§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Robert G. Hughes.]
§ 10.4 pm
§ Mr. James Kilfedder (North Down)
I count myself extremely fortunate that I have been successful in obtaining this Adjournment debate. I am fighting to save the national health service as we know it in North Down. That is the essence of my fight. The Eastern health and social services board, with contemptuous regularity, has imposed drastic cuts on health and social services, in particular on the North Down and Ards unit.
About two weeks ago I made a speech in the House in which I attacked, with all the fervour that I could command, the latest cuts and hospital bed closures in North Down. In that speech, I accused the board of having already decided to close Bangor hospital in my constituency in due course. I then maintained that the bed closures at Bangor hospital, and particularly the closure of the entire surgical ward, were cunningly calculated by the board to provide it with an excuse for the closure of the only hospital we have in Bangor.
Today, I heard from the media that at a meeting to be held some time today the board would decide to close a number of hospitals in its area, within the next 10 years, including Bangor and Ards hospitals. Such a decision can only be described as scandalous, and it makes me extremely angry. It will certainly add to the waiting lists in other hospitals and the period of waiting will grow longer. The situation is already intolerable, and I have written on numerous occasions to complain about the delays that my constituents experience before obtaining a hospital appointment.
We need a hospital in Bangor, in particular a casualty department. Bangor and the surrounding areas have an immense and ever-growing population, and it is a disgrace that no casualty department exists. The board has dismissed my appeals for such a department and for a fully operational hospital in Bangor.
We will fight to save our hospital, but unfortunately people never think about hospital services until they need medical attention. It is then too late to complain. I therefore call on the people of North Down to mobilise in defence of a proper and decent national health service in North Down and Ards.
I have referred to the Eastern health and social services board for many years. Who are the members of that board? They are all appointed by the Minister—they are his minions. They have not been elected by the people and therefore have no loyalty to them. The board has deliberately set out to deceive the people. Sadly, the Ulster people have been robbed of much of their political power during the past 10 years or more. There is no Northern Ireland assembly where matters vital to the wellbeing of the community could be thrashed out and officials made to justify their decisisons.
We do not have a Select Committee on Northern Ireland. Despite all the demands made in the previous Parliament and in the House since the general election, the Government have flatly refused to establish one, but that would give political muscle to the Ulster people through the Members of Parliament who represent them. If we had such a Committee, which could cross-examine Ministers, officials and members of the Eastern health and social 547 services board, the board might not be so ready to take decisions detrimental to the health and welfare of my constituents and others. Therefore, I am exercising my fundamental right to pursue this vital matter on the Floor of the House and to attack the Minister responsible for the Department of Health and Social Security in Northern Ireland.
We do not even have in this House the Minister responsible for health in Ulster. He lurks in another place, where he seeks sanctuary. So I am denied the opportunity of criticising him face to face. Instead, I must direct my anger at the Minister who will reply to this debate and who is responsible for other equally important matters. I understand that he flew to Northern Ireland this morning for another, perhaps final, meeting of phase one of the talks.
§ Mr. Kilfedder
I take it from the dissent being expressed by my hon. Friend that it was not the final meeting. I am glad to hear that. He then flew back for tonight's debate. I wish him well in his great task of seeking political progress. I have the utmost confidence in his ability.
I urge my hon. Friend to convey to his lordly ministerial colleague the sense of outrage felt by me and by the people who live in the North Down area. My hon. Friend is a man of compassion. Perhaps he can exert influence on the Minister responsible for health in Ulster and persuade him to defer all cuts and radical changes until such matters can be thoroughly discussed, either by an Ulster Select Committee or a new Northern Ireland assembly.
We have a plethora of documents claiming to protect the rights of citizens. They include the citizens charter and the patients charter, and recently the North Downs and Ards community unit launched its own charter for clients with the main aim of "Putting the Customer First". One official declared in a statement:It is always important to involve the people in agreeing the services that ought to be provided.That sounds magnificent and democratic, but it is a meaningless diatribe because the bureaucracy is interested only in itself. It is interested in the money, and the people and patients come a poor second.
