NHS Trusts (Hansard, 23 May 1991)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, National Health Service trusts are bound by the provisions of the National Health Service and Community Care Act 1990 and other statutory requirements. We have issued general guidance to all units within the National Health Service, both self-governing and directly managed, on the operation of the new contract-based system; and specific guidance to trusts has been issued under the title NHS Trusts: A Working Guide, copies of which are available in the Library.

§ Lord Dean of Beswick
My Lords, is the Minister aware that I have a letter in my possession which was circulated by the newly formed Christie Hospital Health Service Trust to district health authorities in its area suggesting that a ward which has been closed could be re-opened if district health authorities each make a financial contribution? The letter from Mr. Fry, the chief executive, contains the following short paragraph: Our aim is to secure the necessary funding from all of our purchasing authorities. In the event of authorities choosing not to contract with us for this even better level of service then the additional facilities will not be available to residents of that district". Is it the intention of the Government that health trusts should behave in that manner? If the Government do not support that will they give them a categoric instruction to cease this type of practice, which in fact is an immediate introduction of a double tier health system?

§ Baroness Hooper
My Lords, the object of creating national health trusts was to allow flexibility for innovative and forward-thinking arrangements in the provision of health care for the benefit of patients at large. We want to see the purchasers of care learning 327 from each other so that the benefits are spread to all patients as soon as possible. We want every opportunity to be taken to level up the provision of health care and we want to see all the available facilities used. If the noble Lord prefers certain facilities not to be used, then he presumably would go ahead and ban those opportunities.

§ Lord Dean of Beswick
My Lords, can we take it therefore that the Minister and the Government are totally in support of this disgraceful practice which will operate against the largest sections of the community attending that hospital for treatment? Is she standing by that practice?

Bareness Hooper
My Lords, we do not consider it disgraceful practice.

§ Lord Boyd-Carpenter
My Lords, can my noble friend say why the Opposition appear to have such an enormous prejudice against self-governing hospital trusts, unless it is a love of bureaucracy for its own sake?

§ Baroness Hooper
No, my Lords, I cannot explain why the Opposition wish to see these opportunities for improving the services to patient care going ahead.

§ Lord Molloy
My Lords, is the noble Baroness aware that one of the reasons we are apprehensive—and this is shared by nearly every sector of the medical profession—is that people could live in an area of a particular trust where the trust is not wealthy enough or cannot get the money to send patients for specialist treatment. Large numbers of the medical profession all over the country are of the opinion that that is a fundamental break from the principles that were created when the NHS was first formed.

§ Baroness Hooper
My Lords, a great many people in the medical profession are involved in the trusts; a great many people in the medical profession are enthusiastic about the opportunities that the trusts afford. If noble Lords want evidence, it is that there are well over 100 applications for trust status in the second wave.

§ Lord Mellish
My Lords, would it not be a good idea to allow the trusts a little time to settle down and do their job properly? It seems unlikely that a trust would be so foolish as not to consider the admission and treatment of patients as almost its entire priority. Without that there is no point in anything.

§ Baroness Hooper
My Lords, the noble Lord makes an important point. We are a mere seven weeks into the operation of the reforms. The benefits arising from this opportunity have not yet had time to be seen. We believe that the effect of the trusts will be to improve patient care.

§ Lord Gisborough
My Lords, can my noble friend say roughly how long it takes for a trust to start after an application has been made?

§ Baroness Hooper
My Lords, it is probably about a year. The formal applications so far received for trust 328 status to start in April 1992 are already being considered. The decision will probably be made towards the end of this year.

§ Baroness Hollis of Heigham
My Lords, will the Minister confirm that no trust will be able to opt out of providing essential services such as geriatric care or mental health care without the express consent of the district health authority?

§ Baroness Hooper
My Lords, there is a good deal of misunderstanding about the way the reforms are operating. It is the duty of the district to provide for the health care needs of its population. The district will therefore contract with National Health Service trusts and other units. It is the duty of the trust to perform the contract that it has agreed with the district.

§ Lord Carter
My Lords, can the Minister confirm that there is no limit on the number of private beds in an opted out hospital whereas there is a 10 per cent. limit in directly managed hospitals? Why is there a distinction? Would the Government intervene if an opted out hospital decided to take more than 10 per cent. of private patients, particularly if the decision resulted from taking in private patients from overseas?

§ Baroness Hooper
My Lords, what is important is that National Health Service trusts should perform the contracts that they have entered into with district health authorities and GP fund holders. They will have to fulfil the terms of the contracts. If over and above the terms of those contracts to meet the health needs of the district they have spare capacity, there is no reason why they should not use that to earn income which will benefit general patient services. I refer the noble Lord to Section 5(9) and the relevant annexes of the National Health Service and Community Care Act 1990 which makes specific provision for safeguards in this area.

§ Lord Carter
My Lords, I should be grateful if the Minister could answer the first part of my question. Why is there no limit on private patients in opted out hospitals but a 10 per cent. limit in directly managed hospitals?

§ Baroness Hooper
My Lords, the system of contracting will ensure that National Health Service trusts provide the amount of care that is required by the district to fulfil its needs. Therefore there is no reason to specify a particular amount. It would be ridiculous to do so.

