HC Deb 29 October 1992 vol 212 cc1146-59

4.9 pm

The Secretary of State for Wales (Mr. David Hunt)

With permission, Madam Speaker, I should like to make a statement on what I consider to be a significant development for the national health service in Wales, which I believe will bring long-term benefits not only for patients but also for staff and local communities.

NHS trusts are now seen as the natural organisational model for delivering health care. The pace of change in Wales matches that in the rest of the United Kingdom. I look forward to Welsh trusts taking full advantage of the opportunities available to them to gear their services to the needs of their patients and to deal with the issues raised by the application process and during public consultation.

My announcement is confirmation that doctors, nurses, other professional groups and managers increasingly recognise that Government policy towards the NHS benefits patients by allowing for the provision and management of services locally. NHS trusts will remain firmly within the national health service; to suggest otherwise is a grave distortion. Accordingly, I have today signed orders to establish a further 13 NHS trusts in Wales on 16 November. The orders also provide that the trusts will commence formal operation on 1 April 1993. By that date, and taking account of the Pembrokeshire NHS trust, some 65 per cent. of acute health services, and 60 per cent. of community health services in Wales, will be based on NHS trusts.

Let me make it clear that my decision to establish further NHS trusts was reached by Ministers only after the most careful consideration of each representation received on the individual applications, all of which were subject to an extensive and wide-ranging consultative exercise lasting three months. Hon. Members from Wales were invited to comment on applications relating to their constituencies. In addition to community health councils, health authorities, family health services authorities, GP practices, local voluntary organisations, and, of course, staff at the health units and ambulance services were among the important range of interests that had the opportunity to make known their views on the proposals contained in the applications.

The views expressed during consultation have received close attention, alongside the individual merits of each application, and I have maintained my undertaking that I would not approve any application unless I was personally convinced that patients would benefit from the move to NHS trust status. My decisions reflect that commitment.

I shall shortly be announcing details on the chairmen and non-executive directors for the trusts that are to be established, and I make it clear to the House that my guiding principle is that individuals will be selected for the personal contribution that they can make to a trust.

I now refer to the application from the east unit of West Glamorgan health authority, which includes the plan for a new hospital for Neath and Port Talbot. I remain determined that there will be a new hospital on that site and I expect that the health authority will shortly let the contract for the next stage of infrastructure. Indeed, I am looking to further improvements in services in the area beyond the provision of a hospital and I am therefore inviting the authority, in consultation with the adjoining authorities of East Dyfed and Mid Glamorgan, to review the appropriate balance between primary and secondary care into the next century, taking into account the remarkable advances being seen in medical technology and medical practice.

I will be looking to the authority to take independent advice and to have the review substantially completed and to report back to me by the end of March 1993. Because of the importance of awaiting the outcome of the review, I feel it prudent to defer the application for NHS trust status. I know that that will come as a disappointment, but I stress that the application is only deferred.

Turning now to the expressions of interest which have been submitted, the fact that I have invited 14 applications carries no commitment that subsequently I will approve any application or, indeed, that any application has to be submitted. The position remains that the decision whether formally to apply to become a NHS trust is a matter for local determination. There is not, and will not be, any pressure from Ministers in the Welsh Office.

My decisions on whether to invite further applications from three of the health units in South Glamorgan is dependent upon the outcome of the authority's review of unit management structure and services. When that has been agreed in discussion with the prospective applicants, I look forward to receiving updated proposals for implementation as soon as is practicable.

The applications will need to be submitted formally in the early summer of next year and, as was the case this year, every submission will be subjected to a consultation exercise, normally for three months. No decisions will be reached until I have had the opportunity to consider the representations received, alongside the specific proposals for trust status. I would expect to announce the outcome on the applications in the autumn of next year.

Mrs. Ann Clwyd (Cynon Valley)

Despite what the Secretary of State for Wales has said, the statement is a further step down the route towards the American health care system in this country. Everyone in Wales knows exactly what that means. Conservative Members may shake their heads and claim that that will not happen. However, they do not recognise that a growing number of Tory Members support a private insurance system of care in the United Kindgom. In the meantime, what do the Government do for the national health service? They cut public spending, with further cuts ahead. They underfund and privatise community care. They commercialise and privatise the NHS. Where there should be more care and better care, the Government offer us competition. Where there should be service, we have the internal market, the GP fund holder, a two-tier health service and nurses out of a job.

