NHS Trusts

HC Deb 16 October 1991 vol 196 cc311-28 3.30 pm

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

I will, with permission, make a statement about national health service trusts.

On 4 December 1990, I reported to the House that I had received 66 applications from hospitals and other units wishing to operate as NHS trusts from 1 April 1991, and that I was able to establish 57 of these as the first-wave trusts.

The decision to pursue trust status was one which the managers and the clinical staff in those units took for themselves. Hon. Members will recall that, in the great majority of the 57 first-wave trusts, most of the consultants expressly supported the applications.

The experience of the first-wave trusts confirms the confidence which was shown by the managers and professional staff, who recognised the benefits to be gained from putting management responsibility back where it ought to be, in the hospitals themselves. Many of my hon. Friends have constituencies, as I have, which are within the catchment areas of trusts. They will know, as I do, that it is easy to find examples of the new, devolved arrangements improving care for patients.

I will give just four kinds of examples out of the many which are available. On waiting lists, the Royal Liverpool university hospital trust now sees 90 per cent. of all its patients within 10 months—one of the best performances in the country. On activity levels, the Freeman hospital trust in Newcastle has treated 4,700 more patients in the first five months of this year compared with last. On front-line recruitment, the East Gloucestershire trust is to recruit an additional seven consultants to meet growing demand for its services, and the South Devon trust is recruiting an extra 55 nurses and midwives. On improved quality, the Norfolk ambulance trust has speeded up its training programme for paramedics and aims for a target of 24 paramedic teams for its ambulances each year.

Independent surveys—for example, by the consultants Newchurch—quoted warmly last year by the Opposition spokesman, the hon. Member for Livingston (Mr. Cook) and by The Sunday Times—point to the same conclusion, that the trusts are improving their performance, treating more patients and cutting waiting times. A British Medical Association survey published this week has also shown increasing consultant support for trusts. This has strengthened our commitment to the trust programme, through which more and more NHS patients can benefit from the clearer and simpler management structure which trust status gives to hospitals and other services. I was glad therefore to receive applications from 113 hospitals and other units—double the number of first-wave trusts—wanting to become trusts in the second wave from 1 April 1992.

I have considered all these applications very carefully and assessed them against the same criteria that I used last year. Each one has been the subject of a full public consultation. As a result, I have decided today to establish 99 hospitals and other units to operate as trusts from April 1992. The details are available in the Vote Office and have been placed in the Library.

In addition, I have agreed to approve applications from the four London teaching hospitals in the second wave. As the House will know, I have recently Commissioned Sir Bernard Tomlinson to act as my adviser on health services in London, supported by a high-powered team. It is obvious that he may have recommendations to make which would affect the shape of the London teaching hospitals. In order to allow the four new London teaching hospital trusts to develop their plans with the benefit of Sir Bernard's advice, I have therefore decided to delay the date on which they become operational until April 1993. However, I have asked the NHS Management Executive to establish devolved management in these hospitals at the same time as the other trust boards are established. In this way, these four great hospitals will get as early as possible the benefits of devolved management.

Seven other units have the potential to become successful NHS trusts, but I have not felt able to establish them in the second wave. I am sure that they will benefit from having longer to develop their applications and I hope that they will reapply next year. A further three units have withdrawn their applications from 1992. However, I can tell the House that I have today agreed that 153 expressions of interest from hospitals and other units may be pursued for the third wave, starting in 1993. I have also made this list available in the Vote Office and placed a copy in the Library.

All trusts are accountable to me through the NHS Management Executive. I have now asked the Management Executive to strengthen and expand its monitoring arm in order to ensure that the growing number of trusts remains fully accountable to the centre. This will be done without increasing overall NHS administrative numbers.

The campaign against trusts and against devolved management fostered by the Opposition has failed. Throughout the NHS, as the British Medical Association has confirmed, there is increasing recognition of the benefits which trust status brings. My statement today is good news for the national health service and good news for its patients. After next April, when the new trusts which I have announced today will begin operating, more that one third of all NHS hospital and community health services will be in the capable hands of trusts.

Despite a truly scurrilous campaign by the Opposition parties, no informed observer can now doubt that trusts represent a necessary modernisation and simplification of NHS management, which is already proving itself good for patients, good for staff, and good for the country. It is a tribute to their commitment to the NHS that so many doctors, nurses and managers have put so much work into preparing the applications that I have been able to approve today.

Mr. Robin Cook (Livingston)

The Secretary of State will be aware that today's announcement follows three months of consultation. Does he recognise that his statement today makes a farce of that consultation? If not, why has he approved the application from Burnley after a local opinion poll found that local people opposed it by 4:1, and why has he approved the application from East Birmingham after the staff who work there voted against it by 9:1? Does he even know that, out of 21 ballots of all staff in hospitals on his list, not one was in favour of the trust status?

Why does the right hon. Gentleman think that he knows better than local people what is good for their hospitals? Is it not just possible that local people are right when they oppose their local health service being broken up; that local health staff are right to worry about what happens when their hospitals have to compete against each other in a market, not co-operate in a public service?

The Secretary of State claims—[Interruption.] Conservative Members may be able to shout down the voice of opposition, but they will find that they will not be able to shout down the voice of the electors when they come to vote. The Secretary of State claims success for existing trusts. Is he aware that trust hospitals are already in deficit in London, Leeds, Liverpool, Southend, Sheffield, Crewe and Manchester? The right hon. Gentleman quoted the Newchurch survey. Is he not aware that that very survey concluded that, without extra money, trusts will have to cut patient care?

