NHS Trusts

HC Deb 29 April 1991 vol 190 cc21-32 3.32 pm

Mr. Robin Cook (Livingston)

(by private notice): To ask the Secretary of State for Health if he will make a statement about the business plans for self-governing trusts and recently announced job losses.

The Secretary of State for Health (Mr. William Waldegrave)

The prospectuses of the trusts were published last year. There were no "secret" business plans. The business plans, which are required to be returned to the national health service management executive in the early part of this year, are part of the arrangements for monitoring both NHS trusts and directly managed units by the national health service management executive. As management documents, they were never intended under the National Health Service and Community Care Act 1990 to be public documents. The annual report of each trust will of course be published.

That leads me to a wider point about accountability. For the first time, we now have a system in place where, through the contractual arrangements, hospitals will be fully accountable to the district health authorities for the quality and quantity of the services they provide for patients.

Within that reformed system my job is to ensure that patients have the access that they need to comprehensive, free, health care. I exercise this responsibility through a strengthened chain of accountability from districts through regions to the NHS management executive.

With this accountability for the provision of health care goes more delegated management freedom for the hospitals themselves, including directly managed units. It is not for Governments to tell hospitals how to organise their services and how many staff to employ. That must be a matter for the hospitals themselves. In a service that employs over 1 million people, it would be ludricous if Ministers or civil servants attempted to run the service from Whitehall.

What I sought last year, and will seek this year when examining trust applications, is a management team which will match in professionalism the professional standards of the doctors and nurses themselves. For far too long we have had outstanding clinical professionalism allied to second-rate management systems. One cause of that over the years has been the political intervention in what are properly management decisions, of which this bogus pre-local elections row, stirred up by the Opposition parties, is a classic example.

Referring to the situation in London, I have noted the comprehensive review of their hospital proposed by the new management at Guy's. I am pleased to note that they have given a number of undertakings: that patient care will not suffer; that compulsory redundancies will be used only as a last resort; that services in the local community will be protected; and that quality of service is an overriding objective.

I am also pleased to be able to reassure the House that Lewisham and North Southwark health authority, in whose district Guy's hospital is situated, believes that the contracts which it has let to Guy's, and to other hospitals, provide satisfactorily for the health needs of its resident population. Moreover, it recognises that prompt action is needed to tackle the financial situation at Guy's, and prefers that to unplanned action later in the year.

I am also pleased to record that, in Bradford, no reduction in services or activity is planned by the trust. It is the judgment of the public health authorities in the city that some increase in emphasis in primary and community services is right for local people. It is likely that, in terms of staff numbers, any reductions in hospital staff would be more than offset by further increases in community nursing and in the resources available to GPs.

The proposals by those two trusts illustrate a fundamental point. Neither district health authorities nor hospital managers are any longer prepared to accept that, simply because a hospital has always provided a certain service in a certain way, they should necessarily continue to do so. The needs of the patients they serve are constantly changing. Leading hospitals like Guy's and Bradford need to respond to those changes. Hospitals that can adapt successfully to change will flourish and expand. That is what I believe we are beginning to see happen in Bradford and south-east London; and, since any savings will go straight back into the health service, it will be the patient now, and in the future, who benefits.

Labour Members have nothing to say on health. Their leader yesterday finally let the cat out of the bag: under Labour there would be no more money for health. They have no proposals for dealing with the obvious managerial problems of the service. Their sole interest is in playing party politics with it. Their behaviour over the past few days is the final proof, if any was needed, that that is the truth.

Mr. Cook

The Secretary of State's assurance that health authorities are happy with the cuts would carry more weight if those health authorities represented anybody in the community for whom they now administer the health service.

Will the Secretary of State explain to the House how he reconciles his many statements over the weekend and his statement today to the House that there will be no cuts in patient care with the financial memorandum of Guy's, which was leaked today to my hon. Friend the Member for Peckham (Ms. Harman), and which states that managers recognise that in acute services there will be inevitable reductions in direct patient care and that in mental health services, which are local services, there will be "substantial reductions in service"? After those internal statements by the management of Guy's itself, should not the Secretary of State apologise for all those misleading statements?

