out see it as a threat and want to have a say.
All the talk about local enthusiasts springing up all over the place is nonsense. People who work in hospitals want to have a say because they care about the services that they help to provide and because they feel that they know about patient care. They also want a say because they would no longer be employed by the district health authority under Whitley terms and conditions. The Secretary of State said that those people would still be national health employees and that hardly anything would change. We spent many hours in Committee discussing clause 6. I remind the Secretary of State that that clause provides for the transfer of staff from health authority to national health service trust employment. Without their approval, they would no longer be employed by the district health authority but by the opted-out hospital. Of course they should have a say.
§ 6 pm
§ Mr. Clarke
At present staff can be transferred from one district health authority to another if a particular part of the service is transferred. People may be transferred from an authority to a trust, but they will still be national health service employees. The Labour party pamphlet on that is plainly wrong when it claims that the staff will not be national health service employees.
§ Ms. Harman
The Secretary of State seeks to mislead the House. People who transfer from one district health authority to another retain the same Whitley council terms and conditions. Staff who transfer from a district health authority to an NHS trust will take with them their contract of employment, but they will not take with them their right to trade union membership and to have their trade union recognised to negotiate on their behalf. The contract of employment, which is backed by a national structure of union recognition, would therefore be nothing more than a piece of paper. The Secretary of State knows the difference between a contract of employment backed by nationally recognised negotiating procedures, and a piece of paper, the contents of which are unenforceable.
§ Mr. Clarke
I think that the hon. Lady has conceded that such people will remain national health service employees. She has moved on to what she is really worried about—that local management might choose not to be governed by Whitley council national rates. That is what the Labour party wants to defend. People might choose to recognise their own local trade unions. As the hon. Lady knows, the Whitley council arrangements cover trade union representatives such as those from the General, Municipal, Boilermakers and Allied Trades Union on the ambulance men's Whitley council who do not have any members working for the national health service in that grade. The recognised trade unions at Whitley council level include trade union representatives who may have no relationship whatever with the trade union membership of that grade of staff in a local hospital or unit. People will remain NHS employees, but they can be represented by local unions of their choice.
§ Mr. Martin Redmond (Don Valley)
On a point of order, Madam Deputy Speaker. The Secretary of State has moved a guillotine motion to restrict debate on this 354 important Bill. He is now seeking to utilise the little time that we have with a series of interventions. If he wants time to discuss the matter further, he should lift the guillotine.
§ Madam Deputy Speaker
That is not a matter for the Chair. The hon. Member for Peckham (Ms. Harman) had given way. I think that the Secretary of State has finished his intervention.
§ Ms. Harman
One of the advantages canvassed by the Secretary of State in support of opted-out hospitals is that they will have the freedom and opportunity to cut through nationally agreed pay terms and conditions, and he has said that people will not necessarily have their union recognised. People should at least have a say before their terms and conditions of employment are changed so materially.
The Government have made contradictory statements about consultation. They were finally backed into an amendment in another place which would require consultation before opting out. We support that amendment, because the Government should of course consult. If consultation is to have any meaning, the Secretary of State must not just consult but must take that consultation into account. The Government amendment says that there will have to be consultation, but there was fierce opposition to our amendment which said that they should take into account the results of such consultation. Unless they take that course, they will make a mockery of consultation. It would be a sham for the Government to proceed with opting out after they have consulted and found no substantial support for opting out among the local community or the staff.
We know why the Secretary of State opposes ballots. He is redolent of sincerity, so he has clearly undergone some sort of psychological transformation. His arguments about ballots are ludicrous, but he seems to believe them. Anyone not in the same peculiar state as the right hon. and learned Gentleman will realise that he and the Government are against ballots because they know that they will not be able to win them. The Secretary of State said that there was no ballot about the creation of the national health service. But there had been a general election—that was the ballot.
The idea that the subject is too complicated for patients to understand is ludicrous and insulting. I presume that the Secretary of State also thinks it too complicated for consultants to understand and that that is why they should not be entitled to a ballot. He said that a ballot is not held for a Walsall lock and chain factory, so why have a ballot when a hospital wants to opt out. He does not seem to realise that people throughout the country regard the national health service and their local hospital as very different from the local lock and chain factory.
The Secretary of State's opposition to ballots is based purely and simply on the fear that they will show overwhelming opposition to opting out. The ballots already conducted have shown a tide of opposition. No matter where they take place, who conducts them or what the question is, the Secretary of State can find no support for his proposals. He talked about our "misleading leaflets", but he has spent millions of pounds of taxpayers' money on grotesquely misleading leaflets. Yesterday I picked up 12 leaflets produced by Trent health authority involving a scandalous misrepresentation of the effect of the proposals.
§ Ms. Harman
There are 12 of them. I do not want to go through them all, but I will write to the Secretary of State.
Despite spending millions of pounds of taxpayers' money, the Government have failed to win the argument and lull people into a false sense of security. Their propaganda has not worked. That is why they fear ballots. I shall give a few examples. People working for the West Lambeth health authority were balloted and 82 per cent. were against applying for self-governing status and 18 per cent. were in favour. In Doncaster, which I visited yesterday, the borough council commissioned a MORI poll and found that 68 per cent. of people were opposed to the local hospital, Doncaster royal infirmary, opting out.
The Secretary of State says that such ballots are a waste of money, but they would not be a waste of money if he paid some attention to them. It is a waste of money to test public opinion only if there is a determination to ride roughshod over it. General practitioners local to Guy's hospital were balloted and 66 per cent. were against that hospital, to which they refer their patients, opting out. In the 28 hospitals where ballots have been held, even consultants have voted by a ratio of 2:1 against their hospitals becoming self-governing. The Secretary of State says that the local enthusiasts who seem to be covering the country include enthusiastic consultants. Mr. Paddy Ross, chairman of the BMA consultants committee, says in a letter:
I remain very concerned about the fact that in many of the front-runner hospitals, plans for self-government still appear to be progressing despite clear evidence of lack of support from consultant staff. We have identified some twenty eight hospitals on the Department's list of those likely to progress to Trust status in April 1991, where recent ballots of consultant staff have been held on the issue of self-government. As you will see from the results of these ballots, in 2l of the hospitals the consultant staff have overwhelmingly rejected the concept.Already some expressions of interest have been shaken out of the system because of the overwhelming hostility which the Secretary of State knows exists. In January 1989 the White Paper triumphantly trumpeted that 320 hospitals would be available to opt out. In June 1989 the figure was only 189. In November 1989 it had dropped to 79. In May 1990, although the Secretary of State still holds out that about 70 hospitals are interested in opting out, the chief executive said that 50 hospitals were likely to become self-governing trusts. Already hospitals are being shaken out in recognition of the overwhelming local opposition to opting out.
The Secretary of State says that even consultants' views will be overridden if they dare to oppose opting out. Now only the views of the patients matter, but we are not allowed to ask the views of the patients—the only person who knows the views of the patients is the Secretary of State, so only he can make the decision. His tactics of public misinformation simply have not worked.
Let us consider the tactics used with the consultants. The tactic with the public was misinformation, but with consultants it has been slightly different. First, the tactic was to ask consultants, "Why do you not express an interest? Expressing an interest does not commit you to anything. All it says is that you are interested in finding out more information." Of course, as soon as they were lured into an expression of interest, consultants were immediately written down as fully in support of opting out. The first tactic was to lure consultants into expressing 356 an interest because it hardly made any difference. But they would be ridiculous if they did not want information about what might affect their local area.
After the "expression of interest" tactic, a combination of blackmail and bribery was used. That was referred to by the hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes). The Government said, "We will see you all right if you opt out. You know that this is a highly political matter for us and we will see you all right if you are one of the first opt-outs. You know—nudge, nudge, wink, wink—that we cannot afford to let you fail. But if you do not opt out you have a large deficit to worry about. It looks like phase 2 is in doubt and you can forget phase 3." That was the message sent round to browbeat consultants who disagree with the internal market and opting out into believing that they should vote to opt out as the only way in which to survive in the jungle. That is disgraceful. Despite that tactic, the Secretary of State has failed to take the consultants with him.
I should like to take this opportunity to make our position clear. One of the Secretary of State's most annoying misrepresentations is his misrepresentation of our position. I will state it in words of one syllable which I hope that he will understand. We do not agree with the internal market. Health care is damaged by the fragmentation of the services into competing units. We do not agree with riding roughshod over public opinion when people do not want local hospitals to opt out. We believe that people should be consulted and that their views should be taken into account. We make this promise to people whose hospitals are threatened with opting out. The Government and the Secretary of State might not be prepared to listen, but we are. That is why we shall press these amendments to a division.
I finish by repeating the words of Ken Gibson, an 80-year-old gentleman whom I had the opportunity to meet when I visited Doncaster royal infirmary last night. He said, "During the war we brought sandbags to the Doncaster royal infirmary to protect our hospital from the enemy. We have been fighting to protect our hospital ever since. It is our hospital. It is not the Secretary of State's to give away." I believe that people such as Ken Gibson should have the right to vote on the future of his hospital and to have his views taken into account.
§ Sir George Young (Ealing, Acton)
I hope that the House will agree with the Lords in the amendments and will reject the amendments tabled by Opposition Members. I simply cannot understand why the Labour party makes such heavy weather of the establishment of self-governing trusts within the national health service. I should like to give three reasons why it is wholly misguided in what it plans to do this afternoon.
First, we already have self-governing trusts within the NHS. General practices and health centres in many constituencies are self-governing trusts within the NHS. They are the most popular and successful model of management within the NHS. The Bill proposes to extend that model of management to other parts of the NHS. The people who work in health centres and general practices decide how the unit should be operated. Any savings are ploughed back. Such centres are responsive to local needs and are not involved in the bureaucracy of the NHS. The Government seek to extend that successful, popular model 357 of management to other parts of the NHS. The Labour party is making a fool of itself by seeking to prevent the extension of that style of management.
Secondly, we already have self-governing trusts within the public sector. We have established them in education and on roughly the same model in housing, where it is fairly common to devolve the management of estates to local people.
§ Sir George Young
I shall come to the issue of ballots in a moment.
We heard all the same propaganda that we heard from the hon. Member for Peckham (Ms. Harman) today when it was proposed to allow schools to become self-governing. None of the fears expressed this afternoon materialised with self-governing or grant-maintained schools. Such schools are popular. Some were given grant-maintained status by the Secretary of State and others were not. 1 should be surprised if any Labour Government said that they planned to nationalise or bring back under local authority control some of the popular grant-maintained schools that have been established.
We have made it possible for local authority tenants on an estate to run the estate themselves. We have devolved the management of such estates. The Government are not afraid of ballots on such issues. We have established arrangements for ballots on grant-maintained status for schools, on the creation of housing action trusts and on the transfer of new town property to local authorities.