Mr. Roger Gale (Thanet, North)

The public do not believe you.

Mr. Cook

On the contrary. The hon. Gentleman's problem is that the public do not believe him.

The Secretary of State quoted the Freeman hospital in Newcastle as a success story. He cannot be aware that yesterday that hospital's top heart surgeon said that there should be an end to trusts, the market is essentially inefficient, and the NHS is being systematically privatised. That, from the very hospital that the right hon. Gentleman quotes as a success story.

In the face of all the evidence from the first wave, how can the Secretary of State justify taking the risk of putting 99 other hospitals into the same unproven market? Would it not be much more responsible to halt the second wave until the right hon. Gentleman has worked out answers to some of the problems that arose in the first wave?

Is the Secretary of State aware that he himself has ensured that most comment will focus not on the hospitals that he has included but on the four London hospitals that he has put in the deep freeze? Does he concede that his inquiry into London health services is an admission that the market in health care has not made any London hospital more efficient but has made them all more insecure? Will he explain to the House, and particularly to those right hon. and hon. Members who represent constituencies outside London, why it is wrong to go ahead with trusts inside London this year, but right to press ahead everywhere but London—except perhaps in Kincardine and Deeside?

As the Secretary of State for Scotland will not be coming to the Dispatch Box today, can the Secretary of State for Health say when the Government will make up their minds on the application from Aberdeen—an application so unpopular that not even the Conservatives' own by-election candidate dares to support it? Or do the Government hope to get the election over first, before coming clean with the people of Kincardine?

Before the Secretary of State proceeds to ignore all my questions and reads out his prepared text of party abuse —[HON. MEMBERS: "Oh."] Conservative Members do not like the truth —will the Secretary of State at least address his mind to a constitutional question? How can the right hon. Gentleman, in the fag end of this Parliament, invite hospital managers and health staff to go through the upheaval in the next six months of preparing for trust status when the Government know that every other party will oppose it in the election that must follow?

The Secretary of State has just repeated the discredited health policies of a Government living on borrowed time. They will be the first policies to be reversed by the Labour Government that will replace them.

Mr. Waldegrave

That was not one of the hon. Gentleman's greatest performances. As to his final question, on what he called a constitutional point, I can only take it that the tens of thousands of people who have put all that work into trust applications have a very low opinion of Labour's chances at the polls. I suspect that they are right.

I will answer the two other questions that I extracted from the hon. Gentleman's rhetoric. First, as regards London's teaching hospital trusts, I am sure that the hon. Member for Livingston (Mr. Cook) will have noticed that we have appointed new trusts in London. However, it is merely common sense, as everyone knows, that the Greater London teaching hospitals may well have to change their patterns of provision; there is no secret about that. It is obvious to them that the new teaching hospital trusts which I have approved—they do not have to seek renewed applications—should get advice from Sir Bernard Tomlinson, and that is sensible.

On consultations, it is true that local Labour parties, usually by talking in misleading terms about hospitals opting out of the national health service, in some places managed to get rather small letter-writing and pre-paid postcard campaigns going. However, having surveyed those, I do not think that they can even have got all their local members to fill in their postcards because we got so few.

I notice that this year the hon. Member for Livingston did not stand on the opposition of doctors, and he was wise not to do so. Last year he argued that doctors were against. This year he knows that that is not so. The British Medical Association survey has shown growing support from doctors. The hon. Gentleman may have managed to persuade the Confederation of Health Service Employees to oppose the trusts, but what else is new?

Several Hon. Members

rose—

Mr. Speaker

Order. I remind the House that we have a busy day ahead of us. I shall have to impose a 10-minute limit on speeches in the subsequent debate tonight. I shall allow questions to continue until half-past four and then we shall move on. I ask for brief questions from all hon. Members please.

Dame Jill Knight (Birmingham, Edgbaston)

Is it not true that the overwhelming majority of genuine experts in health service matters, who are quite apart from party politics, unlike the National Union of Public Employees and COHSE—whose members will follow anything that the Labour party says —have already said that trusts within the health service are an excellent thing? Is it not the case that those people who oppose hospital trusts are really saying that hospitals are quite incapable of managing their own affairs and must always take guidance from above?

Mr. Waldegrave

That is so. I have every confidence that, in a few years, if anyone should try to change these reforms, we shall see the Opposition defending them with the same energy with which they defended the reforms made by my right hon. Friend Lord Joseph in 1973, which they opposed at the time. The truth is that they are simply scaring people up and down the country and opposing necessary reform. My hon. Friend is right that devolved management in hospitals must be right and is overwhelmingly getting support from senior clinicians and senior management in those hospitals.

Mr. Charles Kennedy (Ross, Cromarty and Skye)

Is not by far the most significant part of the Secretary of State's announcement his decision concerning the four London teaching hospitals? By conceding that they can benefit from devolved management without trust status is he not completely contradicting the entire argument that underpinned trust status, when he said that the future of hospitals would no longer be decided by Ministers but by market forces? Is he not admitting that that is a ludicrous and politically unsustainable way to run the health service, and if it is good enough for London, why not for the rest of Britain—and especially for Aberdeen?