If the business plans are to assist the Government in monitoring the progress of the trusts, why cannot those business plans be published so that we can all assist in the monitoring? What is in those business plans that needs to be hidden? How many more of those business plans contain cuts similar to those that we have heard about at Guy's this past weekend?

Will the Secretary of State publish the report on trusts from Coopers and Lybrand? Will he now tell the House what he has already told journalists—that last November Coopers and Lybrand found that only 12 of the 57 trusts had plans with which there were no financial difficulties? If that is true, was it not totally irresponsible of the right hon. Gentleman to go ahead with all 57 trusts? How did he keep a straight face when he told the House on 4 December that, in deciding which hospitals should opt out, the key criterion was financial viability?

Will the right hon. Gentleman also explain how Guy's can be so much in debt and yet can afford to pay its chief executive the highest salary in the entire NHS? Is he aware that, in the past year, Guy's has advertised 44 new management posts at a total cost of £1.3 million—one quarter of its deficit? Will he explain how it can be value for money to hire more managers on bigger salaries to run a reduced service?

Finally, after this weekend, does not the Secretary of State realise that leaving hospitals to sink or swim in the marketplace is regarded by the public as a wholly unacceptable way of running their health service? Will he now accept that he cannot plough ahead with the second wave of opt-outs while hospitals in the first wave are foundering?

May I give you and the House notice, Mr. Speaker, that the Opposition will return to this matter until we get an assurance from the Secretary of State that he will not take any more decisions on opt-out until the people of Britain have had their say in a general election about the health service they want?

Mr. Waldegrave

The hon. Gentleman knows perfectly well that hospitals are not being left to sink or swim in the marketplace. Hospitals are being asked to respond to specific contracts from public health authorities to provide the services at the quality and the quantity that are needed. That is what we are seeing, and it will provide much better and more comprehensive health care.

The hon. Gentleman has once again shown that he has not troubled to understand the reforms that he criticises. It is not for a single hospital to provide comprehensive health care across the range that is needed by a district. Indeed, there are seven major hospitals and other minor hospitals within range of the district that we are talking about, and it is for those hospitals together to provide comprehensive health care, responding to the district's contracts. That is what the district is perfectly prepared to say that it has achieved.

We have discussed the Coopers and Lybrand reports before in the House. It is true that Coopers and Lybrand stated that a minority of the trusts had no financial problems at all. My judgment was that the new managements that we were seeking were far more likely to solve the underlying problems than the old systems that had created those very problems. [Interruption.] The hon. Gentleman may think that that is odd, but it seems crazy that he should wish to return to the system that caused those problems in the first place.

The hon. Gentleman was forced by the House to back down two weeks ago in his threats to NHS managers, and his spending pledges were shot out of the water by his leader yesterday. He has no credibility whatsoever.

Mr. Simon Hughes (Southwark and Bermondsey)

Is the Secretary of State aware that the cuts of £12.8 million in the Guy's and Lewisham budget in one year is the largest cut for any NHS unit since the national health service was set up? Did the right hon. Gentleman approve the plan last autumn knowing that there would be that cut, or did he learn of the nature and size of the cut after he had approved the plan but before the cuts came into operation in April?

Is the Secretary of State aware that his right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), the then Secretary of State for Health, told me in a debate in the House in the early hours of 13 March that one of the criteria for approving an opt-out plan was that services for the local community in Lewisham and Southwark would be preserved? Is the right hon. Gentleman aware that almost nobody working at any level in Guy's hospital or using it as a patient believes that an overstretched, overworked work force can suffer a cut of 10 per cent. in its numbers and budget without the risk of the health care that is provided in the inner city being substantially affected for the worse?

Is not the reality that the Secretary of State has power, if he wishes to use it, under his legislation, to dissolve a health service trust? Should he not now dissolve that trust and allow that unit to be part of the national health service with everything else?

Mr. Waldegrave

The hospital is part of the national health service, as the hon. Gentleman knows. He has misunderstood what it is proposing, which surprises me, because I know that he has been in touch with the hospital. It is not proposing £12 million-worth of cuts. It has to put its underlying deficit in order, which amounts to about half that figure, and wishes to redirect another £6 million towards growing services, which is different from what the hon. Gentleman said. Among other things, it is saying that it will preserve and perhaps develop the local community aspects of its hospitals.

