National Health Service

HC Deb 10 May 1993 vol 224 cc604-21 10.36 pm

Mr. Ian McCartney (Makerfield)

I beg to move, That the National Health Service (Determination of Districts) Order 1993 (S.I., 1993, No. 574), dated 9th March 1993, a copy of which was laid before this House on 10th March, be revoked. I understand that with this it will be convenient discuss at the same time the following motions: That the National Health Service (District Health Authorities) Order 1993 (S.I., 1993, No. 572), dated 9th March 1993, a copy of which was laid before this House on 10th March, be revoked. That the National Health Service (Determination of Regions) Amendment Order 1993 (S.I., 1993, No. 571), dated 9th March 1993, a copy of which was laid before this House on 10th March, be revoked. We are about to debate orders that relate to the reorganisation of the English national health service. Frankly, the orders do not do justice to the reorganisation proposed by the Government. The Government are reorganising the NHS by stealth and by the back door. The Minister is the Lord Hanson of the national health service. Merger mania, takeovers, corporate raids on funds, asset-stripping, sackings of staff, profit-taking, commercialisation and privatisation are all contained not only in these orders, but in previous orders which have been passed by the House without parliamentary or public scrutiny.

In 1982, the Government introduced proposals for the reorganisation of district health authorities. They created 192 authorities—[Interruption.]

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

On a point of order, Mr. Deputy Speaker. The orders are tremendously important. It is impossible to hear what my hon. Friend the Member for Makerfield (Mr. McCartney) is saying.

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)

Would hon. Members leaving the Chamber please leave quietly? If any sub-committees are meeting, will they please meet outside.

Mr. McCartney

I thank my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody). It is the first time that I have been shouted down in the House before I have got two minutes into my speech. I shall try to provoke Conservative Members a little more as I get further into my speech.

In 1982, the Government reorganised the district health authorities of England, creating 192 on the basis that the previous 85 were too remote, too large, had no control locally of the delivery of service and showed no signs of being consistent with local democracy and local accountability. Yet 11 years on, the Government are by stealth reversing that policy and are reducing the number to between 85 and 90. With the reorganisation, they are removing much of the public accountability and public participation in local health services. Why is that?

Why is the Minister reorganising the national health service in this reorganisation that dares not speak its name? Why, with little local consultation and hardly any parliamentary scrutiny, are the Government undertaking the biggest reorganisation of the health service in England since 1982? It is all about the creation and development of a market in the national health service.

At a time when the Government are causing bed closures, when there are nearly 1 million people on the waiting lists, when prescription charges are rising, when limited lists are being introduced, when student nurses are being made redundant and qualified nurses are being sacked, when GPs are saying that the community care proposals are a shambles and when charities both locally and nationally are paying for life-saving equipment because the national health service cannot afford it, the Under-Secretary is appointing Conservative after Conservative to chairmanships and non-executive positions on the boards.

The money that is being spent is an absolute scandal —a scandal of major proportions. Let me give the House some indication of the size of the gravy train that the Under-Secretary is driving. Take the hon. Gentleman's own constituency as an example. In Bolton, during 1990–91, £17,100 was available in remuneration for the chair and non-executive members. By 1992, that figure had risen to £49,356. The Parliamentary Under-Secretary of State for Social Security, the hon. Member for Bury, North (Mr. Burt), who is trying to reduce income support for the unemployed, has presided over an increase from £35,000 to just under £50,000 in remuneration for Conservative appointees on the health authority in his constituency. The Government are introducing income support, using public funds, for Tory party members to run quangos in the national health service.

Some of my hon. Friends want to speak tonight about the situation in the north-east, which is even more devastating. For example, the Newcastle upon Tyne, expenditure in respect of chairmen and non-executive members has risen from £46,000 to £107,469. In Cumbria, the figure has risen from £15,000 to £48,000; in Gateshead, from £29,000 to £43,000; and in Northumberland, from £31,000 to £63,000.

One can cite area health authority after area health authority—and that at a time when the Government cannot find the money to pay student nurses finishing their courses and are giving them a certificate with one hand and a UB40 with the other. It is outrageous that the Government are spending these rare resources not on primary health care or care in the NHS but in payments to Tory party members to run the national health service.

The reorganisation involves centralisation; it is leading to services being planned by people who do not know their own populations and who do not live in their areas. The Minister is creating purchasing giants because he wants to ration care in the national health service. He wants to create offices of health regulation by replacing public health officers and appointing health commissioners, 50 per cent. of whom have no medical qualification whatever. He is replacing qualified medical staff with consultants and accountants whose responsibility is not to prepare and deliver a local health care service on the basis of need, but to ensure that purchasing is the main drive of health care in the regions. There will be no public accountability whatever. The new organisations are to be run exclusively by political appointees. After last Thursday's election debacle, the Government will have hundreds more ex-councillors to appoint to those positions.

Finally, I want to ask the Under-Secretary about London. He argues that we should have conterminosity —the hon. Member for Ribble Valley (Mr. Evans) is surprised that I managed to pronounce that properly—and that the reorganisation is about trying to ensure that districts are amalgamated and that there is a commonality of boundaries with local authorities. Why is it then that, for Kingston, Esher, Richmond, Twickenham and Roehampton, there is no conterminosity? The Government have broken it up. They have divided the new health authority between four or five district councils. I believe that the reason is that the right hon. and learned Member for Putney (Mr. Mellor) has an interest in a particular hospital there. He is concerned—

Mr. Ian Taylor (Esher)

Will the hon. Gentleman give way?

Mr. McCartney

No, I will not give way.