Mr. Waldegrave

It is not a question of it being good enough for London. There are a large number of trusts in London now. Those four teaching hospitals argued hard that they should be given the additional freedoms inherent in trust status, and they will get them. However, it is right that they should have advice from Sir Bernard Tomlinson before they write management plans which are put before the Select Committee on Health and analysed in the House. The Liberal party is always in favour—it alleges —of devolution until someone proposes it. Then it lines up with the Labour party in favour of the status quo every time.

Mr. Nicholas Winterton (Macclesfield)

Will my right hon. Friend assure me and the House that each and every application by a hospital or unit to which trust status is to be given after 1 April next year has been fully analysed, evaluated and vetted in accordance with the criteria that his Department have laid down, and that those evaluations have been carried out by individuals with the experience and accountancy qualifications to enable them to reach a correct decision? Will we thereby not have any further Guy's and Lewisham, Central Manchester and Bradford hospital trusts, which occurred since the first wave became effective on 1 April this year?

Mr. Waldegrave

The answer to the first part of that question is yes. As for the second part, I believe that the management in the two hospitals that my hon. Friend has named—both of which are dealing with long-standing problems—are doing a very good job in bringing those problems under control.

Mr. Stan Crowther (Rotherham)

Is the Secretary of State aware that the South Yorkshire metropolitan ambulance service is highly efficient and highly regarded? Will he explain how the service will be improved by being separated from the health authorities with which it has to work, and by management's being top-loaded with half a dozen salaried non-executive directors? How will that improve the service for patients?

Mr. Waldegrave

I advise the hon. Gentleman to go and look at some of the ambulance services that are already operating as trusts. A number of those services have actually increased the pay of their ambulance men through more flexible working. They have bought more vehicles, and have increased the supply of paramedics by devolving management downwards, closer to where the real work is done. That system works just as well for ambulance services as it does for hospitals.

Mr. Cranley Onslow (Woking)

Is my right hon. Friend aware that sensible people who actually care about the national health service will reject the union-driven reactions that we have heard from Opposition Members? Such people will welcome the greater involvement of local input in efficient management of the NHS, which will benefit an acute unit in my part of Surrey, and community and ambulance services all over the country. They will accept, as I do, that the best contribution that the Opposition could make would be to stop spreading smears and scares.

Mr. Waldegrave

My right hon. Friend is entirely right. As was pointed out very eloquently in The Independent on Sunday, the Opposition parties have no policy of their own. Independent commentators—many of them not sympathetic to my party—left the plans of the hon. Member for Livingston riddled, describing them as having no substance whatever.

The Opposition's only policy has been a policy of scares. Most of those scares have now been rebutted, above all the great scare about privatisation. If I were the hon. Member for Livingston, I would give the House and the country the period of silence on these matters that I think that they deserve.

Mr. Terry Davis (Birmingham, Hodge Hill)

Is the Secretary of State aware that, when the hon. Member for Birmingham, Edgbaston (Dame J. Knight) refers to the views of experts, she—like the right hon. Gentleman—is ignoring the expressed opposition of the overwhelming majority of the consultants at East Birmingham hospital, an even larger majority of the junior doctors, the individual nurses, the rest of the hospital staff and the local general practitioners who voted 9:1 against the hospital's opt-out?

Mr. Waldegrave

I hope that the hon. Gentleman received good service from the NHS, which he has obviously had to use; I am sure that the House will offer him its sympathy.

East Birmingham hospital will be a fine trust. Having assessed the management and clinical support given to the trust application, I am certain that it will be very successful, and will further improve its service to the community.

Mr. Tim Rathbone (Lewes)

People in my constituency who are covered by Eastbourne and Brighton district health authorities welcome this step, which they see as a further marriage between better health services and better administration. Does my right hon. Friend accept that many long-time Labour supporters in the area are thoroughly embarrassed by the stand that the party has taken in this regard, and by the bogus referendum measurements that have been made in some parts of the country?

Mr. Waldegrave

I must say that the Labour party's record on these matters in recent years has not been good. When he was lined up with the drug companies, the hon. Member for Livingston said that the limited list would fail; he was wrong. He predicted that the GP contract would fail; he was wrong. He predicted that no GP fund holders would come forward; he was wrong. He predicted that there would be no applications for trust status; again, he was wrong. Labour will be wrong in this instance as well.

Ms. Dawn Primarolo (Bristol, South)

rose—

Hon. Members

Order.

Ms. Primarolo

The House is very fractious on this important statement.

The Secretary of State referred to waiting lists. I am sure that he must be aware that, in the city that both he and I represent, the waiting lists are being fixed. One of my constituents was told that he could not go on a waiting list because it was 60 weeks long and that he would be contacted again when the waiting list was lower. Does the Secretary of State condone the fiddling of the waiting list figures by trusts in order to create a false impression?

Mr. Waldegrave

What the hon. Lady says is nonsense. There is no change in the waiting list policy. If the hon. Lady is anxious to look at fiddles, she should look at the poster that her party is paying for —or that the unions are paying for —to be put up around the country. It contains a considerable untruth. It compares waiting lists now with those in 1979, but it leaves out the day patient waiting lists in 1979 in order to produce the bogus appearance that waiting lists have increased. Waiting lists have come down since 1979. Under every Labour Government that there has ever been, waiting lists have risen.

Mr. Toby Jessel (Twickenham)

I warmly support my right hon. Friend's statement. Will he take note of Teddington memorial hospital —an excellent small hospital within the national health service that has an astonishing league of friends which has raised £1 million for capital projects, including a GP unit for which my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) laid the foundation stone? Is my right hon. Friend prepared to take into account the need for GP beds, as demanded by GPs, when deciding on trust status for the third wave?