The reason why ballots are not practicable for NHS trusts were given by the Secretary of State. The electorate is well defined for a ballot on a housing action trust, on new town property or on a school. The electorate for a hospital or ambulance service is not well defined. We have established that it is simply not practicable to hold a ballot on whether an NHS trust should be created.
I now come to my third reason. I suggest that Opposition Members read an Adjournment debate initiated by the then Bob Mellish, now Lord Mellish of Bermondsey, in 1979 about St. Olave's hospital in Bermondsey. The thrust of his argument was that St. Olave's was run far better when it had a board of governors. He wanted to return to the days when people identified with their local hospital, the hospital was run by local people and it was easier to raise money for it. He deplored the transfer of the management of St. Olave's from the board of governors to a district health authority.
The Bill seeks to give the opportunity to Bob Mellish—were he still here—to support the reversion to local management of St. Olave's and many other hospitals. I suspect that if he were in the House this afternoon he would speak in favour of devolving management—[Interruption.] I see that the hon. Member for Sheffield, Hillsborough (Mr. Flannery) agrees with me. Bob Mellish would be on this side of the argument. He would argue for local control and against the bureaucracy of the NHS.
§ Mr. Robert N. Wareing (Liverpool, West Derby)
The hon. Gentleman told the House how wonderful it was to have ballots in the schools sector. Is he really saying that it is impossible and inconceivable to hold a ballot of local people who, after all, are the consumers of the national health service? Is it not possible within every community health council to hold a ballot? When were CHCs 358 consulted? Is the hon. Gentleman saying that democracy is too inconvenient for administrative reasons, or is it really for political reasons, of which the Government are all to well aware?
§ Sir George Young
I am not sure whether the hon. Gentleman was in his place when the Secretary of State dealt with that point. He made it clear that, if any of us were taken ill, we should not have the slightest idea which hospital we might be referred to. It is impossible to define the catchment area of large hospitals such as Bart's and Guy's. Many cottage hospitals were closed by the Labour Government. There was no ballot then. That was a far more dramatic decision for local people to cope with than the change of management that we are debating.
The hon. Member Livingston (Mr. Cook) said that every proposal for self-government would be treated as a local by-election. There have been four local by-elections in Ealing during the past two years, three in Labour-held wards and one in an Alliance-held ward. The Conservative party won all four by-elections. If the Opposition want to have a fight about this in Ealing, I suspect that they will be on dodgy ground.
If a proposal is put forward that a hospital in my constituency should become self-governing, we shall consider it on its merits. We shall not be influenced by the fact that the Labour party is campaigning against it. We shall consider whether it would be good for local people. If it would be good for them, we should back the proposal. If we decided that it would not be good for them we should not back it. For the Opposition to try to turn this into a popularity contest between the two major parties is wholly counter-productive. I welcome the amendment. I hope that the House will support it.
§ Mr. Winnick
I apologise, Madam Deputy Speaker, for the fact that after I have finished my speech I shall have to leave the Chamber to see whether the Select Committee on Procedure is still sitting.
The Secretary of State for Health and the hon. Member for Ealing, Acton (Sir G. Young) have put forward all sorts of reasons why balloting is unnecessary and irrelevant. The Opposition know why the Government oppose ballots. If ballots were held they would lose by a landslide. If the Secretary of State believed that local communities would accept his proposals, would he say that balloting was wrong and irrelevant? Of course not. He would say the very opposite. He would argue that the Conservative party believed in democracy and balloting. He knows, however, as we do, that local communities are not in favour of his proposals.
The Secretary of State jeered at what my local council, Walsall, has done. I congratulate it. The local health authority decided not to hold a ballot on the future of the district general hospital—the Manor, as it is generally known. The local authority therefore decided to hold a household referendum. I congratulate it on its initiative. If the Secretary of State suggests that warped and twisted questions were asked in order to get the kind of responses the local authority wanted, I must point out to him that those questions had already been put to the health authority. It was asked whether it approved the questions; it was not asked whether it approved of balloting, because it did not. For the Secretary of State to sneer shows his contempt for the views of the local community.
359 The result was that 6,004 were in favour and 27,639 against; 78.5 per cent. were not in favour, while 17 per cent. were. The local authority asked people whether they believed that they should be consulted, and 94.7 per cent. were in favour and 3.3 per cent. were against. It also asked people whether they thought that opting out would affect the service that the Manor provides. Fifteen per cent. said that a better service would be provided and 8.5 per cent. said that it would make no difference, but 68 per cent. said that it would result in a poorer service.
The Secretary of State says that those questions do not count. That shows his arrogance. He believes that local people should have no voice and should not be asked for their opinion. To him, democracy is a charade. I do not believe that.
§ Mr. Winnick
The people in my borough have a deep attachment to their district general hospital. I concede that people do not always know which hospital they will be sent to. People who do not live in the borough are treated—rightly—at the Manor. However, nearly all those in the borough who need hospital treatment are likely to go to the Manor. They have a link with that hospital.
§ Mr. Clarke
No proposal was put forward by anyone to establish a local national health service trust. The council campaign was all about opting out and threats to local services—hence the Romanian-type election results. Of course we believe that local people should have a say. We have always promised local consultations. The amendments that we are debating are in line with the opinions expressed by 94 per cent. of the respondents, who presumably had been told, quite falsely, by the council that the Government resisted the idea of local consultations.
§ Mr. Winnick
The best form of local consultation in this matter is democracy. That is the system that has operated in this country since the Reform Act 1834 and the other Acts that allow people to have a voice. We believe that the best way for people to express their point of view is by voting. The Secretary of State refers to Romania. The former Communist leaders in eastern Europe did not want genuine elections to be held. They were, rightly, frightened of democracy. The recent election results in most eastern European countries at least show that they knew that they would be turfed out. That is why the Secretary of State and his Cabinet colleagues are so hesitant about and are opposed to the holding of ballots on controversial proposals.
§ Mr. Graham
The Secretary of State suggests that those who call for a ballot are influenced by the Labour party. The local Labour party in my area has not called for a ballot; a well-known newspaper, which is not a Labour party paper, called for a ballot.
§ Mr. Winnick
My hon. Friend illustrates the fact that opposition to the proposal goes far wider than Labour party supporters. The Opposition make no apology for being associated with the campaign. We fought for the creation of the national health service. The Secretary of State quoted Nye Bevan. I imagine that the Tories will soon be claiming him as one of their own. However, we remember the Tory opposition to which he was subjected 360 in the House of Commons. There was strong opposition from the Conservative party to the creation of the national health service. However, the Labour party has always been associated with the NHS and we are determined to defend it at all costs. Why, therefore, should we apologise about what we consider to be a halfway house towards privatisation?
§ Mr. David Wilshire (Spelthorne)
The hon. Gentleman says that he and his colleagues are prepared to defend the NHS at all costs. He has spent the last few minutes, however, saying that fact and truth are important. If I understood him correctly, one of the questions to which he referred—which might have been agreed by the local health authority, though I care not who agreed it—asked whether people were in favour of opting out. If the words "opting out" were used, the truth was not put to the local people when they voted. No such suggestion has been made.
§ Mr. Winnick
The people in my borough require no lectures from the hon. Gentleman about what they know or do not know. They have followed the debate and they know what the position is. I challenge the hon. Gentleman to allow a ballot to be held on the issue in his constituency and to stand by the result. The result in his borough would almost certainly be the same as that in my borough.
I tabled a written question to the Secretary of State in which I asked him to list the national medical organisation that had made representations to him expressing support for the proposal that national health service hospitals should become self-governing. I received his reply yesterday. Not one national medical organisation seems to be in favour of the proposal. The Secretary of State said in his reply that much of the discussion with the national organisations had been about the detailed implications and practical details of the implementation of the proposals.
The Government cannot name a single medical organisation, and we know why. As my hon. Friend the Member for Livingston (Mr. Cook) pointed out, it is not just the Labour party or the British Medical Association that opposes the proposals—and, incidentally, the BMA is not normally looked upon as a Labour party front organisation. What about the joint consultants committee? I can hardly imagine that that body's representatives are all eager to vote for Labour at election time. The House should listen to what they have to say:These proposals"—the opting-out 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 hospitals. 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.The joint consultants committee takes the same view as we do; it is highly sceptical and highly suspicious of the Minister's proposals.
I take the view that, whatever one calls such hospitals —self-governing hospitals, national health service trusts or anything else—they will place a greater emphasis on commercial considerations, on the selling off of land and property. As I said, they will undoubtedly be a halfway 361 house to privatisation. The Minister argues—as one would expect him to—that they will remain part of the national health service. We know that initially they will, but we also know that the Government are hostile to the national health service and that they seek to destabilise it, even if, understandably, they do not have the political courage to repeal the Act, as many Tories would like them to. After all, the national health service goes against the very foundations of Thatcherite policy and ideology. This proposal is another means of destabilising the national health service.
The hon. Member for Spelthorne (Mr. Wilshire) said that those in my community did not understand the questions in the poll. They understood the questions perfectly well, and they understand what the Tory Government are about. They understand the Government's hostility to the national health service. That is why we are perfectly justified in fighting the proposals all the way.
§ Dame Jill Knight (Birmingham, Edgbaston)
The hon. Member for Walsall, North (Mr. Winnick) commonly talks a fair old load of rubbish, but he has excelled himself this evening: I have never heard a greater load of rubbish. His assertion that the Government are hostile to the national health service flies in the face of every single fact —[HON. MEMBERS: "Eye tests?"]—and everything that has been done—[HON. MEMBERS: "Eye tests?"] I am not sure whether we have parrots or Members of Parliament on the Opposition benches. They sound rather like parrots to me.
No Government who have trebled expenditure on the health service can possibly be described as hostile to it. We have far more doctors, nurses and dentists than ever before, and far more in-patients and out-patients are being treated than ever before, and with infinitely more complicated and expensive treatments. The hon. Gentleman's statement flies in the face of the facts.
No Conservative Member has any objection whatever to ballots, but let us ensure that the information given to those taking part is absolutely clear and straightforward. The Labour party has constantly used the words "opting out" to frighten people into voting against hospitals obtaining self-governing status in the straw polls that it has set up. It is a lie that hospitals are to opt out of the health service. No hospital will be opting out of the service. It is quite true that, if people believe the propaganda that the Labour party has been peddling—if they really believe that we intend hospitals to come out of the national health service—they have good reason to vote as Labour Members say they do. But it must be clearly understood, by a far wider public than have so far understood it, that there is not the slightest question of a hospital that opts to become self-governing opting out of the national health service.
§ Mr. Martin Flannery (Sheffield, Hillsborough)
Does the hon. Lady know that the Conservative party voted against the health service in the first place? Why does not she admit that the Government are doing all this complex organising and reorganising because, if they dared to tell the truth—that they are against the health service—they would be thrown out? They are doing all kinds of things to pretend that they are not against the service because they do not dare to say that they are.