The right hon. and learned Member for Putney obviously wants to ensure that the boundaries suit the Government politically rather than suit the national health service.

Mr. Taylor

rose—

Mr. McCartney

I know that the hon. Gentleman comes from Esher, but he has an opportunity to put the case in the same way as I am trying to put the case. Perhaps for once he will speak in the House on health service matters and put the case.

The Government owe it to the House to explain why, in the areas that I have mentioned, they are getting rid of conterminosity and replacing it with politically biased boundaries irrespective of the health care needs of the borough.

It is absolutely essential that there is more public debate about the proposals. It is clear that the orders that the Government intend in the weeks and months ahead to propose further major reorganisation of district health authorities, uprooting local accountability, destroying the commonality of each community, removing local purchasing and replacing it with big takeovers and mergers. In some areas, local authorities will also lose the opportunity to co-ordinate community care in a rational way.

Local community health councils will be under threat from the Government when the Government remove the coterminosity of the boundaries as a result of the major changes and takeovers that are taking place. That has already led in many areas to the closure or partial closure of hospitals as big organisations drive down the cost of health care at the expense of services to the local community. I ask my colleagues not only to speak against the orders but to vote against them in the Lobby.

10.46 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)

It is always a pleasure to follow the hon. Member for Makerfield (Mr. McCartney). When he hits that top C sharp and holds it for 10 minutes it is a marvel of oratory and Conservative Members know that he is destroying whatever case he is trying to put to the House.

The debate gives me an opportunity to discuss with the House the merits of mergers of health authorities and the benefits that they give to patients and the health service. Most people know about the remarkable changes that have been made on the provider side of the health service.

Trusts are undoubtedly one of the great success stories of the health service and probably the greatest single radical change since its inception.

Rather less well known, and perhaps more important, is the new position and role of health authorities as purchasers. Purchasing is a new concept not entirely understood by Opposition Members, as we have just heard, but it is enormously important. In case the hon. Member for Makerfield has not noticed, health authorities will not manage hospitals in future; that will be the duty of trusts. Purchasers will have an entirely new role. They will assess the health needs of their area.

Mrs. Dunwoody

Would the Minister like to tell us whether this system went live on 1 April and whether, if that is so, almost all the authorities on his list are trying to implement illegal contracts?

Mr. Sackville

I do not recognise the constitutional validity of what the hon. Lady says. The Opposition are praying against orders to merge health authorities which became effective on 1 April.

The new merged health authorities will set standards for care in their areas. They will target the resources allocated to them by the regional health authorities. They will demand value for money through the contracts that they set with providers. Lastly, they will monitor quality. But they will also have a wider remit. They will also be the bodies that influence the health agenda in each area. The vision for that was set out in "The Health of the Nation" White Paper. Health authorities will be encouraged to form healthy alliances with other agencies, such as local authorities and voluntary organisations, and even with private sector companies to influence and improve the health of their populations.

Mr. Harry Cohen (Leyton)

How can the new health authority in Redbridge and Waltham Forest, in my area, improve the health of the people there when it will suffer a £13.5 million cut over the coming five years? The first £2 million cut was implemented this year. That authority, local Members of Parliament and the local public have not been consulted. The Minister talks of a new role for those health authorities. Is this not another way of telling the public that they cannot get the treatment that they need?

Mr. Sackville

On the contrary: they will be in a position better to marshal the resources at their disposal, for reasons I shall explain. Health authorities now have a formidable brief, so we need to develop and strengthen NHS purchasers.

Mr. Mike Gapes. (Ilford, South)

There has been a terrible dispute between Redbridge health authority and the Redbridge health care trust in recent weeks, and only in recent days has the authority taken contracts to the trust. That has resulted in a massive problem financially, including a potential £400,000 deficit for the new trust. Is that some of the co-operation about which the Minister is talking?

Mr. Sackville

I have no doubt that in many areas there will be certain constructive tension between purchaser and provider, and that is an example of the contracting system. Indeed, it is one of the strengths of the system.

I shall not delay the House long because other hon. Members wish to take part in the debate. What are the benefits of mergers? They will play an important part in helping larger health authorities to assess and meet the health care needs of the population in the way that they relate to other local bodies, particularly family health services authorities and local authorities.

A high proportion of district health authority mergers will help to simplify those relationships by, as the hon. Member for Makerfield rightly said, conterminosity, meaning common borders with other agencies. We do not pretend that they will guarantee success, and there will not be common borders in every case, as the hon. Gentleman pointed out. Common boundaries can help with the integrated purchasing of primary and secondary care and with the task of commissioning care in the community.

Larger authorities will have a more stable population on which to assess the needs of their local populations and they will be better prepared for eventualities in those larger areas. They will be in a better position to place contracts for specialised services and special care groups.

Mergers can offer the prospect of increased purchaser leverage, giving district health authorities more bargaining power and clout in dealing with providers and getting a proper deal for their patients. DHAs must be strong enough to bring the benefits of GP fundholding—which is a whole new factor in the NHS—to all GPs, whether or not they are fund holders, and to their patients. They will enable purchasing authorities to make the best use of human resources. Purchasing will not require large numbers of people, but it will need a critical mass of highly skilled personnel if it is to be properly performed. In the past, DHAs have suffered from the migration of high-quality staff to trusts, but larger authorities will be better placed to attract and retain the best people to do the job.

Mergers will produce administrative savings and considerable economies of scale, which should be welcome to all hon. Members. By simply reducing the number of contracts, a considerable saving can be achieved. Of the mergers under discussion, that in South West Durham will reduce the number of contracts to be negotiated from 220 to 120. I know that one health authority in the west country has claimed, since merger, to have saved more than £1 million in administrative costs.