Indeed it is true that the hospital is overstretched, as are others in London. As anyone who knows anything about the NHS realises, there has been over-provision of total hospital numbers in London for 50 years as the population has moved away. Now we have to fund hospitals in London properly to offer the services needed in London, in addition to the specialties that are more widely needed. That is what Guy's is proposing to do, and that will secure its long-term future rather than going from crisis management to crisis management, which is what has happened for more than 20 years.

Mr. Max Madden (Bradford, West)

Will the Secretary of State now do what his junior Minister refused to do last Wednesday: will he propose an emergency funding package to ensure that there are no redundancies or service cuts in hospitals in Bradford? The people of Bradford whose health needs are most acute do not want their hospitals to become supermarkets. We are not dealing with cans of food and packets of cornflakes; we are dealing with sick people, and we know that patient care will suffer if there are cuts.

The people of Bradford do not trust the trust, and most of all they do not trust the Government, because they know that the national health service is unsafe in Tory hands. They want the necessary money, staff and patient care, and, most of all, the damage that the Government have done to the NHS in the past 12 years to be repaired.

Mr. Waldegrave

They have been firmly told by the leader of the Labour party that they will not get a penny more from a Labour Government. The health service in Bradford and elsewhere in this country, and throughout the world, is developing in different ways. Primary care is developing fast in Bradford, which has had some of the most dramatic improvements in the size of GP lists. I suspect that that is the way in which things will go in the future, with further development of primary and community services in Bradford.

If the hon. Gentleman wishes to defend for ever the exact pattern of the hospital services that we have now, he will be in the position that his party has always been in—looking backwards, defending private interests—[HON. MEMBERS: "Oh!"]—defending producer interests. I am perfectly prepared to stand by my accusation about private interests, too. The Labour party is more concerned with the interests of the Confederation of Health Service Employees arid the National Union of Public Employees than with patients. That remains as true now as it has been in the past.

Mr. Jerry Hayes (Harlow)

Does my right hon. Friend agree that it is a serious matter when the professor of surgery at Guy's warns publicly that manpower has got out of control and that management must get a grip on it? Would not management be failing in its duty to patients and to health care in the area if it ignored such remarks? Does my right hon. Friend agree that, although it is regrettable that people should lose their jobs, especially in the health service, if the public can be satisfied that that will mean fewer ward closures, more patients being treated and more operations rather than have the Opposition's promises, that is the way forward?

Mr. Waldegrave

My hon. Friend is perfectly right. The Labour party proposes to return us to the old management systems that created the problems with which the House is all too familiar. We are now doing the right thing, which is to put the management in the hospitals where it should be. When the management of one of our great hospitals takes action early in the year to balance its budget, that seems to me responsible behaviour which is in the interests of the patients and should be applauded.

Ms. Joan Ruddock (Lewisham, Deptford)

Is the Secretary of State aware that, despite its size and importance, Lewisham hospital has always been considered the poor relation of Guy's? Indeed, he did riot even mention it today. Having been dragged into the Guy's and Lewisham trust, Lewisham hospital is now in grave danger of being dragged down by it.

How many staff posts are to be cut at Lewisham hospital? What will be the reduction in the service standards available at that hospital? What will be the impact on mental health services, which are so crucial to the inner-city constituency that I represent? Will the right hon. Gentleman tell me whether the surgical ward that was closed temporarily last year will now be reopened as planned? What will be the impact on the imminent transfer of children's services from Sydenham hospital to Lewisham? Is phase 2 of Lewisham hospital still secure? Is it really true that my constituents have nothing to worry about, as he suggests?

Mr. Waldegrave

As a result of this electioneering campaign, they are probably worried now. The hon. Lady is quite right to rebuke me for not using the full title of the Guy's and Lewisham trust, because it is essential that Lewisham hospital as well as Guy's should have the full attention of management. I can tell the hon. Lady's constituents that those two hospitals are safe, and that the proposals will develop their long-term future. As I am sure she understands, it is the duty of the district health authority to ensure comprehensive health care for her constituents. It has told me that it has no doubt that, with these changes, it will be able to ensure that.