The trusts are run like private sector companies. Although it is true that they are not in the private sector now, they have the potential to be lifted into it at the whim of a Minister. It will not be long before hip replacements are advertised in the medical appliance section of Exchange and Mart.

The statement is a further nail in the aspirations of our national health service, which is still the envy of the world despite all the Government's attempts to destroy the vision and inspiration of Aneurin Bevan.

The Secretary of State for Wales is now trying to persuade the Welsh people that the trusts, which are not accountable to local people, are for their benefit. From England, we hear reports of throat-cutting commercialisation and cuts in services and staff, but not in waiting lists. The experiences of some of my hon. Friends are not happy experiences. These are the newspaper headings that are only too commonplace in their experience of trusts: NHS Trust mishandled injured baby case"— not the Morning StarHeart patients wait as budget runs out one month early"— not the Morning Star, and Four heart patients die for lack of money". The North Middlesex hospital NHS trust recently announced cuts of £1.7 million and told its patients that, instead of two meals a day, they would get one meal and a snack and, after 6.30 pm, no evening drink. Is that what we must expect of our more caring, more efficient, health service as trusts become the order of day, or is it simply yet another example of trusts putting financial savings before patient care?

Why must Wales always be a post office for the Department of Health? That was a finding that we made when I was a member of the Royal Commission on the national health service, the only true look into the national health service since it started. Why must we always ape England in the provision of health services? Why does the Secretary of State not deal instead with the many hospitals in Wales at which no waiting list surgery is being done, leaving patients in pain and discomfort?

My hon. Friend the Member for Pembroke (Mr. Ainger), who has vigorously opposed the trust in his area, has taken up the very pertinent matter of NHS trust executive directors' salary packages. Will the Secretary of State assure us that the details of salaries and other payments to senior managers and executive directors of trusts in Wales will be published in future? Certainly, the Pembrokeshire NHS trust seems to be very good for those with a passion for German sports cars but not so good for the patients in Pembrokeshire.

All who care about the NHS in Wales—that is, all my hon. Friends—will be anxious about the service that will be provided in future. We all know about purchasing and providing, but who does the strategic planning? The only strategy that the trusts seem to have is how to make money, not how to provide for the needs of the community.

The Government believe in governing by leak, just like their leaks on the pit closures. First of all, they leaked their plans to the Western Mail. The Western Mail had all the details about the trusts yesterday. That is another discourtesy to the House. Why does the Western Mail seem to have a list of the hospitals that are to be new trusts? The list in the Western Mail includes the Royal Gwent, Newport, Singleton, Swansea, West Wales, Carmarthen and the Princess of Wales hospital in Bridgend. Perhaps the Secretary of State for Wales will provide us with the list and tell us the number.

The Government are not really concerned about discussing. Opposition Members greet with a wry smile the Secretary of State's declarations on discussion. We cannot believe that he believes in proper consultation and providing for the health needs of Wales. After all, we should not be too surprised at that because the Secretary of State for Wales, the right hon. Member for Wirral, West (Mr. Hunt), with an English constituency, simply fails to understand the passion and the feeling with which we who represent the majority of the people of Wales defend our national health service.

The Secretary of State must understand that we will continue to campaign to prevent the creeping commercialisation of our national health service. We will continue to win the support of the people of Wales because they believe that health is safe in our hands. We created the national health service and we will fight to protect it.

Mr. Hunt

That was a quite disgraceful response. To attempt to be taken seriously on the national health service but to talk about throat-cutting commercialisation is to trivialise the very important issues involved.

The hon. Lady may want to go back to all the arguments that we rehearsed during the last general election when we had much misinformation about the national health service. Indeed, the Labour party thought that it would win the United Kingdom election on that misinformation. It did not win the election because its lies were exposed. The idea that the national health service was being privatised when we were talking about non-profit-making national health service trusts was seen by the public as the nonsense that it undoubtedly was. The hon. Lady should consult some of her hon. Friends. Some Labour Members work closely with national health service trusts in England. I am aware of them in my own area. I find that the trusts put the interests of patients first and improve patient care.

