NHS Trusts: Applications (Hansard, 20 July 1990)

§ Lord Henley
My Lords, 205 units have expressed an interest in becoming self-governing and 51 formal applications have now been received.

§ Lord Molloy
My Lords, I thank the Minister for that Answer. However, can he tell us what criteria the Government use for deciding whether or not a hospital should opt out of the National Health Service? I am sorry; I do not really mean opt out of the National Health Service scheme; I meant to refer to hospitals becoming self-governing. What precisely are the criteria upon which decisions will ultimately be made?

§ Lord Henley
My Lords, I hope that I misheard the noble Lord. I hope that he did not say that our hospitals are opting out of the National Health Service. The situation has been made quite clear to him on many occasions.
Applications for National Health Service trust status will have to demonstrate, first, potential benefits to patients and improved quality of service; secondly, they will have to demonstrate adequate managerial skills and capacity to run the hospitals as self-governing units; and, thirdly, they will have to show the involvement of senior professional staff in the management of a hospital. Further, the Secretary of State will need to be satisfied that the proposal is consistent with maximising choice for patients and GPs, that it is financially viable and that self-governing status is not being sought as an alternative to closure.

§ Lord Peston
My Lords, perhaps I may pursue the issue of criteria. Bearing in mind the fact that the evidence overwhelmingly suggests that doctors, nurses and paramedics tend to be opposed to self-governing status and that it is only the management staff who seem to think that they will do well out of it, will the Secretary of State, in making such a decision, actually make public in documentary form the precise reasons to which my noble friend referred as to why he took the decision in the way he did? In other words, will the reasons as to why the hospital concerned did or did not meet the required standards become public knowledge? Alternatively, will he simply say yes or no?

§ Lord Henley
My Lords, as the noble Lord knows, we shall consult all the bodies involved in the hospital, the regional health authorities and all other interested parties. My right honourable friend will then make his decision based upon the application document which will be published, as will the comments received in consultation and all the other information relevant to that application. As yet, my right honourable friend has not said whether he will make public the reasons for his decision.

§ Lord Mellish
My Lords, I understand that the phrase "opting out" really means that hospitals want to get away from what some of them call the dead hand of bureaucracy which is applied by the district health authority. I must therefore ask the following questions. Can the Minister say who are the people in the district health authorities? Further, when they make a good decision, who is the person above them who says, "No, we shall not have that either"?

§ Lord Henley
My Lords, membership of the district health authorities is another matter. I must stress again that National Health Service trusts will not opt out of the National Health Service.

§ Lord Mellish
I know that.

§ Lord Molloy
My Lords, in so far as the Minister has outlined the criteria which will be used, can one assume that the information will ultimately be published in detail? Further, will it be possible for 1117 interested people to protest about something that the Government may be intending to put upon them which they do not want?

§ Lord Henley
My Lords, as I said, there will be consultation with all interested bodies. Obviously such consultation will be taken into account by my right honourable friend the Secretary of State when he makes his decision.

§ Lord Peston
My Lords, I am sorry to pursue this matter, but my noble friend asked an important question. Perhaps I may clarify the position in regard to your Lordships' House. If a particular hospital were granted self-governing status, would Members of this House be able to ask precisely why this had happened? Alternatively, if such questions were asked, would the Minister, if it were his job to do so, simply rise and say, "My right honourable friend the Secretary of State has taken this decision and there is nothing more to be said"? That would be a very serious situation given the way in which we have debated such matters in this Chamber. We need to know upon what basis, especially in terms of public documentation, we shall be able to examine such decisions.

§ Lord Henley
My Lords, I said that the application document will be made public and that comments received through consultation will also be made public. After such consultation, it is the duty of my right honourable friend to make his decision.

§ Lord Tordoff
My Lords, with all due respect to the Minister, that does not answer the question. Are we at any stage to be told on what basis a decision has been made? Further, is there any way in which Members of your Lordships' House will be able to challenge a decision?

§ Lord Henley
My Lords, quite obviously my right honourable friend is accountable to Parliament. Therefore, to that extent, any decision he makes can be challenged.