HC Deb 30 November 1990 vol 181 cc1172-8

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

2.30 pm
Mr. David Winnick (Walsall, North)

I am glad to have the opportunity to raise a matter which I originally raised on 3 July last year when a different Minister replied. The subject of the debate is the district general hospital, usually referred to as the Manor, in my borough, which, together with Goscote hospital, is the subject of a self-governing trust application.

On the last occasion I said that various medical bodies, including the British Medical Association, the Joint Consultants Committee and the Royal College of Nursing, were vigorously opposed to opting out. I am not aware that any of those organisations has changed its mind in the slightest. With a new Prime Minister, however, one hopes that much of what would be rightly described as Thatcherite policies will be modified. The opting-out proposal is one such test. I know that the Minister will say that hospitals are not opting out of the Health Service. The formal designation of the proposal relates to an application to be a self-governing trust, but the practice is usually referred to as opting out.

If the opting out proposals are intended to remain, one can only reach the conclusion that the same doctrinaire viewpoint will be taken on the Health Service and other matters as has been taken for the past 11½ years, despite there being a new person at the top. I understand that there will be a statement next Tuesday about the applications, so we shall wait and see.

The applications from the Manor and Goscote to opt out have been approved by the West Midlands regional health authority. It will be up to the Secretary of State to say yes or no. On 17 September I responded to the RHA's invitation to comment on the applications for those hospitals to become self-governing. That invitation was described as a consultation process. I wrote a letter of formal objection to the applications and I questioned whether what was taking place could be deemed to be a genuine consultation exercise aimed at ascertaining views on the proposals or whether the matter had been decided upon already and the consultation exercise was merely a charade.

I have since asked whether the results of the consultation exercise on the two hospitals could be put in the Library. The reply to my parliamentary question was a simple no. I can only assume that the reason for that ministerial response is that the exercise was meaningless and of the kind that was practised in eastern Europe until last year.

All along, the Government have refused to allow ballots to be held before opting out occurs. It is interesting to note, as I have said before, that a ballot is necessary before schools can opt out and before council accommodation can be sold to private landlords. Why should not a ballot be held before the self-governing trusts are approved? The real reason—which is not the reason that the Minister is likely to give today—is that Health Ministers know that in any ballot, whether in my borough or elsewhere, there would be overwhelming objection to the application for opting out.

A formal application has been made for the two hospitals to become trusts. The prospectus says—and I have chosen the words carefully—that the needs, opinions and preferences of the local population will be recognised. It says that it will be essential that local views are canvassed to ensure that future developments are responsive to local preferences. It all sounds very good——

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

It is.

Mr. Winnick

If it is all very good, what does the Minister think of the reaction of the local health authority, the manager of which drew up the prospectus for the trust? The results of a household postal referendum carried out by the local authority showed an overwhelming rejection of the proposal. Everyone in the borough was given the opportunity to express his or her view by the local authority. As my hon. Friend the Member for Walsall, South (Mr. George) knows, a fair summary of the two options was given.

The Minister may say, "People were of the view that it was a question of opting out of the National Health Service." In fact, the local health authority agreed that the summary was fair in setting out the arguments for and against the Manor and the Goscote becoming a trust. The result of the referendum was that 27,639 people were opposed to opting out and only 6,004 were in favour. That is a pretty large majority, although the general manager of the local health authority said that it meant that only about 35 per cent. of people participated. In 1989, 35.9 per cent. of voters participated in the Euro-elections and in 1984 the figure was under 32 per cent. The referendum was not by any means a bad response and the manager's argument was weak. There is no doubt that if the vote had gone the other way, and if there had been overwhelming approval for the application for a self-governing trust, we should not have heard any criticism about the allegedly small number who responded.

By a majority vote, the local health authority decided to ignore the referendum. That did not show much recognition of the needs, opinions and preferences of the local population. The only ballot that I know of which was actually allowed by the health authority involved the consultants. At the Manor hospital, 30 consultants were opposed to opting out and 11 were in favour, despite strenuous canvassing by those who were promoting the trust. The unions at the two hospitals organised a ballot. They were not given much encouragement and it was difficult for them to carry out the ballot, but no one has suggested that it was not a fair vote. Of the staff at the hospitals, 401 opposed the trust and 94 were in favour of it. The Royal College of Nursing members held a ballot and, again, there was overwhelming rejection at the Manor and Goscote hospitals.

