HC Deb 03 December 1991 vol 200 cc145-62 3.31 pm
The Secretary of State for Scotland (Mr. Ian Lang)

rose—

Mr. Alex Salmond (Banff and Buchan)

On a point of order, Mr. Speaker.

Mr. Speaker

I will take points of order afterwards.

Mr. Lang

With permission, Mr. Speaker, I would like to make a statement about NHS trust applications in Scotland.

As the House is aware, applications for NHS trust status in Scotland have been submitted on behalf of the Foresterhill group of hospitals in Aberdeen, the Royal Scottish National hospital at Larbert and the South Ayrshire group of hospitals. Statutory public consultations have been carried out and I am grateful to all those who responded. I have carefully considered all the comments submitted and I have today written to the sponsors of the applications separately, setting out my decisions. Copies of the letters have been placed in the Library.

In all three cases, the responses to the public consultation revealed concern that trusts might not be part of the NHS and that services might be fragmented. Those concerns are misplaced. The position, as the Government have repeatedly made clear, is that trusts will remain part of the national health service. Services will continue as at present to be free at the point of delivery. Trusts will operate in a framework in which health boards will be required to fulfil their statutory obligations to cater for the health needs of all those in their areas. Bearing that in mind, I have closely examined the three proposals and the comments that they have attracted, in accordance with the published criteria which included the likely effect on patient care, the competence of the management teams, including involvement in management of senior professional staff, and the financial viability of the hospitals concerned.

Taking Foresterhill first, a recurring comment in the responses to the trust proposal alluded to the contribution that individuals have made to the development of hospital care in Aberdeen over very many decades. I fully understand that and I recognise the justifiable pride which people in Grampian have in the services provided and in the developments which have taken place in conjunction with the medical school. None of that, for reasons that I have already explained, is put in jeopardy by the trust proposal. Indeed, I am satisfied that the proposed trust, operating from a sound financial basis, with a management team, including clinicians, possessing a proven track record, and with sound proposals for improving facilities, offers a great opportunity to build on the already high reputation for patient care which the hospitals enjoy. I have therefore decided to grant the application.

Hon. Members

Shame!

Mr. Speaker

Order.

Mr. Lang

I turn to south Ayrshire. The sponsors of the trust proposal see the new Ayr hospital as providing an excellent opportunity for further enhancing the quality of services provided in south Ayrshire. I am sure that they are right. I am satisfied that the proposals for NHS trust status for the south Ayrshire group of hospitals also meet the criteria which I have outlined, and in particular that they will secure benefits for patients and an improved quality of service. Again, therefore, I have decided to grant the application.

Finally, there is the application from the Royal Scottish National hospital at Larbert. The hospital serves people with a mental handicap. It has been suggested during the consultation period that, because of the vulnerability of that group, the hospital would not be an appropriate candidate for trust status. I do not accept that proposition. NHS trust status is about providing a means for improving care. I see no reason why that should be denied to those hospitals serving the mentally ill or people with a mental handicap.

As with Foresterhill and South Ayrshire, I am satisfied not only that the RSNH is financially viable but that significant benefits for improved patient care will flow from trust status. It is also clear to me that, on past performance, the management are well able to take forward the changes in a very difficult area of health care.

However, the proposals arise at a time when we are beginning to put in place the policy of care in the community, as enunciated in our White Paper "Caring for People". Work on the development of joint planning between local authorities and health boards and the preparation of individual care plans has begun. But more activity on those fronts is expected in the coming months. The resources of the RSNH management team may not be sufficient to cope with the additional administrative burden of implementing simultaneously "Caring for People" and the immediate transition to trust status. Consequently, I have decided, in granting the application, that the start-up date will be April 1993.

To sum up, I have concluded that all three applications will lead to improved patient care; that all three will have the required management, including clinician participation, to operate free of health board control and that all three are sufficiently robust financially. I shall therefore be bringing forward shortly the necessary orders to establish trusts at Foresterhill and South Ayrshire in April 1992 and at the Royal Scottish National hospital in April 1993.

The three units face a challenge, but one which offers the promise of improved patient care in their areas. Whatever political differences exist on policy, I am sure that hon. Members on both sides of the House will wish to offer them every support in that endeavour.

Mr. Donald Dewar (Glasgow, Garscadden)

There is no justification for what the Secretary of State is doing. Foresterhill, the South Ayrshire general hospital and the Royal Scottish National hospital should not be forced out of the main stream of the health service. It is a betrayal —a victory for prejudice over common sense. The Secretary of State has toed his party's line but undermined confidence in the health service. He is once more distancing himself from the people of Scotland.

The Secretary of State claims that opting out is in the best interests of patients. On what does he base that claim? Does he know better than doctors, nurses and the other health service staff whose life work has been delivering the service? Does the Secretary of State remember the response of the Grampian area medical committee, which expressed concern that the additional resources consumed by the trust will put at risk priority specialties such as psychiatry, geriatric medicine and physical disability?

The Secretary of State claims that the basis of opting out is to make hospitals more responsive to the local community. How can that be so when today's diktat is a contemptuous dismissal of the community's united protest? Did the right hon. Gentleman not canvass in Kincardine and Deeside'? How does he reconcile today's announcement with the fact that consultants voted against the opt-out scheme by 87 votes to two in Foresterhill and by 50 to nine in South Ayrshire?

Is it not reducing consultation to the level of farce when the responses to the consultation, together with the polling evidence, show overwhelming opposition? In Ayrshire this July, Systems Three found that four out of five of those polled were strongly opposed to the scheme. In Grampian, 80 per cent. of general practitioners gave it the thumbs down.