Mr. Waldegrave

I think that my hon. Friend will welcome the fact that I have approved the application from Teddington to be considered for third wave trust status. I know about the hospital in detail. It is an extremely good hospital. One of the benefits of the GP fund-holding scheme, I believe, is that we shall see an increase in GP-controlled beds.

Mr. Bob Cryer (Bradford, South)

Would the Minister care to remember that, in Bradford, the first trust was greeted by the sacking of 300 workers, the closing of a baby unit and bitter opposition from the vast majority of the people of Bradford? Does he accept that the second trust will almost certainly result in the selling off of assets, including Westwood hospital for mentally handicapped people, who will be decanted into any sort of community care that can be found for them so that the trust managers can line their pockets with their enhanced salaries?

Mr. Waldegrave

As usual, the hon. Gentleman is cheap and inaccurate. The mental health trusts throughout the country are strongly supported by their clinicians. 'They have made it absolutely certain that any money released from the closure of old mental health institutions will have to be ploughed back into mental illness and mental health. That is a very good thing.

Sir Marcus Fox (Shipley)

Following from what the hon. Member for Bradford, South (Mr. Cryer) has just said, I am sure that my right hon. Friend heard last week, as I did, with dismay and disbelief reports of the resignation of Dr. Mark Baker, the chief executive of the Bradford trust. The hon. Member is not present who made that allegation so I shall not mention him, but character assassination is now in play on the Opposition Benches. There was no truth in that allegation. I hope that my right hon. Friend will warn the new trusts, which I welcome, that they will be judged by the Labour party, not on performance but by political dogma.

Mr. Waldegrave

One of the things that encourages me is that so many trust applications have come forward for this year and next year, despite the totally unfair campaign that has been waged against them by the Labour party. The Labour party has wanted the trusts to fail in order to advance its own political campaign. The story about Dr. Baker was only the latest of the bogus scares that have been put about. We made the hon. Member for Coventry, South-East (Mr. Nellist) back down on his threat to staff. He did that in this House. I hope that there will be no more similar tactics.

Mr. Robert N. Wareing (Liverpool, West Derby)

Is the Secretary of State proud of the fact that the Liverpool children's hospital trust has cut 112 beds during the last two years and that recently a child of two died in a corridor in her father's arms because she had had to wait for two and a half hours before a doctor was available?

Is the right hon. Gentleman proud of the fact that his apparatchik manager of Alder Hey hospital is on an £11,000 bonus to do his dirty work and cut expenditure in the national health service?

Mr. Waldegrave

That is exactly the kind of story that damages the NHS and usually turns out to be false. Will the hon. Gentleman not welcome the fact that a new paediatric intensive care unit has just opened in the hospital that he named? Would he like to put alongside each other, for comparison by any independent authority that he could name, the performance of the health service on Merseyside and that of Liverpool city council, which the hon. Gentleman's friends control?

Mr. David Evans (Welwyn Hatfield)

Will my right hon. Friend accept my congratulations on his speech at the party conference last week, when he nailed the lies of the other side?

Hon. Members

Withdraw!

Mr. Speaker

Order. That may be a legitimate comment to make at party conferences, but not here, please.

Mr. Evans

My right hon. Friend nailed the untruths of the other side. [HON. MEMBERS: "Withdraw."] Does my right hon. Friend remember that in 1978, when the Labour party was in charge of the NHS, dying cancer patients were refused entry to hospital, supplies were not allowed in, and nurses' pay was cut in real terms? Shall we contrast that with the 30,000 extra patients treated every week in the NHS, with the 60,000 more nurses, and the £30,000 million NHS budget—four times more than was spent by the Labour party? East Hertfordshire health authority cannot wait to get out of the clutches of NUPE and COHSE. That is who they want —

Several Hon. Members

rose—

Dr. John Cunningham (Copeland)

On a point of order, Mr. Speaker.

Mr. Speaker

Order. I asked the hon. Member for Welwyn Hatfield (Mr. Evans) to withdraw. I said that a charge of lying might be legitimate at a party conference but would not be legitimate in the House of Commons. I thought that the hon. Gentleman had withdrawn his remark. Will he make that clear, please?

Mr. Evans

I withdraw the remark.

Mr. Waldegrave

Whatever they are, they will be nailed. I am happy to say that I have had considerable assistance from Labour Members weaselling and wriggling on the "Walden" programme and elsewhere during the last few days. My hon. Friend the Member for Welwyn Hatfield (Mr. Evans) is right to remind us who is paying for the posters that the Labour party is now putting up. They are the same people who closed cancer and emergency wards in 1978–79. Those are the people who run the Labour party and dominate its policies.

Mr. John Bowis (Battersea)

Is my right hon. Friend aware that there will be a special welcome in London for his statement from the four hospitals that have been given the go-ahead so that they can prepare for trust status in 1993 at the same time as welcoming the Tomlinson inquiry which will look into overall health provision in London? Does he agree that many of London's financial problems were caused by a decision of the Labour Government when, through the Resource Allocation Working Party —the RAWP system —they took money away from London without rationalising the provision of teaching hospital services there? We can now get that right. Will my right hon. Friend go on speaking up for patients, as he has done today, in sharp contrast to the voice of Bickerstaffe opposite?