Mr. Roger Sims (Chislehurst)

Does my right hon. Friend think that the first priority of the NHS should be to provide jobs or to provide a high standard of health care? If the trustees of Guy's or any other hospital believe—as the Guy's trustees do—that, by cutting costs, hospitals can provide a higher standard of care for the people in the immediate community, and, through contracts, for those outside the area—and, in so doing, provide better pay and conditions for their own staff—should they not be commended rather than criticised?

Mr. Waldegrave

I entirely agree with my hon. Friend. The number of people employed in the health service has increased at about twice the rate of the number of patients treated. We cannot be proud of that; it does not show a very impressive gain in efficiency over the years.

The hon. Member for Livingston (Mr. Cook) said this morning on television that he could not guarantee that jobs would not have to be lost in different parts of the health service, and that the number of jobs might have to be reduced in some areas. He might like to tell the House where he believes the number of jobs should be reduced, but he was right in saying that. The total number of doctors and nurses increases, but the shape and pattern of health care must change over the years.

Mr. Bob Cryer (Bradford, South)

Did the Secretary of State know, when he approved the detailed proposals for the Bradford trust, that one of its first actions would be to sack newly qualified nurses, and that, within a month of taking over the operation of all the acute hospitals in Bradford, it would announce the sacking of 300 staff at a saving of £7 million? If the Secretary of State knew that, was it not incompetent of him to allow the plan to go ahead? If he did not know that, does it not show that he is treated with complete contempt by the people who made those proposals?

The people of Bradford rejected the trust; the doctors, nurses and health workers rejected it. Why did not the Secretary of State listen to those people instead of to the spivs he appointed to run it? People will be satisfied that something is being done only when this miserable, incompetent Minister resigns.

Mr. Waldegrave

I am sure that the Minister—[Interruption.] The hon. Gentleman was, I believe, a Minister in the Labour Government at the time that the International Monetary Fund arrived here. Inadvertently, I am sure, he gave a wrong fact to the House. As he well knows, there is no question of 300 sackings in Bradford. The trust has made it perfectly clear that it thinks it likely that there will not need to be any compulsory redundancies. It has already fulfilled a considerable part of its target by not filling vacancies. I hope, therefore, that the hon. Gentleman will withdraw his remark that there will be 300 sackings.

Last year I had to judge whether the management offered by the new trust was better and more likely to produce good health care for the people of Bradford than the existing system. I have no hesitation in saying that that is so, that the hospital's quality will improve, and that it will maintain its output of work, as it says it intends to do over the next year.

Dr. Keith Hampson (Leeds, North-West)

Is my right hon. Friend aware that in hospital trusts, such as the two in Leeds, the management are rightly asking the practitioners how they can get costs down so that they can treat more patients? Whereas in the past there was the long-term problem of financial pressures which sometimes involved cuts, under the new trust system there is no logic whatsoever in reducing patient numbers, because that would simply reduce income.

Mr. Waldegrave

There is no difference in the importance that both trusts and directly managed units ought to lay on finding proper cost savings to plough back into health care. As the Prime Minister made clear over the weekend, every penny of savings from this or any other exercise in the NHS goes straight back into health care. The Opposition ought to welcome that. Our job is to see that the funds that we vote treat efficiently as many patients as possible and at as high a quality as possible.

Mr. Derek Fatchett (Leeds, Central)

Does the Secretary of State realise that his comment that the anxieties of people up and down the country are related to electioneering does him no credit and adds not one iota to his own job security? What does he have to say to the people of Leeds, three weeks after the introduction of the hospital trust at the general infirmary? Its chief executive has told unit trust managers to make cuts of £5 million in services——

Dr. Hampson

Five per cent.

Mr. Fatchett

Five per cent. of £100 million is £5 million. It would help if there were some numeracy among Government Members.

Can the right hon. Gentleman explain to the people of Leeds that that will not add to the waiting list and that it will not reduce patient care?

Can the right hon. Gentleman confirm that the Coopers and Lybrand report said that the Leeds general infirmary trust was not financially viable and that it would inevitably lead to cuts in services and jobs? Why does not the Secretary of State publish that report? Why did he let the trust go ahead in the knowledge that it would result in a cut in patient services?