Does the right hon. Gentleman recall the promise of Bill Fyfe, chair of the Ayrshire and Arran health board: the decision rests and has always rested with the hospital doctors. It cannot be otherwise: self governing will happen only with the doctors' approval and only if they are convinced that patients will benefit. I do not mourn for Mr. Fyfe, but is he to be branded a dishonest man because of the Government's insensitivity in railroading through these unwanted applications?

Just a fortnight ago, on 14 November, Councillor Mike Hastie, who is the Tory leader on Aberdeen district council, was reported as saying that he could not believe that the Government would now push through the measures. In his view—I quote him precisely— it would be an act of sheer folly and I do not believe Mr. Lang is capable of that. He knows better now.

Does the Minister not recognise the dangers of fragmenting the health service and destroying the planning framework; the cost of ever-increasing bureaucracy; the reduction in choice for the doctor; the fear that this is a road that leads to a two-tier system in which money comes first and the Health Service is relegated to a safety-net, fallback provision?

In detail, will the Minister give the capital debt figure that will have to be shouldered by these three hospitals? What percentage of this, in each case, is public dividend capital and what percentage interest-bearing debt? Will he announce now the external financing limit for each hospital? Is he satisfied that the complications arising from the ownership of a large part of the Foresterhill site by Aberdeen university have been overcome?

It is a disgrace that the Royal Scottish National hospital at Larbert is included in this misbegotten scheme. A hospital dealing with the mentally handicapped is by no stretch of the imagination a candidate for the market mechanism. The postponement to 1993 simply to await the Government's belated funding of community care will overcome none of the difficulties.

Finally, may I make it unambiguously clear that Labour will reverse the decisions on these three hospitals announced today and will do so immediately after the general election? The policy is fundamentally wrong. It commands no support and will damage the Health Service. This is vandalism, all the more wounding because it is authorised by the Secretary of State who is supposed to protect Scotland's interests. The scheme will not survive this Government, and will, indeed, contribute to their downfall.

Mr. Lang

The hon. Member for Glasgow, Garscadden (Mr. Dewar) has not had the advantage that I have had of studying these applications with very great care, and it is quite clear that he has not addressed the issue in any great substance. He talks about the hospitals being forced out of the main stream of the Health Service. That is precisely the kind of distortions and misleading implications that he and his party have placed upon this exercise throughout the consultation process, which have led to so many people misunderstanding what it is all about.

It is hardly surprising that the national opinion poll carried out in Aberdeen showed that 75 per cent. of the people asked thought that it was about privatisation, and that in Ayrshire a Systems Three poll showed 74 per cent. thought that it was about privatisation or opting out of the health service, because the Labour party was putting about pamphlets saying such things as Now the Government is forcing our hospitals to opt out of the NHS. That is simply not true. We are not forcing them out of the NHS; they will remain in the NHS, and the services will remain free at the point of delivery. Indeed, I am persuaded that the central criteria against which I have had to measure these applications will be met, and that patient care will be advanced very considerably. Greater autonomy and greater local flexibility, greater local ownership and decision making, will be of advantage to the hospitals which are receiving trust status.

The hon. Gentleman asked me about the degree of support from medical staff. In the case of Foresterhill, all the main clinical departments have given their support to the proposal—a proposal that has been drawn up by a multidisciplinary team. In the case of Larbert, there has been support for the application from the Institute of Health Services Management, the Forth Valley college of nursing and midwifery and the National Board for Nursing, Midwifery and Health Visiting. In the case of South Ayrshire, there has been support from a majority of consultants in general surgery, orthopaedics and radiology. As for fragmenting the health service, that is not true. When the hon. Gentleman reflects on the fact that 97 per cent. of the services of the trusts will be purchased by the health boards he will see how self-evident is the nonsense that he talks about fragmentation.

The hon. Gentleman talked about a two-tier system. I have been looking at the Labour party document for health in Scotland, "A Prescription for Change". It says that Labour will continue devolution of management to unions within health boards. It will "devolve budgets" —[HON. MEMBERS: "To units."] Yes, to units. It will devolve budgets to units, giving them a significant measure of control over their own finances. The budget will be flexed in order to take account of work done. If we are contemplating a two-tier service, so is the Labour party. The fact is that we are contemplating not a two-tier health service but a better health service. These proposals will help to achieve it.

Mr. George Younger (Ayr)

Is my right hon. Friend aware—

Hon. Members

Is he a Member?

Mr. Speaker

Order. He is a former Secretary of State.

Mr. Younger

Is my right hon. Friend aware that in Ayrshire we are extremely proud of the new hospital which was built from start to finish within five years, a record for anywhere in the country? We expect it to produce even better services in the future. Will my right hon. Friend confirm that his announcement today means that the hospital will be under more local management than it was? Will he confirm also that it will remain entirely within the national health service and that anyone who needs treatment will get it, as now, free of charge?

In contrast to the irresponsible and negative remarks of the hon. Member for Glasgow, Garscadden (Mr. Dewar), whose responsibility in his party for destroying the consultation process is well known, will my right hon. Friend confirm that, in future, the objective of the new hospital will be to produce even better services? He can be assured, if that is so, that even those who disagreed with his decision will work together to make it a great success.

Mr. Lang

I am most grateful to my right hon. Friend. I agree entirely with absolutely every point that he has made so effectively. Among the benefits to patients that will be derived from trust status for south Ayrshire, I envisage the improved use of facilities, mainly theatres, enhancing cost-effectiveness, increasing throughput and reducing waiting times, upgrading the facilities at Ballochmyle and Biggart, as well as investment, for example, in a CAT scanner and a short-stay surgical unit, and perhaps in the longer-term investment in phase 2 being brought forward.

