NHS Trusts: Government Guidance (Hansard, 21 May 1996)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, guidelines were in place on most issues before the National Audit Office published its report. The National Health Service Executive has nevertheless clarified its guidance on a number of points raised in the report.

§ Lord Dean of Beswick
My Lords, I am grateful for that reply. I know that the Minister studies these matters thoroughly. Does she recall that two or three years ago your Lordships' House spent much time discussing the Wessex and West Midlands health authorities as regards which some serious financial irregularities had arisen? The report states quite clearly that the same irregularities were occurring in the Yorkshire health authority at the same time. It would appear that there was an epidemic of such incidents at that time. Will the Minister try to persuade the Secretary of State to investigate health authorities as I believe that much money has been misused that could be reclaimed to the advantage of the health service? Is the Minister also aware that Mr. Alan Langlands, the chief executive of the health service, said that Mr. Keith McLean, who was involved in the incident I am discussing, would not be offered another contract by the National Health Service but nevertheless he has been given one by a National Health Service trust based in Mansfield? Will the Minister explain how that can occur?

§ Baroness Cumberlege
My Lords, I refer first of all to the Wessex situation which was on a completely different timescale from the Yorkshire situation. The Wessex incidents occurred in 1987 to 1989. In 1990 that whole project was abandoned. In the case we are discussing the first improper payments came to light in 1992. Therefore, it was a totally different timescale. This practice is not widespread. It would be remiss of the noble Lord to suggest that it is. It was in the 1990 legislation that we introduced the Audit Commission to supervise and monitor regional health authorities, district health authorities and trusts. Indeed the Audit Commission unearthed this particular instance. It has reassured us that there are no other cases pending at the moment. Finally, on the question of the job that was 726 offered to Mr. McLean, we have to look at the laws governing this land. It was a different employer because trusts have employment contracts with individuals. They are not employed by the National Health Service per se.

§ Lord Clark of Kempston
My Lords, does my noble friend agree that in an organisation employing over a million people quite obviously every now and again there will be cases of human error, deplorable though that may be? Does my noble friend further agree that the way the health service has been run in the past 15 or 16 years has resulted in lower waiting lists and more treatment for patients? That is one aspect of the health service that we should surely blazon from the hill tops.

§ Baroness Cumberlege
My Lords, I thank my noble friend for those contributions. Of course he is absolutely right in that the health service has never been better as regards the services it gives to patients. I agree with his first comment. One has only to look at organisations such as the Salvation Army, of which I am a great admirer. It also has had problems in terms of a few million pounds walking away, but it has also recovered them.

§ Lord Carter
My Lords, is the Minister aware that with the scandals in health authorities involving their purchasing and employment practices, the hospital consultants association is forecasting—in its words— a financial meltdown for NHS trusts? The Audit Commission has called into question the claimed benefits of GP fundholding and the Secretary of State has had to launch a major initiative to reduce the mountains of paperwork which are the direct result of the Government's own policy. Is the Minister still absolutely sure that the internal market is working?

§ Baroness Cumberlege
Yes, my Lords. I am sure the noble Lord will agree that Ms. Harriet Harman also agrees with that. In the "Today" programme only this week she said that if the Labour Party came into power it would want to keep the purchaser/provider split. We are at one on that. Of course consultants and doctors in the health service are finding some of the changes difficult, and some of that is because they are being called to account in a way that they were never previously called to account.

§ Lord Carter
My Lords, if the Minister does not know the difference between the purchaser/provider split and the internal market, it is no wonder that the NHS is in such a mess.

§ Baroness Cumberlege
My Lords, I think the noble Lord totally misunderstands the purchaser/provider split and the internal market.

§ Lord Mackie of Benshie
My Lords, is the Minister aware that the Salvation Army got back the money?

§ Baroness Cumberlege
My Lords, yes, I said that it did; and in this case we also got back a great deal of the money.

§ Baroness Hayman
My Lords, I speak as one who has had experience of and battle scars from the past five years of the internal market in the NHS. Does the Minister accept that there is a large difference between separating responsibility for assessing health needs and responsibility for providing it; and what is the time-wasting, money-consuming, paper-chase of the internal market that diverts us from clinical priorities?

§ Baroness Cumberlege
My Lords, I am sure that the noble Baroness will agree with me that before the purchaser provider split we saw fewer patients, as my noble friend said. We treated fewer people. We had much longer waiting lists; we had "never-never" waiting lists; patients recognised that they would never be treated. Today we have brought the waiting time down to under two years, under 18 months and, in the West Midlands, under six months. That is a huge improvement. We are seeing general practice undertaking more and more. Primary care is being strengthened in terms of vaccination and immunisation. We have almost eliminated measles, the first country in Europe to do so. The successes go on and on.

§ Lord Dean of Beswick
My Lords, I am sorry to disagree with the Minister's answers; I do not usually do so. However, when comparing the timescale between Wessex and the West Midlands, is the noble Baroness aware that I did not quote my own figures but the observations in the report by the Comptroller and Auditor-General?
Finally, I am deeply concerned, as I am sure that most noble Lords are, that, while Mr. Alan Langlands, the top person in the National Health Service, has stated that Mr. McLean will not be offered a contract because of his conduct in this area, there is no mechanism to prevent him obtaining a contract from a national health trust in another area. Is that what the Minister is saying? If so, the legislation needs altering very quickly.

§ Baroness Cumberlege
My Lords, this is a question of employment law. If the noble Lord feels that the legislation is wrong, he will have to bring a Bill through Parliament and change the employment law. Individual contracts for employees are held with individual employers. In this case, as the noble Lord is aware, regional health authorities, other health authorities at district level, former FHSAs, and trusts, hold the contracts.
Finally, I respect the noble Lord, Lord Dean of Beswick. He has diligently sought to ensure that the health service provides good services with propriety. I respect that and I thank him for bringing this to our attention.