District Health Authority Mergers (Hansard, 17 March 1993)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, no directives have been issued to compel existing district health authorities to merge. My right honourable friend the Secretary of State for Health will consider the individual merits of any merger proposals which are made to her by the regional health authorities.

§ Lord Dean of Beswick
My Lords, I am grateful to the Minister for that Answer, but is she aware that there appears to have been some coercion in certain areas by officials from the Department of Health? I am not too sure of the present situation, but if an amalgamation has taken place between Bolton and Wigan I am told that coercion was used. In fact, the chairman of the regional health authority was heard to say that he would use his reserve powers if the amalgamation did not take place. If the authority rests with regional health authority chairmen to use their powers in that arbitrary manner, will the Minister see that it is withdrawn immediately and that notice is taken of the Secretary of State's wishes?

§ Baroness Cumberlege
My Lords, I have no knowledge that regional chairman have reserve powers in such instances. It is the Secretary of State's decision. She has made it absolutely clear that she will be receptive to mergers between district health authorities where they have a degree of local support, where they are clearly in the interests of patients and where they are seen as part of a strategy to develop the purchasing of services.

§ Baroness Faithfull
My Lords, may I ask my noble friend the Minister whether, with the reorganisation of local government and the introduction of community care, it will be possible to make the health authorities coterminous with the local authorities?

§ Baroness Cumberlege
My Lords, my noble friend Lady Faithfull is absolutely right. Where there is coterminosity, it certainly makes for much better working, but that is not the sole criterion on which mergers are judged.

§ Lord Ennals
My Lords, first, I hope that the Minister will feel inclined to subscribe to the view that coterminosity is an important consideration. Secondly, does she consider that the disadvantage of health authorities which are too large and which do not really represent the community's interests has an effect on the work of the community health councils? If there is an enlarged, merged district health authority, is it automatic that the community health councils will be enlarged and merged?

§ Baroness Cumberlege
My Lords, I agree with the noble Lord's first point about coterminosity. It certainly makes for easier working. With regard to the community health councils, there is no obligation on them to merge in line with the district health authorities. We have instances of one district health authority with three community health councils.

§ Lord Rea
My Lords, does the noble Baroness accept that not only coterminosity but also small is beautiful? Is she aware that one of the few aspects of the National Health Service changes which is viewed at all favourably by these Benches is the role of the district health authorities in commissioning services to match the ascertained needs of their populations? If district health authorities are merged into larger units, is there not a danger that it will become more difficult for them to ascertain those needs in detail?

§ Baroness Cumberlege
My Lords, my heart is in tune with what the noble Lord says, but my head tells me that we can make economies of scale where we have mergers and that we shall therefore get more money for patient care. In a recent merger involving the Dorset health authority, £600,000 was realised in the first year. Larger district health authorities are better able to attract, retain and develop the high calibre of staff that is needed for effective purchasing. In agreeing to mergers, my right honourable friend the Secretary of State is very much aware that they must reflect the needs of the local population.

§ Baroness Seear
My Lords, is it too late to ask the noble Baroness to try to avoid the monstrosity of "coterminosity"?

§ Lord Carter
My Lords, can the Minister tell the House whether any plan to amalgamate district health authorities would help to prevent the recurrence of the gross misuse of public funds, amounting to fraud, which occurred in Wessex and in the Midlands concerning computer installations and the use of product consultants? Would any attempt to amalgamate district health authorities help to prevent that recurring?

§ Baroness Cumberlege
My Lords, my right honourable friend the Secretary of State for Health has made it quite clear that she does not condone or endorse the actions that were taken in those two instances. She has instigated inquiries through the National Audit Office. However, those two schemes had nothing to do with the district health authorities; they were regional schemes.

§ The Countess of Mar
My Lords, can the noble Baroness say what degree of local agreement the Secretary of State considers to be necessary? The noble Baroness may recall that I asked an Unstarred Question about the merger between Kidderminster and Bromsgrove. Nobody agreed to the merger in the case of Kidderminster. It was suspected that the money from Kidderminster was wanted for Bromsgrove and, as it turns out, that is exactly what has happened.

§ Baroness Cumberlege
My Lords, the Government have made it quite clear that we expect to see tangible benefits to patients and clear evidence that there is some degree of local support when we agree to mergers.

§ Lord Dean of Beswick
My Lords, may I take it from the Minister's Answer to me that, in regard to the fact that there is significant opposition in Tameside, where I live, to the proposal that Tameside district health authority should amalgamate with Oldham, no merger will take place unless a considerable majority of the members of both district health authorities are in favour of it?

§ Baroness Cumberlege
My Lords, I am sure that my right honourable friend the Secretary of State will take into account not only the views that have been expressed in your Lordships' House but also the views of local people.