The 13 units are: Clwyd acute north unit, which is at Llanllwyd hospital; Clwyd acute south unit, which is at Wrexham Maelor hospital; Clwyd community and mental health unit; Powys health unit; south Gwent acute unit; Gwent community and mental health unit; Llandough hospital health unit; Ogwr health unit; west unit, which is, of course, Singleton hospital in Swansea; Llanelli/Dinefwr health unit; Carmarthen Dinefwr health unit; Ceredigion health unit; and the Gwent, Powys and South Glamorgan joint proposal for the ambulance service. The hon. Lady will see from that list that the list that she saw in the Western Mail was incomplete.

The hon. Lady said that it would be possible for hospitals to transfer out of the national health service into the private sector. That is not possible under the law of this land. I make that absolutely clear. The hon. Lady also mentioned Pembrokeshire. Pembrokeshire has done extremely well. Its NHS treated 6 per cent. more in-patients and 25 per cent. more out-patients in the first four months of operation. That is the truth.

The hon. Lady referred to strategic planning. The national health service in Wales is proud to have not only the finest people working in the service but the finest executive of any service. It has published a strategic intent which I believe is the envy of many other parts of the United Kingdom, Europe—[Interruption.]—I was asked about the strategic intent—and the world. I recently met representatives of the World Health Organisation which complimented me—I was proud to receive the compliment as Secretary of State—on the way in which the health service in Wales applied itself to the strategic intent of putting the service in Wales on course to be on a par with the best in Europe and to go into the 21st century, adding years to life and quality life to years. We were the first part of the United Kingdom to have that strategic intent.

I remember the hon. Lady being involved with the Royal Commission on the national health service. That royal commission reported in 1979 after many years of a Labour Government. What did the hon. Lady and her colleagues on the royal commission say about funding? On 25 October 1989, she said: The Royal Commission reported that we had a good and comprehensive health service but that it was grossly underfunded".— [Official Report, Welsh Grand Committee, 25 October 1989; c. 88.] That was thanks to the Labour Government. What has happened since then?

The picture is different now. At that time, my predecessor pointed out to the hon. Lady that in cash terms the funding of the national health service in Wales had trebled. I am happy to tell the House now that funding has quadrupled. We have had to put right the inequities of those years of Labour government. In 1979, less than £500 million was spent on the national health service in Wales; we now spend £1,946 million. That is a fourfold cash increase. The increase in real terms is 67 per cent.

I shall explain that in simple terms. In 1979, the national health service in Wales spent £171 for every man, woman and child. We have now increased that figure to £675. We have remedied the underfunding of the national health service to which the hon. Lady drew attention.

Mr. Jonathan Evans (Brecon and Radnor)

Will my right hon. Friend confirm that, in some of the consultations, the responses that he has received—even from those people who may not have been convinced by some of the applications--have not shown the hostility to NHS trusts that we have heard from the Opposition Benches? Will he confirm that in the Powys area—a large part of which I represent—there is much support for what Powys health authority has done for health promotion and there is much trust in that NHS trust application?

Mr. Hunt

I could not agree more with my hon. Friend and I am grateful to him for putting the record straight. One of the key criteria for becoming an NHS trust is that the application must demonstrate realistic and achievable measures to improve patient care. That is what is going to happen.

Mr. Alex Carlile (Montgomery)

Does the Sectetary of State recognise that there will be anger in rural mid-Wales at the dismemberment of the Powys ambulance service into some enormous centralised and independent organisation? Does he accept that he has a long way to go to persuade staff in Welsh hospitals that what he has decided for Powys health authority will benefit the patients? Will he give an undertaking that the Welsh Office will advertise for chairmen and non-executive directors of trusts, so that the selection can be made from a cross-section and is not confined largely to members of his party?

Mr. Hunt

That was a cheap point. The best possible people will have to run the NHS trusts. That is why I have been receiving suggested names from Opposition Members, and why I am considering them carefully. Everyone in Wales knows that we are looking for the best possible people. If Opposition Members think that any people are not being considered, I want to hear from them immediately.

Mr. Carlile

What about the ambulance service?

Mr. Hunt

I am just coming to that, but I must deal with the hon. and learned Gentleman's cheap point. I am determined that the best possible people will be involved in NHS trusts. Approved NHS trusts are committed to improving the ambulance service. That is one of the key points in the applications before me. The NHS trusts are at the forefront of health service reforms, to make the service directly responsive to patients' needs. That is what the trusts will put at the forefront of their objectives.

