NHS Trusts (Hansard, 18 June 1991)

§ 3. Mr. Buckley
To ask the Secretary of State for Health if he will make a statement on his projections for the future activity levels of NHS trusts.

§ The Secretary of State for Health (Mr. William Waldegrave)
I expect further significant growth in the activity of national health service trusts roughly in line with increased activity across the NHS as a whole.

§ Mr. Buckley
Does the Secretary of State realise that those who run, work in and use the national health service see no benefit from the introduction of hospital trusts? Does he further realise that those who work in the NHS consider that the job losses that are occurring as a result of the introduction of hospital trusts will have a direct bearing on patient care to the detriment of the service? Does the right hon. Gentleman consider all that to have been a satisfactory outcome of the implementation of the Government's hospital trust policy? Does he further consider—[Interruption.]

§ Mr. Speaker
Order. The hon. Member is about to ask a third question. I think that is enough.

§ Mr. Waldegrave
The hon. Gentleman is completely wrong. More than 100 new applicants for trusts are coming along, supported by many thousands of senior clinicians and managers in the health service. My constituents are served well by a trust and I know the workings of the trust well. The scares that have been handed to the hon. Gentleman to get him to join in our questions on the subject today are quite off the beam.

§ Mr. Nicholas Winterton
I thank my right hon. Friend for deciding that NHS trusts should make public their business plans. That decision will be widely welcomed. Will he give an assurance that the specialist department in the Department of Health will scrutinise more adequately the financial plans of potential trusts and ensure that their projections of income and expenditure are accurate and are based on fact, not on assumption?

§ Mr. Waldegrave
Detailed projections for a year ahead are always likely to be false, in some cases because of the allocations that are made later in the year. So there is no way in which those making proposals in July and August can exactly describe the financial situation the following year. However, I agree with my hon. Friend that we must examine all applications with great care, as we did last year.

§ Mr. Kennedy
As there was no reference in the Conservative manifesto to setting up trust hospitals and as the results of every local referendum on the issue have been overwhelmingly in one direction—against them—although they have been ignored by the right hon. Gentleman, does he agree that when it comes to phase 2 of the trusts, it would be sensible to learn the lessons of the first wave and allow the matter to be put to the test at the next general election, before any more trust hospitals are established?

§ Mr. Waldegrave
The hon. Gentleman's difficulty is that throughout the country local Liberal parties have taken a completely different line. That is not surprising, as many Liberals have supported trusts. The hon. Gentleman 133 tries to maintain a uniformly negative position from here, even though that position is not supported by many of his party's members.

§ Mr. Wolfson
Will my right hon. Friend confirm that when taking a view of trust applications, he will not always be looking merely at trusts that are currently in a good financial state but will encourage others to take NHS trust status to improve their financial position in the future?

§ Mr. Waldegrave
My hon. Friend puts his finger on an important point. The improved management that we obtain from NHS trusts is necessary in places where there may be problems. That is why I am delighted with the improved management at, for example, Guy's and Lewisham, because everybody knew that for many years there were problems there.

§ Mr. Robin Cook
Further to the point of the hon. Member for Macclesfield (Mr. Winterton), does the right hon. Gentleman recall that a surplus was forecast when he approved the application from Bradford? By last month Bradford was forecasting a deficit and by last week it had announced the closure of 13 wards, including the special care unit to which my hon. Friend the Member for Bradford, West (Mr. Madden) referred. Why were none of those service closures included in the consultation document published less than a year ago—or was that also one of the biggest lies since the ancient Greeks? If the Minister did not know when he approved that application that approving Bradford as a trust would lead to those closures, will he now halt the second wave of opt-outs until he can tell us what went wrong with the first wave?

§ Mr. Waldegrave
I liked the word "also". If the hon. Gentleman will think about the implication of his words, he will realise that he has just acknowledged that what he stated in his leaflets is untrue—as I think he very well knows. I am sure that the hon. Gentleman has studied the report of the Select Committee, which discussed these matters more seriously than the hon. Gentleman has done today. It is obvious that ahead of the allocations produced last December, it was impossible to produce a detailed cash flow for a hospital for the next year. What I had to adjudge—as I shall have to do again in respect of the second wave—was whether the management were capable of dealing with the problems in the hospital. Labour is getting wholly left behind on this, as on other things.
There will be a major second and third wave of trusts and that will be the pattern of hospital management for the future.