Those are some of the improvements that can be looked forward to at South Ayrshire under trust status. I entirely share my right hon. Friend's view that we are concerned about improving health care and benefits to patients, which I believe trust status at South Ayrshire will achieve.

Mr. Malcolm Bruce (Gordon)

Will the Secretary of State accept that there are those of us who have never made the point that trust status is about opting out of the national health service, but have said that it is about local accountability and the views of local people? Is it not also about turning a caring service into a business? Is not the Secretary of State misrepresenting the consultation process when he denounces the people who have submitted representations? Indeed, all the consultants, doctors, local health councils and general practitioners have expressed their opposition.

Does not the Secretary of State recognise that there is no confidence in the community in the type of managers he proposes to put in control of the trusts? He knows that they are regarded simply as Tory party stooges put there to do a job on behalf of central office rather than to represent the interests of the people. Will he accept that in a democracy, when people say no, they mean no?

Mr. Lang

That was an uncharacteristic and, I have to assume, an unintended attack by the hon. Gentleman on the present management qualities of the Foresterhill group of hospitals. I have a high regard for Foresterhill and what it has achieved in the last few years under this Government. The aims of the trust will be to build on the achievements, to become more responsive, to build a closer local link with the community and closer links with the health councils and with the GPs, to upgrade wards and facilities in the hospital, to upgrade theatres and equipment and to build on the success of recent years. Of course, it is about greater and more local accountability and greater flexibility—we have that in common—and that is what the trust will deliver. I am confident that the quality of the people who will be running it will be excellent.

Mr. Robert Hughes (Aberdeen, North)

Is the Secretary of State aware that his scandalous decision will be greeted by outrage not only in Aberdeen and the surrounding area by everyone connected with the medical and caring professions but by everyone right across the political spectrum in the north-east of Scotland, including the hapless Marcus Humphrey? Is he aware that his information is totally wrong and that nothing in the application shows that patient care and services will improve under the trusts? Is he not aware that every specialty at the Foresterhill site, with the exception of laboratory services, voted overwhelmingly to reject the trust? Is it not the case that the right hon. Gentleman's delay in coming to the House to announce his decision is because, when he looked at the facts, he was minded to reject the application but was told by the puppet master sitting next to him that he had to make a political decision?

Mr. Lang

I have taken the decision to approve the trusts. It was my decision. I was required to take it in accordance with the published criteria. When I was considering the applications from Foresterhill and others, I made it clear that I would not approve an application unless I was personally persuaded that the criteria would be met. I regard the most important criterion as an improvement in the delivery of patient care by the hospital in question. After the closest and most detailed scrutiny, I am absolutely persuaded that that will be achieved. I am perfectly happy to be judged on the performance of those trusts in the years ahead—[HON. MEMBERS: "You will be."] Indeed, I intend to remain very close to the development of the trust and to its inception on 1 April to ensure that all that has been promised will be delivered.

Sir Hector Monro (Dumfries)

Does my right hon. Friend agree that the structure of the health service in Scotland is somewhat different from that in England and Wales, and that our area health boards are very much closer to the hospital management than is the case elsewhere? How has my right hon. Friend come to judge the weight of opinion between those who wish to stay but to move forward into an area of ever better care in those hospitals against those who want a move into a future of some uncertainty?

Mr. Lang

My hon. Friend is absolutely right. The health boards in Scotland are very close to the hospitals, which is why I set considerable store by the approval that had been granted to the applications by the Grampian health board in the case of Foresterhill and by the Ayrshire and Arran health board in the case of South Ayrshire. Their approval and commendation of the applications has featured in my consideration.

My hon. Friend talked about the future, but we do not need to look into the crystal ball when we can read the book. Some hospitals south of the border already have trust status. In Yeovil, in the constituency of the leader of the Liberal Democratic party, the number of patients waiting for more than 12 months has been reduced by 45 per cent., and the total waiting list is down by 10 per cent.

Since April, that trust has received 53 letters of complaint and 1,344 letters of praise. I look forward to a comparable result for trust-status hospitals in Scotland.

Mr. Martin O'Neill (Clackmannan)

Does not the Secretary of State understand that the people in the Forth Valley health board area will greet his decision with great dismay, especially the families of the mentally handicapped patients in that hospital, who do not have a vote, could not be consulted and who are now greatly exercised by the prospect of being cast into the free market system? Does not the right hon. Gentleman realise that there will be outrage tonight in my constituency and in that of my hon. Friend the Member for Falkirk, East (Mr. Ewing) at his betrayal of the trust that has been placed in that hospital by the people in its care?

Mr. Lang

I am sure that the hon. Gentleman is wrong, because the consultants and management were unanimous in their support for trust status for Larbert. The possible developments that the trust could achieve include more emphasis on research, on training and education, on challenging behaviour, and on autism and brain damage. The trust contemplates many benefits for patients, including continuing the systematic assessments and the reductions in institutional accommodation, and has plans to break up the large wards and to increase the staff-patient ratio. Does the hon. Gentleman really want to set his face against the improvements that trust status could deliver?

Mr. Dennis Canavan (Falkirk, West)

How on earth can the Secretary of State justify his disgraceful decisions, particularly on the Royal Scottish National hospital in my constituency, where the application for trust status was opposed by virtually the entire community, the patients' relatives association and 96 per cent. of the staff? Is the Secretary of State so arrogant that he thinks that he knows better than the people who are actively involved in the care of the mentally handicapped? Is he so politically inept that he virtually signals to the people of Scotland that the only thing which will stop this arrant nonsense is the next general election, when he and his cronies will be swept out of power and the interests of patients will be put before political dogma?

