NHS Trusts (Hansard, 14 July 1992)

1. Mr. Alan W. Williams
To ask the Secretary of State for Health what restrictions exist on the number of pay beds in hospital trusts.

§ The Minister for Health (Dr. Brian Mawhinney)
It is a statutory requirement that private practice in national health service trust hospitals does not significantly interfere with the performance, by the trust, of its obligations under NHS contracts or imposed by order. The actual number of private patient beds that may be made available at any one time is for local determination.

Mr. Williams
As trust hospitals are not required by law to make contracts with the NHS, and as private insurance companies are seeking a greater use of trust hospitals to reduce their premiums, is there not a danger that the number of private beds in those hospitals will dramatically increase without anyone being consulted? If the Government want us to believe that the NHS is safe in their hands, why do they not make the 10 per cent. limit for private beds that applies to health authority-managed hospitals apply also to trust hospitals?

§ Dr. Mawhinney
The hon. Gentleman's fears are unfounded, not least because the local population is protected by the purchasers who are responsible for purchasing health care on their behalf.

§ Ms. Harman
Is it not the case that the more hospital trusts such as Guy's hospital in London concentrate on private patients, the longer NHS patients like the Slennet family, whose case was reported recently in the newspapers, have to wait? The longer NHS patients must wait, the more they are forced to go private. To protect NHS services and justify the Minister's claims that trust hospitals are not about privatisation, will he impose a strict and specific limit on the proportion of private work that NHS trusts can do?

§ Dr. Mawhinney
The hon. Lady should be aware, better than most, that common waiting lists for urgent or seriously ill patients exist in all hospitals and that those arrangements were agreed with the medical profession. She should be aware also that there is a statutory requirement that private practice in hospital trusts must not interfere, to a significant extent, with performance under NHS contracts. The hon. Lady is trying to scare patients unnecessarily.

§ 2. Mr. Kirkwood
To ask the Secretary of State for Health whether special considerations can be applied to health units or organisations wishing to seek trust status in very rural areas; and if she will make a statement.

§ Dr. Mawhinney
No. Each application for trust status is measured against four main criteria: that the establishment of the trust will give clear benefits and improved quality of service to patients; that management has the necessary skills and capacity to operate independently; 955 that senior professional staff, particularly consultants, are involved in the management of the unit; and that the trust will be financially viable.

§ Mr. Kirkwood
But is there not a case for giving special consideration to small health board, district and regional health authority areas providing health care in disparate rural communities and, where they are performing well already, leaving well alone? In particular, what guidance is being given to those authorities in rural areas on the purchaser's ability to keep in touch with local communities so that they can deliver the kind of services that those communities seek?

§ Dr. Mawhinney
That is a perfectly fair question. I assure the hon. Gentleman that all purchasers have the responsibility to assess health needs and the preferences of the local population. That is true in both rural and urban areas. Given the distance that some patients may have to travel, purchasers in rural areas need to have particular regard to accessibility of services. Let me encourage the hon. Gentleman by giving him one example: a purchasing project in North Yorkshire, not far from the hon. Gentleman's constituency, covering about four and a half former districts, has developed 25 natural communities around which it has planned the sort of health care that the hon. Gentleman seeks.

§ Dame Jill Knight
Does my hon. Friend agree that when trust status is conferred on a hospital, the local people virtually run the hospital themselves and they, after all, know best?

§ Dr. Mawhinney
As is so frequently the case, my hon. Friend is exactly right.

§ Mrs. Dunwoody
Then how would the Minister explain the situation that has arisen in my area, which has a large rural contingent, where one fund-holding general practitioner can distort the provision of health care by demanding that the practice's patients go ahead of those of every non-fund-holding general practitioner?

§ Dr. Mawhinney
I have to say to the hon. Lady what I said to her last time, which is that I am not prepared to accept her interpretation of events. If the health authority has such a problem, it is perfectly free to get in touch with me.

