§ 13. Mr. Bob Russell (Colchester)What plans he has to increase public accountability in the NHS. [38686]
§ The Secretary of State for HealthSince we took over, we have opened trust board meetings to the public, and removed the gagging clauses on staff. We have appointed people more representative of the communities that they serve. For example, more than half the appointments are of women, and we have doubled the proportion of black and Asian representatives.
§ Mr. RussellDoes the Minister agree that a strong body of opinion in the Labour party would like some democracy to be introduced to the people's national health service? May I suggest that we should do away with quangos? I invite the Minister to consider the three trusts in my constituency, plus the area health authority, in which all four chairmen are Conservatives, two of whom have been rejected by the electorate. Is it not the case that the present Government are just providing retirement jobs for defeated Conservatives?
§ Mr. DobsonOn the hon. Gentleman's last point, I do not think that that has been the main burden of the Conservative attack on the people whom I have appointed. I thought the point was—I may have missed it slightly, but I do not think so—that I was heaving out too many Tory deadheads. However, I may be wrong. The hon. Gentleman appears to think that he is an expert on the internal affairs of the Labour party.
§ Mr. Dennis Skinner (Bolsover)He is a retread.
§ Mr. DobsonI understand that the hon. Gentleman was once a member of the Labour party, and he remains an expert on it. However, I assure him that there is no substantial body of opinion within the Labour party seeking a wholesale change to the national health service. Labour Members want to see that service working. 141 When it comes to elected representatives, I do not think that there is a council in this country comprising 50 per cent. women members or 9 per cent. black and Asian members. Those percentages certainly apply to my appointments to the national health service.
§ Mr. Paul Flynn (Newport, West)What can members of the public do when they suspect that their relatives are being over-prescribed neuroleptic drugs in residential homes? There is a wealth of evidence to suggest that anti-psychotic drugs are being administered to make the homes easier to run rather than to benefit the patients. Will the Secretary of State aim to reduce costs and damage to patients in the health service by avoiding the over-prescription of not only neuroleptic drugs, but antibiotics?
§ Mr. DobsonWe must aim to ensure that the right people are prescribed the right drugs in the right amounts at the right times so that there is no over or under-prescribing, or people getting no prescriptions at all. That is our target. As to people in one institution or another being treated badly, the fact that we have opened trust board meetings to the public and removed the gagging clauses on staff should provide substantial new protections.
§ Mr. John Wilkinson (Ruislip-Northwood)Does the Secretary of State believe that he increased public accountability by announcing yesterday to a private NHS meeting his plans to create a single health authority for London, which will take over the role of the North Thames and South Thames NHS executives? How did that increase public accountability? Should not the Secretary of State have done us the courtesy of making that announcement to the House of Commons? Ought he not to have borne in mind the implications that the announcement would have for NHS trust hospitals, such as Mount Vernon in my constituency, which straddles the Greater London boundary? Furthermore, what is the future of the home county areas that are currently administered by those two executives?
§ Mr. DobsonIf my announcement yesterday to a private meeting was a secret, it was one of the worst-kept secrets in the national health service. Sir Leslie Turnberg proposed a London-wide health region in his review, which we published. It was endorsed in the Government's written response to that review, which we also published and which I introduced with a statement in the House. I went no further than saying that we should get on with it a bit more quickly than we intended originally.
There will obviously be certain problems with the boundaries, and we shall look at them carefully. From the point of view of the health care of Londoners, having a London-wide health region that will take London-wide strategic decisions is better than having two bodies that serve the south and the north of the Thames—and which are notoriously very bad at liaising with each other—taking those decisions.
§ Mr. Ken Purchase (Wolverhampton, North-East)Does the Secretary of State accept that accountability goes further than appointing people to positions in the NHS? It includes NHS systems that people understand readily. Will the Secretary of State encourage health authorities 142 and trusts to adopt the standards of the King's Fund and the equivalent of International Standard Organisation 9000—which, incidentally, the authority in my constituency has just been awarded? Will the Secretary of State take on board my comments, and congratulate my authority on taking that action?
§ Mr. DobsonI am happy to congratulate the Wolverhampton authority. Like many others in the west midlands, it is innovatory and dedicated to looking after local people better. The previous Government changed the arrangements in the NHS for consultation and for complaints. For good or ill, those procedures should stay in place for a while for us to see how well they work, rather than our deciding to rip them up without examining the evidence. We want far more genuine consultation in future.
Of all the changes that we are making to the NHS, the most far-reaching is perhaps the proposal that each health authority should in future be required to draw up a health improvement programme for its area, identifying what is wrong and presenting proposals to put it right, and that that should be done in consultation with local authorities, voluntary organisations, staff, professional bodies and local businesses. When all have signed up to it, they should buckle down and put those programmes into action.
§ Mr. Julian Brazier (Canterbury)In light of the fact that community health councils are publicly accountable in a way that district health authorities are not, will the Secretary of State take particular note of the views of Canterbury and Thanet community health council if, as appears likely, it refers to him East Kent health authority's dreadful proposals to close the Kent and Canterbury hospital? Following his answer to my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson), will the Secretary of State confirm that there is no danger of East Kent suddenly moving regions, in the middle of an already fraught consultation?
§ Mr. DobsonEast Kent is fairly likely to stay where it is. I know about the history of the Goodwin lands becoming the Goodwin sands, but Kent is probably fairly safe for the immediate future.
If the community health council objects to the proposals affecting the hon. Gentleman's constituency, that decision will come to me, as he well knows. It will be my responsibility to decide what happens. The hon. Gentleman is not a churlish Member, generally speaking, so I would have hoped that he would welcome the £3.6 million extra that we provided for his area to reduce the waiting lists, whatever the hospitals.