§ Dame Jill Knight
That is the last time that I shall give way, as stupid comments take up time and get us no 362 further. The hon. Member for Peckham (Ms. Harman) said that she objected to Conservative Members saying what the Labour party's views were. I have the same feeling about what the hon. Member for Sheffield, Hillsborough (Mr. Flannery) said. He has not the slightest right to say what the Government intend to do because he does not know. He does not listen and he does not take a blind bit of notice of what the Government have done so far. He made a historical point about the voting on the National Health Service Act. In fact, a Conservative, Sir Henry Willink, was the originator of the terms of what later became the national health service. The Conservative party voted not against the principle of the health service, but against the way in which the legislation was being introduced—[Laughter] This is historical fact. Opposition Members can go to the Library and look it up.
The hon. Member for Walsall, North is fond of quoting the BMA. He may like to remember that, at the beginning, the BMA opposed the national health service root and branch. It has always opposed any changes in the national health service. [HON. MEMBERS: "It was wrong."] The fact is that it was against it. If the hon. Member for Hillsborough wants a history lesson, I shall be happy to give him one. In any case, he can check everything that I have said in the Library. All the facts are there on record.
There is another very important point. Never once have those who have a political motive for trying to hit the Government in any way they can asked the general public, "Are you against bringing back the matron?" In many cases, that is what self-governing hospitals would entail. There is hardly a patient or a patient's relative in the country who would not very much like to have the matron back in place. Hospitals were infinitely better run when we had matrons, and I for one want to see them back. If hospitals are self-governing, they will have their own boards—and they ran very well wen they had them before —and they will have the opportunity, should they wish, to put a matron back in place. Labour Members should try telling their constituents that and see whether they vote against the proposals.
§ Mr. David Hinchliffe (Wakefield)
I make no apology for being somewhat parochial; I suspect the some other hon. Members—certainly Labour Members—will wish to voice their concerns about opting-out proposals in their areas.
In Committee, I expressed my concern that, last December, the district general manager of my health authority in Wakefield proposed that the entire authority should opt out. I was concerned that that had been done without any consultation or discussion with the local bodies that were interested—not even with the local health authority itself.
Since that time I have had vast correspondence from people in my area. Every letter—there are hundreds—has been in opposition to the proposal for opting out, which is the Government's philosophy behind the legislation. I have not received one letter from a constituent who favours what is being put forward by the Government or by the district general manager in Wakefield.
Locally, the whole affair has been a costly shambles. As a direct result of the proposals put forward by the district general manager, the district finance officer was sacked because he had the bottle to say that he objected to the expenditure of scarce national health service resources on proposals for something of which he could not see logic 363 and which were not supported at local level in any way. In a letter that he wrote to the district general manager before he was sacked, he wrote:
Managers complain of dangerously low levels of nursing staff and in this context they are throwing money away on the issue of the opting out process.The district health authority in Wakefield has been taken to court by that gentleman for unfair dismissal, being forced to pay £24,000 in lieu of a year's salary—I assume that it was because he was wrongly dismissed—and having to pay out huge amounts on its own legal representation and, I understand, the costs of Mr. Corner, the district finance officer.
I suspect that the whole shambles will cost about £40,000. I shall happily give way if the Secretary of State wants to query that. I am having difficulty obtaining the details, but we know that Mr. Corner received £24,000 compensation. On top of that there was a complicated legal case. In addition, the health authority has had to pay for another officer to replace Mr. Corner since he was suspended and sacked.
The only good thing that has come out of the matter is that the regional health authority has leaned on Wakefield health authority and the district general manager is to take what is termed early retirement. I and everyone in Wakefield hope that he will be joined in early retirement by his proposals for opting out.
Local people should have a say in such matters. People in my constituency have been deeply perplexed and amazed by the events of the opting-out process in Wakefield health authority. They foresee the problems that will arise when opted-out hospitals operate within the context of the national health service. The complete lack of planning of any sort of health care will make it impossible, if we are all competing against each other, to plan a coherent national structure that will respond to known and recognised needs. Hospitals will treat patients who generate the most income. Chronic patients, not the acute sector, will be neglected and forgotten because they do not attract the finances that other sectors can get.
Local people recognise that quality will go by the board, that cheapness will rule and, that the quantity of services will be affected. In future, traditional services—for example, the excellent maternity services in my area—may go by the board and local people will no longer have in their own health authority areas the services that they have had for many generations, certainly since the NHS came into being.
The patient will have absolutely no choice where he or she is treated. My constituents, who, by and large, are utterly opposed to private medicine may end up being treated in a private hospital. It is unacceptable for people who have campaigned and fought for the national health service—a state health care service—to end their days in a private hospital such as Methley Park, which is in my area.
I am aware that many of my hon. Friends wish to contribute to the debate, and I do not want to take up too much time. However, it offends me that the Secretary of State compares the management of a private firm in Walsall to the opting out of the hospital service in any constituency. How on earth can he suggest that there is any common ground between the running of a private company in Walsall and the running of the national health 364 service? All hon. Members can see the difference. The Secretary of State's remark was stupid, and it illustrates his concept of the national health service.
§ Mr. Kenneth Clarke
I have never heard a more ridiculous description of what I said. I expressly said that the national health service is much more important, in the service that it delivers, than whatever is manufactured in Walsall. I said that it was irresponsible, therefore, to run the management and financing of a nut and bolt factory in a sensible way but to turn the management of the national health service into a party political football subject to idiotic referenda of the sort that the hon. Gentleman describes.
Wakefield has suffered more than any other part of the health service from the importing into the health authority of party political squabbling for the past five or six years. The difficulty in Wakefield is that different parts of the Labour party argue with each other and bring all their quarrels to the health authority. Every aspect of the health authority's dealings is part of the local industry of propaganda in the newspapers, as the hon. Gentleman has illustrated by even making the hiring and firing of staff and the position of individual officers a matter of party political controversy in which he immerses himself completely. His activities and those of the Labour party have made Wakefield health authority almost impossible to run.
§ Mr. Hinchliffe
I am grateful to the Secretary of State for that personal tribute.
The right hon. and learned Gentleman needs to read the official record of what he said. I was astounded that anyone could be so naive as to make that remark about the management of a private company. We are talking about a public health service that should be run in the interests of the public. We pay for it. It is beyond me how a comparison can be made between a private company and the national health service.
§ Mr. Geoffrey Lofthouse (Pontefract and Castleford)
The problem, as my hon. Friend will remember, is not the political aspect of the health authority, it is the health authority's major decision to transfer waiting list money, which would have provided 500 operations at Pontefract general infirmary, to Methley Park private hospital for only 230 operations. Therefore, 270 of my constituents had to continue on the waiting list for operations that could have been done in Pontefract infirmary if the health authority had not decided to transfer that money to the private sector.
§ Mr. Hinchliffe
My hon. Friend has been active on this issue in the Wakefield area. I am sure that, like me, he resents the suggestion that we have anything other than honourable motives in defending the health authority against some of the Government's attacks and against some of the agents who have been placed in positions of prominence in Wakefield district health authority.
I am aware of the concern of community health councillors throughout Britain about the way in which their role is being eroded. Local authority representatives will be removed from health authorities with effect from next year. We have seen the complete erosion of local 365 democracy or influence in the health service. It is essential that we support the amendments and give local people a say in their health service.
§ Mr. Rowe
Not long ago there was a sick joke about a child saying: "Mummy, mummy, mummy, why am I running round in circles?" The answer was, "Shut up or I'll nail your other foot to the floor." When I hear the hon. Member for Peckham (Ms. Harman) I am often reminded of that exchange. In an elegant and vocal way, she runs round and round in circles because her foot is nailed to the floor by her passionate devotion to the over-provision of hospital accommodation in south London. One of the clear abuses of the present administration of the national health service is that there is a dense concentration of very large hospitals in south London which are often so desperate to find patients that they will go trawling round the home counties and beyond looking for people to treat.
That presents a serious difficulty for the Opposition—who are the local people who will decide what should happen to their local hospital? Is it people who have travelled from Hastings, Dover and the south coast of England to be treated at St. Thomas's hospital, or is it the declining population within walking distance of St. Thomas's? It emerged in Committee that the prospect of some of the constituents of the hon. Member for Peckham having to travel four miles to hospital instead of half a mile was a burden too intolerable for her to bear. Patients in my constituency must frequently travel long distances to hospitals like St. Thomas's, because the enormous concentration of resources in south London means that places such as Medway are grossly underprovided with the resources to which they are entitled according to the growing size of the local population. Under the present cumbersome national health service arrangements, they are deprived of services, and I foresee no prospect of the proper quota being reached for a long time.
I am in favour of alternative methods of organising hospitals and other parts of the health service to ensure that local conditions receive rather more consideration than under the present cumbersome arrangements. South East Thames regional health authority and many others delay and increase the cost of decisions that should be taken locally.
The second-guessing that occurs among regional health authorities is probably the quickest way of destroying the morale of good consultants, managers and heads of department in local hospitals. I have said before, but I shall repeat it as Opposition Members' memories are dramatically short, that there is a clear example of that in one of my district health authorities which, having valued its capital stock most scrupulously using the most professional of firms, decided to sell some of its property, to the benefit of its patients. But the regional health authority said, "We are not sure that you have done it right. We shall appoint a similar firm and revalue the entire stock." When it reached almost exactly the result, it discovered to its dismay that the property market had crashed and that it was not worth selling the stock. My constituents are suffering from a much lower level of health provision than if the district health authority had been able to take decisions much nearer the ground.
The opportunity to be a self-governing trust will motivate managers and professional staff better than any other proposal. Earlier in life, I had the tremendous opportunity of working in the Whitley system in Scotland.
366 On behalf of the Secretary of State, I received letters from all over Scotland saying, "Would it be possible, please, to readvertise the post of pharmacist in our hospital as the post of senior pharmacist, because having advertised it as pharmacist we have discovered we cannot get anybody?" The Secretary of State had to take those decisions.
Things have improved a little, but, as we all know, in a prosperous part of the country such as my constituency it is impossible to find national health service cooks because of competition from local firms. The solution being pressed on the Secretary of State by the health service unions is dramatically to upgrade the pay of cooks from John O'Groats to Lands End. That is an absurd proposition and would lead to costs escalating out of proportion to need or opportunity.
We should make it possible for local self-governing trusts so to organise their affairs that, taking account of the state of the local market, they can decide whether they will raise the salaries and wages of some staff, whether they will contract out to private firms or whether they will find another way of tackling the problem. That is good management and is what self-governing trusts are about. All the nonsense being spuriously generated by the Opposition is so much folderol that should be dismissed out of hand.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
It was disingenuous of the hon. Member for Ealing, Acton (Sir G. Young), who unfortunately is no longer present, to say that this part of the Bill giving hospitals self-governing status was a minor devolution of responsibility and power and to compare it with GPs and how similar parts of the health service currently work. That glossed over the extent of the fundamental change that the internal market, of which self-governing hospitals are part, will make.