Mr. Waldegrave

It is true that, when the Labour Government started the RAWP system, they postponed decisions which should have been taken then and which will now be taken. Nobody who knows anything about health services in London doubts that reforms are needed —such as more primary care in some places and a different pattern of hospitals in a number of ways. Now, because of the new system and the referrals made by GPs and district health authorities, we are getting the clear signals that we need to give us the information on which to base sensible reforms. I welcome what my hon. Friend said and thank him for it.

Ms. Kate Hoey (Vauxhall)

Is the Secretary of State aware of the current confusion and uncertainty in the London teaching hospitals? The right hon. Gentleman seems to have already decided what the review of London will say. Can he clarify whether the teaching hospitals are opting out or not? Can he provide a little certainty for the people living in the areas covered by the teaching hospitals —they may be teaching hospitals, but they are their local hospitals? Can he give us an assurance that, for example, St. Thomas's hospital will not be considered for closure at any stage?

Mr. Waldegrave

I am by no means prejudging what Sir Bernard will advise. There are at least a dozen rival plans within the NHS family in London, and every hospital has its own view about what should happen. The position of the four is clear: their present status remains and they will become trusts a year later than the others. We are giving them the benefit of devolved management by asking the districts, which remain their accountable authorities, to establish that devolved management within the hospitals.

Mr. Quentin Davies (Stamford, and Spalding)

Is my right hon. Friend aware that there has been a great welcome in Lincolnshire for the achievement of trust status by Lincolnshire ambulance service? Under the new status, Lincolnshire ambulance service has been able to make much better use of its budget by hiring more people for the same money and putting 10 more ambulances on the road, and is well on the way to achieving a target of one paramedic per ambulance by 1994, which is way ahead of the national guidelines.

Mr. Waldegrave

I can confirm what my hon. Friend has said. Some of the most innovative trusts are ambulance services, and I am delighted to see further ambulance services coming forward in the third wave. They will bring great benefits to their patients. Incidentally, in Devon, members of the local union—NUPE—voted unanimously to support the trust.

Mr. Simon Hughes (Southwark and Bermondsey)

A year ago, the Secretary of State's hopes proved to be false, in that Guy's and Lewisham did not have the money to survive its first year, and nor did some other trusts. Before proceeding to approve a second wave, would it not have been better to find out what the users of the already opted-out services thought, because they are not yet persuaded? Also, would it not have been better to wait until the already opted-out trusts had shown that they were solvent, which Guy's and Lewisham still has not done, and to wait until the process that he started last year was seen to provide not just a better service but more choice for patients? People for whom the teaching hospitals are also their local general hospitals now have less choice and are still not persuaded that these changes bring anything but a worsening of the health service as it affects them.

Mr. Waldegrave

I should like to lay to rest the implication —I do not think that the hon. Gentleman meant it—that Guy's will not survive. It is in good shape, and is being better managed now than in the past. The element of balance between district hospital and teaching hospital of the great hospitals will have to be addressed by Sir Bernard. I believe that Londoners do not often receive a good enough local district health service. Let us face it, that is partly because the pull of teaching over the years has perhaps distorted services to the locality. That must now be sorted out. I have worked with the hon. Gentleman in the past for the interests of his constituents, and I hope that he will give evidence to the review because there are long-standing issues that should now be properly sorted out.

Mr. Peter Thurnham (Bolton, North-East)

Will my right hon. Friend utterly refute the bogus scare stories about the cancellation of 300,000 operations? Were not more than 1 million more operations performed last year than in 1979 and will not the reforms produce even better services?

Mr. Waldegrave

That was yet another of the Labour party's scare stories. It was instantly refuted by health authorities up and down the country as completely meaningless. Incidentally, when the Labour party told a similar meaningless story last year, more operations were carried out. I do not know what that proves. I can confirm what my hon. Friend has said. The health service has improved the range of treatments and the number of people treated since we were elected, and it will go on doing so.

Mrs. Sylvia Heal (Mid-Staffordshire)

Can the Secretary of State tell the people of mid-Staffordshire how their ambulance service will be improved when, in the application for which he has just given approval, the accident and emergency service will be reduced from 72 ambulances to 60, and when a courier service is to be introduced for industry?

Mr. Waldegrave

The hon. Lady might well have listened to my hon. Friend the Member for Stamford and Spalding (Mr. Davies). There are good ways of making better use of the expensive equipment that they have. I do not mind if services seek to earn money from outside to be ploughed back into the NHS: that is for the benefit of patients. I beg the hon. Lady to look at the ambulance service trusts which are up and running and, in many cases, producing spectacularly better services for their locality.

Dame Elaine Kellett-Bowman (Lancaster)

May I thank my right hon. Friend for granting trust status to both the applications from Lancaster? They were granted solely on the criterion of improved patient care. May I point out to other people that, as my right hon. Friend already knows, we are not opting out of the health service: we are simply opting out of bureaucracy from Manchester.

Mr. Waldegrave

The more one sees of trust hospitals in action, the more clear it is that devolved management and management in the hospitals, with nurses on the governing bodies of hospitals again as in the old days, must be right. Trusts are simpler and quicker for decision-taking and are gathering strength every day. There is no question about that in my mind.

Mr. Thomas Graham (Renfrew, West and Inverclyde)

The Secretary of State is probably aware that the Tory party in Scotland is facing in all different directions on trusts. Is that the reason why today we have not seen any trust status granted in Scotland? Is it because there is to be a by-election? The local people in Scotland will reject the trusts. Face up and tell the truth now.