It would be wrong to force through such a deeply controversial scheme in the face of such hostility from the local community and from the large majority of medical and non-medical staff at the two hospitals. When the matter came before the regional health authority, which wrongly approved the proposal, note was taken of the extent of the objections, including that of the Walsall community health council. Apparently, under this Government and their arrangements for appointing people, the views of those who live in the borough and of the staff at the hospitals are simply ignored if they do not go the Government's way.

There is considerable doubt about the financial viability of a trust. Wrong assumptions in respect of public dividend capital may well result in the postponement of capital development and investment. For example, a new maternity unit is included in the current operational capital programme of the regional health authority. I hope that that new maternity unit will come to the borough in the near future. But there is certainly no guarantee that the plan will not be postponed indefinitely if the trust does not prove financially viable. Instead of opting out, and all the unnecessary gambling with the health of the local community that it entails, we urgently need resources for the Health Service in the borough.

To maximise income and stay in business, the proposed trust will sell services for the private sector at the expense of National Health Service patients. One of the fears in the borough—and it may or may not be justified; no doubt the Minister will tell us—is that long-stay patients with serious illnesses will be among those to be treated outside the borough. There is certainly a great deal of understandable and, in my view, justified, concern about the proposals in general.

Time and again, Ministers tell us that opting out has nothing to do with privatisation and that the self-governing hospitals will remain in the National Health Service. I accept that that is so—certainly in the first instance. But I believe that the proposals are a half-way house on the way to privatisation. That is probably the best summary of the Government's intentions. In my view, this right-wing Tory Government have no real commitment to the Health Service. The Health Service has remained in existence since 1979 because it has the overwhelming support of the country—Tory and Liberal voters as well, of course, as Labour voters. The Government cannot simply go ahead and finish off the National Health Service by legislation. Nevertheless, they have strengthened the private sector and kept the NHS short of funds, as well as introducing the opting-out proposal, which, as I have said, is a half-way house to privatisation. All those measures have been aimed at eroding and undermining the National Health Service. The Minister may say that that is just Labour Member's view, but it would appear that it is also the view of a large number of people in the country.

There is no doubt that the proposal is deeply unpopular in the borough; I do not think that the Minister will question that. Whenever local residents or hospital staff have been given the opportunity to vote, they have decisively rejected the proposal. The Minister should ask the Secretary of State this: if the proposal is so unpopular, and if it gambles, as it undoubtedly will, with the health of the people of the area, why go ahead with it? Why go ahead with a totally doctrinaire policy which is not needed and which is irrelevant to the health of the people? I hope that, if there is a statement on Tuesday, we shall hear good news, although I doubt it. I can only cross my fingers and hope that by next week we shall hear that the application has been rejected.

2.44 pm
Mr. Bruce George (Walsall, South)


Mr. Deputy Speaker (Mr. Harold Walker)

Does the hon. Gentleman have the consent of the hon. Member for Walsall, North (Mr. Winnick) and the Minister to speak?

Mr. Winnick


Mr. Dorrell


Mr. George

I am grateful to my hon. Friend the Member for Walsall, North (Mr. Winnick) for leaving me a few minutes.

For many years, we campaigned for a new district general hospital in Walsall. The hospital was opened just a few months ago at the end of that long campaign. Within days, we heard that, as a result of the Government's ideologically driven campaign, the hospital was to be removed from local control and handed over to politically motivated administrators.

The essence of the proposal has been driven ideologically from London and it has been supported locally by a handful of people, most of whom are administrators, who will benefit from the transfer of the hospital from local health authority control to the new trust. I am not suggesting that there is anything illegal about the process. However, many years ago Aneurin Bevan accused the consultants of being motivated against the Health Service. It is said that he resolved the problem by stuffing their mouths with silver or gold. It appears today that the administrators are stuffing silver and gold in their own mouths.

There is no support for the proposal locally. As my hon. Friend said, consultants, doctors, trade unions, the community health council, a survey by the Walsall Observer and the local referendum all show that the proposal is supported only by a minority of the local community. The consultation has been bogus. It was a frivolous act to give the impression of wide approval that does not exist. It is important that we see the results of the consultation. Let us know how many people or organisations wrote in. We would then learn why the Government want to go ahead with the proposal: a semi-privatised status which, as my hon. Friend said, is merely a transit camp to a full-blown system of privatisation, is ideologically conducive to the Government.

