HC Deb 19 June 1991 vol 193 cc281-3
6. Mr. Strang

To ask the Secretary of State for Scotland what is his policy towards hospitals opting out of health board control; and if he will make a statement.

16. Mr. Robertson

To ask the Secretary of State for Scotland what steps he is taking to strengthen the present arrangements for consulting the local community and the staff of any hospital contemplating trust status.

The Secretary of State for Scotland (Mr. Ian Lang)

NHS trust status bestows a number of benefits, foremost of which is that it provides the opportunity for improved patient care through the delegation of responsibility to a local trust board.

The Government have made it clear that we value an input by the public into the application process, and arrangements for consultations are laid down in the National Health Service Trusts (Consultation Before Establishment) (Scotland) Regulations 1991. Those provide for wide-ranging consultation.

Mr. Strang

Does the Secretary of State appreciate that opposition to this policy in Scotland is intense and widespread? We saw what happened in England when hospitals opted out. At Guy's and Bradford hospitals entire specialties have been closed, and hundreds of jobs are to be lost. If jobs are to be lost on that scale in an opted-out hospital, there is bound to be a reduction in the range and quality of services provided. Why does not the Secretary of State have the courage to call a halt to the proposals before they damage the health service in Scotland?

Mr. Lang

I am sure that the House will agree that it is far too soon to judge the success of trust status developments south of the border. I venture to suggest, however, that if Guy's hospital had enjoyed trust status for some time, it might not have had to face the problems that it has experienced recently.

The purpose of trust status is to improve the quality of health care and the delivery of health services. Trust status hospitals will remain in the national health service, and will continue to treat NHS patients free of charge. I believe that they will be to the advantage of health care in Scotland.

Mr. Robertson

Will the Secretary of State guarantee to abide by the outcome of the consultations on local opinion that will form part of this exercise? Or will we see the same process that we saw in England and Wales, with a decision being made in advance and rammed through despite the recording of virtually unanimous public opinion in the process?

Mr. Lang

I assure the hon. Gentleman that I will make the final decision as a consequence of the consultation process, which is a key part of the exercise. It is laid down in statute and provides for criteria that will be applied. Detailed guidance has been issued, and the process will take place over a substantial period.

Mr. Robert Hughes

Will the Secretary of State reflect on the nonsense that has been talked about the benefits of opting out? He says that the hospitals involved are simply being returned to local control, but in effect he is saying that Grampian health board, for instance, is completely unrepresentative, and incapable of running the health service in Grampian. He describes competition as benefiting the health service, but how can that be so when there is a guaranteed monopoly of supply in the Grampian region? Why not leave things alone? They are working pretty well as they are.

Mr. Lang

I am glad to hear the hon. Gentleman's expression of approval for the quality of the health service in Scotland, which was not reflected in some of the earlier comments made by his hon. Friends.

Grampian health board supports the trust concept, so I do not think that the hon. Gentleman can pray the board in aid. One of the merits of trust status is the fact that key decisions would be made locally without bureaucratic procedures and delays. The hon. Gentleman should look for the positive advantages, instead of approaching trust status with a closed mind.

Mr. Graham

Does the Secretary of State realise that "opt-out" has become a dirty word in Scotland, just as "Tory" has become a dirty word? Will he give us an assurance that TV detector vans will stop hounding and harassing long-term elderly patients in hospitals? Will he call a halt to that despicable practice?

Mr. Lang

I am not sure what that has to do with trust status, but I can reassure the hon. Gentleman that for every pound spent by the last Labour Government on health provision in Scotland, ³4 is being spent now, and there are 1,300 more doctors and dentists and 7,500 more nurses and midwives in the Scottish health service now than there were when we came into office.

Mr. Bill Walker

Is my right hon. Friend aware that general practitioners in Forfar, and those who work in hospitals there, are disappointed not to be able to proceed immediately to self-governing status? Nevertheless, they welcome the announcement by my hon. Friend the Minister of State that Forfar is to have a new all-purpose community hospital. We have waited 25 years for that hospital, but the health board has failed to deliver.

Mr. Lang

I am grateful to my hon. Friend. Positive and constructive thought has certainly been given to the possibility of trust status in the Forfar area. An imaginative concept was presented by GPs in the area, but, as my hon. Friend knows, certain financial and service implications caused us to decide that it should not be implemented. That is not to say that other more interesting and practicable propositions will not be advanced.

Mr. Dewar

Does the Secretary of State recognise that all his talk of consultation has a hollow ring, given that his colleague the Minister is driving ahead with these schemes irrespective of medical and public opinion?

Will the right hon. Gentleman give his personal attention to the case of South Ayrshire general hospital? He is supposed to believe in consultation. Is he aware that not only have the consultants voted against trust status by 50 votes to nine, but general practitioners in the area have now opposed it by 194 votes to seven? Can he doubt that there is also strong opposition among members of the public? Why is he allowing a determined but small group of perhaps politically motivated men to hijack the hospital? Is it not time that he ended the uncertainty, listened to what is said in the consultation process and stopped the application?

Mr. Lang

On the one hand, the hon. Gentleman calls for more consultation, and on the other he tells me to stop it short and end the whole process now. The whole point about consultation is that it will enable us to hear a range of views and arguments on what are complex and diverse issues and not such as can be reduced to simple ballot. We shall look at the merits of the arguments advanced over a measured period of time in the light of the criteria that we have set down and published, and then we shall reach a decision.