Mr. Waldegrave

I will tell the truth by saying that I am not responsible for the health service in Scotland. However, I am sure that the trust movement will bring its benefits to Scotland. I very much hope that it will. I am sure that the hon. Gentleman would not want his constituents to have less good services than they would get in England.

Mr. Harry Greenway (Ealing, North)

Will my right hon. Friend confirm the extent of increased funding to Ealing hospital since 1979 and the increased numbers of staff of every type—doctors, nurses, and the rest? Will he assure my constituents that Ealing hospital will continue to be well funded under trust status, as it has been during the past 12 years?

Mr. Waldegrave

Ealing hospital is an excellent hospital, along with all our other hospitals. It has a strong record and it will be a strong trust. I was delighted to approve Ealing hospital as a national health service trust in response to its request.

Rev. Martin Smyth (Belfast, South)

While welcoming the improvements that have been announced, may I have an assurance that we shall not have a repetition of previous years in which hospitals which took in more patients discovered before the end of the financial year that they had to undertake redecoration schemes or find other ways of not treating other patients, because they did not have the money? In the knowledge that there are people here for Northern Ireland lobbying about low pay in the health service, will there be a statement in the House about hospital trusts for Northern Ireland, or will the House again be ignored by the Northern Ireland Office?

Mr. Waldegrave

I shall have to ask my right hon. Friend the Secretary of State for Northern Ireland about that. I know that there will be at least one applicant for trust status. It is a great hospital in Northern Ireland and I know people who work in that hospital.

The hon. Gentleman referred to the age-old problem of running up against budgetary controls three quarters of the way through the year. Our reforms aim to make the money follow the patients in order to do away with that problem. After six months, I cannot say that we have yet rid ourselves fully of that problem—we have not—but the whole purpose of our reforms is to move away from that problem so that, when the patients come to the hospitals, the money is automatically there to make their treatment available.

Mr. Speaker

Mr. Hayes.

Mr. Jerry Hayes (Harlow)

rose

Hon. Members

Oh!

Mr. Hayes

It appears that the Labour party has had a hectic week on health. May I ask my right hon. Friend to give some guidance to the House about why the Labour party opposes national health service trusts?

Mr. Dennis Skinner (Bolsover)

It is an autocue.

Mr. Speaker

Order. I do not know what the excitement is about. Come on, please.

Mr. Hayes

Why does my right hon. Friend think that the Opposition oppose NHS trusts when trusts treat more patients, waiting lists are falling and the overwhelming majority of NHS consultants support trusts? Is it because the real opposition comes from the Confederation of Health Service Employees and the National Union of Public Employees, which put pay before patients? Is not it good to see the unions here today keeping an eye on their investments?

Mr. Waldegrave

It is genuinely surprising that the Labour party is so adamantly opposed to what is a sensible devolution of management to the hospitals. It is also foolish of the union leaderships concerned to oppose these developments. We are already seeing in some trust hospitals a recognition that we have too many low-paid people in the NHS, which we have, and a search for greater and more flexible ways of dealing with pay, which is to the benefit of those very people. I suspect that we shall see that opposition crumbling too, at least from the grass roots, as the doctors' opposition has crumbled so far.

Mr. Dave Nellist (Coventry, South-East)

May I give the apology of my hon. Friend the Member for Coventry, North-East (Mr. Hughes), whose brother-in-law died earlier this morning, in whose constituency Walsgrave hospital is located and on whose behalf as well as my own I ask the following question? What guarantee can the Secretary of State give us that, after opt-out, Walsgrave hospital will remain a hospital? Is he aware of what happened to the last hospital to move from NHS control four years ago—Whitley geriatric hospital in my constituency—which we were told at the time would always remain a facility for the frail elderly in Coventry?

Two weeks ago the managers of that hospital submitted a planning application to knock it down and build a supermarket. Is the Secretary of State aware that nobody in Coventry wants Walsgrave hospital to leave NHS control and that none of the doctors and none of the people of Coventry voted for it? The sooner we get a general election to stop him and his like playing politics with our health service, the better.

Mr. Waldegrave

The hon. Member was one of those who wrote disgraceful, intimidatory letters to the management of the local hospital, which were disowned by the leader of his party and, more slowly, by his Front-Bench representative on health, the hon. Member for Livingston. The hon. Gentleman should be careful about talking about playing politics with these matters. His story shows one rather obvious point—that, since 1948, some hospitals have indeed closed, and that sometimes it is right to sell their land and to reinvest in hospitals elsewhere. That has nothing to do with trust status or anything else. If the hon. Gentleman is now trying to scare his constituents into the belief that the Walsgrave hospital will close, he is going even further than the Opposition Front-Bench spokesman, which is perhaps not unusual.

Mr. Tony Marlow (Northampton, North)

Is it not the case that, by putting responsibility for decision-making and management close to the patient, hospital management trusts will become more flexible and efficient, so we shall get more care for the cash? I understand that the Labour party cannot provide any more cash for the health service until it gets growth. As it is likely to achieve less growth than we would, is it not the case that, under a Labour Government, there would be no improvement in the health service? The hon. Gentleman, the Dr. Goebbels of Livingston, has not a leg to stand on.