§ Lord Skelmersdale
My Lords, is it not a fact that self-governing hospital trusts are the same hospitals with the same patients, paid for with the same money and treated by the same doctors and nurses? How then can they be described as having opted out of the National Health Service?

§ Baroness Hooper
My Lords, my noble friend is perfectly correct. No one is talking about them opting out of the National Health Service except people like noble Lords on the Opposition Benches who clearly misunderstand the reforms.

§ Baroness Nicol
My Lords, when the noble Baroness agreed a short time ago that it was wise to allow the trusts to settle down to see how they worked out, did she mean that the Government will not accept or declare any more trusts until we have seen how the existing ones have worked out?

§ Baroness Hooper
No, my Lords. We have always said—we put forward the same arguments during the passage of the Bill through this House—that we would expect to see second wave and third wave trusts coming forward in subsequent years. We shall nevertheless have the experience of the first wave of trusts, which, as was made clear in the debate the other day, have been very successful so far in their first seven weeks. In introducing new and important services for patients, we shall have that experience to build on in making arrangements for the second wave of trusts.

§ Lord McColl of Dulwich
My Lords, does my noble friend agree that the ability of the Secretary of State to sack the chairman of a self-governing hospital is a clear indication that in no way can the self-governing hospitals be described as opting out of the NHS?

§ Baroness Hooper
My Lords, my noble friend is correct. I refer again to Part II of Schedule 2 to the 1990 Act which specifies that power among a number of other very important safeguards for the running of these publicly funded National Health Service units.

§ Lord Molloy
My Lords, if, as the Minister and her noble friend have said, there is so little difference between the new system and the system as it was before, why are the Government bothering with this change and causing such grave apprehension throughout the nation?

§ Baroness Hooper
My Lords, we are seeking a more efficient use of public funds in the National Health Service. We believe that the trusts, like the GP fund-holding initiatives, will be front runners in showing us the way forward. They have proved so far that that is the case.

§ Lord Sefton of Garston
My Lords, I should like the Minister to clear up the anxieties of some people who are not experts in this field. Assuming that contracts are entered into between the trusts and district health authorities, what control will the NHS or the districts have over the activities of the trusts? Will she put that information in the Library? Is there any direct control over the trusts apart from the power to sack the chairman of the body or to dissolve the trust? Does the NHS have any control over their activities?

§ Baroness Hooper
My Lords, compliance with guidance or directions given by circular or otherwise to health authorities or particular descriptions of health authorities is one of the conditions of being a National Health Service trust which is specified in the schedule to the Act to which I have previously referred. Furthermore, the contracts, which are the documents of most interest to patients in terms of the patient care that they expect to receive, are public documents and are published. They are certainly available in the districts. If the noble Lord cares to 330 investigate the contract in a district, he may do so. In addition, an annual report is required to be published by every National Health Service trust. It has to be presented at a public meeting. There is ample opportunity for members of the public to know what is going on in the trusts. The Secretary of State, as for any other unit in the National Health Service, has ultimate responsibility to Parliament for the running of the National Health Service, including National Health Service trusts.

§ Lord Mellish
My Lords, in order to get the record straight, is the Minister aware that for 37 years I was associated with Bermondsey? I come through there every day of my life and I know what goes on. There is no demonstration against the decision of Guy's Hospital. It is a beloved hospital.

§ Baroness Hooper
My Lords, I believe that that goes for most of the National Health Service trusts. I thank the noble Lord.

§ Lord Dean of Beswick
My Lords, if the Government are so concerned about the interests of the patients or the consumers, can the Minister say why it is that the community health councils, which were established to protect such interests, do not have automatic access to National Health Service trust hospitals as is the case with the hospitals under the district health authorities? What is the difference? Further, is that not a diminution in the protection for patients?

§ Baroness Hooper
My Lords, in view of all the public documents that are available to the CHCs as well as to every member of the public, I believe that there is quite adequate access.

§ Lord Sefton of Garston
My Lords, I ask again: if in fact the NHS is not satisfied with a contract drawn up between a district health authority and a trust, what effective control do the Government have to insist that it is changed, short of sacking the chairman or dissolving the trust?

§ Baroness Hooper
My Lords, if the Secretary of State finds that a district health authority has not entered into an adequate contract or that the contract has not been performed adequately, he has powers to remonstrate with the district health authority and. therefore, impact on the operations of the National Health Service trust.

§ Lord Sefton of Garston
My Lords, that answer is not clear enough. I am not talking about the control that the NHS has over a district health authority. The specific question was: what sanction or control do the Government have over a trust, short of sacking the chairman or dissolving the trust?

§ Baroness Hooper
My Lords, the Secretary of State has exactly the same powers over National Health Service trusts as he has ultimately over any other unit in the service.

§ Lord Sefton of Garston
My Lords, I take that to mean that the Government can in fact impose a different contract on the trusts. Is that correct?

§ Baroness Hooper
No, my Lords.

§ Lord Sefton of Garston
My Lords, that is not very effective control, is it?