Mr. David Blunkett (Sheffield, Brightside)

How can the Minister argue that merging purchasing authorities saves administrative time and money and is valuable in terms of the patient, when the inevitable thrust of GP fundholding is to break up the purchasing arrangements, the larger contracts and the benefits that can be gained from rationalising and quality of scale, and replace them with small purchasing contracts?

Mr. Sackville

The virtues of GP fundholding are obvious. If the hon. Gentleman talks to fund holders and their patients, he will discover the benefits that they are receiving as a result of the change in their relationship with providers. There is no doubt that economies of scale will result from eliminating duplicated posts in health authorities that merge.

Patient benefits can be achieved by linking the planning and development of services with other agencies and by improving the quality of purchasing bodies in order to make them more responsive to local people. The greater pressure on costs will release resources for care. I should have thought that, given the new role of health authorities, which will not manage hospitals but will be purchasers, it would be clear that new configurations will be necessary.

I heard nothing of any substance in the speech of the hon. Member for Makerfield. He attacked the proposed changes and his speech was yet another gratuitous attack

on the health reforms. It may be indelicate to talk about elections now, but before the general election we heard from the Opposition a litany of gratuitous attacks on the health service, which they sought to denigrate. If they continue with their Pavlovian response of persistent attacks on everything to do with the health reforms, it will be clear that the events of April 1992 have taught them nothing.

10.57 pm

Mr. Alan Milburn (Darlington)

The Minister spoke at length about coterminosity and it is ironic that we should be debating health authority mergers, because this morning the Local Government Commission published its findings about the future of local government services in County Durham. I am delighted to tell the House that the commission recommended a unitary tier council for Darlington. That will restore control that was stripped from the town in 1974 by the then Conservative Government.

Nearly 20 years on, we are debating orders that will, once again, take power from Darlington, this time from its other key public service, the NHS. Just as social services and other services that might impact on health care are to be delivered back to the town, the NHS will be taken out of local hands. That decision is not only illogical but it will create a bureaucratic minefield where patients, once again, will be the casualties. That is only one of the many ironies and concerns that have been revealed by the impact and process of the merger of the Darlington and South-West Durham health authorities.

Together with my right hon. Friend the Member for Bishop Auckland (Mr. Foster) and my hon. Friend the Member for Durham, North-West (Ms Armstrong), I have strenuously opposed the merger from the outset, because we believe it to be a false merger which will do nothing to improve health care in either Darlington or South-West Durham. Our resolve has been strengthened by each twist and turn in the lengthy merger process.

The merger to create the new South Durham health authority did not arrive on the scene from nowhere on 1 April, but had a lengthy gestation period. It was conceived in secret and delivered by a mixture of manipulation and deceit. Members of Parliament were even denied the chance to debate the merger before it came into being on 1 April—an issue which has already been raised by one of my hon. Friends.

The saga of South Durham health authority dates back to 25 April last year when the Northern region health authority published proposals for a new set of consortium arrangements to purchase health care. Seven consortium arrangements were to be created covering the 15 district health authorities in the north, including one for South Durham, covering the Darlington and South-West Durham health authority areas.

Early in March last year I received the first in what was to be a series of leaks from a well-placed source inside the region's NHS, which showed that the new consortiums were envisaged as staging posts to full-blown health authority mergers. My source was able to state which senior managers were to be moved into which posts in order to facilitate the merger. The leaked predictions were to be proved uncannily accurate. The game of management musical chairs involved Darlington's chief executive, Geoff Nichol, and South-West Durham's David Ryan disappearing off the scene to allow a newcomer, Tony Jameson, to take over as chief executive of the joint authorities.

When the story appeared in the local paper, The Northern Echo, a regional health authority spokesman went out of his way to dismiss the document as pure speculation. He said that the possibility of a merger had not even been discussed. I did not want to leave anything to chance and immediately wrote to the regional health authority chairman, Peter Carr—as a good prospective parliamentary candidate should. I received a clear reply from Mr. Carr on 26 March. He said: there is no regionwide blueprint. There is no timetable. Any new consortia management arrangements that are developed would remain accountable to the existing statutory health authorities. By the end of the next month, Geoff Nichol and David Ryan had left their posts, but the region's head of communications, Dr. George Forster—a man who will frequently appear in the course of the saga—told the other local paper, the Darlington and Stockton Times: as for merger well it is just not on the agenda". In the same newspaper on 23 May, the same Dr. Forster greeted the news that Tony Jameson had arrived in Darlington with a categorical assurance that the new appointment of Mr. Jameson is for the post of district general manager of Darlington. He is not being employed to run the joint purchasing function. However, the following week, Dr. Forster had gone strangely quiet. Perhaps that was not surprising as, by that time, Mr. Jameson had been appointed as acting chief executive in South-West Durham as well. My right hon. and hon. Friends and I have the highest regard for Mr. Jameson, so when he said in a newspaper interview that the regional health authority has a view that a smaller number of districts in the region is a desirable arrangement", naturally we all felt concerned.

Our concerns were heightened when, in the middle of July, The Northern Echo received a leaked copy of a memorandum written by Mr. Jameson. It informed senior managers and district health authority members that a proposed merger of Darlington and South-West Durham health authorities would be discussed at the regional health authority meeting on 28 July. All that happened before the two districts had had a chance to meet on 22 and 24 July to ask the region to back the merger proposal. Mr. Jameson's memo had blown the regional health authority's cover about there being no blueprint and no timetable.

It is little wonder that, by that time, the very idea of public consultation was dismissed as an elaborate sham. Ministers connived in a fait accompli to ensure that a merger was forced on Darlington and South-West Durham.