Mr. Waldegrave

On the matter of electioneering, it seems to me a little more than a coincidence that this bogus campaign should be launched on the same day as the Opposition have arranged for a campaign paid for by NALGO on the self-same subject. Perhaps that is just a coincidence. The hon. Gentleman does not seem to understand that problems—I am willing to acknowledge them—existed in that hospital before the trust was set up. My job was to decide whether the new trust management was more likely to solve those problems than the system that created them. That was my judgment. Since the hon. Gentleman knows that under Labour no more money will go to the NHS—his leader has told him so—what proposals can he make to improve the management?

Mr. Gary Waller (Keighley)

Can my right hon. Friend confirm that 50,000 extra doctors and nurses are working in the NHS, compared with the position a decade ago, and that it would be ridiculous if the way in which staff are used did not change in response to clinical practice? Is it not regrettable that the situation in Bradford has been so distorted? Does not the creation of NHS trusts provide hospitals such as Bradford royal infirmary with the opportunity to use its resources in a way that puts patients first?

Mr. Waldegrave

That is right. In Bradford, as elsewhere, the shape of the NHS will undoubtedly change over the next 10 to 20 years. The pattern of hospital services will not remain exactly as it is now, as I am sure my hon. Friend knows. He is perfectly correct when he says that there are 60,000 more nurses; but there are also 16,000 more doctors and dentists than in 1979. I predict that the numbers will continue to rise. What is not certain and what would not necessarily be right would be if all those additional clinical people were in acute hospitals. They should be spread throughout the NHS to meet the needs of patients, not just the existing patterns of provision.

Mr. Terry Rooney (Bradford, North)

Will not the Secretary of State admit to yet another failed Tory experiment in Bradford? Will he explain why he has told the House today that there will be no cuts in patient care when the chief executive and the chairman of the trust have said publicly and in the press that there will be a 6 per cent. reduction in patient services? In the public consultation on the next trust to come before him, will the Secretary of State take account of the priority services rather than the lies which the management of the trust put forward last October?

Mr. Waldegrave

It is the duty of the district to provide comprehensive health care. It has made it perfectly clear that it has already placed contracts to meet local needs with that hospital, and other national health service hospitals. I hope that a considerable number of hospitals will seek trust status next year, because I am certain that that is the best way of managing hospitals.

Mr. Michael Morris (Northampton, South)

Will my right hon. Friend re-emphasise that trusts are, and always will be, part of the national health service and that the money involved is, and will continue to be, part of the national health service? Does he recall saying in answer to me that all the NHS trusts would not report to their regions but would report to the centre? That being so, can he reassure the House and all the trusts in general that, if any of them should get into transitional problems, there is some provision whereby he has reserve powers?

Mr. Waldegrave

I agree with the first part of my hon. Friend's question. I have reserve powers, which I would use if a district told me that the comprehensive health care that it needed to supply was not available from the hospitals because of changes in supply patterns. My hon. Friend is perfectly right, in believing that we shall be monitoring the trusts very closely.

Several Hon. Members

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Mr. Speaker

Order. The House knows that I have an obligation to protect the business of the House. This is a private notice question—[Interruption.] Please hear me out. This is a private notice question that I would normally allow to run for about 20 minutes or perhaps for a maximum of half an hour, but, in view of the great interest in this matter, and taking into account the subsequent business, exceptionally, I shall allow questions to run until 4.15 pm and then we must move on. If hon. Members ask brief questions, I hope that I shall be able to call most, if not all, of them.

Mr. David Winnick (Walsall, North)

Does the Secretary of State recall how often he was warned in meetings, Adjournment debates and parliamentary questions that the trusts were set up in my borough and other parts of the west midlands in the face of overwhelming opposition? Can he say whether job losses will occur in the trusts that were set up in the borough? Is he aware that the miserable and dishonest way in which the Government are treating the health service will do as much damage to the Tory party and the Government as the poll tax has done? They are both products of prejudice and party dogma.

Mr. Waldegrave

We are told in the Evening Standard today that internal documents of the Labour party show that nobody believes its pledges on the national health service. That is entirely true and has been emphasised by what the Leader of the Opposition said yesterday. The Opposition will provide no more money. We have increased the money available to the NHS faster than they did, and are addressing the real management problems.