This is the most far-reaching and fundamental change to the health service and the administration of health care since the service was established 40 years ago. The Government cannot deny that.
I am most worried about the move towards new commercial management, financial accountability, and efficiency, because the present process of accountability, although it is an intangible part of the current system, works. It certainly works in the Borders health board area. Local patients and consumers have confidence in the accountability process because it reflects their views. The new system of management, with executive health boards, regional and district health boards and regional health authorities, squeezes much of that accountability from the current system. The Government ignore danger at their peril.
The debate has not filled me with confidence. I f the consultation process is conducted in the same way as the debate has been conducted in the House, the public will be extremely perplexed. If that analysis is correct, the Secretary of State should consider holding ballots so that he can at least control the arguments. He can ensure that the information that is made available to the public is objective on both sides of the argument.
I am against self-governing trusts, which would be inappropriate for and unpopular in the borders. If the Secretary of State is worried about political organisations and front organisations causing confusion by advancing arguments that are either distorted or untrue, by accepting the amendment for ballots he would be able to control them and ensure they are fair and are administered 367 properly. Ballots would inform the consultation process positively and the Government would be daft not to accept them.
If the Secretary of State leaves the consultation uncontrolled, he will get exactly what he has been evincing worries about this evening—distortions and half-truths. That would do nothing but confuse the public, which is not in anybody's interests. It is a basic tenet of democracy when dealing with something as important as the NHS that the Government should do everything possible to achieve full consultation. That must embrace the opportunity of a ballot to the results of which the Government would have to pay attention.
§ 7 pm
§ Mr. Wilshire
As Opposition Members were so lacking in enthusiasm to accept interventions, before I come to the one point of substance that I wish to add to the debate, I shall say a word or two about their remarks. They need to be commented on as early as possible.
The hon. Member for Peckham (Ms. Harman) made three points which Tory Members sought to challenge, but did not get the opportunity to do so. I hope that I wrote down correctly what she said. No doubt she will put me right if I did not. First, she said that self-governing trust hospitals would seek to attract patients by cutting corners.
§ Mr. Wilshire
I am grateful to the hon. Lady for confirming that. Once again, she made it clear that she has not the first grasp of the best way to achieve and improve quality in anything. It shows a complete poverty of thinking and a lack of understanding. I can think of no example of anybody who has a choice in buying a product or using a service choosing an inferior one. The only way to attract patients is by offering a better quality of service.
§ Mr. Wilshire
I shall give way with the greatest pleasure, even if Labour Members do not like to do so.
§ Mr. Martlew
Can the hon. Gentleman not think of circumstances in which people choose according to price rather than quality? Why, for example, are there so many Lada cars running round in my constituency?
§ Mr. Wilshire
That is yet another example of a failure to grasp what we are talking about. We are talking only about the choice of quality of product, because the NHS is paying the bill. The patient does not have to address himself or herself to the price tag, but only to the quality of the service on offer. That is the difference. Yet again, the Labour party demonstrates its complete failure to grasp that elementary point.
Secondly, the hon. Lady, speaking on behalf of the official Opposition, said that it was against the internal market. That suggests that the Labour party has not learnt the first thing in the past 10 years. It is still saying that it is against the internal market in the health service, and therefore against choice. Despite all the wonderful rhetoric in the glossy brochures that it has has been circulating 368 recently, it is still peddling the view that the Labour party knows best what is good for patients and that patients cannot be trusted to make a choice.
§ Mr. Wilshire
I hear what the hon. Gentleman says, but I am only quoting the comments of Labour spokesmen. It was they, not me, who said that they were against the internal market.
Thirdly, the hon. Lady said that the staff want their say because they care about patients. Again, I hope that I quote her correctly.
§ Mr. Wilshire
I am grateful to the hon. Lady for confirming that. She then elaborated on what she meant rather than what she had said, which was that the staff care about their union membership. It seems that the Labour party is anxious to ensure that people working in the NHS should have it made easy for them to belong to trade unions that care so deeply about patients that they will either organise strikes or work to rule.
§ Mr. Paul Boateng (Brent, South)
If the benefits of the internal market are so obvious, why will not the hon. Gentleman allow patients to make the choice in a ballot?
§ Mr. Wilshire
Another problem with Opposition Members is that some of them wander in halfway through debates, having missed what has been said. The best answer to that is either to be here at the beginning or to read Hansard tomorrow morning. I most certainly will not go over that ground again.
The hon. Lady said that staff want their say because they care about patients. Then she explained that what they cared about was union membership. We were further told that they cared about national agreements. We have already made it clear that national agreements are the bane of the life of hospital managers. I know it only too well from the west London area where it is almost impossible, under the current Whitley arrangements, to attract and keep nursing staff. I address this point almost more to my right hon. and hon. Friends than to Opposition Members. If we truly believe that the best people to manage are the managers whom we appoint, we must give them control of the structures being created and of pay and conditions. We must have the courage to say that effective management means managers negotiating with their own staff. It is nonsense for managers in London to be fettered by what is happening in John o'Groats. Management must be devolved down to the hospitals.
The hon. Member for Walsall, North (Mr. Winnick), whom I am glad to see back in his place, challenged me to respond to what might happen in my constituency. I can tell him what happens there. I have not held a ballot, but a petition is going the rounds. The organisers of the petition tell me that there are 20,000 signatures on it opposing what is being suggested. I accept that the petition is not about self-governing trusts, but it will make the point and allow me to answer the hon. Gentleman's challenge. The petition suggests that my constituents are against closing two hospitals and building a new hospital in a completely inaccessible place. Clearly, they would be against that, would they not? The only snag is that the 369 organisers failed to tell my constituents that so far there are no details of where the new site will be. Yet 20,000 people oppose the new site because it is inaccessible.
§ Mr. Winnick
Obviously, I cannot comment on that local issue because I do not know the details, but no doubt there is another side to it. Would the hon. Gentleman be willing to hold a ballot about whether the hospitals in his borough should become self-governing, if the questions were approved by both sides and if the Electoral Reform Society carried it out? Would he object to such a ballot?
§ Mr. Wilshire
I am happy to put it on record that I should be absolutely delighted to have a ballot in my constituency; it will be called the general election. [Laughter.] To meet the hon. Gentleman's requirements, I am happy to put it on record that I shall fight the general election and put in my manifesto, as I am sure my party will, that we believe in this Bill, which will then be an Act, and in self-governing trusts. We shall put that to the electors. Last time they gave me 60 per cent. of the vote and I have little doubt that they will be enthusiastic to return me again. If the hon. Gentleman manages to be returned, he will have his answer.
§ Dr. John Reid (Motherwell, North)
Why does not the hon. Gentleman answer the straightforward question that has now been put to him twice? He knows that general elections cover a whole range of topics. As he stressed the need for patients to choose quality, will he be prepared to give patients in his constituency the chance to choose quality by a ballot on these proposals? Yes or no?
§ Mr. Wilshire
My patients and electors will be given the chance to choose the quality of their present Member. That is what the democratic process is all about.
The hon. Member for Sheffield, Hillsbrough (Mr. Flannery) said that the Conservative party had voted against the national health service in the past and therefore all Conservatives are against the national health service. I was slightly more than a gleam in my father's eye when the vote to which the hon. Gentleman referred took place. No doubt he can tell me what year the vote took place, but I do not believe that I was out of my pram—[Interruption.] I am sure that some hon. Members think that I have not learnt much since. However, I should be extremely grateful if the hon. Member for Hillsborough would stop trying to suggest that because the Tory party did something some years ago, I must be in favour of transporting people who steal sheep. That is what he seemed to be arguing. I am not in favour of that.
§ Mr. Flannery
Sadly, the hon. Gentleman is conveying to us the impression that he has not really got out of his pram yet. The Conservative party has always been against the national health service and voted against it. The British Medical Association has had the grace to say that it has changed its mind and that it now supports the NHS. However, the Conservative party is still, by its actions, proving that it is completely against the health service.
§ Mr. Wilshire
The hon. Gentleman has made the other point that I wanted to make against him. Not only does he insist that, because something happened 50, 100 or 200 years ago, those of us who were not involved are, by definition, of the same mind. He has just shown that he does not understand that, and he has also claimed to be a mind reader. He suggests that he knows what the 370 Conservative party believes. More importantly, he tried to put words into my mouth by suggesting what I believe. I have always believed in the national health service and I am sure that I always will. I have always done everything possible to further it. It is a gross misrepresentation to suggest that an Opposition Member knows what Conservative Members think.
The hon. Member for Wakefield (Mr. Hinchliffe) would not give way either, so I must respond to him now. He said that self-governing trusts would make central planning impossible. He is yet another member of the Labour party who has failed to understand the principle of how to get quality services. He suggests that command planning from the centre is the best way to run a public service. He obviously has not learnt any lessons from what has happened in Russia or in eastern Europe over the past 12 months.
The hon. Member for Wakefield also thought that it was grossly unreasonable or, dare I say it, somehow morally wrong that his constituents should be expected on occasions to be treated in a private hospital.
§ Mr. Wilshire
I am glad that that is on the record. Obviously his view of Labour policy is that it should abolish the private health service.
§ Mr. Wilshire
I am most grateful to the hon. Gentleman for nodding. A Labour Member has now said in the House that he wants to abolish the private health sector.
I did not serve on the Standing Committee of this Bill and I have not been closely involved with it. I have no intention of going over the general ground. However, those hon. Members—including some Conservative Members—who are against self-governing trusts appear to be in favour of ringfencing. I do not want to pre-empt the ring-fencing debate, but hon. Members who are against self-governing trust hospitals, but claim to be in favour of ringfencing, are deploying a very curious train of thought.
When I served on a health authority, we safeguarded community care and the community health budget, bearing in mind the fact that the great debate in the health service has always been the demands of the acute sector against the demands of community care, by ringfencing them. I understand the ringfencing argument to be about protecting community care. If Opposition Members are in favour of protecting the community budget by ringfencing it, why are they against what is in effect the ringfencing of acute district general hospitals by allowing them to become self-governing trusts? I believe that one of the greatest assets of self-governing trusts is that the remainder of the budget which is outside the acute sector is protected and care in the community is safeguarded. I should have thought that, as they support ring-fencing, self-governing trusts would appeal to Opposition Members.
§ Dame Elaine Kellett-Bowman (Lancaster)
If my hon. Friend had the misfortune to live in the Lancashire county council area or to be in charge of community care there, he would find that it blows every penny that comes its way on the least important things. That council is quite different from my local health authority, which is highly efficient—[Interruption.] The two horses are of a completely 371 different colour. Lancashire county council is profligate, but the local health authority is very good and efficient, as are the hospitals.
§ Mr. Wilshire
I am sure that my hon. Friend's comments will be noted in Lancashire.