Mr. Waldegrave

It is true that our party has given the NHS a bigger share of a bigger national product than did the Labour party when it was in power. The hon. Member for Livingston has at no time been able to respond to the challenges from me, the British Medical Association or anybody else, about what his figure is. We know that that is because his financial colleagues have not given him permission to say anything whatever, as they know that they have no such pledge to make.

Mr. Peter L. Pike (Burnley)

Will the Secretary of State say just whom he takes notice of in his consultation exercise? Obviously, he wholly ignores the public of Burnley, Pendle and Rossendale, where 80 per cent. of the consultants and 90 per cent. of general practitioners voted against the proposal and only one member of the community health council voted in favour of trust status. Who on earth does he take notice of?

Mr. Waldegrave

First, of the leadership who submitted the application for trust status and whether they can demonstrate overall that they have support in the hospital. I am sure that the hon. Gentleman will join me in wishing that NHS trust well. It is a good hospital now, and it will become even better.

Mr. Michael Morris (Northampton, South)

Will my right hon. Friend clarify whether the criteria for the third phase will be the same as for the first and second phases or whether we shall learn from the experiences of those two phases and, if necessary, modify the basis of the third phase? May I congratulate my right hon. Friend on his philosophy of devolved management? Nevertheless, will he recognise that some institutions and hospitals may not wish to go as far as trust status, but may want devolved management? Will he address that problem?

Mr. Waldegrave

It is indeed true that the applications are voluntary and that remains the case. I am sure that the hon. Member for Livingston will be glad to see that his right hon. and learned Friend the Member for Monklands, East (Mr. Smith) and his hon. Friend the Member for Derby, South (Mrs. Beckett) are now in the Chamber to hear what he has to say about expenditure. Perhaps we will now learn a little bit more about it.

Mr. Stuart Bell (Middlesbrough)

Will the Secretary of State note that the people of Cleveland have heard the Prime Minister and the Secretary of State say that there will be no privatisation of the hospital service? However, they will note that, in the second wave of trusts announced today, there will be an NHS trust for North Tees, South Tees and the Cleveland ambulance service. The right hon. Gentleman will be aware that our trust port, the Tees and Hartlepool, which has served our community since 1966, is about to be privatised through Government legislation. Is it any wonder that the people of Cleveland do not believe the statements of the Government on the trusts when they see what is happening to their trust port?

Mr. Waldegrave

It is exactly that kind of bogus analogy that has confused and scared people. A large number of ports have always been in the private sector. We have made it perfectly clear that social care, hospital care and health care will remain provided by the NHS and always will be. I am surprised at the hon. Member for Middlesbrough (Mr. Bell) for making such an analogy, which comes close to the type of misleading statement that we have had from the hon. Member for Livingston. I should have thought that, after the hammering that the Opposition have had in the past few days, they would back off from making such analogies.

Mr. Kenneth Hind (Lancashire, West)

I should like to congratulate my right hon. Friend on selecting the Wrightington hospital to become an NHS trust. No doubt my right hon. Friend will be aware that one of the first actions to be taken will be the appointment of a new upper-limb orthopaedic surgeon and medical team. They will assist in reducing our waiting lists in the north-west, although my right hon. Friend will be aware that they have already been greatly reduced. The waiting list now stands at 10 weeks operating time only for the entire region.

Mr. Waldegrave

My hon. Friend is entirely right. Every example of improved health service care in an NHS trust will give the lie to the campaign that the Opposition have waged. They should look with some nervousness to the next few months as we see steadily improving health care in those trusts, because every time that happens, their scares will be disproved.

Mrs. Alice Mahon (Halifax)

May I tell the Secretary of State how sorry I am that he has not learnt anything from the fiasco of the first wave of trusts? However, I am sorry not for him but for the elderly and the sick who will suffer as he continues to damage the health service.

The Secretary of State has told the House that all trusts are accountable to him. If so, will he tell us why an important circular on the decontamination of equipment used for HIV patients and hepatitis B patients is marked "for action" by health authorities only and "for information" only for the trusts? Today I received a letter from the right hon. Gentleman's Department in which it was admitted that operationally independent bodies … are not bound'' by such circulars.

If the right hon. Gentleman is in control of trusts and they are accountable to him, why is that important circular not a must for the trust hospitals? Is it because the right hon. Gentleman is not really in control and those trusts intend to opt out of the NHS? As far as this circular is concerned, they already have done.

Mr. Waldegrave

I have tried to explain these matters to the hon. Lady in the Select Committee over some considerable time, but clearly I have not made much headway. The hospitals will remain within the NHS, as she knows very well; they are subject to NHS policy, as she also knows very well.

Mr. Paul Marland (Gloucestershire, West)

Is my right hon. Friend aware that his announcement today that the Gloucestershire ambulance trust will be given permission to go ahead will put a spring in the steps of all those involved in the service? For my right hon. Friend's edification and that of the Opposition, may I say that I was involved with the preparation of that trust application. The Gloucestershire ambulance service is convinced that, as a trust, it will be able to provide a better service at less cost to the NHS. That will mean more money for the care of patients.

Mr. Waldegrave

What my hon. Friend says is absolutely right. As I have said before to other hon. Members, in the ambulance service we will see some of the most interesting and innovative developments in all the trusts. The trust applications from that service have been pursued with particular enthusiasm by the people working in it.