Mr. Lang

If the hon. Gentleman sincerely believed that, he would not show so much artificial outrage. He ignores the views of the managers and consultants in the health service. I can understand why some in the medical profession express anxiety. They understand the status quo and do not like the uncertainty of change. There was a similar reaction when we reformed GP contracts, but now, with experience of the contracts, that anxiety is disappearing. There was anxiety about the terms and conditions of future employment. I can reassure the hon. Gentleman that the terms and conditions of junior doctors will continue to be negotiated nationally.

I see for Larbert the prospect of all the changes that I outlined in answer to the hon. Member for Glasgow, Garscadden (Mr. Dewar). If I did not believe that those changes would benefit patients, I would not have approved the application.

Mr. Bill Walker (Tayside, North)

Is my right hon. Friend aware that his decisions on these hospitals will be remembered by many? As on so many of the decisions taken in the past 12 years, such as the sale of council houses and other matters which the Opposition opposed, they have had to change their tune. They will do so on NHS trusts, with the passage of time. Will my right hon. Friend confirm that he will look equally thoroughly and carefully at any proposals from hospitals in Tayside?

Mr. Lang

Yes, I will. Indeed, other hospitals have expressed interest in growing and developing. I expect further applications to come in during the next year and, with time, a growing number of applications as the benefits are seen to come through.

Mr. George Foulkes Carrick (Cumnock and Doon Valley)

Did not Donald MacNeill, the chief executive-designate of the South Ayrshire trust, give the game away last week when he compared trust hospitals with those remaining within the mainstream NHS"? Is that not the truth? Are not trusts the first step towards privatisation? Will the Secretary of State confirm that there were 226 submissions in Ayrshire, 215 of which were against trust status, including 33 from medical, nursing and professional organisations? Why does he arrogate to himself the claim to know more about patient care than all those professionals? Is he not handing over public assets to a few of his Conservative cronies? That amounts to legalised theft and corruption.

Mr. Lang

The hon. Gentleman is characteristically over the top. I do not arrogate to myself a knowledge superior to that of the professionals, but I have had imposed on me the obligation to exercise a quasi-judicial function in assessing applications. I have done that after the most careful scrutiny. The hon. Gentleman mentioned the number of submissions. I have had more submissions than he said about South Ayrshire, but mostly they were tear-out strips from newspapers and from people who had been —

Mr. Brian Wilson (Cunninghame, North)

That is a lie!

Mr. Speaker

Order. I say to the hon. Gentleman, who is an Opposition Front Bench spokesman, that he must withdraw that comment.

Mr. Wilson

But it is true.

Mr. Speaker

In this Chamber we keep our standards. "Lie" is an unparliamentary word.

Mr. Wilson

The statement of fact is that there were 226 submissions —

Mr. Speaker

Order. I am not interested in that. Will the hon. Member withdraw that allegation?

Mr. Wilson

I want the opportunity to state the fact, in which case I will withdraw the statement.

Mr. Lang

The hon. Gentleman might have listened to what I said. I said that there had been substantially more submissions than the number he gave. The figure that I have is about 800 submissions, but most of them were tear-out strips from newspapers. I expect that the people who made them were influenced by the Labour party's "Standard No. 17", which was circulated among people in the area. It said: What would opting out mean? It would mean our new South Ayrshire hospital leaving the NHS as we know it and would pave the way for a two-tier health service in Ayrshire. It is precisely that type of distortion—misleading and alarming people—that has led to the public reaction. The trouble is that too many people in the Labour party are more concerned with scaring than with caring.

Mr. William McKelvey (Kilmarnock and Loudoun)

The people of Ayrshire will be bitterly disappointed by the Secretary of State's announcement from the Dispatch Box. However, they will not be surprised, because they know that, from the beginning, the consultative process has been an absolute rigged farce. It was undemocratic and the Government were not telling the truth when they said that they would look at all the submissions in a fair and honest manner. At least the Under-Secretary of State had the guts to say that at the Dispatch Box.

Putting aside the postcards that were sent to the Secretary of State, how many of the 226 written submissions were of the quality that he desired? Perhaps the five, six or seven which were in favour of trust status. The Labour party will win the next election. The South Ayrshire hospital will revert to its previous status. Managers of trust hospitals will be judged on their ability to manage and not as apparatchiks of a political dogma.

Mr. Lang

It is the ability of the proposed applicants to manage the trusts which has been borne in mind among the criteria that I have had to consider. As I said earlier, we are also able to look at the successes being achieved by other trust status hospitals elsewhere. In Kingston, for example, the list of those waiting more than 12 months has been reduced by 77 per cent. and 1,600 more patients were treated than was planned. In the Northern General hospital NHS trust, six new consultants have been appointed this year and 95 per cent. of patients surveyed are either "satisfied" or "very satisfied" with the service provided. That is my ambition for trust status hospitals in Scotland, and that is what I believe that we shall achieve.

Mrs. Margaret Ewing (Moray)

Does the Secretary of State for Scotland remember that on 16 March, in an interview published in The Press and Journal (Aberdeen), he said that the option for trust status existed if the local will were in favour? How on earth does he now reconcile that statement with the fact that he has ignored submissions from wherever they may have come, be it consultants or pensioners, GPs or the disabled, the elected district or regional councillors or Members of Parliament? Is it the case that he merely dismisses those submissions with which he does not agree and proceeds in an autocratic fashion?

