§ 1. Mr. Mackinlay
To ask the Secretary of State for Health if she will make a further statement on the current reorganisation of the NHS.
§ The Secretary of State for Health (Mrs. Virginia Bottomley)
The national health service reforms provide a stable and enduring structure to the health service which will enable it to respond flexibly to the changing needs of patients. I am pleased that good progress is being made in Committee on the Health Authorities Bill. We are completing the unfinished business of the reforms, streamlining management and cutting bureaucracy.
The House will also know that I have issued today new guidance on NHS appointments. Those appointed to NHS organisations overwhelmingly give outstanding service. The guidance, based on current best practice, will ensure that appointments continue to be made on merit and that the process is open and fair and commands the confidence of the public and staff.
§ Mr. Mackinlay
How did the reorganised national health service respond to the flexible and changing needs of Mark Dwan? Will the Secretary of State tell us why she had to see the Lord Chancellor and what was discussed?
§ Mrs. Bottomley
There is great pressure on medium-secure beds. When the Labour party was in power, the Glancy report recommended medium-secure beds. By 1979, there were none. There are now 700, together with almost 1,000 other medium-secure beds. We are spending £47 million to produce an extra 600 780 next year. I shall be taking steps to make sure that the court authorities are aware of the way of making contact with those most directly responsible for the provision and arrangement of medium-secure beds.
§ Dame Elaine Kellett-Bowman
My right hon. colleague will be aware that one of the parts of the national health service being reorganised is the blood transfusion service. She may be aware that a petition on this matter was presented to her office this morning. Unfortunately, she was too busy to receive it. She may nevertheless be aware that we have a quite outstandling blood transfusion centre in Lancaster and it would be criminal folly to abolish it.
§ Mrs. Bottomley
I much regret that it was not possible to meet my hon. Friend, who is a great champion of the service. She will understand that, with the publication of new guidance on appointments to health authorities and trusts, it has been an extremely busy morning. There is, however, a distinction between improvement and management of the service and, of course, development of improved services for patients and making sure that blood donors have the best possible service. As she will know, the Under-Secretary of State, my hon. Friend the Member for Bolton, West (Mr. Sackville), has been closely involved in these matters and he and I will look carefully at my hon. Friend's recommendations.
§ Mr. Kirkwood
Will the Secretary of State expand a little on the statement that was made earlier about the procedures being set out for the establishment of appointments to NHS organisations? Does she accept that some of us are disappointed that she has not accepted the advice of the National Association of Health Authorities and Trusts that there should be an independent element in that procedure? From my reading of the statement, I believe that there is no such element. Why has she set her face against that?
§ Mrs. Bottomley
I hope that the hon. Gentleman will look at the guidance very carefully. Essentially, it puts into one manual best practice as it has been organised throughout the health service for some time.
We want to advertise widely for people to come forward to ensure that there is proper scrutiny of the names by non-executives who have a range of skills. We need people who understand how the health service works and who are involved in either a health authority or a trust to do that. They may bring outside expertise from the private or public sectors—for example, as a lecturer or a vicar—in vetting those names.
Regions may also wish to add the names of total outsiders. However, on balance, we believe that it is best for the names to be scrutinised by people who are involved in health service delivery. We want excellent people to help us to do the work. The hon. Gentleman will know that in his party Baroness Thomas and many others who are appointed on merit do excellent work within the health service.
§ Mr. Couchman
Will my right hon. Friend join me in congratulating Mrs. Cathy Hull, the wife of the deputy Labour leader of Rochester upon Medway city 781 council, on her recent appointment as a non-executive director and in wishing her a long and successful time in that position?
§ Mrs. Bottomley
I certainly will congratulate my hon. Friend's colleague. People from all political parties as well as those with no political affiliations serve on health authorities and trusts. We want people with ability and commitment who share a vision of having the best health service in the world. Overwhelmingly, those who serve on health authorities and trusts work to achieve that goal. However, we need greater openness and public understanding of the work involved to encourage more people to come forward.
§ Mr. Hinchliffe
In the mad scramble to establish a market in health, what consideration has been given to the implications for other services, such as child protection? Will the Secretary of State accept that it is astonishing that the recent consultation document on general practitioner fundholding made no reference to the importance of GP fundholders liaising with local social service departments and with area child protection committees? Does she accept that the increasing practice of GP fundholders purchasing crucial services, such as health visiting provision, from outside their areas is completely undermining—as she, with her background, should know better than anyone else—child protection collaboration at a local level and that it may cost lives?
§ Mrs. Bottomley
Of course the hon. Gentleman is right: collaboration between agencies is fundamental to service delivery in many areas, including child protection. However, I dispute the hon. Gentleman's knee-jerk attack on the market system. I can only quote Chris Ham who says:The old system of planning by decibels, in which those running hospital services exerted most influence, has been replaced by an arrangement in which health authorities and GPs are in a much better position to shape the direction of the service development".The hon. Gentleman may also consult either The Lancet or the recent edition of the Fabian Review which condemn the Labour party's lack of vision in this area.