Mr. Rod Richards (Clwyd, North-West)

Does my right hon. Friend recognise that the splendid decision that he announced today will be welcomed by everyone in Clwyd —[Interruption.]—by everyone who is sensible and wants the quality of the NHS to improve?

Mr. Hunt

I sometimes wonder why the clear evidence that my hon. Friend has laid before the House is not appreciated on both sides. I shall give some further statistics. In Wales, we are treating 500,000 in-patients, which is an increase of 38 per cent. during the years that we have been in Government, or another 132,750 in-patients, and the number of out-patients has risen by 29 per cent., which is another 122,700. Day cases have increased by 227 per cent. Those are excellent figures and a tribute to the quality of people working in the health service in Wales.

Mr. Nick Ainger (Pembroke)

When the Secretary of State says, "Let's put the record straight", is he aware of what has been going on in the Pembrokeshire NHS trust during the past seven months? He does not refer to that. He says that he assumes that the staff will welcome his announcement because of the benefits that it will bring.

Is he aware that, seven months after the beginning of the trust in Pembrokeshire, not one trade union has been recognised; that the Royal College of Nursing is in dispute with the management of the trust over the application, without consultation, of a local pay spine; that the United States naval facility has entered into a contract with the trust for private ante-natal care; and that the German army has entered into a private contract with the trust for dental care? After seven months of operation, when I receive a letter from the chairman of the Pembrokeshire NHS trust, in reply to my letter concerning the car leasing agreement, to which my hon. Friend the Member for Cynon Valley (Mrs. Clwyd) referred —

Madam Speaker

Order. I regret the fact that questions on the statement are becoming a debate. I remind hon. Members, as well as the Secretary of State, that we want to have questions and answers. That is what statements are all about. We are not in debate. May I have a question from the hon. Gentleman?

Mr. Ainger

May I have the Secretary of State's reaction to the statement by the chairman of the Pembrokeshire NHS trust, in response to my question about the car leasing agreement and salary structures of the executive directors, that that was quite common commercial practice in relation to car leasing deals?

Mr. Hunt

The purpose of the reforms is to take decision-making closer to the people and to have decisions taken locally. I am not going to try to second-guess the national health trust in Pembrokeshire. I do not judge anyone on his or her property or on the car that he or she drives; I judge people on what they are going to do for the national health service in Wales. The Pembrokeshire NHS trust has treated 6 per cent. more in-patients and 25 per cent. more out-patients. That is a pretty good record.

Mr. Walter Sweeney (Vale of Glamorgan)

Will my right hon. Friend accept congratulations from the Vale of Glamorgan on the tremendous strides that have been made in health care in the past 13 years? Will he acknowledge that we have a particular interest in the future of Llandough hospital and that we look for further improvement in that already great hospital as and when trust status is acquired?

Mr. Hunt

I am glad that my hon. Friend referred to Llandough, because that is one of the applications that I approved today. If I may reiterate a point that fits in very neatly with the points which my hon. Friends are making, approved NHS trusts are committed to attacking waiting times and waiting lists, improving the ambulance service, providing local mental illness and mental handicap services, improving local hospitals, improving individual community care programmes and increasing day care facilities.

We look forward with great optimism to their achieving many of those targets in the years ahead.

Mr. John Morris (Aberavon)

I welcome the Secretary of State's determination to have a new hospital at Neath and Port Talbot, a determination which I have long shared.

Will he expand on his cryptic Whitehallese when he referred to a further improvement over a wider area? Will the right hon. Gentleman give an assurance that those are plus words and not minus words and that they mean something beyond the provision of a hospital—not a diminution in capital, the time scale or any specialty at Port Talbot or intended there? Why was Port Talbot singled out? Does this mean a cut at Port Talbot or not?

Mr. Hunt

No, it means exactly what it says. I should like to make some points to the right hon. and learned Gentleman, who was a distinguished predecessor. There is no community hospital programme in West Glamorgan —that is an important point. Elsewhere in Wales, progress is being seen in community care. That is evident. There is a significant move towards day care provision: the twofold increase in West Glamorgan compares with a fivefold increase in Mid Glamorgan and a fourfold increase in East Dyfed. So my statement means exactly what I said: I want to look at further improvements in provision of services in the area beyond the hospital provision, and that is why I have asked for this review.