How on earth is it that, in London, where teaching hospitals are so highly regarded, the issue of trust status has been postponed indefinitely, but in Foresterhill a key teaching hospital is being asked to take trust status? How much money has his Department spent in conjunction with the health board on those applications? How much money is being spent on future applications? How many are in the pipeline and how many are on his desk?

Mr. Lang

The hon. Lady will find the answer to her question about expenditure in a written answer which has been published in Hansard. She referred to some applications in London with which she is especially preoccupied. I have responsibility for assessing applica-tions in Scotland. I have assessed each application individually on its merits, carefully, against published criteria. It is by comparison with the published criteria and all the information available to me that I have reached a judgment. It would be quite wrong if I were to base my view solely on submissions from members of the public who have been unduly influenced by misleading information from other quarters.

The hon. Lady will know that there is an attractive £60 million new hospital in Elgin—the West Grampian unit —and that may well be among those expressing an interest in trust status in due course. I will give the same careful scrutiny to that application, if it reaches me, as I shall give to applications from Princess Margaret Rose orthopaedic hospital, from Lothian college of nursing, from the Victoria infirmary in Glasgow or from any others which express interest. I am concerned to ensure that we continue to build on our excellent record of improving health care in Scotland.

Mr. Nicol Stephen (Kincardine and Deeside)

What view did the Secretary of State take of the outcome of the Kincardine and Deeside by-election in reaching his decision? He will be aware that all five candidates in that by-election were opposed to the Foresterhill opt-out. Is the right hon. Gentleman aware that he is creating in Scotland a clear position of elective dictatorship? The situation is opposed by Conservatives in the north-east of Scotland and he is showing contempt for the people of the whole of Scotland. But he is taking one major step forward today, and that is a step towards the cliff of political oblivion for the Conservative party in Scotland.

What is to happen to the land and buildings owned by Aberdeen university on the Foresterhill site? Does the right hon. Gentleman intend to compensate or confiscate?

Mr. Lang

The hon. Gentleman raised that final issue as a scare during the by-election campaign—[HON. MEMBERS: "Answer."] The answer is that the ownership will remain the same. The health board's interest will transfer to the trust. No difficulty will arise over that. I must tell the hon. Gentleman that, as a new Member of Parliament, he should be more concerned with the possibility of improving the delivery of health care to his constituents. That is what I am concerned with, and that is how I have measured the application.

The hon. Gentleman referred to the Kincardine and Deeside by-election, in the campaign for which he said in his special health service circular: Opting out is a dangerous first step towards market economics and privatisation of our health service. I know, and I hope he knows, that that is not true. Indeed, his party leader, the right hon. Member for Yeovil (Mr. Ashdown) said: I do not believe that the…Government's…intention is, or ever has been, to privatise the health service. Indeed, I believe that those who insist on scaremongering have done the Mselves and the NHS no good by concentrating on the 'privatisation' scare. If the hon. Gentleman will not listen to me, perhaps he will listen to his party leader.

Mr. Brian Wilson (Cunninghame, North)

Will the Secretary of State now recognise that his unworthy but all too predictable statement that the 226 representations on the south Ayrshire opt-out included newspaper forms was in direct contradiction of veracity? Will he further recognise that his announcement today, while totally predictable—nobody ever believed that a genuine consultation process was taking place—represents one of the final death knells for the discredited band of brigands who represent the Scottish Conservative party?

Does the right hon. Gentleman appreciate that, in Ayr alone, the Conservative party is already being torn apart? Does he further appreciate that, throughout Ayrshire, people recognise that any additional assets that are poured into the South Ayrshire hospitals to make them work will be at the expense of the national health service in the rest of Ayrshire?

Does the right hon. Gentleman mercifully recognise that none of this will come to pass because, within days of this misguided, ideological order—introduced at the behest of the arch-agent of prejudice sitting beside him, the Minister of State—coming into being, there will be a change of government and none of it will happen? Will he also recognise that I have never believed that there are no Tories in Scotland, for one Tory has spoken for Conservative respectability in Scotland, and he is the hon. Member for Dumfries (Sir H. Monro)? The further the Government depart from that line, the more their fate is sealed, and the more richly that fate is earned.

Mr. Lang

I give the hon. Gentleman the benefit of the doubt and assume that he did not hear what I said, not once but twice, perhaps because of the noise coming from his hon. Friend the Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes), seated beside him, who referred to 236 admissions. I said that I had had rather more than that, and I referred to having had about 800, the large majority of which were tear-out newspaper slips, and a large majority of those would have been influenced by the leaflet, the Labour party "Standard", with its misleading, scaremongering, alarmist nonsense.

Surely the hon. Gentleman, as an Ayrshire Member, is interested in a trust that may be able to upgrade the facilities in the hospitals in the trust. Surely he is interested in a trust that is willing to carry out further investment, keen to achieve the further development of a quality programme involving multi-disciplinary, quality action groups. Those are the tangible improvements in health care that can be achieved by trust status. The hon. Gentleman should withhold judgment and hope that I am right, and that we shall succeed in achieving those results.

Mr. Alexander Eadie (Midlothian)

Is the right hon. Gentleman aware that today's statement clearly shows that he is a prisoner of the right wing of his political party, which is responsible for the demise of his party in Scotland? Is he aware that his announcement today is not a triumph for the philosophy of trusts but a blow against democracy, consultation and the will of the people? Does not he realise that, in making his announcement, he has, to some extent, signed his political death warrant?