That view is enforced by an examination of the regional health authority's treatment of the responses that it received. I have no doubt that the Minister will say that a majority of the responses were in favour of the merger.However, he will omit to say that the overwhelming majority of the favourable responses came from NHS organisations. Such is the loyalty to the centre in the NHS nowadays that they could not be expected to rebel.

Even when dissent was expressed, it was discounted. The regional health authority managed to count a letter from a consultant paediatrician as expressing no comment in overall support or opposition, despite its clear view: I fail to see how the new larger authority will benefit the people … The people wish to keep their own services locally. Travelling for many is not easy. Transport is expensive. Others were not consulted at all. Darlington MIND, an important local voluntary organisation providing services for the mentally ill, has never been consulted about the proposed merger and the 2,000 people who signed a petition organised by myself and my right hon. Friend the Member for Bishop Auckland were counted as one response.

We are used to health Ministers manipulating the figures. I understand that they have their own interests to serve, but this is statistical jiggery-pokery on a grand scale.

In the headlong rush towards merger, local views have been trampled underfoot. No doubt the Minister has a defence for the merger and I can guess what it is. He will say that it makes financial sense and that there are administrative savings to be made. That is a bit rich coming from a Government who have managed to treble the number of managers and administrators in the NHS since the introduction of its market reforms. Even if that were true, Mr. Jameson, a notable local authority, said in The Northern Echo on 2 May that changes in administrative numbers will be achieved through redeployment; in other words, redeployment to the provider units. It is a question not of cutting bureaucracy but of moving bureaucrats around. The Minister knows that there will be no major savings.

The Minister will also say that those who oppose the merger are worrying unnecessarily because changes among purchasers have no impact on the services that the patients receive from providers, yet provider services are already being merged in Darlington, and South-West Durham. Chiropody and speech therapy are merged services. There will be community services opt out across the two districts and, most seriously, there is still a question mark hanging over the future of Bishop Auckland general hospital.

There is a strong feeling in South-West Durham that the Minister has in mind running down the general hospital to the level of a cottage hospital. That view has been prompted by the long delays in announcing the go-ahead for the phase 3 development, despite the prompting of my right hon. Friend the Member for Bishop Auckland.

The Minister has a chance to end the speculation tonight by giving the green light to that development. I hope that he will grasp the opportunity with both hands.

The result is simple. The new South Durham health authority is more remote and less accountable. It has only five non-executive directors, all appointed by the Tory Secretary of State, where there used to be 10. There will be only one joint consultative committee, so weakening links with the voluntary sector. There are doubts about the future of the two community health councils because the regional health authority document indicated that they were safe, but only for the time being.

I hope that the Minister is listening and that he will take the opportunity of giving a cast-iron guarantee that the future of the two CHCs is safe, regardless of anything else. His failure to do so will leave people in Darlington and South-West Durham with the clear impression that in the new model market NHS the views of local communities count for absolutely nothing.

The Government have clearly decided to let purchasers go the way of providers, so that takeovers and mergers become the order of the day. The new philosophy seems simple: biggest is best. The latest proposal to emerge from the regional health authority is not just for South Durham health authority or North Durham health authority but for a new purchasing consortium—where have I heard this before?—for the whole of County Durham. Twenty years on, we have gone full circle; we are back to the old area health authority structures which were discredited because they were remote, monolithic bureaucracies, out of touch with local people.

We have a more centralised, less accountable health service than ever before. It is also a more secretive organisation. Yet it would be as well for Ministers to remember that the NHS remains a public service. It belongs to the people. It is not the private property either of unelected bureaucrats or of Conservative Ministers, making decisions over the heads of local people.

The process of creating a merged South Durham health authority has been a shameful one. It has been undertaken by stealth. It has relied on misrepresentations, false denials and back-door deals. In a town where there is a proud tradition of public services being run locally, there is understandable and genuine anger about how the community in Darlington has been kept in the dark about the future of its NHS.

It is for those reasons that I ask the Minister not only to rescind the orders but to announce tonight an independent inquiry into the South Durham merger. The people of Darlington and South-West Durham deserve no less.

11.12 pm

Mr. John Greenway (Ryedale)

I agree with one thing that the hon. Member for Darlington (Mr. Milburn) said. Like him, I strongly support community health councils. When the debate was held in north Yorkshire about whether the four district health authorities should merge into one purchasing authority, one of the chief concerns was what that would mean for the future of the community health councils. Both the York and Scarborough CHCs do an excellent job of feeding to officials in our hospitals the feelings of local people about their needs in relation to service provision.

It was only when the Secretary of State for Health made it clear that the community health councils were safe and were not to be merged along with the DHAs that support for the central purchasing authority in north Yorkshire came from the grass roots. I hope the Minister will acknowledge that point.

I invite the Minister to visit Malton. If he wants to see a fund-holding practice that works in conjunction with a small community hospital, he will see none better than in Malton. The last time I talked about Malton in a health debate someone interrupted to suggest that the hospital would close within six months. That was three or four years ago and the hospital has gone from strength to strength. During the recent local election the usual rumours about the future of the hospital were flying thick and fast. I have made strenuous inquiries and I cannot get a handle on any of these rumours—only a flat denial from the chief executive of the Scarborough health trust that it has any plans to cut services at Malton hospital.

Apart from seeing the wonderful fund-holding practice and how the hospital works, the Minister, I hope, will come to Mahon to issue a warning to the health trust, just in case it is thinking of curtailing any services. It must think again. Although I fully support the merger of the four district health authorities in north Yorkshire—with the four hospitals now all health trusts, it makes a great deal of sense for north Yorkshire to constitute one purchasing authority—I have been anxious that that should not lead to any diminution of funding for each of the trusts. Scarborough health trust is facing a shortfall of .l million.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

Surely not.