Mr. Nick Hawkins (Blackpool, South)

Does my right hon. Friend agree that the hon. Member for Cynon Valley (Mrs. Clwyd), who leads for the Opposition, in responding to this statement this afternoon —

Madam Speaker

Order. The Secretary of State is not responsible for what the hon. Lady says. The statement should be questioned.

Mr. Hawkins

Thank you for your guidance, Madam Speaker. May I rephrase the question in this way? Does my right hon. Friend agree that we have heard a great deal this afternoon which has attempted to blacken the work of the NHS trusts in England and which has been used as examples?

Will my right hon. Friend confirm that the experience of the trusts in England has been that waiting lists have been cut dramatically and that "commercial management", which the Opposition think are dirty words, is bringing efficiency to the NHS? The Opposition are concerned about restricted practices and preserving the jobs of those in the Confederation of Health Service Employees and the National Union of Public Employees, not about improving medical standards for patients.

Mr. Hunt

I am grateful to my hon. Friend for making the point about NHS trusts in England, where throughput has increased, waiting lists have been cut, new equipment has been introduced early and capital expenditure is ahead of schedule. That has been a great success story and we in Wales are determined to share in that success.

Mr. Alan Williams (Swansea, West)

The Minister says that he wants to take decision-making closer to the people. Will he explain how 13 unaccountable quangos, packed with Welsh Office placemen, take decision-making closer to the people? If he is concerned about decision-making and the people, why, in a parliamentary answer to me last week, did he say that of 90 representations that he has received in relation to the Singleton trust, only 19 were in favour?

Mr. Hunt

I read through all the representations and I take them into account before I reach a decision. The whole purpose of creating NHS trusts is to make them more accountable and to take decision-making closer to the people. We shall see the results and the benefits as the NHS trust movement in Wales evolves.

Mr. Denzil Davies (Llanelli)

On the subject of accountability and bringing decision-making closer to the people, will the Secretary of State give an assurance that the chairmen and non-executive directors of the trusts will live in the areas that their trusts service?

Mr. Hunt

As I have said on many occasions previously, I shall take great care in selecting the people who will be involved. I shall not rule anybody out, because that would be wrong. The right hon. Gentleman's point is valid, but the important thing is to have the best possible people.

Mr. Ieuan Wyn Jones (Ynys Mein)

The Secretary of State will be aware that, every time the Conservative party has laid its plans for hospital trusts before the people of Wales, they have been decisively rejected, both at by-elections which Conservatives lost during the last Parliament and during the general election. If the right hon. Gentleman and his right hon. and hon. Friends believe that the people of Wales want trusts, why does not he put it to the test and call for a ballot in each of the areas so that the people of Wales have the final decision on the trusts?

Mr. Hunt

Neither I as Secretary of State nor my right hon. and hon. Friends are prepared to walk away from the need to make decisions in these areas. The key decision which we have made is to increase funding substantially for the NHS. I have already made it clear that, since we took office in 1979, cash for the NHS in Wales has been increased fourfold, and that is 67 per cent. more in real terms. We are determined to ensure that every penny and every pound of that money is spent to the best possible effect.

Mr. Martyn Jones (Clwyd, South-West)

The Secretary of State knows that my constituency is serviced by Ysbyty Glan Clwyd and Ysbyty Wrexham Maelor. First, bearing in mind the likely public sector cuts thanks to the Government's handling of the economy, can he guarantee to my constituents that there will be funding for the new hospital trust that he has created from those two hospitals? Will he guarantee that neither hospital will have more private beds after trust status than before? Thirdly, as staff morale in Wrexham is poor, will he ensure that it faces no more ward closures or staff cuts?

Mr. Hunt

I remind the hon. Gentleman that it is thanks to the Government that we have Wrexham Maelor hospital. It was built under this Government. I cannot preview the outcome of the public expenditure survey, but the hon. Gentleman can judge us by results. To quadruple in cash terms the funding for the NHS in Wales is a good advertisement. On the hon. Gentleman's remaining points, the whole point of NHS trusts is to take decision-making on such issues closer to the people. That is down to the NHS trust itself.