The people have not been consulted by the board, certainly not about the applicationn for trust status for the North Down and Ards community unit or the hospital unit. There is only one guideline, and that is profit, which is alarming because the community trust would be handed control of all community health and personal social services in North Down and Ards. Those services include residential homes, day centres and residential units—such as Balligan, which is also unfairly facing closure—physiotherapists, chiropodists and mental health and handicapped services. It also includes services for the elderly and the provision of social workers and home helps, day centres, community nurses and residential homes.
I fear that the trust, once empowered, would close the Banks residential home, which I am fighting to keep open. Imagine what an independent unit not answerable to any democratically elected body would do to the services for 548 the elderly, the young and the mentally handicapped and what the result would be for health and social services in general in the North Down area.
The proposed community trust constitutes a major departure from the situation in Great Britain, where only hospitals and health authorities have been invited by the Government to opt out of NHS control, with social services departments remaining in the English local authority structure. It seems that Northern Ireland, and North Down in particular, is being used as a guinea pig for the rest of the United Kingdom. What happens in North Down in the next few months will then be introduced in the remainder of the United Kingdom.
If the North Down and Ards community unit is given trust status, the highly paid board of directors will have operational independence from the NHS. The directors of the trust will have power to sell public assets, including residential homes, to generate income from private patients, to hire and fire and set new conditions of employment at will for all the staff, in particular the nurses, and power to make their own decisions, right or wrong, including the size of their own salaries. The Minister can tell me whether I am right or wrong, but I believe that the community trust would be expected to make a 6 per cent. return on its assets, and a revenue surplus. Such profit can be made only at the expense of client and patient services.
I thought that the national health service was meant to be for the benefit of the people, young and old, and that their welfare was the only deciding factor, but it has now become clear that self-governing trust status places profit before patients. Already, even before the North Down and Ards community trust unit has been formed, officials have been looking after the bureaucracy by pouring large amounts of money into new administrative posts while freezing posts involved with direct care. I should have thought that the opposite should happen. They should cut the number of officials in the bureaucracy and provide more money for the people who look after the elderly, the mentally handicapped and the young.
The North Down and Ards unit has a new headquarters staff of administrators—a team of officials attempting to put a price on the services to be provided for the community. Trust status will not benefit the public. The national health service will be fragmented, and different services will be provided in different areas. Client and patient needs will become subservient to financial considerations. Health services will be managed by officials whose concern will be profit and loss, not compassion and care. There will be no public accountability, and only minimal local representation on the trust board.
I fear that the proposed community trust unit will signal the end of public health and social services in the North Down and Ards area, and with it the end of compassionate and responsive services based solely on patient need.
I direct this appeal to the Government, especially to the Minister who will respond to the debate: to ensure that no irrevocable decision is made before all the issues can be exhaustively examined either by a Northern Ireland assembly—if one is created before the end of the year—or by a Northern Ireland Select Committee, which would have the opportunity to decide what is in the best interests of the people of North Down.
§ The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Jeremy Hanley)
I congratulate the hon. Member for North Down (Mr. Kilfedder) on being fortunate in the ballot for the Adjournment debate. The debate is on an important subject, but it also allows me to pay tribute to the hon. Gentleman personally. In the time during which I have served at the Northern Ireland. Office I have known of no hon. Member more assiduous in serving his constituents. He has often visited me both at Stormont and at Westminster, serving the interests of the people for whom he has a special responsibility. I can say that without being patronising, not only because people know it to be true but because I feel that it is right that the hon. Gentleman should bring such matters to the Floor of the House, even though weighty events are taking place at Stormont, where we are considering some of the issues that he has raised today.