Mr. Greenway

Well, from my discussion with the chairman of the Yorkshire health authority and his officials, it seems to me that the money that once went to Scarborough is going to other health trusts and health districts in the Yorkshire region, most of which, I have to say, are represented by Opposition Members.

We accept that somebody has to make a strategic judgment about where the resources are needed, but if savings are to be found in the Scarborough health trust, I hope that my hon. Friend the Minister will agree that the way to find the £1 million savings is by having a really forceful campaign against waste and bureaucracy within the NHS, not a campaign to curtail things like maternity service provision at Malton hospital.

I am glad that my hon. Friend nodded and I give him the good news that I read in my Yorkshire Post on the train this morning that that is precisely what the chief executive of the Scarborough health trust plans to do, to attack waste and bureaucracy. I put it to my hon. Friend and the House that he has a clear interest in ensuring that we attack bureaucracy, because he wants, as I and every hon. Member should want, to demonstrate that the Government's health reforms lead not to more bureaucrats, administrators and waste, but to more patients being treated. We have had more patients treated in north Yorkshire over the past 12 months under the Government's health reforms than any member of the Opposition thought possible.

The hon. Member for Sheffield, Brightside (Mr. Blunkett) asked why we needed any kind of larger purchasers, and why not leave it to the GP fund holders. There is an obvious answer to that: we still require some authority to take a strategic view of the needs of each area.

My hon. Friend knows, representing as he does a seat in Lancashire, what a big county north Yorkshire is. Clearly, in some areas, there is scope for asking whether every district hospital needs to provide every medical facility. Do they all need an eye unit, for example, or a cardiothoracic unit, and so on? The answer, obviously, is no, but I ask him to bear in mind that north Yorkshire is a very large county. Travel is difficult. People have long distances to travel already to the district facilities. I hope that he and his officials will bear that in mind when considering the funding requirements of the county.

To sum up, if we are to launch this attack on waste and bureaucracy, we have to accept that we need more competent, professional people, capable of managing this huge national health service, with all the people that it employs. If by merging health authorities we can cut some of the waste, there can be no argument against agreeing that if we now have four health trusts working successfully in north Yorkshire, there should be one central purchasing authority, subject to the caveat that I have made about taking into account the size of our county. I hope that this will not lead to some changes which, in the long term, we might regret.

11.18 pm

Ms Liz Lynne (Rochdale)

It is not very easy to talk about a reduction from some 200 health authorities to 90 in such a short space of time, so I will confine my remarks to a few general points.

With boundary commission changes imminent, why were not regional health authorities told to await the decisions on local authority borders? Would not it be more sensible, if we are to merge authorities, for them to be coterminous with local authorities, as the local authorities have now been given community care responsibilities? I cannot see how the Government can expect collaboration across services such as that called for in "Working for Patients", "Care in the Community" and "Health of the Nation", yet miss the opportunity to effect a change to assist that co-operation.

Then there is the sheer size of merged authorities. The Minister told us in the debate in January that one reason for the changes was that the purchaser would need to take advantage of bulk purchasing power. Did not the Government realise, when they dreamt up their reforms, what would be the logical outcome of the market? Purchasers would need to become bigger and bigger in the face of competition and more and more remote from the community.

Just over a decade ago, the Government abolished the area health authorities and gave as their reasons for doing so that AHAs were too large to be managed effectively and that authority members were necessarily remote from the patient in the hospital and in the community. They said that what was needed was a pattern of operational authorities similar to single district authorities. Now, we are told that the functions of the authority have changed, with its operations reduced, as it no longer provides services or manages hospitals, so it is no longer viable in its old form.

However, the strategic role of the authority has not changed. It is still expected to assess and provide for the health needs of the local community and to play a role in enhancing primary care through an ever-more integrated set of relationships with local social services and community health councillors, and in improving its population's health. Most importantly, it is a purchaser of care for the local community.

In January, the Minister told us that the reason for the mergers was the savings that could be made on administration, which would be worth several hundreds of thousands of pounds over time, but he could not be more precise. I am sure that he could achieve similar savings elsewhere in the NHS if the sole objective were to provide a service without taking into account need and quality of care. As a large majority of the changes have already taken place, will the Minister assure the House that the health authorities will at least be accountable and sensitive to the public health needs of their different communities? One way to ensure that would be to have directly elected health authorities, for which we have been calling for a number of years, instead of what we have now—political appointees.

11.22 pm

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

It is a disgrace that a matter of such importance should be debated only because of action by the Opposition parties. However, that is in line with the outrageous behaviour of the Government towards the NHS. They have split up the service into non-viable units and made trusts the centrepiece of their policy, when they know that the trusts do not have the money to deliver the services. What is more, they have now produced these orders.

The system began on 1 April. The Department of Health made no attempt to pass the correct information to any of the services concerned and many of those services do not have the software in their expensive computers to run the contracts that the Secretary of State tells us are the purpose behind the way in which she wants to operate the NHS. It is an outrage that incompetent, overweeningly arrogant behaviour can produce a result that will lead to total chaos and will add enormously to the expense.

There is a case for the National Audit Office to look at the operation of computers not just in one health authority but throughout the NHS. It is clear that, under the aegis of the Government, many private computer companies are getting away with enormous sums of money under the guise of offering a better contracts system. If the order goes through, retrospectively many health authorities will have to amend their contracts. That will cost them not only time, but an enormous amount of money.