Mr. Barry Jones (Alyn and Deeside)

Does the right hon. Gentleman accept that, in Clwyd, there is no popular backing for trust status at the great hospitals at Wrexham and Glan Clwyd at Rhyl? Is not the right hon. Gentleman proposing a high-risk policy for which there is no backing from the people of Wales? Is it not a dark day in the history of his office that he should now be proposing this wretched measure, coming as it does after water privatisation and the poll tax?

Mr. Hunt

I have always had a lot of time and respect for the hon. Gentleman, but he has gone a bit over the top. We are proud of our record in the NHS in Wales. Wrexham Maelor hospital was built thanks to this Government providing the necessary funding —there has been a number of such examples under the Government. We have increased funding to record levels and we now want to introduce the right reforms to take management closer to the people to ensure that every penny and every pound is spent to the benefit of patients. That is the key to the reforms.

Mr. Peter Hain (Neath)

Is the Secretary of State aware that, in the West Glamorgan area, there is widespread fear that the new Neath and Port Talbot hospital will be a victim of the Government's capital spending cuts? Will he give us an absolute assurance that he is committed to a capital programme during the next few years which involves ring-fencing the sum of £80 million, with the specialties provided as part of the plan also being protected? Will he also confirm that, as part of his review, he intends to establish a new ambulance service trust for Dyfed and west Glamorgan, a proposal which, if carried through, will be bitterly resented by local people?

Mr. Hunt

On the first point, I remind the hon. Gentleman that the representations that I received in Neath were very much to the effect that the hospital should not be built on the site, because it was felt at the time that the hospital should be in Neath rather than in Port Talbot.

Mr. Hain

They wanted a new hospital .

Mr. Hunt

They did want a new hospital, but do not let us rewrite history. As I said in my statement, I remain determined that there will be a new hospital on this site. I have made that clear. But against the background of the changing health picture in Wales, it is right to have a review, which I have asked to report to me by next spring so that I can consider the overall situation. Any future applications are a matter for the applicants.

Mr. Ron Davies (Caerphilly)

Has the Secretary of State a policy for whole district applications for opt-out?

Mr. Hunt

My policy is to look at each application on its merits.

Mr. Gareth Wardell (Gower)

First, if any of the trusts gets into financial difficulty and is in debt, will the Secretary of State pick up the tab for that debt? Secondly, as the Secretary of State knows, Wales has one of the highest incidences of cardiac disease of any country in the western world. Will his announcement today affect in any way the possibility that a second cardiac surgical unit will be built in south Wales, providing 400 adult open heart operations a year?

Mr. Hunt

The need for a second cardiac centre is continuing to be reviewed for us by consultants. We are talking about units and trusts within the NHS, which will be funded in the time-honoured way through the NHS. People cannot criticise the Government for underfunding, in the way that the hon. Member for Cynon Valley (Mrs. Clwyd) criticised the Labour Government in the 1970s for underfunding, because we have substantially increased funding. We are determined to ensure that the money is spent in the best possible way for the patients.

Mr. Paul Flynn (Newport, West)

Will the alien governor-general for Wales tell us, the elected representatives of the people of Wales, a little more about the most careful consideration that he gave to the representations that he received? On the three trusts for Gwent, how many people supported the ideas and how many were opposed?

Mr. Hunt

I do not recognise the description, but I shall still answer the question. I gave very careful attention to all the representations that I received.

Mr. Alan W. Williams (Carmarthen)

Will the Secretary of State tell us the number of representations supporting the trust status application for Carmarthen hospital and the number opposing it? My experience over many years has been that thousands of people have queued up to sign petitions that we have organised about the trust application. The overwhelming feeling of the public is total opposition to those trusts.

Mr. Hunt

I shall supply the individual figures. We asked for responses from 5,000 organisations and individuals and received about 400. I assure the House again that I carefully considered all the responses that I received.