Mr. Lang

No, I do not, because I believe that the electorate will judge by results and that, even before the trusts are up and running, they will begin to see the benefits that will flow from the trusts. The hon. Gentleman said that my statement was a blow against consultation. There was a three-month thorough consultation period for each specific trust, during which detailed application forms were sent out extensively. In the case of Larbert, they were sent out to every applicant who sought them. I have looked carefully over a period of weeks at those applications, and have reached the view that they deserve to be granted.

I am proud to be a member of a Government who have increased health spending in real terms since 1979 by nearly 40 per cent., treated 900,000 more people in Scotland last year than in the year in which we came into office, increased the number of nurses by more than 9,000 and now pay them 41 per cent. more in real terms than when we came into office. The hon. Gentleman should look back at the Labour party's record in government before he starts to criticise ours.

Mr. John Marshall (Hendon South)

May I congratulate my right hon. Friend on ignoring the scaremongering campaign conducted by Opposition Members? Is he aware that a similar campaign was carried out by the hon. Member for Livingston (Mr. Cook) against trust hospitals in England, which have now delivered more patient care, cut waiting lists and been innovative in the service that they offer to patients? Is he surprised that the hon. Member for Livingston now spends less time talking about trust hospitals than producing racing tips for the Glasgow Herald? Moreover, is not the hon. Gentleman equally bad at both?

Mr. Lang

All I can say on that is that, as regards the delivery of patient care in the areas from which we have received trust applications, we are on to a winner.

My right hon. Friend represents a seat in the south and he will know that the Guy's and Lewisham NHS trust intends to improve the pay of more than 1,200 lower-paid workers by 6 per cent., and that it will treat some 6,000 more patients than planned. There are many other examples of health trusts in England that are already up and running a year ahead of those in Scotland, from whose experience we can benefit. We can draw considerable encouragement from the improved quality of their health care.

Mrs. Maria Fyfe (Glasgow, Maryhill)

It is interesting that the Secretary of State does not claim that he has a majority of public opinion on his side but merely that the very large majority against trust status was ill informed and listened to Labour propaganda. Can the Minister assure the House that, if a general election goes against his wishes and people cross their ballot papers having been influenced by Labour propaganda, he will accept that result?

Mr. Lang

Of course I will accept an election result, as anyone would. That is rather a silly question on such an important occasion. If Labour Members abandon the trusts, which, from the terminology that I have quoted, are so close to their own policy, would they but acknowledge the fact, it is not the Conservative party that would be the loser but the delivery of patient care in Scotland.

Mr. Gavin Strang (Edinburgh, East)

Is the Secretary of State aware that his disgraceful announcement will add to the fear in Edinburgh at the suggestion that the Princess Margaret Rose hospital might also be granted trust status? Is he aware that that hospital was threatened with closure because of the Government's underfunding of the service in Lothian and that it now seems to be faced with a choice of closure or opting for trust status? Is it not a measure of the damage that the Government are prepared to inflict on the health service in Lothian that, having closed the internationally famous Longmore hospital, they are now prepared even to close the Princess Margaret Rose?

Mr. Lang

No, the hon. Gentleman is wrong. It is not because the Princess Margaret Rose hospital was threatened with closure. If that were the case, no trust application would be acceptable and none would be considered.

Mr. Ian Bruce (South Dorset)

Using his budget, will my right hon. Friend be able to afford to get a bus to take hon. Members down to my constituency in south Dorset to see the results of trust status? Two years ago, I felt exactly the same as my hon. Friend the Member for Dumfries (Sir H. Monro) and was worried about the health service policy that we were introducing. It is about time that Scotland saw the results, so that it does not miss the bus on this issue.

Mr. Lang

I am most grateful to my hon. Friend, and I am absolutely sure that we can draw considerable comfort from the experience of hospitals in England. I am also confident that the trust hospitals where applications were approved today will soon be able to demonstrate for themselves the benefits to patients.

Mr. Alistair Darling (Edinburgh, Central)

In the light of his announcement this afternoon, will the Secretary of State confirm that any hospital that expresses an interest in opting out will be granted its wish at the end of the day, and it will not matter what the public, doctors, nurses or anyone else thinks? The minute an application is made to opt out, the hospital is as good as opted out. That being the case, will the Secretary of State confirm that the Princess Margaret Rose hospital in Edinburgh will be the next opted-out hospital?

Mr. Lang

No, of course I cannot confirm that, because I have not yet seen an application from that hospital. When I do, I shall first want the view of Lothian health board, which I expect to have investigated the matter thoroughly, and I shall then wish to examine the application myself. I would not wish to deny the people of Edinburgh the benefits of trust status if any application that reached me contained demonstrable advantages.

The hon. Gentleman talks about the lack of medical support. Perhaps he did not hear me state that the heads of all the main clinical departments at Foresterhill hospital have given their support and that, in south Ayrshire, the majority of consultants in general surgery, orthopaedics and radiology have also done so. It is evident from the second wave of applications in England that there is a growing groundswell of support from consultants as they begin to realise the benefits of trust status.

Mr. Nigel Griffiths (Edinburgh, South)

Does not the Secretary of State realise that his chilling announcement today will send a shiver of fear down the spine of every patient in Scotland and most doctors, nurses and health staff? If he is so confident in the public process, why does he not publish the full business plan, so that we can all see it? Why does he instead take his decisions in the bunker of St. Andrew's house, surrounded by acolytes who do not represent anyone in Scotland?