Sir David Price (Eastleigh)

Does my right hon. Friend agree that none of us can determine whether any hospital is correctly manned without an analysis of the staffing needs of that hospital in relation to its detailed health objectives? I can well understand that my right hon. Friend does not normally wish such figures to be published, but as two particular cases have been the subject of great public controversy, will he make them available to the Select Committee on Health, if not to the House?

Mr. Waldegrave

The proposals of the Guy's and Lewisham trust are for discussion with its staff and are far from finalised. I have no doubt that it would respond to the Select Committee as my Department would.

Mrs. Rosie Barnes (Greenwich)

What guarantees can the Secretary of State offer that essential services and the quality of care will be maintained at Guy's and Lewisham hospitals? Will provision be protected for particularly vulnerable categories such as geriatric patients and mentally ill people?

Mr. Waldegrave

I can guarantee that the quality of Guy's work will be the same as it always has been. On behalf of the district and the hon. Lady's constituents, we must protect comprehensive health care, which will come from a variety of hospitals. It is the district health authority's duty to ensure that it has the necessary provision. That is the purpose of the health reforms, and that is right.

Mrs. Edwiina Currie (Derbyshire, South)

Has not the number of people working in the national health service increased fourfold in its lifetime, while the number of patients treated has only doubled? Does not that suggest that there is a substantial amount of waste and bureaucracy in the NHS, that there probably always has been, and that it has been getting worse recently, at least partly because of the Government's generosity in funding it?

Mr. Waldegrave

The figures at least show that those who believe that they can maintain and improve health care with fewer staff are likely to be telling the truth, and they are likely to know more than some of the amateur experts in the House.

Ms. Diane Abbott (Hackney, North and Stoke Newington)

Will the Secretary of State answer the specific point that has been made more than once? All weekend we have had to listen to the right hon. Gentleman assuring us that cutting 600 jobs at Guy's will not affect the service. My hon. Friend the Member for Livingston (Mr. Cook) quoted specifically from an internal management document, which said that acute and mental services at Guy's will suffer. Who is right—Guy's management, or the Secretary of State?

Mr. Waldegrave

Guy's services must be of the highest quality. District purchasers must have a comprehensive range of services from Guy's, "Tommy's" and other hospitals. As a result of the system that the hon. Lady seems to support—I am surprised by that—hospitals are overstretched, none of them is providing a service of the quality necessary, and staff are highly demoralised.

Mr. Robin Squire (Hornchurch)

On the specific point of job losses, will my right hon. Friend compare the position of Marks and Spencer, which provides necessities such as clothing and food, with that of hospitals? Does he agree that customer satisfaction in Marks and Spencer will not be shaken as a result of its unfortunate announcement today? Had there not been so much second-guessing by politicians on day-to-day hospital management, the announcement would not have received such a bad and unfair reception from Opposition Members.

Mr. Waldegrave

The national health service is in a more privileged position than Marks and Spencer: it has a guaranteed real terms increase in funding for this financial year, which is more than any shop, however grand, can guarantee. However, good managements must try to spend money where it is necessary—on patients—and if that can be achieved with fewer people so that more money is ploughed back into patient care, that is surely right.

Mr. Tony Lloyd (Stretford)

Does the Secretary of State understand that there is a crisis of confidence in the basis of trusts? How can he convince my constituents in one of the poorest parts of Manchester—their hospital has opted out and every health indicator shows that their health and health care are worse than elsewhere—that the provision of services will continue and that they will not face cuts and a diminution in services? Why should we believe him?

Mr. Waldegrave:

I am sure that the hon. Gentleman knows his constituency extremely well. The best way of meeting the health needs of his constituents may be an expansion not of acute care but of community medicine. We cannot say that the only important NHS provision is acute hospitals, but I can reassure him that the trust in Manchester will continue, like other trusts, to offer patients a first-rate service.

Mr. Richard Page (Hertfordshire, South-West)

Is my right hon. Friend aware of the annoyance and anger felt in the past by most, if not all, Members of Parliament for Hertfordshire about the unfair distribution of finance within the North West Thames region between the shires and London? We have 41 per cent. of the population but receive only 33 per cent. of the money. That has led to ward closures, and is caused by overmanning, shroud waving and expensive operations in London. At last, we are moving towards equal treatment and the same cost per operation. Anyone who complains has no idea about value for money and does not care about my constituents.