Mr. Win Griffiths (Bridgend)

The Secretary of State will be aware that the Ogwr health unit undertook eight public meetings in my constituency and that of my hon. Friend the Member for Ogmore (Mr. Powell) and that the consensus was against the establishment of a trust. In the trust document and in those public meetings, two points of view were put forward by the management for the trust: first, that it would improve local accountability; and, secondly, that it would ensure that phase 2 of the Princess of Wales hospital would be started. That information was contained in the trust document. In my response through the Bridgend constituency Labour party, I asked whether, if the trust was to be appointed, a guarantee would be given that that capital programme would be carried out. Will the Secretary of State give us that assurance?

On local accountability, will he assure us that the people chosen to be non-executive directors will have a proven track record of interest in the health service? Will he publish the names of all those people before he makes his decisions?

Mr. Hunt

A number of questions are coming in my direction, and, if I am to deal with them all, that will take a considerable time. On representations, we sent out our request for consultation to 5,000 organisations and recipients. We received 416 responses, 192 of which opposed the proposals. I recognise that that is a majority. However, applications for national health service trust status raise complex issues and it is important for representations received to be considered by the Secretary of State, alongside the individual merits of the application document. In the main, representations focused on the general principle of national health service reform and the trusts themselves, rather than on specific issues raised in the applications.

On the specific issue that the hon. Gentleman raises, I can give no guarantees, because the exact amount available next year for capital and income is not yet known to me. I shall make my announcements in the usual way, and people in Wales will have to judge the Welsh Office and the Government on their results. The results are that we now have record funding for the national health service in cash and real terms.

Mr. Jon Owen Jones (Cardiff, Central)

As the Government's justification for trust status is that it would introduce competition into the health service, why was trust status now been given to Llandough hospital in South Glamorgan but denied to the Cardiff royal infirmary? It cannot be because of the financial difficulties of the CRI, because, although it is in difficulty with spending at 1.7 per cent. over budget, Llandough is 1.2 per cent. over budget. If there is to be competition for health care, why are some hospitals not allowed to compete? We know that the plan is to close the CRI, and it is not having a chance to compete with other hospitals.

Mr. Hunt

May I make it clear that I can deal only with applications for national health service trust status which are received by me and meet the criteria? I received an application for Llandough which met the criteria. I have not received an application that meets the criteria from the CRI. We must take into account, in the context of the review that I have explained, future health care in South Glamorgan.

Mr. David Hanson (Delyn)

Will the Secretary of State accept from me the fact that there is dismay in Clwyd at the announcement of his decision today? Will he publish for me the consultation replies of Glanclwyd and Wrexham so that we can see how many supported it and how many were against? Why is he so coy in naming chairmen today, bearing in mind that it is well known in Clwyd—I have heard from the individual himself—that one individual has already told everybody that he is to be chairman of the new Glanclwyd trust? Why does not the Secretary of State name him today?

Mr. Hunt

Because I have not yet decided who should be chairman. With the qualification that I must be careful to check that individuals were aware that their responses would be published, I shall do my best to meet the hon. Gentleman's request about representations.

Mr. Donald Anderson (Swansea, East)

Will the Secretary of State consider the nomination of Sir Anthony Meyer, Baronet, who, for some reason, is the only former Tory Welsh Member of Parliament not to have been given a quango post? As the Secretary of State will know, the proposed Morriston hospital trust will include the new burns and plastic unit transferred from Chepstow. In that new regime of purchaser and provider, will the Secretary of State give a clear undertaking that he will protect the integrity of that new unit for the first years?

Mr. Hunt

I am happy to give the assurance that there will be special provision for the first two years for regional units.

I have always felt very close to Anthony Meyer. I have a great deal of respect for him, and the hon. Gentleman's move to propose him for a post is welcome. I promise to give it careful consideration.

Mr. Rhodri Morgan (Cardiff, West)

Will the Secretary of State accept from those of us who represent Welsh constituencies and whose constituents go to those hospitals the fact that we shall watch carefully, during the five months until those trusts are formed, to see that there is no further squeeze on the finances of those hospitals? The abolition of all waiting list surgery, for example, at Llandough, Prince of Wales and Cardiff royal infirmary should not continue until 1 April so that the national health service trusts look artifically good next year and are able to say, "We are re-starting operations which we have not seen for eight months at Llandough and for six months at Cardiff royal infirmary." I am sure that the same thing will happen elsewhere in Wales regarding waiting list work.