I want to challenge Opposition Members and one or two of my colleagues about ringfencing. If hon. Members are against self-governing trusts and they vote that way tonight, bearing in mind the fact that the trusts are the best way to ringfence the acute sector, I fail to see how in all conscience they can vote in favour of ringfencing something in local government. The two arguments do not hang together. I believe that Members must be consistent and I will explain later, if I catch your eye, Mr. Deputy Speaker, why ringfencing in local government would be nonsense.
§ Mr. Bradley
I will try to bring the debate back to the issue of opt-out. I will also be brief, because we have suffered long rambling speeches from Conservative Members. The Conservative party has tried to get as many of its Members as possible to speak to talk about specific issues that affect their constituencies.
Like my hon. Friend the Member for Wakefield (Mr. Hinchliffe), I have received hundreds of representations from my constituents opposing the proposals for opt-out. I have not received one letter in favour. That is particularly significant, because the world-famous Christie hospital is in my constituency. Local people are very proud of that hospital and they have raised thousands of pounds for it. I strongly believe that Christie hospital is at the top of the list of hospitals which the Government want to see opt-out as soon as the Bill becomes an Act.
We must consider what has been happening to the opt-out proposals during the Bill's passage through the House, and in that context I want to refer to Christie hospital. The management of Christie, at a very early stage, expressed an interest in opting out. However, the management only consulted some consultants in the hospital.
The Secretary of State said tonight that he does not believe that the consultants should be the sole custodians of views about whether a hospital should opt out and that there should be more consultations with staff. In Christie, no other staff were consulted. Similarly, the local community and local representatives such as the community health council were not consulted. The issue was not even drawn to the attention of South Manchester health authority because the authority did not believe that it should have a say in whether the hospital should have expressed an interest.
It is absolutely clear that hospitals are seeking opt-out status because of the financial crisis in many health authorities. The financial crisis facing south Manchester health authority is the reason why Christie hospital is expressing an interest in opting out.
The Secretary of State recently crept into south Manchester to look at what was going on. The headlines in the local paper stated that all that the people of south Manchester ever did was moan about the state of the health service. Well, they have plenty to moan about. In the last few years, we have had ward closure after ward closure; waiting lists have been growing and staff have not 372 been recruited because of lack of money. Now, Christie hospital has admitted for the first time that it cannot open a crucial ward because of lack of money. As the Secretary of State has said, the unit manager of the Christie hospital is the local enthusiast—he is the only local enthusiast—who has put forward proposals for opting out. He admitted in an article in the local health paper thata Unit such as Christie with potential for growth and development of cancer services must recognise that for the foreseeable future there will be no growth monies available from Regional funds. From April 1990 the budget of the North West Region begins to reduce and this will inevitably mean that already hard pressed district Health Authorities"—such as south Manchester—will encounter further financial problems".That is why the hospital is going down the road of opting out.
The consultants are fed up with the lack of resources. They are prepared to go along with the proposals as long as they believe—as I do—that the first hospitals to opt out will be stuffed full of money by the Government to show that such hospitals can be successful. I believe that the Government will go forward to the next general election on that basis.
For its "consultation", the management has produced a glossy magazine—
§ Mr. Bradley
I shall not give way to the hon. Gentleman, because he has only just walked into the Chamber.
The management has produced a glossy new magazine to try to justify its opting out, which states:we would still be required to treat a similar number of patients, but we would have no guaranteed funding because the service contracts would be held by South Manchester Health Authority.That is what the management have told the staff. However, in a written answer the Under-Secretary of State for Health has stated that, whether the contract is held by the NHS trust or by the directly managed hospital in south Manchester, the money will go to the hospital where the patient has been treated. Therefore, the management are not telling its staff the truth about the way in which the funds from the contract will be allocated.
The management then ask how they should continue the consultation process. As I have said, they have already drawn up a document, which they are ready to throw at the Secretary of State at the first opportunity, which states that the staff should try to borrow a copy of the document from the administrator so that they may know what is going on. They can then attend a series of public meetings at which only the general manager will be allowed to speak. Instead of having a show of hands at the end of the meetings to determine the views of the staff in the hospital, the general manager himself will assess the consensus and judge the feeling of those in the room. The general manager—the local, the only, enthusiast—will determine whether to submit a formal application.
That is the way in which consultation is taking place, and that is why we in south Manchester say, on behalf of Christie hospital, that we want a ballot. We want the staff to be able to express their view. We cannot believe that the Government are not prepared to accept the idea of ballot, 373 which is what they argued for in education and housing. The hon. Member for Ealing, Acton (Sir G. Young) said that he does not support ballots on the opt-out of hospitals, because where there have been ballots on, for example, education and housing, they have proved popular.
I ask the House to consider whether one single school has opted out in Manchester. Has a single council house moved to the control of a private landlord? The answer is no, because people in Manchester know the value of the public sector and of public provision. They know the value of local accountability for those services. That is why the people of south Manchester want hospitals that are directly managed by local people, which are locally accountable and which are properly funded within the public sector.
§ Mr. Quentin Davies (Stamford and Spalding)
It was not my original intention to speak at this point. However, I feel that I must do so to give the hon. Member for Peckham (Ms. Harman) some assistance in a vital matter. All of us who know the hon. Lady know that she would not have the slightest intention of deliberately deceiving the House, but I fear that if an important passage in her speech at the beginning of the debate stands without correction, she may succeed in deceiving the House, albeit unwittingly and by strong implication rather than explicit statement.
When the hon. Lady was talking about ballots, which are the central issue of the debate, she said that, notwithstanding the extremely compelling technical reasons against holding ballots to determine public opinion about the proposed changes in the administrative arrangements for hospitals, it is right and reasonable that such ballots should take place. When she dealt with the sensible if obvious point that in 1948 the Labour Government did not introduce any specific ballots on their own administrative arrangements for hospitals, which were contained in the National Health Service Act 1946, she replied. "Ah, but the difference is that at that time we had had a general election."
The clear implication of the hon. Lady's statement was that there had not merely been a general election, which there had been in 1945 and which the Labour party won—just as we won the election three years ago—but that, in its manifesto or otherwise, the Labour party had made clear its proposals for the administrative arrangements for hospitals that it would incorporate into any national health service Bill that it might introduce. The hon. Lady implied that when the public went to the booths in the election of 1945, they knew exactly what administrative arrangements for hospitals they were voting for. She suggested that that was unlike what happened with the Conservative in 1987.
In case any hon. Member has forgotten, I remind the House that no such thing occurred. The Labour party's 1945 manifesto did not make any reference to the administrative arrangements that it was proposing to introduce for hospitals. Indeed, no statement on that subject was made during the whole of the campaign that summer. That was for the very good reason—this is why I can be dogmatic on the point—that, at that stage, the Labour party itself had not decided on the administrative arrangements.
§ Dame Elaine Kellett-Bowman
Does my hon. Friend accept that Christie hospital does not belong to its staff? It belongs to the people of the north-west and it would be extremely difficult to ballot all those people. I must advise the House that in some specialties, 49 per cent. of the patients dealt with by my local health authority are out of district, mostly from Cumbria. On average, it is 29 per cent., but the proportion is 49 per cent. for some specialties. Who exactly does the Labour party expect us to ballot? It is not possible to find a constituency to ballot on these things, although that is what Opposition Members are suggesting.
§ Mr. Davies
I agree entirely with my hon. Friend's helpful comment. There are strong reasons for not having ballots, and no doubt Labour was right in 1948 in not holding specific ballots on that issue.
The hon. Member for Peckham suggested that there was no need for ballots, not because technically they are not feasible or were otherwise undesirable, as my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) suggested, but because the public already knew in 1948 what the arrangements would be and voted accordingly.
§ Mr. Davies
No. I am sure that the hon. Gentleman will be able to catch your eye later, Mr. Deputy Speaker.
The truth is quite contrary to the hon. Lady's argument. When the electorate went to the polls in 1945, it had every reason to suppose that whichever Government was elected—Conservative or Labour—they would introduce a national health service along the lines of the Willink White Paper of 1944. I was not alive at the time, but I am sure that you, Mr. Deputy Speaker, will remember as though it were yesterday that when that White Paper was produced by the then coalition Government, it set out a plan for the health service that contained almost all the features that were eventually incorporated in the Labour Government's national health service in 1948, with one vital difference, in that the Willink White Paper did not propose hospital nationalisation. In 1945, without giving any warning to the electorate, Labour introduced the nationalisation of hospitals, with none of the specific ballots that, according to the hon. Member for Peckham, it would have been reasonable to expect Labour to hold.
I could make a powerful political point, because the facts I have set out could explode the sincerity of all that has been said about ballots by Labour Members this evening. However, there was a more positive reason why I rose to speak. It was to help maintain the integrity of the debate by giving the hon. Member for Peckham an opportunity to set the record straight and to make it clear that there is no difference between the attitude towards ballots taken by Labour in 1948 and that of the Conservative party in 1990.
§ Mr. Redmond
The majority of people in the Doncaster health authority area are totally opposed to the opting out that is supported by a small minority. The Secretary of State continues to display arrogance and conceit. He ought to be present, because I do not want to say anything behind his back. I welcome the Secretary of State back to 375 his place, and repeat that his arrogance and conceit continue. Thank God, people fought to get rid of that kind of dictatorship during the second world war. They will fight again to do so.
If the Secretary of State is so convinced that he is right, the simple answer is for him to ballot the people. If he wants to be doubly sure, why does not the right hon. and learned Gentleman convince his master to call a general election? I am convinced that the vast majority of people are wholly opposed to the Government's reforms for a two-tier system, which will lead to privatisation.
The Secretary of State condemns local authorities that utilise local money to sound out people's opinions. Doncaster is Labour-controlled, but it not only stated its opposition to the reforms—which the Secretary of State might argue was party political propaganda—but consulted local people. The Secretary of State says, in effect, that consultation may take place but that he will ignore it.
The pity is that the Secretary of State did not spend the millions of pounds used to promote his views and to hold meetings throughout the country with unit managers and other interested parties on consulting the public, which would have been a far better use of that money. The Secretary of State spent millions promoting his voice and his master's voice against local authorities who spent a few pounds. He ought to be interested in freedom and democracy. The iron curtain has gone, but the dictatorship that used to exist behind it now exists in this country. The Government use the phrase "the enemy within", but the enemy within now are Conservative policies that seek to undermine our social fabric.
Whom will the Secretary of State consult? What criteria will he set and how will a local authority determine whether its application to opt out meets them? The right hon. Gentleman said that he will ignore consultants and any other group that consults its members or holds a ballot and then opposes the reforms. That is the kind of dictatorship and arrogance that he uses to bulldoze opposition.
The Government imposed a guillotine on this important debate, and now Ministers intervene time and again. If the Secretary of State wanted to explain his policies, the Government should not have guillotined debate but fully utilised the time available to explain their proposals. The right hon. and learned Gentleman has failed to convince the majority of the public.