If the Minister thinks that I am exaggerating, let him break the habit of a lifetime and speak to the people who work in the service. They will tell him time and again that, far from relating to "coterminosity", the order relates only to chaos and incompetence. Let me point out to the Minister that, in Crewe, coterminosity does not relate to the borough of Crewe and Nantwich; the borough of Congleton (except the parishes of Congleton, Hulme Walfield … the district of Vale Royal … Macclesfield … Aston, Dutton, Frodsham and various other areas.

The Secretary of State, through her minions, is destroying the existing administration of what was one of the best and most cheaply administered health systems in the world—a system that spent only 6 per cent. on administration. Under the present Government, it is not only tripling the number of administrators, but doing so in a grossly incompetent and irresponsible manner. If the people had the opportunity to know what secretive, impossible and unfortunate deals they were doing, they would be taken by the scruff of their necks and thrown out tomorrow.

I had the unfortunate experience of listening to two of those non-elected gentlemen. They were on a train, explaining how they would rearrange the health service in my area: their plans included building a large, very specialised surgical unit in the north of the country, because it had always been the dream of one of these Conservative party nominations.

That is what the Government have made of the health service. I know that they will not be ashamed of themselves; but if the Minister seriously thinks that he can do this in secret, he underestimates the House of Commons.

11.26 pm

Ms Hilary Armstrong (Durham, North-West)

I support the effective speech of my hon. Friend the Member for Darlington (Mr. Milburn). I came into the Chamber expecting a very different performance from the Minister. Earlier today, we were told that the Prime Minister had instructed Ministers to act differently—that they were to be less arrogant and to listen more. This evening's display from the Minister demonstrates that, although he may have listened, he has heard nothing. He has heard none of the objections put to him during the process of merging authorities; he has not heard—and, indeed, seemed not to understand when my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) drew attention to it—that 10 May is later than 1 April and that there is a gap of some six weeks within which authorities have been acting without parliamentary approval. Moreover, he clearly had not listened to, or understood, anything about what is going on in the areas that he is now merging.

Part of my constituency covers part of Wear Valley district council, which was in the South West Durham health authority area. It is a very mixed area: although very rural, it contains a number of industrial villages—or villages that used to be industrial—in which there are severe health problems. It has very little in common with the population covered by the Darlington authority. No member of the health authority now lives remotely near the area that I represent: no member has any contact—through business, through the voluntary sector or in any other way—with my constituents who are now covered by the new authority. I have been unable to discover the voting habits of the people concerned; if they are Tories they are very exceptional in our area, but I am sure that the Minister has spent a long time looking for them.

The Minister has demonstrated that he knows and understands little of the area's needs. His justifications for merger do not hold up in our area. Financial reasons only justify it, yet, as my hon. Friend the Member for Makerfield (Mr. McCartney) said, they are undermined by the Government having spent vastly greater sums on the members of these smaller and unaccountable authorities than they did on the members of larger authorities, who were accountable because those authorities were elected.

Arrogance, lack of attention to democratic procedures and centralisation are the hallmark of this order. It is about time that the Government began to listen to and heard what the electors are saying. If the Minister thinks that we are wrong, why does not he put it to an election?

It being half-past Eleven o'clock, MR. DEPUTY SPEAKER put the Question, pursuant to Standing Order No. 14 (Exempted business).

The House proceeded to a Division—

Mr. Blunkett (seated and covered)

On a point of order, Mr. Deputy Speaker. My colleagues and I heard no one on the Conservative Benches object.

Mr. Sackville

Further to that point of order, Mr. Deputy Speaker. My hon. Friend the Member for Chipping Barnet (Mr. Chapman) shouted no.[Interruption.]

Mr. Deputy Speaker

Order. The Whip shouted no. I clearly heard him. Clear the Lobbies.

The House having divided: Ayes 187, Noes 235.

Division No. 261]	[11.30 pm
AYES
Adams, Mrs Irene	Armstrong, Hilary
Ainger, Nick	Barnes, Harry
Ainsworth, Robert (Cov'try NE)	Barron, Kevin
Alton, David	Battle, John
Anderson, Donald (Swansea E)	Bayley, Hugh
Anderson, Ms Janet (Ros'dale)	Beith, Rt Hon A. J.