Ultimately the most important poll will take place in six months, a year or perhaps two years. If the Labour party is elected, I am certain that there will be genuine consultation. If the majority of the population want this nonsense to be perpetuated, I believe that we should acquiesce. However, if they are not in favour of the proposal, it should be thrown on to the rubbish heap where it belongs. It is important that our local campaign continues to expose the self-interest of those concerned. I welcome my hon. Friend's initiative in initiating this debate.

2.46 pm
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

The hon. Member for Walsall, North (Mr. Winnick) speculated about the effect of the change of Prime Minister. He wondered whether the new Prime Minister would carry on what he described as the same "doctrinaire" policies as his predecessor. I am pleased to be able to assure the House that I have absolute confidence that my right hon. Friend the new Prime Minister will indeed carry on the doctrinaire commitment to the National Health Service of his predecessor. I am pleased to confirm that we shall continue the programme of reinforcing the National Health Service and providing it with growing resources. We will continue to carry through the programme of reforms of the Health Service's administration to ensure that we can secure better quality health care for the patient and better value for money for the taxpayer from the expenditure, which is growing in real terms.

The hon. Member for Walsall, North insisted on using the phrase "opting out" because he regarded the policy of the establishment of NHS trusts as a halfway house to privatisation. That is explicitly not the purpose of trust status. Any hospital or other unit which becomes an NHS trust will remain an integral part of the National Health Service.

The difference between a trust and a directly managed unit is simply one of the style and system of management of that unit within the National Health Service. The question is whether a unit is more effectively managed as a self-contained trust more responsible for its own future or whether it is better managed within the context of a local health authority that is also the purchaser of health care in that locality.

Perhaps I may begin by going into a little detail on why we have introduced the concept of trust status and what its purpose is. In any discussion of the management of the National Health Service, which is all that we are talking about, it is important to be clear about the central purpose of the National Health Service. I am very clear about that: it is to ensure that health care is available to every citizen on the basis of need, not of ability to pay. The National Health Service should exist to enable any citizen who needs it to gain access to the health care that he needs, and the process of running a hospital should be clearly secondary to the priority for NHS managers, which is to ensure that their resident population can secure the health care that they need.

That is why, after next April, the primary function of district health authorities will be defined as the purchasing of health care on behalf of their resident population rather than the running of hospitals. The traditional model of managing the Health Service can be characterised—perhaps even caricatured, but none the less informatively caricatured—by the health authority having to build a hospital, open the doors and treat the patients who came in through the doors.

The result of that policy is that the articulate and well-organised—perhaps the middle class—are the ones who have been able to get the health care that they need, and too often the needs of the inarticulate and the disorganised sections of the community have not been sufficiently met. By imposing on the purchaser authority the obligation to think about the health care needs of every resident of its area, we are consciously creating a "pressure cooker" device that is designed to ensure that the health care needs of every resident of a district are met and addressed by the health authority.

The purchaser function of the health authority is the important function within the NHS. The function of managing the hospital is, of course, important, but it is secondary to the primary purpose of ensuring that every resident and every citizen of this country has access to the health care that he or she needs. That is why I regard the process of applying for trust status and of giving trust status where we feel that the quality of management and the financial security and so forth justify it are a step forward. It distinguishes the primary purpose of the National Health Service—the enabling function—from the secondary purpose, which is the function of running hospitals.

Mr. Winnick

Why are all the national medical bodies totally opposed? Are we really to believe that the British Medical Association, the Joint Consultants Committee and the Royal College of Nursing are not fully committed to ensuring patient care? They are all opposed. The Minister is reading from a brief on Government policy. He is a well-known wet. Whether those are his views, one does not know, but of course he has ministerial responsibilities. Why not listen to the people? The people had an opportunity in my borough—I have quoted the vote. Why should they be simply ignored and rejected with contempt by the local health authority, the regional health authority, and possibly and unhappily even by the Secretary of State?

Mr. Dorrell

The hon. Gentleman has asked me two questions. I do not know whether he has ever seen a Government brief. I assure him that Government briefs are not normally written like the papers in front of me. I am making my own speech, and nobody else's.