The newly appointed chairman of Doncaster health authority, the newly appointed unit manager and the newly appointed district nursing officer all support opting out. They are the people that the Secretary of State has connived to put in place so that he may claim that Doncaster supports his proposals, when that is false. If the Secretary of State wants to be true to himself, he should return to the Dispatch Box and announce that he is withdrawing this ludicrous and uncaring Bill.
§ Mr. Jim Cousins (Newcastle upon Tyne, Central)
In the northern region, the dwindling list of hospitals that want to opt out is down to five, and they are located in the city of Newcastle. The opting out and trust proposals that would affect the citizens of Darlington and Tynemouth, which are among the shrinking band of Tory seats in the northern region, have also been dropped. That is an 376 interesting sign that the Government are not confident about the little lifeboat that they have launched for the national health service.
We in Newcastle are confronted with opting out by all four of the city's major hospitals, but we are told by the Secretary of State that they do not anyway belong to us, as patients or as citizens—yet he is apparently content for them to belong to a small band of self-appointed people. No one knows who they are or what credentials they have. He is happy about that. As the proposals for NHS trusts are tested, the credentials of the people who lend their names to those trusts will be closely tested.
The Secretary of State, in one of his throwaway remarks that will come back to haunt him, described local councils as a bunch of bandits. We suspect that that description far better suits the type of people who will self-recruit, self-appoint and keep the NHS trusts in their pockets for ever.
My hon. Friend the Member for Peckham (Ms. Harman) was absolutely right to highlight the process that is going on in Newcastle in the four hospitals that are the subject of opt-out proposals. She said that there is a whispering campaign of bribery and blackmail and that promises of promotion, pay increases and extra resources for particular facilities are being made to grease the wheels and smooth the process of opting out. We must have ballots so that such below-the-line rumours and whispering are forced above the line so that they are on the record and publicly known.
I note that the ministerial team are furiously engaged in a discussion about this matter. The unit general manager in Newcastle may be promising a Westminster or a Wandsworth to the people who work in those hospitals, but it is much more likely that the Minister will be gifting them something more like a west Lambeth. Promises to run those hospitals on Westminster or Wandsworth lines will prove to be a mirage; west Lambeth will be the reality. That is not good enough. Such major proposals cannot be forced through on the basis of false promises.
The Government's proposals are fundamentally wrong because of the false expectations that they are arousing in some people's minds. The proposals will be undone not by anything that we do in this House tonight, but by what the Secretary of State does or fails to do. If people proceed with the trusts, they will find that they have been cheated. Those people, above all, will remember the proposals with regret.
My hon. Friend the Member for Livingston (Mr. Cook) said that we shall fight against the proposals as though we were fighting a by-election. I understand what my hon Friend means, but by-elections have a date at which they must terminate. In cities such as Newcastle we shall not fight against the proposals in that way; we shall persist with the scrutiny with rigour and record all the promises, the whispers and the rumours. We shall never forget them.
The hon. Member for Spelthorne (Mr. Wilshire) is apparently willing to say to nurses in west London that if NHS trusts are accepted they will be free of the NHS pay scale and paid more. With what? Do the Government propose to issue some kind of NHS junk bond with which to pay the money? The answer is no.
All those false promises will be placed on the record. It is much better to force such a corrupt and unacceptable method of doing public business into the open so that such practices can be properly recorded. Whether or not the Government decide to do that, the job will be done. Such 377 practices will be recorded and will not be forgotten. They will bounce back again and again in the lifetime of the Government.
§ Mr. Fatchett
I agree with what my hon. Friend the Member for Newcastle upon Tyne, Central (Mr. Cousins) said in his excellent speech.
During the debate, one Conservative Member after another—when the Government have found it possible to get people into the Chamber to support the Bill—has said that the opt-out proposals are self evidently popular. They have said that there is no argument about the nature and potential success of opt-out hospitals. If that is so, why are Conservative Members so afraid to put that proposal to the electorate so that the people can have a voice? They are running away from the issue.
The Secretary of State told us that the enthusiasm for the proposals would come from a small group of independent-minded people, some of whom would be local business people with or without experience of the NHS. The Secretary of State has now invented another category of person capable of running the NHS with his approval—someone with no experience of it, that is to say, someone who has spent all his life as a patient of the private sector and who supports it. That is the person who the Secretary of State believes is capable of running the NHS. We do not want such self-appointed people running the NHS, but those who represent the public and who are concerned about the NHS and have its interests at heart.
The Secretary of State has tried to be emollient and I know that that is difficult for him. I understand why the chairman of the Conservative party said that the right hon. and learned Gentleman needed some advice on public relations. In his attempt to be emollient, the right hon. and learned Gentleman said that he would consult and listen, but at no point in his speech did he tell us what the test would be before he said no to a particular trust proposal. The answer is simple—if the proposal is backed by a small group of Conservative party supporters and Conservative central office wants it, it will go through.
Let us consider a local example dear to my heart and to that of the people of Leeds—St. James's hospital, now nationally known as Jimmy's after the television programme. What will happen to that hospital? What test would the Secretary of State use to determine whether that hospital should opt out? The health authority, the consultants, the community health council, the nonmedical staff and the public of Leeds have said no to that hospital opting out, so on what moral grounds could the Secretary of State approve a decision to allow it to opt out? Yet as there is a Conservative party nominee in the chair of the health authority and the unit manager is a close advisor of the Secretary of State, I suspect that there is no question but that the decision on that hospital opting out will go ahead roughshod without any reference to public opinion.
My hon. Friend the Member for Peckham (Ms. Harman) spoke of bribes and blackmail. It is interesting to consider what has happened in Leeds Western health authority in relation to the general infirmary. The district general manager, without the approval of the health authority, appointed an outside consultant to write a report on the future of the general infirmary. That report was commissioned and paid for by one of the key 378 ideological advocates of the opt-out proposals. The report's sole conclusion was—surprise, surprise—that it would be in the interests of the general infirmary to achieve opt-out status. The report also stated that, if the hospital continued in its current state, with its current fabric, it would not be fit to be judged a modern hospital. Rumour after rumour has come from the chairman of the authority and the district general manager. That has been passed on to the consultants, the staff and the public. The message is clear: "If you do not opt out, the money for phases 1 and 2 of the general infirmary will not be forthcoming". Those are the tactics of the bully boys who have gone into the gutter in desperation to force their proposals through.
The obvious conclusion from the debate is that the Conservatives have no confidence in their proposals. They are driving them through for pure ideological reasons, and that will be part of their down fall. We look forward to campaigning on this issue, because we know that we speak for the public on the NHS.
§ Mr. Foulkes
I shall take just a couple of minutes to show from our experience in Ayrshire that the Government's proposals represent one of the biggest cons ever perpetrated on the British people.
The chairman of the health board confirmed in December that throughout Ayrshire there was no interest in opting out. The Under-Secretary of State for Scotland, one of the ideologues of the Government, could not stand that, so he instructed the health board to manufacture an interest. The administrator in north Ayrshire was against the proposal and said that there was no interest. What happened to him? He was moved sideways to a position where he had no influence.
The administrator in south Ayrshire decided to go along with the health board. He used bribery, saying that phase 1 of the hospital will come about more easily under NHS trust status, and the hospital agreed to consider it. The consultants voted on it and, as 89 per cent. of them were against opting out, they decided not to consider it. In spite of that, the unit administrator went ahead with the proposals and a working party has now been set up to look into the possibility of opting out. The Scottish Office is paying for consultants to carry out a business plan. That demonstrates the way in which they are considering the proposal. It is not a care plan or a feasibility study, but a business plan.
We know what will happen next. That business plan, which will be prepared by the end of August without any of the necessary information being available, will be accepted by the health board nominated by the Tory Ministers. They will agree to that plan and put it up to the Secretary of State and of course he will accept it. There is no demand for it in Ayrshire, yet it will be forced on the people of Ayrshire. It is absolutely clear that, if there were a ballot, the people of Ayrshire and Arran would reject it overwhelmingly. That is why all Opposition Members who represent Ayrshire constituencies support the amendments to the Lords amendments. Although we support such ballots, one ballot that would end all such proposals once and for all—and we would much rather have that ballot as quickly as possible—is a general election.
§ Mr. Kenneth Clarke
We have had a long and rather animated debate on a proposal that we have discussed many times before. Those who may be listening to our heated exchanges might be surprised to reflect on the fact 379 that the Government amendments moved in the Lords, which I suggest we agree to, are hardly controversial. They were tabled in support of the proposal that we have been advocating from the beginning—that there should be widespread consultation on all applications for NHS trusts. We are now putting that consultation in statutory form. I hope that the debate might have served to educate people more generally about exactly what we shall be consulting on. However, public consultation cannot possibly start until we have promoters in Ayrshire, Doncaster or wherever, coming forward and explaining their proposals for the hospitals for which they are responsible. Then people can give sensible and considered views.
The amendments that I am resisting concern ballots, about which the Labour party has made repeated claims for the past six months or so. I shall not repeat my arguments, but I believe that the Labour party, which is stuck for ideas on what to propose, prefers political campaigning on local ballots based on fears about our proposals. My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) was correct to describe the nature of most of the ballots that have taken place so far. It is extraordinary to compare such ballots with the ordinary electoral process, as there are no promoters and no definite proposals. Nobody will be arguing the case for local NHS trusts until we receive the applications next month.
However, in various localities people have produced the most extraordinary claims about what they suppose NHS trust status will mean in their localities. They have talked about hospitals opting out of the national health service. We heard that a pensioner in Doncaster was persuaded that sandbags were needed to defend the national health service against Tory assault. The hon. Member for Sheffield, Hillsborough (Mr. Flannery) kept going back to the vote in 1948 which was one of the most galling exchanges on health service policy that I have heard for a long time.
Such ballots produce a sort of Romanian election result if no one is proposing anything or arguing the case for NHS trusts and there are no propositions to consider. All we have is sometimes a highly financed and organised campaign against a non-existent proposition. Proceeding in that way can achieve a 9:1 result against what it is suggested will happen.
We are about to move on to genuine consultation, but first we need some NHS trust applications and some descriptions by the promoters of what is proposed for hospitals in each locality.
§ Mr. Max Madden (Bradford, West)
When I called for ballots of staff and patients in Bradford, I was told by Ministers that the main reason why ballots were opposed was that the issues surrounding self-governing trusts were too complicated and complex to be considered in ballots. When all the information is known, will the Secretary of State accept in principle the offer of ballots for staff and patients to decide those important issues? Bearing in mind that we had a referendum on whether to remain in the EEC and that the Government have held ballots on schools and housing, why on earth are they continuing to resist ballots on the national health service?