Benn, Rt Hon Tony	Jones, Jon Owen (Cardiff C)
Bennett, Andrew F.	Jones, Martyn (Clwyd, SW)
Benton, Joe	Jowell, Tessa
Bermingham, Gerald	Keen, Alan
Blunkett, David	Kennedy, Charles (Ross, C&S)
Boateng, Paul	Kennedy, Jane (Lpool Brdgn)
Boyce, Jimmy	Khabra, Piara S.
Boyes, Roland	Kirkwood, Archy
Bradley, Keith	Lewis, Terry
Brown, Gordon (Dunfermline E)	Livingstone, Ken
Brown, N. (N'c'tle upon Tyne E)	Lloyd, Tony (Stretford)
Burden, Richard	Loyden, Eddie
Byers, Stephen	Lynne, Ms Liz
Callaghan, Jim	McAllion, John
Campbell-Savours, D. N.	McAvoy, Thomas
Canavan, Dennis	McCartney, Ian
Cann, Jamie	McCrea, Rev William
Chisholm, Malcolm	Macdonald, Calum
Clarke, Eric (Midlothian)	McFall, John
Clelland, David	McGrady, Eddie
Clwyd, Mrs Ann	McKelvey, William
Cohen, Harry	Mackinlay, Andrew
Connarty, Michael	McMaster, Gordon
Cook, Frank (Stockton N)	Madden, Max
Cook, Robin (Livingston)	Mahon, Alice
Corbett, Robin	Mandelson, Peter
Cousins, Jim	Marshall, David (Shettleston)
Cryer, Bob	Marshall, Jim (Leicester, S)
Cunningham, Jim (Covy SE)	Martin, Michael J. (Springburn)
Cunningham, Rt Hon Dr John	Martlew, Eric
Dalyell, Tam	Maxton, John
Darling, Alistair	Michael, Alun
Davidson, Ian	Michie, Bill (Sheffield Heeley)
Davies, Bryan (Oldham C'tral)	Milburn, Alan
Davies, Rt Hon Denzil (Llanelli)	Miller, Andrew
Denham, John	Mitchell, Austin (Gt Grimsby)
Dixon, Don	Moonie, Dr Lewis
Donohoe, Brian H.	Morgan, Rhodri
Dowd, Jim	Morley, Elliot
Dunnachie, Jimmy	Mudie, George
Dunwoody, Mrs Gwyneth	Murphy, Paul
Eagle, Ms Angela	Oakes, Rt Hon Gordon
Eastham, Ken	O'Brien, Michael (N W'kshire)
Enright, Derek	O'Hara, Edward
Etherington, Bill	Olner, William
Fatchett, Derek	Paisley, Rev Ian
Field, Frank (Birkenhead)	Parry, Robert
Flynn, Paul	Pendry, Tom
Foster, Rt Hon Derek	Pickthall, Colin
Foulkes, George	Pike, Peter L.
Fyfe, Maria	Pope, Greg
Galbraith, Sam	Powell, Ray (Ogmore)
Gapes, Mike	Prentice, Ms Bridget (Lew'm E)
Gerrard, Neil	Prentice, Gordon (Pendle)
Gilbert, Rt Hon Dr John	Primarolo, Dawn
Godsiff, Roger	Purchase, Ken
Golding, Mrs Llin	Quin, Ms Joyce
Graham, Thomas	Raynsford, Nick
Grant, Bernie (Tottenham)	Reid, Dr John
Griffiths, Nigel (Edinburgh S)	Rendel, David
Griffiths, Win (Bridgend)	Robertson, George (Hamilton)
Gunnell, John	Roche, Mrs. Barbara
Hall, Mike	Rogers, Allan
Hanson, David	Rooker, Jeff
Heppeil. John	Rooney, Terry
Hill, Keith (Streatham)	Ross, Ernie (Dundee W)
Hinchliffe, David	Salmond, Alex
Home Robertson, John	Sheerman, Barry
Howarth, George (Knowsley N)	Short, Clare
Hoyle, Doug	Simpson, Alan
Hughes, Kevin (Doncaster N)	Skinner, Dennis
Hughes, Robert (Aberdeen N)	Smith, Andrew (Oxford E)
Hughes, Simon (Southwark)	Smith, Llew (Blaenau Gwent)
Hutton, John	Spearing, Nigel
Illsley, Eric	Spellar, John
Jackson, Glenda (H'stead)	Steel, Rt Hon Sir David
Jackson, Helen (Shef'ld, H)	Steinberg, Gerry
Jamieson, David	Stevenson, George
Johnston, Sir Russell	Stott, Roger
Jones. Barry (Alyn and D'side)	Taylor, Mrs Ann (Dewsbury)

Tipping, Paddy	Winnick, David
Turner, Dennis	Wise, Audrey
Wallace, James	Worthington, Tony
Walley, Joan	Wray, Jimmy
Warden, Gareth (Gower)	Young, David (Bolton SE)
Wareing, Robert N
Watson, Mike	Tellers for the Ayes:
Wicks, Malcolm	Mr. Peter Kilfoyle and Mr. Alan Meale.
Williams, Alan W (Carmarthen)
Wilson, Brian