Mr. Lang

This canard about lack of information has been running throughout the consultation process. Applications have been readily available in great detail, the contracts will be available for public inspection, and the annual accounts of the trusts will be published in the same way as annual accounts of health boards are published. It is nonsense for the hon. Gentleman to claim that he is not getting enough information. The most convincing argument for the hon. Gentleman should lie in the results. I am persuaded that they will improve dramatically and that there will be a continuing flow of good news and benefits for patients from the trust applications.

Mr. Archy Kirkwood (Roxburgh and Berwickshire)

Will the Secretary of State accept that, whether the decision is right or wrong, there is a strong argument for hastening slowly, so that people can evaluate the optimistic claims that the right hon. Gentleman has made for trusts this afternoon? Therefore, will he give a guarantee that the next wave will be discouraged for at least three to five years, so that the experiments can be properly evaluated?

Mr. Lang

I am sorry about the hon. Gentleman's reluctance to enable the benefits of trust status, if available —as I believe they will be—to flow through to others. The hon. Gentleman can hardly accuse us of moving too fast. First, we are a year behind England; secondly, I am approving two applications for implementation in 1992 and one for implementation in 1993, as compared with 156 or 157 applications that have already been approved in England. That is a sensible pace, which I expect to accelerate. I think that more applications will be submitted as the benefits of trust status become apparent to more people.

Mr. John McAllion (Dundee, East)

The Secretary of State has told the House that statutory public consultations were carried out in all three of the applications, and that, in three out of three of the consultations, public opinion was totally ignored. On Tayside, local NHS staff and patients, and local people, are totally opposed to a local management proposal to consider allowing Ninewells, Dundee royal infirmary and King's Cross hospitals to opt out of health board control. Since Tayside people now know that their view will be equally ignored by the Government, will the Secretary of State confirm that the only option that remains for Tayside is, at the next general election, to kick out the two remaining Tory Members of Parliament in Tayside who have given him such servile support this afternoon?

Mr. Lang

I am sorry that the hon. Gentleman is not prepared to consider any possible improvements or changes of any kind to the health service. The reality is that every change that we have introduced in the health service during recent years was attacked or criticised, or caused concern, when it was originally announced. But, step by step, as each of them has been implemented, the benefits have begun to become apparent and are now apparent in increasing numbers, many of which I have already outlined to the House—including the increase in the number of patients treated, shorter waiting lists, more nurses and doctors, better pay and 74 major new hospital developments completed, with 7,500 extra beds, 19 under construction and 18 at the planning stage. That is evidence of our commitment to the health service. Had we not believed that trust status would lead to a genuine advance in patient care, we would not have embarked upon it.

Dr. Norman A. Godman (Greenock and Port Glasgow)

Why does the Secretary of State so flagrantly disregard the principles and good practices of genuine consultation on matters of this kind? May I remind him that, many months ago, the overwhelming majority of consultants at the Inverclyde royal hospital completely rejected the concept of opting out? Therefore, the right hon. Gentleman's disreputable approach to consultation is not at all welcome on the lower Clyde. If, in the few months left to him, he brings that shabby approach to consultation to the lower Clyde, one result will he the doubling of the majority of my hon. Friend and neighbour the Member for Renfrew, West and Inverclyde (Mr. Graham).

Mr. Lang

What I think is a shabby approach to consultation is to mislead and alarm people with distorting statements printed in party literature, circulated to cause concern, fear and anxiety, and then just to count the number of tear-off slips or pre-printed postcards that have been circulated. Consultation involves weighing as well as counting the advice that is sent in. I have carefully weighed the advice against the published criteria, and I am completely persuaded that the trust applications will improve health care in Scotland. If I had adopted the same closed mind that the Opposition have, the health service, instead of advancing as it has done all these years, would be retreating.

Mr. Alex Salmond (Banff and Buchan)

When the Secretary of State witnessed the stampede of English Tory Members from the Chamber which delayed his statement, was he not embarrassed by the fact that he depends on their votes to ram his policies down the throats of the Scottish people? How can he start a consultation exercise saying that he will abide by the popular will in the north-east of Scotland and end up by ignoring, distorting or rigging the outcome? Does he accept that there is one popular consultation which he will not be able to rig because, long before the damage is done to the hospitals, the political damage to the Secretary of State for Scotland will be terminal?

Mr. Lang

Something that the hon. Gentleman may never learn is that being in government is about taking decisions, making choices and being judged by them. I am willing to be judged by my approval of the applications and by what I believe will be the improved delivery of health care in the north-east of Scotland. I hope that, when that is proved, the hon. Gentleman will be sufficiently embarrassed— to use his word—to come to the House and apologise.

Mr. James Wallace (Orkney and Shetlands)

The Secretary of State did not respond to the request of the hon. Member for Edinburgh, South (Mr. Griffiths) for the publication of business plans for the various hospitals. Will he secure the publication of the business plan for Foresterhill? Can he confirm the rumours circulating in Grampian and the Isles that some capital sum would be made available to Foresterhill if it opted out? If so, will that money come from other parts of the Scottish health service budget? Does he accept that the court of Aberdeen university has been told that it is not an option for it to carry on as it has done before? Is the right hon. Gentleman deaf to what has been said to him?

Mr. Lang

On the contrary: I have paid great attention and care to what has been said to me. It will be for the trusts to decide what details of their business plans they can publish, but there will understandably be an element of confidentiality.

As to the apportionment of resources, the health board will continue to have the statutory obligation to ensure the delivery of health care in its area. It will enter into a contract with the trust,, and I will be responsible for approving the trust's external financing limit. That exercise will be conducted in a responsible and sensible way, to ensure the delivery of improved patient care not only through trust hospitals but in all the other areas for which the health board will remain responsible in Grampian.