Mr. Waldegrave

The first report that analysed the unfair share of hospital services in London was produced in 1905. Partly because of political pressures, it was never tackled. Anyone who knows anything about the health service will welcome the fact that, at last, we are beginning to match hospital services to where people live now and not where people lived in 1905.

Mr. Jim Cousins (Newcastle upon Tyne, Central)

Does the Secretary of State recognise that the first decision in the first week by the three NHS trusts formed in Newcastle was to increase the salaries of the top managers by substantial and secret amounts? Does he recognise that the fourth trust application, launched today in Newcastle, for the Royal Victoria infirmary involved not only an important community hospital but a major centre of medical and dental education in England and a major centre of children's health services in England? Will the right hon. Gentleman ensure that that part of the business plan that refers to the future of medical and dental education and its financing and that part of the application that concerns children's health will be made known to the people of Newcastle?

Mr. Waldegrave

Those vital services will prosper better under the clearer and more accountable management of a trust than they ever did under the previous system. That will be true of all services in the hon. Gentleman's city, as it is of services in other cities.

Mr. Richard Tracey (Surbiton)

In the face of the sustained political attack on health trusts by the Labour party, there is great confidence in the management and structure of the Kingston health trust. Does my right hon. Friend agree that, following the television interview yesterday by the Leader of the Opposition, the public must appreciate that what the Labour party says about health is just words and more words and provides nothing tangible?

Mr. Waldegrave

Although I entirely agree with my hon. Friend's first point, the position is worse, in that the hon. Member for Livingston (Mr. Cook) has given a range of spending pledges—from minimum wages to no-fault compensation—which would cost hundreds of millions or perhaps billions of pounds. Yesterday, the Leader of the Opposition shot all those pledges out of the air. Therefore, those spending pledges will have to be financed out of patient care, because there is no other way to finance them.

Mr. John Battle (Leeds, West)

Is the Secretary of State aware of the announcement about Leeds general infirmary that there will be £5 million cuts this year and £10 million cuts in the medium term? Is he aware also that it was made plain in the bid document that, if the budget did not balance, there would be reductions in services, staff or wages? What advice did the auditors' report give the right hon. Gentleman, and which of those actions did he sanction? Will he publish that report? Will the trusts be publicly accountable for their budgets before we are any further into this financial year?

Mr. Waldegrave

There was no auditors' report. The hon. Gentleman knows that in his hospital, as in others, there have been lurches from crisis to crisis. Is it not better that hospitals should manage their affairs to match income with expenditure so that there are no crisis cuts? Once again, I say to the hon. Gentleman that the district is perfectly satisfied that it can purchase on behalf of its people the comprehensive health care that is needed in his city.

Sir Geoffrey Johnson Smith (Wealden)

I warmly support my right hon. Friend's policy. Will he take time, in the cause of accuracy and truth, to remind the BBC that, when describing hospital trusts, it should be aware that they are not hospitals that have opted out of the national health service?

Mr. Waldegrave

My hon. Friend is right. It is worth reaffirming the position, particularly as leaflets still being circulated in the Labour party's name refer to hospitals opting out of the NHS. That is not true, and the Labour party knows it. I am sorry if the BBC slipped into using that language; it was an uncharacteristic mistake.

Mr. Keith Bradley (Manchester, Withington)

One hospital that should not be affected by any changes in patterns of health care referral is the famous Christie hospital trust, in my constituency, which is a centre of national and regional excellence. Will the Secretary of State allay public anxiety which was raised by the fact that before the trust was even formed the hospital could not afford drugs essential for cancer care? Will he confirm that the trust will not be one of those with financial problems, that there will be no job losses, and that in future all patients can be referred to the hospital and will receive all the health care prescribed by consultants so that the public who require such excellence of cancer health care may be assured about the future?

Mr. Waldegrave

The hon. Gentleman knows perfectly well that the future of Christie hospital is assured and he also knows—or he should know—that the story of the drugs to which he referred was a little more complicated than he thought when he launched into it.

Several Hon. Members

rose——

Mr. Speaker

Order. I remind hon. Members that questions to the Secretary of State may be tabled tomorrow for answer in a fortnight. Furthermore, I shall keep carefully in mind those hon. Members who have not been called today in order to give them precedence when we return to this issue.