NOES
Ainsworth, Peter (East Surrey)	Evans, Nigel (Ribble Valley)
Aitken, Jonathan	Evans, Roger (Monmouth)
Alison, Rt Hon Michael (Selby)	Fabricant, Michael
Allason, Rupert (Torbay)	Field, Barry (Isle of Wight)
Amess, David	Fishburn, Dudley
Arbuthnot, James	Forman, Nigel
Arnold, Jacques (Gravesham)	Forsyth, Michael (Stirling)
Arnold, Sir Thomas (Hazel Grv)	Fox, Dr Liam (Woodspring)
Ashby, David	Fox, Sir Marcus (Shipley)
Aspinwall, Jack	Freeman, Roger
Atkinson, Peter (Hexham)	French, Douglas
Baker, Rt Hon K. (Mole Valley)	Fry, Peter
Baker, Nicholas (Dorset North)	Gale, Roger
Baldry, Tony	Gallie, Phil
Banks. Matthew (Southport)	Garnier, Edward
Banks, Robert (Harrogate)	Gill, Christopher
Bates, Michael	Gillan, Cheryl
Batiste, Spencer	Goodson-Wickes, Dr Charles
Bellingham, Henry	Gorst, John
Beresford, Sir Paul	Greenway, Harry (Ealing N)
Biffen, Rt Hon John	Greenway, John (Ryedale)
Blackburn, Dr John G.	Griffiths, Peter (Portsmouth, N)
Booth, Hartley	Grylls, Sir Michael
Boswell, Tim	Hague, William
Bottomley, Peter (Eltham)	Hamilton, Rt Hon Archie (Epsom)
Bowis, John	Hamilton, Neil (Tatton)
Brandreth, Gyles	Hannam, Sir John
Brazier, Julian	Hargreaves, Andrew
Brooke, Rt Hon Peter	Harris, David
Brown, M. (Brigg & Cl'thorpes)	Haselhurst, Alan
Browning, Mrs. Angela	Hawkins, Nick
Burns, Simon	Hawksley, Warren
Burt, Alistair	Hayes, Jerry
Butler, Peter	Heald, Oliver
Carlisle, Kenneth (Lincoln)	Heath, Rt Hon Sir Edward
Carrington, Matthew	Heathcoat-Amory, David
Carttiss, Michael	Hendry, Charles
Cash, William	Hicks, Robert
Channon. Rt Hon Paul	Horam, John
Chapman, Sydney	Hordern, Rt Hon Sir Peter
Churchill, Mr	Howell, Rt Hon David (G'dford)
Clappison, James	Hunt. Rt Hon David (Wirral W)
Clark, Dr Michael (Rochford)	Hunter, Andrew
Clarke, Rt Hon Kenneth (Ruclif)	Hurd, Rt Hon Douglas
Clifton-Brown, Geoffrey	Jack, Michael
Coe, Sebastian	Jackson, Robert (Wantage)
Colvin, Michael	Jenkin, Bernard
Congdon, David	Jessel, Toby
Coombs, Anthony (Wyre For'st)	Johnson Smith, Sir Geoffrey
Coombs, Simon (Swindon)	Jones, Gwilym (Cardiff N)
Cope, Rt Hon Sir John	Jones, Robert B. (W Hertfdshr)
Cran, James	Kellett-Bowman, Dame Elaine
Currie, Mrs Edwina (S D'by'ire)	Key, Robert
Davies, Quentin (Stamford)	Kilfedder, Sir James
Davis, David (Boothferry)	King, Rt Hon Tom
Day, Stephen	Kirkhope, Timothy
Deva, Nirj Joseph	Knapman, Roger
Devlin, Tim	Knight, Mrs Angela (Erewash)
Dicks, Terry	Knight, Greg (Derby N)
Douglas-Hamilton, Lord James	Knight, Dame Jill (Bir'm E'st'n)
Dover, Den	Knox, David
Duncan, Alan	Kynoch, George (Kincardine)
Duncan-Smith, Iain	Lait, Mrs Jacqui
Dykes, Hugh	Lang, Rt Hon Ian
Elletson, Harold	Lawrence, Sir Ivan
Emery, Rt Hon Sir Peter	Legg, Barry
Evans, David (Welwyn Hatfield)	Lester, Jim (Broxtowe)
Evans, Jonathan (Brecon)	Lidington, David

Lilley, Rt Hon Peter	Sims, Roger
Lloyd, Peter (Fareham)	Smith, Tim (Beaconsfield)
Lord, Michael	Soames, Nicholas
Luff, Peter	Spencer, Sir Derek
Lyell, Rt Hon Sir Nicholas	Spicer, Michael (S Worcs)
MacKay, Andrew	Spink, Dr Robert
Maclean, David	Spring, Richard
Madel, David	Sproat, Iain
Maitland, Lady Olga	Stanley, Rt Hon Sir John
Malone, Gerald	Steen, Anthony
Mans, Keith	Stephen, Michael
Marland, Paul	Stern, Michael
Marlow, Tony	Sfreeter, Gary
Martin, David (Portsmouth S)	Sumberg, David
Mawhinney, Dr Brian	Sweeney, Walter
Merchant, Piers	Sykes, John
Milligan, Stephen	Tapsell, Sir Peter
Mitchell, Andrew (Gedling)	Taylor, Ian (Esher)
Monro, Sir Hector	Taylor, John M. (Solihull)
Montgomery, Sir Fergus	Temple-Morris, Peter
Moss, Malcolm	Thomason, Roy
Nelson, Anthony	Thompson, Patrick (Norwich N)
Neubert, Sir Michael	Thurnham, Peter
Newton, Rt Hon Tony	Townsend, Cyril D. (Bexl'yh'th)
Nicholson, David (Taunton)	Tredinnick, David
Nicholson, Emma (Devon West)	Trend, Michael
Norris, Steve	Twinn, Dr Ian
Oppenheim, Phillip	Viggers, Peter
Paice, James	Walden, George
Patnick, Irvine	Walker, Bill (N Tayside)
Pattie, Rt Hon Sir Geoffrey	Waller, Gary
Pawsey, James	Wardle, Charles (Bexhill)
Peacock, Mrs Elizabeth	Waterson, Nigel
Porter, David (Waveney)	Watts, John
Powell, William (Corby)	Wells, Bowen
Renton, Rt Hon Tim	Wheeler, Rt Hon Sir John
Richards, Rod	Whitney, Ray
Riddick, Graham	Whittingdale, John
Rifkind, Rt Hon. Malcolm	Widdecombe, Ann
Robathan, Andrew	Wilkinson, John
Roberts, Rt Hon Sir Wyn	Willetts. David
Robertson, Raymond (Ab'd'n S)	Wilshire, David
Robinson, Mark (Somerton)	Winterton, Mrs Ann (Congleton)
Roe, Mrs Marion (Broxbourne)	Winterton, Nicholas (Macc'f'ld)
Ryder, Rt Hon Richard	Wood, Timothy
Sackville, Tom	Yeo, Tim
Sainsbury, Rt Hon Tim	Young, Sir George (Acton)
Shaw, David (Dover)
Shaw, Sir Giles (Pudsey)	Tellers for the Noes:
Shephard, Rt Hon Gillian	Mr. David Lightbown and Mr. Robert Hughes.
Shepherd, Colin (Hereford)
Shersby, Michael

Question accordingly negatived.