NHS Trusts (Hansard, 7 May 2002)

§ 1. Mr. James Plaskitt (Warwick and Leamington)
What changes he plans to make to the system for auditing spending by NHS trusts. [52772]

§ The Secretary of State for Health (Mr. Alan Milburn)
All NHS trusts are currently subject to an annual external audit of their financial statements by independent auditors appointed by the Audit Commission. That will not change, although a new commission for health care audit and inspection will be created from the current functions performed by the Commission for Health Improvement, the value-for-money studies of the Audit Commission and the private sector health care work of the National Care Standards Commission. I expect the new commission to be in place, so that it can audit NHS performance, by 2003–04.

§ Mr. Plaskitt
How will my right hon. Friend strike the right balance between ensuring that everyone who uses 2 NHS services can see the benefits of increased investment, and not impeding professional choice or adding unnecessary bureaucratic burdens?

§ Mr. Milburn
As my hon. Friend suggests, if people are putting more money into the national health service, it is important that they see what they are getting out of it. The truth is that, at the moment, we have a fairly bureaucratic and fragmented system of inspection. That system has evolved in the past few years, but because it is fragmented it weakens inspection. We have an opportunity to combine in a new, strengthened system the integrity and independence of all the various organisations that contribute to regulation not just of the NHS but of the private sector. That system will make the issue of where the money goes and how performance is improving much more transparent to the public.

§ Mrs. Marion Roe (Broxbourne)
Does the Secretary of State accept that Mrs. Drew, a constituent of mine, would welcome a thorough audit as soon as possible of the spending of Barnet and Chase Farm Hospitals NHS trust? On 19 April, she was interviewed by the oncology department consultant in the hospital's new unit, which was opened in February. Unfortunately, she was informed that she has cancer; she was also told that she must be treated at North Middlesex hospital, in Edmonton. Although the new unit at Chase Farm is fully equipped to provide her treatment, there is no funding, and North Middlesex hospital is the only alternative to provide her six-month treatment. When such mismanagement is revealed, how can she have faith in the Government's claim that they are providing services for patients?

§ Mr. Milburn
I have every sympathy with the plight of the hon. Lady's constituent, and if she cares to write to me, I shall look into the matter. However, she might be aware of the horns of the dilemma that she and her hon. Friends now face. She says that she wants more investment, but she voted against it a fortnight ago. 3 She cannot have her cake and eat it. Does the national health service need more investment, or not? Our answer is yes; what is hers?

§ Dr. Howard Stoate (Dartford)
My right hon. Friend will know that the vast majority of hospitals have excellent accounting arrangements and offer exceptional value for money for the NHS system. Some, however, have been unable to meet the Government's strict requirements, and have had to be franchised. How is the franchising process progressing, and when will the Dartford and Gravesham acute trust, in particular, receive some news on when the process is likely to be completed?

§ Mr. Milburn
My hon. Friend is aware of the good work being carried out in his local hospital, as well as some past problems with its management and organisation. As he says, a franchising process is under way, and I hope to finalise it before too long. In all parts of the national health service, it is very important that, where there are persistent problems with performance, poor management and lack of organisation, they be dealt with. Every part of the NHS deserves the best management because, as he knows, good management makes a huge difference.

§ Sir Teddy Taylor (Rochford and Southend, East)
Does the Secretary of State agree that it is unfortunate that, although the audits tell us that money is being properly and legally spent, they offer no guidance on issues of policy? For example, how much extra does the provision of agency nurses, rather than ordinary ones, cost the health service? How much does the existence of hospices save the health service, given that 72 per cent. of the money comes from voluntary donations? Given that the NHS is not a profit-making organisation but a public body, should not the audit provide wider interpretations of what is happening, where money is being spent, how it could be saved, and the ways in which it has not been saved?

§ Mr. Milburn
That is precisely the idea behind our proposed new audit arrangements. Obviously, the new commission for health care audit and inspection will require legislation, and that will be a matter for debate in the House. The idea is that, for the first time, one organisation will be responsible for examining clinical standards throughout the health service; for considering performance issues, which my hon. Friend the Member for Dartford (Dr. Stoate) rightly described as important; and for considering where NHS money is actually spent—the issue that the hon. Gentleman raises. The public, who put money into the national health service, will therefore know where it is going and the results that accrue from it.

§ Paddy Tipping (Sherwood)
Does the Secretary of State accept that any strengthened and reformed audit system should look at strengths as well as weaknesses? Will the new system be used to promote success, using the staff and the trusts that develop good and modern practices?

§ Mr. Milburn
My hon. Friend makes an important point. He knows as well as I do of the many examples of good practice in the NHS. Part of the function of the existing Audit Commission and Commission for Health 4 Improvement, to which I pay tribute today, has been to highlight good practice as well as poor practice, so that others can learn from that. That will also be part of the new commission's function. We need to ensure that all parts of the NHS, and every patient, have high standards of treatment and care, and that taxpayers are assured that they are getting a good deal from the extra money going to the NHS.