Mr. Andrew Faulds (Warley, East)

rose—

Mr. Speaker

Was the hon. Gentleman present for the statement?—[HON. MEMBERS:"Yes"] All right—I know.

Mr. Faulds

I am surprised that you, Mr. Speaker, have not heard me in the Chamber.

Mr. Speaker

I have—that is the trouble.

Mr. Faulds

I am most grateful.

Will the Secretary of State attempt to be honest? Will the projected changes have the support of the public in Scotland?

Hon. Members

No.

Mr. Lang

In due course, they will.

Sir Nicholas Fairbairn (Perth and Kinross)

rose—

Mr. Speaker

Order. As the hon. and learned Gentleman has listened to the answers, I will call him to put his question.

Sir Nicholas Fairbairn

Given that I have been branded —within your parliamentary authority, Mr. Speaker—a "brigand" by the hon. Member for Cunninghame, North (Mr. Wilson), and as "subservient" by the hon. Member for Dundee, East (Mr. McAllion)—which I would not have thought was one of my more obvious characteristics; and having within the authority of the hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes)—

Mr. Speaker

Order. The hon. and learned Gentleman surely means within my authority, and I do not want him to be branded with a reputation for being long-winded.

Sir Nicholas Fairbairn

The hon. Member for Carrick, Cumnock and Doon Valley suggested that the present bureaucracy was guilty of theft and corruption.

Mr. Foulkes

Correct.

Sir Nicholas Fairbairn

Will my right hon. Friend confirm that the biggest theft and corruption occurred when bequests to the national health service were spent on things for which they were not bequeathed? Will he tell Opposition Members why he thinks that it is better that money should be spent on the bureaucrats running hospitals and not on those who deserve to receive proper treatment in them?

Mr. Lang

I entirely agree with my hon. and learned Friend's last point. One of the benefits of trust status will be that management will be much closer to the point of delivery and more flexible, and that there will be closer local contact with the community being served. That will reduce bureaucracy and allow more money to go straight to the point of patient care.

Mr. Sam Galbraith (Strathkelvin and Bearsden)

The Secretary of State failed to answer several important questions asked by my hon. Friend the Member for Glasgow, Garscadden (Mr. Dewar), so I will repeat them. What is the originating capital debt of each of the three institutions? What percentage will be interest-bearing debt, and what percentage will be public dividend capital? When will the Secretary of State announce the external financing limits for all three?

The Secretary of State spoke of the promised improvements in opted-out hospitals. Is it not the case that such improvements are available anyway, and are not dependent on a hospital opting out? Is it not the case also that opting-out hospitals simply restrict patient and doctor choice, waste resources in an acute bureaucracy, and create a two-tier health service?

I make it clear once again that the incoming Labour Government will immediately return those hospitals to the people of the country and to their health boards. Health care will once again be about treating patients, not perpetrating outdated dogma, as is the case with Government policy.

Mr. Lang

The hon. Gentleman asked a number of financial questions, which will be resolved and to some extent announced as the public expenditure round is completed and the health budget announced. As to general policy, on 13 June the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) was quoted in the Glasgow Herald as saying: The increased funding to which we are committed will be used to create a reserve at health board level which can be released in the course of the financial year to those hospitals who have out-performed and delivered high activity levels in the priority areas. That is a dramatic departure from the image that Labour seeks to project. It is the image of a party that is determined to create some kind of two-tier health service. We are committed to delivering a better health service, in which trust status will pay an important part.

am confident that that will be achieved from greater local ownership of the decision-making process and resource allocation and from greater autonomy and flexibility. I have no doubt that residents of the areas to be served by the trusts will be the beneficiaries in the years ahead.

Mr. Tom Clarke (Midlands, West)

On a point of order, Mr. Speaker.

Mr. Speaker

Was the hon. Gentleman seeking to put a question?

Mr. Clarke

A question, yes. I did not seek to catch your eye, Mr. Speaker, because I had not heard the statement, but I was here before the hon. and learned Member for Perth and Kinross (Sir N. Fairbairn).

Mr. Speaker

It is a bit late, but I will call the hon. Gentleman, although it does make life difficult for the Chair.

Mr. Clarke

Given the Secretary of State's quite outrageous answers this afternoon, may I ask two questions? First, among the tragic decisions that he has announced, does he not realise that there will be great sadness, to say the least, about his decision on Larbert, which will affect mentally handicapped people and people who have no advocates? If he accepts that community care will be postponed until 1993, why does he not at least postpone that decision?

Secondly, when the right hon. Gentleman crows about the success of trusts in England, why does he not take on board the evidence that has been given to the Select Committee on Health, on which I have given many hours of membership? Does he not accept that that is a shambles that he should not be seeking to inflict on the people of Scotland?

Mr. Lang

I shall not repeat all the benefits expected for the Larbert trust. As the hon. Gentleman was not present at the beginning of my statement, he will no doubt read them in Hansard. He says that there is no support for the application. I listed a number of bodies that support it, and said that all the management and consultants do so. In addition, positive comments have been made by the Greater Glasgow health board and, following the consultation, Forth Valley health board has endorsed the application. They expressed confidence in their professional support, their management teams and their strategic skills.

For the reasons that I gave in my statement, which again the hon. Gentleman will have to read in Hansard, the application is being approved, but deferred until April 1993. I am confident that it too will be able to deliver improved benefits. I do not think that it would be right to deny those benefits to those suffering from mental handicap.