Before the Secretary of State announces his decision on the 1994 trusts—the so-called third wave—on which he asks for an expression of interest today, will he carry out an independent evaluation on whether those hospitals are performing better than the hospitals that have already been put into the trust status framework by today's announcement? Parliament will then be able to make a proper comparison between trust and non-trust hospitals to see which perform better, before the right hon. Gentleman finally makes a commitment to put other hospitals in the third wave before April 1994.

Will the right hon. Gentleman also tell us a little more about the appointing procedure, following the point made by the hon. and learned Member for Montgomery (Mr. Carlile)? We are anxious to see that the procedure for the choice of chairman or chairwoman and the non-executive directors is made regardless of race, creed, sex and political persuasion. Will he give us guarantees about how that will be achieved?

On the confusing situation in South Glamorgan in particular, where the right hon. Gentleman has declared that the Llandough trust can have the go-ahead, there is a messy situation in the other major hospital groups and in the ambulance trust, where, apart from the Llandough hospital, no proper unit managers are in post. The ambulance trust manager is on extended sick leave. The Whitchurch hospital has an acting unit manager. The Cardiff royal infirmary has an acting unit manager, as does Heath hospital. Until this management chaos is put right, will the right hon. Gentleman ensure that no further moves are made to set up trusts?

Does the right hon. Gentleman agree that the figures he has given on funding of the health service in Wales wholly contradict those given to me by the former Member for Pembroke, Mr. Nicholas Bennett, just before the last election? It was like drawing teeth, but Mr. Bennett reluctantly gave us the figures for the period of the last Labour Government. After allowing for the health service inflation rate, the rate of increase in real resources going into the NHS in Wales rose by 2.8 per cent. a year under Labour. Since the Government came to office, it has risen by 2.3 per cent. a year. So the real purchasing power of the NHS, on behalf of patients, rose 20 per cent. faster under Labour than under the Conservatives.

Finally, will the right hon. Gentleman give us more details about the representations that he has received? Every time he has been asked this afternoon by hon. Members on behalf of their constituents what representations he has received and whether they were in favour of or against the formation of trusts, he has suddenly been struck dumb. Why? How many people were in favour and how many were against the formation of trusts? We who represent the people of Wales know that, apart from the accountants and managers who will do well out of this, not to mention the German sports car salesmen, who will do extremely well out of it, the overwhelming majority do not support the formation of any more trusts than the pathetic one that we already have in Wales.

Mr. Hunt

The hon. Gentleman said that he was going to watch me carefully. I thought that he was doing that already. I am not paranoid, but I sometimes look over my shoulder when I am strolling along the road to see whether he is following me. His scrutiny is remarkably assiduous, and I pay tribute to it: he is a good parliamentarian. I sometimes think that he is listening to almost every meeting that I take part in. He is always so well informed —except that on this occasion he has got it wrong.

The hon. Gentleman ought to have a word with his hon. Friend the Member for Cynon Valley before he claims that the Labour Government did not grossly underfund the national health service.

Mr. Win Griffiths

He did not say that.

Mr. Hunt

I am so sorry. The hon. Member for Bridgend (Mr. Griffiths) appears to be telling me that his hon. Friend did say that the Labour Government grossly underfunded the national health service. The two of them had better go out and get their act together, because that is what the hon. Member for Cynon Valley said.

I will pay careful attention to every aspect of the applications that may be made in 1994. Of course I will look at the performance of all the hospitals in Wales when reaching a decision. I have made it clear that these trusts remain fully part of the national health service and part of the strategic intent of the health service in Wales. They are introducing new management arrangements into the family of the NHS, but they are still part of it. I am responsible for the health service in Wales, so I will pay careful attention to all these aspects.

We will make sure that we appoint the best possible people, as I have said before. No decisions will be taken on applications until there has been wide public consultation for three months and until I have been able to consider the results.

The applications have demonstrated to me—I refer to the ones that I am allowing today—that they will benefit patients and that those who made them are committed to improving services. Only time will tell whether they are able to live up to expectations. Today I am giving the trusts the opportunity to show us that NHS trusts can be as successful in Wales as they have been in England arid that we can maintain our strategic intent to put the NHS in Wales on course to be on a par with the best in Europe as we enter the 21st century. That is a good objective. With all the good people whom we have working in the NHS in Wales, I am determined to attain that objective and proudly boast it to the rest of the world.

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