§ Mr. Clarke
When the proposals are produced, it will be clear that they are complex matters concerning the future of each part of the service, how each part of the service might be developed and how financial management and other matters will be arranged. It would be ludicrous to reduce them to a yes/no answer. I have repeatedly said that the national health service does not belong to the staff who happen to be in post, so a straight staff ballot should not decide those issues. The problem of having a ballot of patients is that there is no catchment area of patients for each hospital. Hospitals are not run on that basis and there is no identifiable group of the population who could sensibly be balloted, assuming that one could find enough people to absorb all the proposals.
When applications come in, there will be no simple response to any of the proposals, even among the consulting staff, the nursing staff and everyone else who supports the health service. Many people will want to make suggestions concerning particular aspects of the service, and I hope that that public consultation at local level will not be damaged by the Labour party's clear intention to turn every application into a simplified by-election.
Let me deal briefly with the comments made about the internal market by the hon. Members for Peckham (Ms. Harman) and for Roxburgh and Berwickshire (Mr. Kirkwood). The phrase, "internal market" is jargon that leads people into arguments about commercialisation and so on. It is quite convenient jargon, but it is always misused. It is not true that the proposal for NHS trusts has anything to do with the internal market. The basis of distributing the money in future according to so-called contracts, agreements between the planners and purchasers on the one hand and the providers of care on the other will apply to all hospitals and all units regardless of whether they are self-governing NHS trusts. The NHS trusts will look for referrals and their revenue in the same way as other hospitals do. We are talking about the extent to which, within the new system, self-governing trusts will have their own local board of management and will not be answerable to the district, the region, my civil servants and to me for day-to-day matters, compared with others that will still remain subject to the DHA.
I regret that the hon. Member for Peckham said that the Labour party is against those aspects of the reforms. She tried to make the position clear, as the Labour party never has before. I refer her to the article that appeared a couple of days ago written by Chris Ham, who has been one of the more reluctant supporters of my reforms. He does not suggest them all; he does not support self-governing hospitals. The last time that I said he was a Marxist he corrected me and said that he was not a Marxist, although he writes for Marxism Today. However, he has supported most of the White Paper proposals, because he takes the view that although he is obviously far to the left of me, he believes in well-managed public services that strive for the same levels of efficiency and public responsiveness as the best of the private sector. As someone who in on the left, he firmly believes that a public service such as the NHS is capable of being at least as well run and responsive as the private sector. I share his view. We are striving to bring the NHS up to the levels of performance achieved by private sector organisations delivering less important services.
In his latest article, Chris Ham yet again particularly commended the division between those in the health authorities who work out the population's health needs 381 and seek to use the money available to procure the provision of health in line with need, and those who have to provide those services. It would be a disaster if the Labour party, for purely populist reasons, were incapable of taking on board the best aspects of the reforms.
National pay has been mentioned. I wholly agree with what my hon. Friends the Members for Spelthorne (Mr. Wilshire) and for Mid-Kent (Mr. Rowe) said about reactions to the proposals in their districts and the way in which they rightly said that running through many Labour Members' speeches was what they actually fear about self-governing hospitals. Much of the argument about NHS trusts is bogus—for example, that people think that opting out of the NHS is the same as privatisation. I have difficulty in being persuaded that even passionate Labour Members seriously believe a word of that.
What makes some people in the service excited—from the British Medical Association, through the Trades Union Congress affiliates to the Labour party—is that they see national pay, terms and conditions being changed. The staff should not see that as a threat; it was rightly welcomed by my hon. Friends. Contrary to them, the hon. Member for Peckham gets passionate about defending Whitley council arrangements, national trade union recognition arrangements and other factors that stop the management having any discretion locally about how they recruit and reward their staff.
My hon. Friend the Member for Ealing, Acton (Sir G. Young) began our debate by making one of the best defences of the concept of local, responsible management in our national health service that I have heard for a long time. I commend what he said. We shall be consulting about the proposals for the next three months and more. I commend the amendments made in another place that will pave the way for the public consultation that we have always promised.
§ Question put and agreed to.
Lords amendment: No. 2, in page 6, line 14, at end insert—
(1A) In any case where the Secretary of State is considering whether to make an order under subsection (1) above establishing an NHS trust and the hospital, establishment or facility concerned is or is to be situated in England, he shall direct the relevant Regional Health Authority to consult, with respect to the proposal to establish the trust,—
(1B) In any case where the Secretary of State is considering whether to make an order under subsection (1) above establishing an NHS trust and the hospital, establishment or facility concerned is or is to be situated in Wales, he shall consult the relevant Community Health Council and such other persons and bodies as he considers appropriate.
(1C) In subsections (1A) and (1B) above—
§ Read a Second time.
Amendment proposed to the Lords amendment: (c), in subsection (1A), at end add
'who shall not make an order under subsection (1) above, unless those consultations establish substantial support for an NHS trust among the staff of the hospital, establishment or facility and the local community it serves.'.—[Ms. Harman.]
§ Question put, That the amendment to the Lords amendment be made:—
§ The House divided: Ayes 210, Noes 295.385
|Division No. 268]||[8.2 pm|
|Adams, Allen (Paisley N)||Ewing, Mrs Margaret (Moray)|
|Allen, Graham||Fatchett, Derek|
|Alton, David||Faulds, Andrew|
|Anderson, Donald||Fearn, Ronald|
|Archer, Rt Hon Peter||Field, Frank (Birkenhead)|
|Armstrong, Hilary||Fields, Terry (L'pool B G'n)|
|Ashley, Rt Hon Jack||Fisher, Mark|
|Ashton, Joe||Flannery, Martin|
|Banks, Tony (Newham NW)||Flynn, Paul|
|Barnes, Harry (Derbyshire NE)||Foot, Rt Hon Michael|
|Barnes, Mrs Rosie (Greenwich)||Foster, Derek|
|Barron, Kevin||Foulkes, George|
|Beckett, Margaret||Fraser, John|
|Bell, Stuart||Fyfe, Maria|
|Benn, Rt Hon Tony||Galloway, George|
|Bennett, A. F. (D'nt'n & R'dish)||Garrett, Ted (Wallsend)|
|Bermingham, Gerald||Gilbert, Rt Hon Dr John|
|Bidwell, Sydney||Godman, Dr Norman A.|
|Blair, Tony||Golding, Mrs Llin|
|Blunkett, David||Gould, Bryan|
|Boateng, Paul||Graham, Thomas|
|Boyes, Roland||Grant, Bernie (Tottenham)|
|Bradley, Keith||Griffiths, Win (Bridgend)|
|Brown, Nicholas (Newcastle E)||Grocott, Bruce|
|Bruce, Malcolm (Gordon)||Hardy, Peter|
|Buchan, Norman||Harman, Ms Harriet|
|Buckley, George J.||Haynes, Frank|
|Caborn, Richard||Heal, Mrs Sylvia|
|Callaghan, Jim||Henderson, Doug|
|Campbell, Menzies (Fife NE)||Hinchliffe, David|
|Campbell, Ron (Blyth Valley)||Hoey, Ms Kate (Vauxhall)|
|Campbell-Savours, D. N.||Hood, Jimmy|
|Canavan, Dennis||Howarth, George (Knowsley N)|
|Carlile, Alex (Mont'g)||Howell, Rt Hon D. (S'heath)|
|Clark, Dr David (S Shields)||Howells, Geraint|
|Clarke, Tom (Monklands W)||Howells, Dr. Kim (Pontypridd)|
|Clay, Bob||Hoyle, Doug|
|Clwyd, Mrs Ann||Hughes, John (Coventry NE)|
|Coleman, Donald||Hughes, Robert (Aberdeen N)|
|Cook, Frank (Stockton N)||Hughes, Simon (Southwark)|
|Cook, Robin (Livingston)||Illsley, Eric|
|Corbyn, Jeremy||Ingram, Adam|
|Cousins, Jim||Janner, Greville|
|Cox, Tom||Johnston, Sir Russell|
|Crowther, Stan||Jones, Barry (Alyn & Deeside)|
|Cryer, Bob||Jones, Ieuan (Ynys Môn)|
|Cummings, John||Kaufman, Rt Hon Gerald|
|Cunliffe, Lawrence||Kennedy, Charles|
