§ 4. Mr. Douglas Alexander (Paisley, South)
What progress has been made in reducing the number of NHS trusts operating in Scotland. 
§ The Secretary of State for Scotland (Mr. Donald Dewar)
Detailed proposals for new trust configurations are currently the subject of public consultation in each 580 health board area. Subject to the outcome of public consultation, I expect to be in a position to take decisions about the new configurations in late summer.
§ Mr. Alexander
How much investment are those changes likely to free up for patient care in Scotland?
§ Mr. Dewar
We hope that, over the course of this Parliament, it will be possible to redirect about £100 million to front-line patient care. When fully implemented, I hope that the dismantling of the internal market and the streamlining of the trusts will produce around £40 million a year. Major reform in the health service, as elsewhere, depends on teamwork, and I greatly value the efforts and commitment of the civil service. In particular, I pay tribute to my permanent secretary, Russell Hillhouse, who retires in a few days. He has been a skilful and expert guide, philosopher—indeed, friend—to me, and, I suspect, to many of my predecessors.
§ Mrs. Ray Michie (Argyll and Bute)
On behalf of my colleagues, I endorse what the Secretary of State just said. Surely the consultation documents on health service trusts are a complete sham. It seems that, across Scotland, they are just going for a preferred option. Who on earth is being consulted, and why? Can the Secretary of State assure me that he or the Minister responsible for health will make the final decision on the trusts, as the Minister promised that it will be based on what best suits the needs of particular communities?
§ Mr. Dewar
We shall certainly listen to the consultation exercise. We shall also listen to hon. Members. I heard what the hon. Lady said. The plan is radical, but it is not a preconceived rigid framework into which every area will necessarily be fitted. Reducing the trusts from, I think, the present 46 to something under 30—depending on the results of the consultation exercise—makes sense and will provide a more efficient machine to drive patient care, but we shall, of course, listen to local opinion. While Ministers take the final decision, they will be influenced by what is said by the hon. Lady and others.
§ Mr. Brian H. Donohoe (Cunninghame, South)
How will the saving of £100 million affect waiting lists in our hospitals in Scotland?
§ Mr. Dewar
Waiting lists, which now stand at about 87,000, are a considerable worry to us, and our concern is apparent from the decision to allocate £44.5 million to bring them down. Our expectation is that they will be below their present level in a year's time. The £44 million is being used not only to depress waiting lists temporarily but to tackle the obstructions, the bottlenecks and the structural difficulties that have allowed waiting lists to rise to their present level. We shall want to keep that campaign going. I have no doubt that the additional funds will have a part to play in that, although I hope that the substantial saving by stopping the paper chase that is the internal market will be used on a wider spread of improvements than simply on waiting lists.
§ Mr. John Swinney (North Tayside)
What assurances can the Secretary of State give my constituents in the non-city areas of Angus and Perthshire, in implementing 581 the Government's desire to reduce the number of trusts, that health care services will not be concentrated in the major cities and that local services will continue in areas where people need them, in the county areas of Angus and Perthshire?
§ Mr. Dewar
As the hon. Gentleman will recognise, there is always a balance to be struck between centres of excellence and expertise and the need to spread throughout the community adequate and top-class health care. We certainly do not consider the streamlining of the trusts to be a death sentence for local hospitals and local centres of excellence. The use of GP co-operatives and reform of primary care functions are also designed to ensure that people who live in more remote communities always have adequate medical care within reach. That is important. I accept that entirely. We hope that we get the right balance. Again, it will be a matter for consultation. We shall look at acute service review and other matters.
§ Mr. Dennis Canavan (Falkirk, West)
Should not the aim of the reorganisation of NHS trusts be to look after the generation of people who built the national health service, far too many of whom were deprived of a national health service bed because of the previous Tory Government's agenda, which was to shift ever more people out of the NHS into private sector nursing homes? If so, will my right hon. Friend investigate the situation in the Forth Valley health board area where, under existing plans, by 2000 there will be an NHS bed for under 0.4 per cent. of the elderly population? Will he therefore intervene and change that agenda to ensure that there is an NHS bed for every elderly person who requires one?
§ Mr. Dewar
I certainly accept that there should be a national health service bed for everyone who requires one, although there may be some argument about how to define that term. I have much sympathy with what my hon. Friend says. The important thing is that there is adequate, supportive care tailored to the needs of the individual in whatever setting may be best for that individual. A great deal of emphasis is now placed on keeping people in the community if at all possible and in familiar surroundings. There is always a balance to be struck, but we are undoubtedly committed to investing in the health service. We are well aware that people from the older generation—I am beginning to have a pressing personal interest in the matter—have particular demands to make on the health service and have to be properly catered for.
§ Dr. Liam Fox (Woodspring)
On behalf of the official Opposition, I also offer my best wishes to Russell Hillhouse and wish him the very best of health for his retirement.
Does the Secretary of State understand the worries expressed by many general practitioners in Scotland that the Government's meddling in the overall structure of the NHS in Scotland will move influence from primary care back into the hands of hospital consultants, and that that will be a retrograde step? Will he accept personal responsibility if the change results in increased waiting 582 lists, in decreased patient choice and in a decrease in doctors' freedom, as many in the health service are now predicting?
§ Mr. Dewar
The hon. Gentleman is wrong in every particular, but it is of course a matter of judgment. I have talked to many GPs, and I did not get the impression that that was their opinion at all. The proposals in the White Paper have been widely welcomed by official bodies and individual GPs. I believe that the proposals will allow GPs to be very influential within the health service and will, if anything, increase patient choice. I hope that the hon. Gentleman will welcome the fact that this year, for example, very nearly an additional £7 million is being invested in GP premises. Indeed, I had the pleasure of opening a new surgery at the edge of my constituency only the other day. I spoke to a range of general practitioners there, and I did not get any of the gloomy forebodings that darken the hon. Gentleman's mind.
§ Mr. John McAllion (Dundee, East)
Can my right hon. Friend confirm that the advent of the new primary care trusts and, within them, of the GP health co-operatives, will signal the end of the pernicious system of GP fundholding and of Tory attempts to create a two-tier national health service in Scotland? If he can confirm that, does he agree that the socialist principles that helped to establish the national health service are as relevant today as they were 50 years ago and that therefore what we need from a Labour Government is more of those old Labour ideas, not fewer?
§ Mr. Dewar
I can do better and give my hon. Friend a date: 1 April next year will see the end of that particular form of fundholding in Scotland. It is very important that we win the support and trust of the public because of our values, not despite our values. There is no more important set of values than the essential principles that the health service is comprehensive in cover, free at the point of delivery and pays no attention to the size of the patient's bank balance.