Mr. Henry Bellingham (Norfolk, North-West)

In welcoming today's announcement to include King's Lynn and Wisbech NHS hospital trust, may I ask the Secretary of State whether he is aware that that application had broad support from the overwhelming majority of consultants, doctors and management, as well as an overwhelming majority of NUPE members?

Mr. Waldegrave

What my hon. Friend says about his constituency's trust is true, and it is true in the case of many other trusts, too. That is not the only matter at which I looked. I considered the overall balance of benefit for the hospital, and it was by judging those matters in a wider round that I could approve so many trusts. The support in the case of my hon. Friend's trust was indeed widespread.

Mr. Eddie Loyden (Liverpool, Garston)

May I ask the Secretary of State to answer a question that he has not yet answered? Approaches were made to him about St. Paul's hospital in Liverpool by two Chairmen of Select Committees, the CHC, myself as a patient, and another patient at St. Paul's. Bearing in mind the fact that the CHCs have a constitutional right to represent patients' interests at those meetings, who does the Secretary of State regard when he takes the final decision if he ignores such approaches to him? What criteria did he consider before accepting the decision of the area health authority against the background of the patients' approaches?

Mr. Waldegrave

I know that the hon. Gentleman was unhappy with the decision. However, he knows that my hon. Friend the Under-Secretary of State and I met the CHC and him and his colleagues. Those decisions are often difficult but we believe that we took the best advice with strong clinical backing before making our decision. But I recognise that it was unwelcome to the hon. Gentleman.

Mr. Alan Meale (Mansfield)

May I remind the Minister of all the derogatory remarks that he made earlier about the trade union movement, which represents hundreds of thousands of people within the health service? It represents far more people than any Member of Parliament, including the right hon. Gentleman. When he says that it is a disgrace that so many people are on low pay in the health service, may I remind him that the Government have been in office for 13 years? Why have they done nothing about that problem instead of privatising the health service?

Mr. Waldegrave

The hon. Gentleman is very unwise to use that phrase, which he knows to be false. The fact that there are so many low-paid people in the health service should make them consider whether the structure of trade unionism which has represented them for all those years has delivered much to them.

Mr. Roger Gale (Thanet, North)

Would my right hon. Friend find time to add his good wishes to those already expressed by the Minister of State on the retirement of the unit general manager at Thanet district hospital? My right hon. Friend will know that Dr. Voysey ended 30 years of dedicated service to the health service, both as a doctor and a consultant, by preparing the hospital for full district hospital status and trust status. Will he ensure that her aspirations can be realised by her successor as quickly as possible?

Mr. Waldegrave

I give my hon. Friend the assurance that, although I did not judge that application to be ready yet, I hope that it will be very shortly.

Several Hon. Members

rose

Mr. Speaker

The choice is very difficult. The hon. Member from Scotland.

Mr. Tom Clarke (Monklands, West)

Thank you, Mr. Speaker. I am sure that Scotland will have noticed your choice.

The Secretary of State referred to his evidence to the Select Committee on Health, but has he given some thought to other people's evidence? For example, has he considered the Chairman's draft report before the 20 pages were torn out? If so, what did he feel about the quality of evidence from Bradford, Leeds and Lewisham, which showed that the business plans bore little resemblance to what happened thereafter? There was no mention of bailing out. In view of the shambles that was made known to the Select Committee, should not the Secretary of State at least have hesitated before making a statement today containing the same mistaken policies?

Mr. Waldegrave

I know that the hon. Gentleman hopes for a shambles because he hopes to make political capital out of it, but there is no such shambles. As for the first part of his question, I cannot comment on the internal discussions of a Select Committee.

Mr. Roger Sims (Chislehurst)

My right hon. Friend will understand that there will be a deep sense of disappointment among those who worked so hard to prepare the proposals for the Bromley acute unit, only to find that they have been refused. That sense of disappointment will be felt particularly deeply by our new chairman and manager, who are committed to the proposals because they feel that they would be in the patients' best interests. Can my right hon. Friend assure me that officials of the executive will be available to give advice and assistance to the authority to enable it to ensure that the proposals are of a standard to enable the Secretary of State to approve them in the third wave?

Mr. Waldegrave

That application was greatly strengthened during the past year; it was very nearly there, and I am certain that it will be ready for approval by next year. I understand that it must be disheartening for the team, but I hope very much that it will continue to work to bring the benefits of NHS trust status to its hospital and the patients who will use it. I am sure that the proposals will be approved in due course.

Mr. Huw Edwards (Monmouth)

Does the Secretary of State appreciate that those at Nevill Hall hospital in my constituency last month decided that they would not apply for it to be granted trust status because they believe that, within the NHS, they provide a high quality of service that cannot be enhanced by trust status? They also consulted hospital staff, who were overwhelmingly opposed to trust status. I invite the Secretary of State to come to my constituency and share a public platform with me to debate the health changes.

Mr. Waldegrave

I should of course be delighted to do so, and if the hon. Gentleman writes to me, I shall see if I can find a date. The hon. Gentleman has, unfortunately, torpedoed a main part of the argument advanced by the Labour party's Front-Bench spokesmen, to which he cannot have been paying very close attention. Their argument was that hospitals were being forced to apply; the hon. Gentleman has just shown that that is not so.

Several Hon. Members

rose—

Mr. Speaker

Order. I am sorry, but we must move on. I shall keep a careful list of those Members who were not called. I hope that the debate to which the hon. Member for Monmouth (Mr. Edwards) has just referred will take place in the House rather than in his constituency.