HC Deb 09 December 1997 vol 302 cc783-5
6. Mrs. Humble

What changes he intends to make to the current role of NHS trusts in shaping local health care. [18232]

Mr. Milburn

The White Paper which will be issued shortly will set out how we shall fulfil our pledge to remove the wasteful competition of the NHS internal market. We shall show how all NHS bodies, including trusts, will play their full part in improving health care.

Mrs. Humble

I thank my hon. Friend for that reply. In examining the role of NHS trusts, will he look especially at major tourist destinations such as Blackpool, which provide for the health care of large numbers of visitors as well as the resident population?

Mr. Milburn

I am aware of the problems faced by local health services in that respect. The thousands of visitors to Blackpool every year usually have a great time—including at the party conferences, when they manage to get there—but occasionally one or two fall ill. The current arrangements do not budget for that and, worse, the health authority has to issue an invoice every single time a patient falls ill on holiday. That is costly and expensive and it is regarded as an anathema by hospital clinicians. If my hon. Friend waits approximately 34 minutes, she may hear some good news.

Mr. Brazier

Is not one advantage of the trust system that it has allowed direct comparisons between hospitals? When a decision comes to be made on the future of the Kent and Canterbury hospital, should not the Secretary of State consider which is the most cost-efficient hospital in Kent, which hospital in Kent is able to recruit and retain the best staff and, above all, which hospital in east Kent has the support of the most general practitioners, who, after all, are the representatives of the patients?

Mr. Milburn

As the hon. Gentleman is aware, the matter is the subject of consultation. If it is contested by one of the local community health councils, it will end up on Ministers' desks, so it is inappropriate for me to discuss the specific issues. Of course the Government recognise the important role of NHS trusts in providing health care for millions of people. We want to build on the success of some NHS trusts, but we want that success to be achieved across the country and to ensure that the shortcomings in some trusts are nipped in the bud rather than allowed to escalate.

Mr. Burden

Has not one of the worst aspects of the internal market been the way in which it has set GP against GP and hospital against hospital? In overcoming that internal market, is there not an important strategic role for local commissioning groups and health authorities in fostering co-operation? Does my hon. Friend the Minister welcome the review being undertaken by Birmingham health authority, and will he join me in encouraging the fullest public consultation on the proposals in the hope that it will bring Birmingham the capital investment that it has needed for too long?

Mr. Milburn

As my hon. Friend knows, I am aware of the consultation being undertaken by Birmingham health authority. I very much agree that there should be proper public consultation. The review covers public services and the public have a right to expect their voice to be heard. Those charged with the responsibility of shaping and delivering health services in future should operate to a simple maxim: the national health service is a public service—it belongs to the public and should listen to what the public have to say.

Mr. Simon Hughes

I am sure that the Minister will agree that one of the most common pressures on NHS trusts is that of shortage of staff. Given that his answers and official figures show that, at the moment, in England alone, we are short of about 1,000 GPs and there are about 1,500 hospital doctor and more than 8,000 nurse and midwife vacancies, will the Minister assure the House that the health service will be given the money to recruit and fill all those thousands of vacant posts?

Mr. Milburn

The health service is being given the money to deal with such problems. I remind the hon. Gentleman, in case he has forgotten, that, during this year and next year, an extra £1.5 billion will be invested in the NHS in such areas as his. I hope that he will welcome that.

Mr. Tony Clarke

Does my hon. Friend agree that we must consider not only what is happening now but the legacy left by the previous Government, especially relating to debt in trusts? Many trusts, especially those in Northampton in my constituency, are unable to take advantage of our new plans due to the legacy of debt. Will he comment on the desirability of allowing, in special circumstances, extensions to the time taken to pay off debt, which will allow trusts to plan health care more effectively and thus reduce waiting lists?

Mr. Milburn

My hon. Friend makes a very good point. The legacy left to this Government by the previous Government is one of record waiting lists and record debt. That is what we are having to tackle; and we shall tackle it. The Government do not want the NHS to enter the next financial year as it entered this financial year—up to its eyes in debt. That means that difficult and robust decisions will have to be taken. Of course we expect those decisions to be undertaken sensitively. Where it is warranted, I know that the NHS executive will be prepared to discuss with individual health authorities an extension to ensure that debts are paid off over time.

Rev. Martin Smyth

Does the Minister accept that, under the trusts, we were able better to evaluate costs of procedures, and some trusts were doing better than others? Will he acknowledge that the number of procedures has increased the cost to the NHS? The previous Administration forgot that when they were praising the number of procedures undertaken but not funding them. Will the Minister assure the House that, when considering local health care, there will be proper evaluation of pilot schemes, meshed in with trust provisions?

Mr. Milburn

The hon. Gentleman makes a very good point. All incentives under the market system were for NHS trusts to expand their business, regardless of whether that was in the interests of the wider health community—or, i6ndeed, the community in general. In future, we shall be expecting NHS trusts to co-operate and work with one another so that there is maximum gain for patients. Not only doctors and nurses but managers in NHS trusts want that. They want to work together rather than being forced to compete against one another.

Mr. Pike

In the past, has not federation between NHS trusts on fairly routine services totally ignored the views of the public in consultation exercises? Do not most people want such services to be provided locally and not far from where they live?

Mr. Milburn

My hon. Friend will be pleased to know that, just last week, in Committee, we approved an order opening trust board meetings to the public. That is important because trusts are public organisations and the decisions that they take have a real impact on the local community. In future, there will be no more secrecy concerning NHS trust board meetings and no more commercial, in-confidence information held concerning trust boards. Trust boards and NHS trusts are part of the wider NHS family and they must start acting as such.