The hon. Gentleman mentioned a possible Northern Ireland Select Committee. That is very much a matter for the House authorities, but I hope that progress in the constitutional talks in Northern Ireland can return greater authority to the people of Northern Ireland—on the issue of health as well as on many other issues. There is great talent in Northern Ireland, which should be bearing the responsibilities to which the hon. Gentleman rightly referred. For reasons well known to the hon. Gentleman—I find it difficult not to call him my hon. Friend—our duty as a Government is to govern fairly. He may not always agree about Government policies, but I hope that he agrees that we adminster those policies fairly.
The Eastern health and social services board today published a consultative document on the future of hospital services in its district. It sets out the board's views on the changes needed in acute hospital services if patients are to continue to receive the best services that the latest technology and techniques can provide. My noble Friend Lord Arran is the Minister responsible for health and social services in Northern Ireland, and I know that he is taking a keen interest in this debate. For almost 18 months I had the honour of holding that post, so I also take a personal interest in the matter.
The board's document could be regarded as—I know that my hon. Friend the Minister believes that it is—a valuable contribution that will stimulate public debate, out of which will emerge firm proposals for change. Neither the board nor the Department of Health and Social Services proposes specific changes to particular hospitals. Such action will come later, probably next November when the board begins to firm up its purchasing intentions.
It is clear that with the remarkable and—I am sure that the hon. Gentleman agrees—welcome advances taking place in equipment, and medical and surgical techniques, particularly with the less invasive forms of surgery, patients spend considerably less time in hospital and can even be treated on a daily basis, which is for their convenience and happiness. I was once told by a surgeon that the majority of time a patient spends in hospital when undergoing surgery is used to heal the operation wound. Therefore, if the wound is smaller, the time spent in hospital will be less. That means that one can treat more patients in fewer beds as more patients can be treated in the available time.
The document of the Eastern health and social services board estimated that possibly up to 750 fewer beds would 550 be needed over the next five years in its area. That will not, as the hon. Gentleman might fear, ruin the services provided to patients and prospective patients, but the reverse— hospitals will be able to take advantage of new techniques, but not waste money when it is not needed. We are running not a furniture warehouse, but a health service. We need to spend the money efficiently and wisely when serving patients.
The board usefully sets out in its consultative document a list of the standards and criteria that it expects hospitals to meet if they are to secure contracts in future. The document comments on the extent to which existing hospitals meet the standards. The consultative document stated that Ards hospital fell short of the standards required to ensure clinical effectivenss. It stated that Bangor hospital had not operated as an acute hospital for some time and it did not envisage it doing so in future.
The board has set out its thinking in relation to those two hospitals, and it is now for the local management unit and local community to respond and engage in a debate with the board. I take this debate as the first salvo in the consultative process. I assure the hon. Gentleman that he will always be free to consult my noble Friend the Minister, but I do not believe — and I know that my noble Friend does not believe—that now is the time to do so. It would be better to wait until after the board has decided before petitioning the Minister, who will listen.
The hon. Gentleman spoke about prospective trust status for the community services in his area. Government reforms in the health and personal social services in Northern Ireland are working extremely well. The process, which includes the new arrangement for the provision of community care from April, is directed at ensuring the continued provision of high-quality cost-effective health and social care for the population of the Province. Health and social service trusts form a key element of the service and will ensure a clear separation between the purchasing of services by the four health and social services boards and, as from April, some GP fundholders. and the provision of those services by the provider units. The trusts will remain firmly part of the health and personal social services. There is no question of opting out of privatisation.
The hon. Gentleman spoke about profits. There are no profits to be made by a health service trust. There may be surpluses or returns on capital, but those are merely extra funds for patient care. There are no dividends and no tax to be paid. It is purely a case of a business being run efficiently and being able to provide extra funds for the people for whom it exists. The trusts have freedom to manage. That will make separation from the purchaser more clear cut, but the timetable for the implementation of "Working for Patients", the document describing the Northern Ireland reforms, was a year behind the rest of the United Kingdom. That has provided a good opportunity for Northern Ireland to see some of the benefits already accruing from the separation of the purchaser and provider functions and especially from the establishment of GP fundholders and trusts in Great Britain.