The hon. Gentleman asked how I account for the attitude of the BMA and professional bodies. I account for it in the same way as Aneurin Bevan no doubt did in 1948. They are conservative bodies that represent the status quo, and they have done so at every stage in the development of health care since the war. We are concerned about managing the Health Service to secure the social objective of providing health care on the basis of need, of ability to pay. Within the context of a health service in which I regard the primary purpose as——

Mr. Winnick

What about the people's voice?

Mr. Dorrell

I shall refer to the people's voice because I wish to talk about consultation later, but, before I do that, I stress that the NHS trust concept is part of the process of decentralising the management of hospitals and provider units in the NHS. The National Health Service is the largest employer in the world, with two exceptions—the Red Army and Indian railways, and I would not hold many bets on the Red Army for too much longer. The NHS is a vast organisation which, to ensure efficient management, must make sure that management authority and power is decentralised away from Whitehall towards the managers with the day-to-day job of running the units that deliver the health care. That is why, in the provider side of the NHS, no change will not he an option from next April.

We are setting up two new models of managing NHS hospitals. The first is a directly managed unit within the local authority with much more decentralised power than is traditional in the existing NHS model. The second is trust status, which simply takes one stage further the same logic as will be applied to the directly managed unit and the delegation of management power.

The process of delegation and decentralising power away from the centre of a vast bureaucracy towards the front line of management has been undertaken, often many times, by every big organisation in the rest of British society. I come from a business background. I do not regard the NHS as a business—it is not—but that does not mean that it cannot learn to deliver its objectives more efficiently from the experience of business. Every large British company has at least once—most of them several times—in the years since the NHS was set up, conducted a process of decentralising management power away from the centre, towards the front line, giving managers more authority over their own units and holding them to account for the way in which that authority is used. That is the logic that informs the NHS reforms and is carried through in the concept of NHS trust status.

The hon. Member for Walsall, North asked about consultation and described the consultation process which started when the trust applications were filed as a "charade". I reject that charge absolutely. The consultation process in which we have been engaged has been a serious exercise of gathering views about each individual application. The hon. Gentleman asked why we did not want to accept a public opinion poll on what should happen to a unit. The straight answer is that my right hon. Friend the Secretary of State is accountable to the House for the way in which the National Health Service is managed and no hon. Member should seek to remove from him that responsibility. Therefore, the consultation process is, unashamedly, one of informing my right hon. Friend about the issues on which he has to decide and whether application for trust status holds out the prospects for better quality management as a trust or as a directly managed unit.

Mr. Winnick

I am grateful to the Minister, who has been kind enough to give way to me twice. Although the Secretary of State is answerable to the House, when making his decision, why should he not take into account the overwhelming rejection of the proposals, as shown by the figures that I quoted? The Minister denies that the consultation exercise is, as my hon. Friend the Member for Walsall, South (Mr. George) and I said, a farce and a charade. But why has not the result of the consultation exercise on the Manor and Goscote hospital been placed in the Library? I suspect that the reason is that it would prove what my hon. Friend and I have just said: that there was an overwhelming rejection of the proposal by those involved in the hospital and local residents. If that were not so, why should not the results of that consultation process have been placed in the Library, a few yards away from here?

Mr. Dorrell

When my right hon. Friend makes his decision about this application, along with the other 66 applications for trust status, and announces those decisions to the House, he will take account of all the evidence that he receives during the consultation process. He will also take account of the advice given to him from within the Department, which it has never been the practice of any Government to publish. If we were to publish the result of the consultation exercise without the internal advice available to my right hon. Friend, the House would have only half the available evidence——

Mr. Winnick

That is a weak excuse.

Mr. Dorrell

The hon. Gentleman describes it as a weak excuse, but it seems that if the House wants to know the evidence on which my right hon. Friend makes his decision, the House should see it all, not merely half of it.

The consultation is, quite properly, part of a process whereby Ministers consult, weigh the arguments—not just the numbers—and decide which applications to accept. I am old-fashioned enough to believe that Ministers will be held to account in the House for the way the decision goes. I look forward to being held to account by the hon. Member for Walsall, North for the improvement of health care that will flow to his constituents as a result of the Government's tenure of office.

Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.