§ 3. Mr. David Martin
To ask the Secretary of State for Health how many hospitals have now achieved trust status.

§ 14. Mr. David Shaw
To ask the Secretary of State for Health if she will make a statement on the national health service trust programme.

§ The Secretary of State for Health (Mrs. Virginia Bottomley)
A total of 156 national health service trusts are currently operational and 151 applications have been received from hospitals and other units to become operational from April 1993 in the third wave of NHS trusts.

§ Mr. Martin
Is my right hon. Friend aware that the result of the general election, particularly in Portsmouth, has led directly to applications for trust status there? As the British Medical Association has withdrawn its misguided opposition to that sensible policy, is it not high 956 time that the Labour party and the Liberal Democrats followed suit and stopped misrepresenting it as privatisation?

§ Mrs. Bottomley
My hon. Friend is exactly right. Since the election, a great many people have said that the future lies in NHS trusts, which provide a better form of management. I was delighted to hear that the BMA chairman said: The reforms exist. Our task must be to ensure that, for the sake of our patients, we do everything we can to make them work. I visited the hospital where he works, which has become a trust, and was most impressed with its progress. I know that hospitals in my hon. Friend's constituency are applying for trust status in the next wave, with the warm support of the clinicians. I hope that the Labour party will be able to adopt a similar approach.

§ Mr. David Shaw
Can my right hon. Friend confirm that trust hospitals result in reduced waiting lists, an improved number of patient treatments and an improved quality of service? Therefore it is not surprising that Dover and Deal hospitals are applying for trust status to deliver to my constituents an even further improved quality of service.

§ Mrs. Bottomley
Trusts are cutting their waiting lists, improving the quality of service and increasing the number of patients treated. They are also a good place for the staff to work. There are overwhelming reasons for devolving the management of health care to the level nearest to that at which decisions on clinical work are undertaken. NHS trusts are the model for the future and provide important new freedoms. They are better for staff and for patients.

Mr. Robert Ainsworth
The Secretary of State will be aware that among the 151 third wave applications, there is one jointly made by the two Coventry hospitals, which want to become a single trust. Is she aware of fears that that will result in the closure of the Coventry and Warwickshire hospital and of the refusal by the management at either site to give any assurances? Will she ensure that there is full consideration and that the assurances sought are given before trust status is approved?

§ Mrs. Bottomley
I give the hon. Gentleman a clear assurance that the most important criterion for agreeing trust status is better service for patients. A trust must certainly be financially viable and there must be good management—under which clinicians and managers work closely together. The criterion for the future is improved services to patients and that is the basis on which decisions will be made.

§ Mrs. Bridget Prentice
Does the Secretary of State agree that the Guy's and Lewisham Trust is so strapped for cash that it is moving more and more towards private medicine? What reassurances can she give Lewisham families that they will not be forced into private health care, as was the Slennet family in my constituency so that they could have their child treated in a hospital?

§ Mrs. Bottomley
I have no time for the politics of envy, in which criteria for the success of the health service are judged against the work of the private sector. Frankly, that is immaterial. I want ever-greater improvements to the national health service. I ask the hon. Lady to re-examine 957 the situation at Guy's, which is paying its low-paid workers an extra £6 a week, is tackling junior hospital doctors' hours a year ahead of schedule, has made excellent inroads into waiting times and is treating more patients. Improved patient care, not the criterion of redundancies, should measure the national health service's success.

§ Mrs. Roe
Does my right hon. Friend recall a survey undertaken among trust patients at the beginning of this year, which showed that seven times as many thought that services had improved as a result of trust status as those who noted a decline? Does she agree that such noticeable gains should be spread further and wider throughout the health service?

§ Mrs. Bottomley
How much I welcome my hon. Friend's remarks; as ever, she hits the nail exactly on the head. We ought to consider the effect of trust status on patients and others who use the service. An independent survey published earlier this year showed that 96 per cent. of patients were very satisfied or quite satisfied with the quality of service that they received from NHS trusts.