Initially there were 59 trusts and in the second wave there were more than 100 applications. In Northern Ireland, there was only one application for trust status in the first wave. There have since been 10 more. I assure the hon. Gentleman that people do not apply for trust status merely because they think it is smart, a craze, the new thing to do. People who work in the health service are dedicated 551 and do not always earn the salaries that they could earn in other milieux. Applications for trust status should not be considered with despair, disdain or suspicion. People apply for trust status because they believe that it is a better way to provide services for patients.
As I have said, Lord Arran is responsible for this matter and he wants to continue the long reputation of the Province for high calibre health services. I mentioned earlier that the Department of Health and Social Services has received 10 more applications for trust status. They were from the eight units of management in the Eastern board, the Eastern ambulance service and the Craigavon area hospitals group, which is in the Southern health and social services board area. My noble Friend announced last week that those applications are to be the subject of a three-month public consultation exercise, during which everyone can express an opinion. Those taking part may include hon. Members, MEPs, councillors, trade unions, the hon. Gentleman and his constituents and statutory and voluntary health and personal social services organisations. I know from the Royal group of hospitals that such opinions are carefully considered. By 8 September my noble Friend will have a considerable body of opinion and after that decisions will be taken.
When we make decisions about applications for trust status—particularly that made by the North Down and Ards community unit, to which the hon. Gentleman referred—a number of elements will be considered. First, there will need to be a sound business plan. Business is not a dirty word. A potential health and social services trust must demonstrate that it will be financially viable, it has a clear understanding of how it intends to develop into the future, and how it intends to use the freedoms conferred by trust status. Secondly, management must be able to demonstrate the necessary skills and capacity to run the unit. In this connection, the Minister would want to see the involvement and commitment of senior professional staff. Thirdly and perhaps most significantly, I shall expect a potential candidate to be able to demonstrate that the establishment of a trust will result in tangible benefits for patients, clients and the community. It is important to remember that trust status is not an end in itself but, as I stressed earlier, the means of providing a better service to those who need our care.
At the very heart of our proposals is the conviction that health and social services units are best run locally by the 552 professionals and managers who have first-hand knowledge of the service. This is another way of saying that those actually involved in caring for patients and clients usually know best what patients and clients need and are in the best position to meet those needs.
Our aim is to give those working in the service the freedom and support to use the skills which professional training and experience bring. The key, therefore, is greater delegation and our proposals for the health and personal social services as a whole should lead to greater freedom, flexibility and responsibility for all hospitals and units. The trusts will be both the ultimate expression of this greater delegation and, I hope, the spur to its achievement.
Units that are approved for trust status will have the maximum freedom possible to run their own affairs. Each will be run by its own board of directors, which will allow it to develop its own sense of identity and those associated with it will be able to share in the pride in the trust and in its achievements, as we have seen throughout Great Britain.
I say again to the hon. Gentleman, and I beg him to accept it, that the trusts are not opting out of the national health service, or the health and personal social services of Northern Ireland. They are opting for their future to be within those bodies, providing for the patients who want to continue to receive services free at the point of delivery. The unit will take pride in its identity and its belonging both to the health service and the people of Northern Ireland.
I hope that the hon. Gentleman does not believe that there is any ulterior motive in creating the trusts. I hope that he will see, as countless thousands have seen here in England, the benefits that trust status can bring. I hope that he will take note of the votes that we have had, and the polls that have been taken among those who work in hospital trusts in Great Britain—the nurses who would not go back and the doctors who would not now surrender the freedom to deliver their service better than they could in the past. I hope that he will not believe that we are there to protect beds when we should be there to protect patients, or that we are saving money because of cuts in Government expenditure. In fact, we do so in order to use the money better to serve the people for whom he and we have a special responsibility.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-seven minutes to Eleven o'clock.