|Cunningham, Dr John||Kilfedder, James|
|Dalyell, Tam||Kirkwood, Archy|
|Darling, Alistair||Lambie, David|
|Davies, Rt Hon Denzil (Llanelli)||Lamond, James|
|Davis, David (Boothferry)||Leadbitter, Ted|
|Davis, Terry (B'ham Hodge H'l)||Leighton, Ron|
|Dewar, Donald||Lewis, Terry|
|Dixon, Don||Litherland, Robert|
|Dobson, Frank||Livingstone, Ken|
|Duffy, A. E. P.||Lloyd, Tony (Stretford)|
|Dunnachie, Jimmy||Lofthouse, Geoffrey|
|Dunwoody, Hon Mrs Gwyneth||Loyden, Eddie|
|Evans, John (St Helens N)||McAllion, John|
|Ewing, Harry (Falkirk E)||McAvoy, Thomas|
|Macdonald, Calum A.||Rooker, Jeff|
|McKelvey, William||Ross, Ernie (Dundee W)|
|McLeish, Henry||Ross, William (Londonderry E)|
|McNamara, Kevin||Rowlands, Ted|
|Madden, Max||Salmond, Alex|
|Mahon, Mrs Alice||Sheerman, Barry|
|Marek, Dr John||Sheldon, Rt Hon Robert|
|Marshall, Jim (Leicester S)||Shore, Rt Hon Peter|
|Martin, Michael J. (Springburn)||Short, Clare|
|Martlew, Eric||Sillars, Jim|
|Maxton, John||Skinner, Dennis|
|Meacher, Michael||Smith, Andrew (Oxford E)|
|Meale, Alan||Smith, C. (Isl'ton & F'bury)|
|Michael, Alun||Smith, Rt Hon J. (Monk'ds E)|
|Michie, Bill (Sheffield Heeley)||Spearing, Nigel|
|Michie, Mrs Ray (Arg'l & Bute)||Steel, Rt Hon Sir David|
|Molyneaux, Rt Hon James||Steinberg, Gerry|
|Moonie, Dr Lewis||Stott, Roger|
|Morgan, Rhodri||Strang, Gavin|
|Morley, Elliot||Straw, Jack|
|Morris, Rt Hon A. (W'shawe)||Taylor, Mrs Ann (Dewsbury)|
|Morris, Rt Hon J. (Aberavon)||Taylor, Matthew (Truro)|
|Morris, M (N'hampton S)||Thomas, Dr Dafydd Elis|
|Mowlam, Marjorie||Thompson, Jack (Wansbeck)|
|Mullin, Chris||Turner, Dennis|
|Nellist, Dave||Vaz, Keith|
|Oakes, Rt Hon Gordon||Wallace, James|
|O'Brien, William||Walley, Joan|
|O'Neill, Martin||Wareing, Robert N.|
|Orme, Rt Hon Stanley||Watson, Mike (Glasgow, C)|
|Parry, Robert||Welsh, Andrew (Angus E)|
|Patchett, Terry||Welsh, Michael (Doncaster N)|
|Pendry, Tom||Wigley, Dafydd|
|Pike, Peter L.||Williams, Rt Hon Alan|
|Powell, Ray (Ogmore)||Williams, Alan W. (Carm'then)|
|Primarolo, Dawn||Wilson, Brian|
|Quin, Ms Joyce||Winnick, David|
|Randall, Stuart||Wise, Mrs Audrey|
|Redmond, Martin||Worthington, Tony|
|Rees, Rt Hon Merlyn||Wray, Jimmy|
|Reid, Dr John||Young, David (Bolton SE)|
|Robertson, George||Tellers for the Ayes:|
|Robinson, Geoffrey||Mr. Martyn Jones and|
|Rogers, Allan||Mr. Ken Eastham.|
|Adley, Robert||Brazier, Julian|
|Alexander, Richard||Bright, Graham|
|Alison, Rt Hon Michael||Brown, Michael (Brigg & CI't's)|
|Allason, Rupert||Bruce, Ian (Dorset South)|
|Amess, David||Buchanan-Smith, Rt Hon Alick|
|Arnold, Jacques (Gravesham)||Burns, Simon|
|Arnold, Sir Thomas||Butcher, John|
|Ashby, David||Butler, Chris|
|Atkins, Robert||Carlisle, John, (Luton N)|
|Atkinson, David||Carlisle, Kenneth (Lincoln)|
|Baker, Rt Hon K. (Mole Valley)||Carrington, Matthew|
|Baker, Nicholas (Dorset N)||Carttiss, Michael|
|Baldry, Tony||Cash, William|
|Banks, Robert (Harrogate)||Chalker, Rt Hon Mrs Lynda|
|Batiste, Spencer||Chapman, Sydney|
|Bellingham, Henry||Chope, Christopher|
|Bendall, Vivian||Clark, Dr Michael (Rochford)|
|Bennett, Nicholas (Pembroke)||Clark, Sir W. (Croydon S)|
|Benyon, W.||Clarke, Rt Hon K. (Rushcliffe)|
|Bevan, David Gilroy||Colvin, Michael|
|Blackburn, Dr John G.||Conway, Derek|
|Blaker, Rt Hon Sir Peter||Coombs, Simon (Swindon)|
|Body, Sir Richard||Couchman, James|
|Bonsor, Sir Nicholas||Critchley, Julian|
|Boscawen, Hon Robert||Davies, Q. (Stamf'd & Spald'g)|
|Boswell, Tim||Davis, David (Boothferry)|
|Bottomley, Peter||Day, Stephen|
|Bottomley, Mrs Virginia||Devlin, Tim|
|Bowden, A (Brighton K'pto'n)||Dickens, Geoffrey|
|Bowis, John||Dicks, Terry|
|Boyson, Rt Hon Dr Sir Rhodes||Dorrell, Stephen|
|Braine, Rt Hon Sir Bernard||Douglas-Hamilton, Lord James|
|Brandon-Bravo, Martin||Dover, Den|
|Dunn, Bob||Knapman, Roger|
|Durant, Tony||Knight, Greg (Derby North)|
|Dykes, Hugh||Knight, Dame Jill (Edgbaston)|
|Emery, Sir Peter||Knowles, Michael|
|Evans, David (Welwyn Hatf'd)||Knox, David|
|Evennett, David||Lamont, Rt Hon Norman|
|Fairbairn, Sir Nicholas||Lang, Ian|
|Fallon, Michael||Latham, Michael|
|Farr, Sir John||Lawson, Rt Hon Nigel|
|Favell, Tony||Lee, John (Pendle)|
|Fenner, Dame Peggy||Leigh, Edward (Gainsbor'gh)|
|Field, Barry (Isle of Wight)||Lennox-Boyd, Hon Mark|
|Finsberg, Sir Geoffrey||Lester, Jim (Broxtowe)|
|Fishburn, John Dudley||Lilley, Peter|
|Forman, Nigel||Lloyd, Sir Ian (Havant)|
|Forsyth, Michael (Stirling)||Lloyd, Peter (Fareham)|
|Forth, Eric||Lord, Michael|
|Fowler, Rt Hon Sir Norman||Macfarlane, Sir Neil|
|Fox, Sir Marcus||MacGregor, Rt Hon John|
|Franks, Cecil||Maclean, David|
|Freeman, Roger||McLoughlin, Patrick|
|French, Douglas||McNair-Wilson, Sir Michael|
|Gale, Roger||McNair-Wilson, Sir Patrick|
|Gardiner, George||Madel, David|
|Garel-Jones, Tristan||Malins, Humfrey|
|Gill, Christopher||Mans, Keith|
|Goodhart, Sir Philip||Maples, John|
|Goodlad, Alastair||Marland, Paul|
|Goodson-Wickes, Dr Charles||Marlow, Tony|
|Gorman, Mrs Teresa||Marshall, John (Hendon S)|
|Gow, Ian||Marshall, Sir Michael (Arundel)|
|Grant, Sir Anthony (CambsSW)||Martin, David (Portsmouth S)|
|Greenway, Harry (Ealing N)||Maude, Hon Francis|
|Greenway, John (Ryedale)||Maxwell-Hyslop, Robin|
|Gregory, Conal||Mayhew, Rt Hon Sir Patrick|
|Griffiths, Sir Eldon (Bury St E')||Mellor, David|
|Griffiths, Peter (Portsmouth N)||Meyer, Sir Anthony|
|Grist, Ian||Miller, Sir Hal|
|Ground, Patrick||Mills, Iain|
|Grylls, Michael||Miscampbell, Norman|
|Hague, William||Mitchell, Andrew (Gedling)|
|Hamilton, Neil (Tatton)||Mitchell, Sir David|
|Hampson, Dr Keith||Moate, Roger|
|Hanley, Jeremy||Monro, Sir Hector|
|Hannam, John||Montgomery, Sir Fergus|
|Hargreaves, A. (B'ham H'll Gr')||Moore, Rt Hon John|
|Hargreaves, Ken (Hyndburn)||Morrison, Sir Charles|
|Harris, David||Morrison, Rt Hon P (Chester)|
|Haselhurst, Alan||Moynihan, Hon Colin|
|Hayes, Jerry||Neale, Gerrard|
|Hayward, Robert||Newton, Rt Hon Tony|
|Heathcoat-Amory, David||Nicholls, Patrick|
|Hicks, Mrs Maureen (Wolv' NE)||Nicholson, David (Taunton)|
|Hicks, Robert (Cornwall SE)||Nicholson, Emma (Devon West)|
|Hill, James||Norris, Steve|
|Hind, Kenneth||Onslow, Rt Hon Cranley|
|Hogg, Hon Douglas (Gr'th'm)||Oppenheim, Phillip|
|Holt, Richard||Page, Richard|
|Hordern, Sir Peter||Paice, James|
|Howard, Rt Hon Michael||Parkinson, Rt Hon Cecil|
|Howarth, Alan (Strat'd-on-A)||Patnick, Irvine|
|Howarth, G. (Cannock & B'wd)||Patten, Rt Hon John|
|Howell, Rt Hon David (G'dford)||Pattie, Rt Hon Sir Geoffrey|
|Howell, Ralph (North Norfolk)||Pawsey, James|
|Hughes, Robert G. (Harrow W)||Peacock, Mrs Elizabeth|
|Hunt, David (Wirral W)||Porter, Barry (Wirral S)|
|Hunter, Andrew||Porter, David (Waveney)|
|Irvine, Michael||Portillo, Michael|
|Irving, Sir Charles||Price, Sir David|
|Jack, Michael||Raison, Rt Hon Timothy|
|Jackson, Robert||Rathbone, Tim|
|Janman, Tim||Redwood, John|
|Jessel, Toby||Renton, Rt Hon Tim|
|Johnson Smith, Sir Geoffrey||Rhodes James, Robert|
|Jones, Robert B (Herts W)||Riddick, Graham|
|Jopling, Rt Hon Michael||Ridley, Rt Hon Nicholas|
|Kellett-Bowman, Dame Elaine||Ridsdale, Sir Julian|
|Key, Robert||Rifkind, Rt Hon Malcolm|
|King, Roger (B'ham N'thfield)||Roberts, Wyn (Conwy)|
|Kirkhope, Timothy||Roe, Mrs Marion|
|Rost, Peter||Taylor, Ian (Esher)|
|Rowe, Andrew||Taylor, John M (Solihull)|
|Rumbold, Mrs Angela||Taylor, Teddy (S'end E)|
|Ryder, Richard||Temple-Morris, Peter|
|Sackville, Hon Tom||Thompson, D. (Calder Valley)|
|Sainsbury, Hon Tim||Thompson, Patrick (Norwich N)|
|Scott, Rt Hon Nicholas||Thornton, Malcolm|
|Shaw, David (Dover)||Thurnham, Peter|
|Shaw, Sir Giles (Pudsey)||Townsend, Cyril D. (B'heath)|
|Shaw, Sir Michael (Scarb')||Tracey, Richard|
|Shelton, Sir William||Trippier, David|
|Shephard, Mrs G. (Norfolk SW)||Trotter, Neville|
|Shepherd, Colin (Hereford)||Twinn, Dr Ian|
|Shepherd, Richard (Aldridge)||Vaughan, Sir Gerard|
|Shersby, Michael||Viggers, Peter|
|Sims, Roger||Waddington, Rt Hon David|
|Skeet, Sir Trevor||Wakeham, Rt Hon John|
|Smith, Sir Dudley (Warwick)||Walden, George|
|Smith, Tim (Beaconsfield)||Walker, Bill (T'side North)|
|Speed, Keith||Ward, John|
|Speller, Tony||Wardle, Charles (Bexhill)|
|Spicer, Sir Jim (Dorset W)||Wells, Bowen|
|Spicer, Michael (S Worcs)||Wheeler, Sir John|
|Squire, Robin||Whitney, Ray|
|Stanbrook, Ivor||Widdecombe, Ann|
|Stanley, Rt Hon Sir John||Wiggin, Jerry|
|Steen, Anthony||Wilshire, David|
|Stern, Michael||Winterton, Mrs Ann|
|Stevens, Lewis||Wolfson, Mark|
|Stewart, Allan (Eastwood)||Woodcock, Dr. Mike|
|Stewart, Andy (Sherwood)||Yeo, Tim|
|Stewart, Rt Hon Ian (Herts N)||Young, Sir George (Acton)|
|Stokes, Sir John|
|Stradling Thomas, Sir John||Tellers for the Noes:|
|Sumberg, David||Mr. David Lightbown, and|
|Summerson, Hugo||Mr. Timothy Wood.|
|Tapsell, Sir Peter|
§ Question accordingly negatived.
§ Lords amendments Nos. 2 to 5 agreed to.