§ Mr. David Amess (Southend, West)There is much that I could say about yesterday's domination of the media by the national health service. The position on appointments is an absolute sham and I am delighted to have the opportunity to share with the Minister my thoughts on how my constituents in Southend, West have been badly let down. What I am about to do, Mr. McWilliam, is something that I have never done in my 17 years in Parliament. It goes completely against the grain to have to name individuals and talk about such matters publicly. I am completely frustrated, so I have followed all the proper procedures, written letters and talked to individuals. All the relevant documents have been copied to Ministers.
§ Mr. Deputy Speaker (Mr. John McWilliam)Order. If the hon. Gentleman wants to follow all the proper procedures, he had better start calling me Mr. Deputy Speaker.
§ Mr. AmessI apologise. I checked with two individuals who gave me different advice before the debate started. I am sorry that I chose the wrong one.
I regret that I have to air the matter publicly, as we would not be in such a serious mess if representations had been listened to properly. I shall speak about a travesty in the health service. I have found complete abuse in relation to South Essex health authority, the appointments to the primary care trust and the merger of the Thameside and Southend trusts. What has been brought to my attention is appalling.
As the Member of Parliament for Southend, West, I was asked to give my views about two individuals who could have been appointed to the post of chairman of South Essex health authority. Other local Members of Parliament had the same choice. I knew one of the individuals, and I was passive in my response to the chairmanship. South Essex health authority has huge powers and responsibility, so the way in which it is managed is important.
My attention was drawn—not by Mrs. Rosie Varley, the regional chairman—to a report to the health authority and the eastern region of the national health service executive. It was prepared by Peter Brokenshire, the chairman of Redbridge and Waltham Forest health authority, and I was flabbergasted to read it. The report was well distributed internally, but the chairman of the region and Ministers thought, for some reason, that local Members of Parliament had no need to see it. It clearly details an appalling set of circumstances. Relationships had completely broken down, to such an extent that the chief executive, the chairman of the health authority and a Labour councillor were not speaking to one another.
The Minister looks surprised, but the report contains evidence of a complete breakdown in relationships. People might say that I will quote selectively from the report, but I would be happy to quote it all if there were time. Mr. Brokenshire says that the achievements of the health authority are generally
good, the control, governance and accountability processes that are in place seem sound, so I have had to ask myself, why the current tensions and adverse climate between some Executive and some Non Executive Directors exist.75WH The report suggests that there were tensions from day one between the board and some executive and non-executive directors, and thatThese tensions have escalated into a lack of trust and respect, because of the circumstances surrounding the deterioration of relationships between the Chairman … and the Chief Executive.so much so that the chairman said that she had lost confidence in him and wanted him removed.When new structures are set up and a new chairman is appointed to work with an existing chief executive, a learning curve will be involved. That learning curve had a disastrous effect on staff morale. Ministers and the chairman of the regional authority knew about the problem but did not have the common courtesy to alert Members of Parliament, who continually expressed anxiety in Parliament about their local health service. It is a disgrace.
The lengthy report states:
The Chief Executive considers that the Chairman does not understand the NHS and big organisation realities, raises expectations that cannot be met, gets involved in management issues and does not focus on the big picture.It continues in that vein. The instigator of the report felt that the chairman's main charge against the chief executive was not as important as the chairman felt that it was.The primary care group will become a primary care trust. I shall not bore the Chamber with my feelings about primary care groups and primary care trusts. I realise that the Under-Secretary was not in post when we considered the Health Bill in Committee last year, but I spoke at great length about how I feel about primary care groups and primary care trusts.
General practitioners in Southend were balloted, and the majority voted against becoming a primary care trust. In a letter from the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), to the chief executive of South Essex health authority, it is clear that the Minister is extremely worried that doctors have not been sufficiently involved in the process. I am sure that the Under-Secretary will have the letter. According to the letter, the Minister expects the primary care trust to demonstrate before 1 April 2000—a month's time—that all the problems have been corrected. That is utterly ridiculous.
The Government often consult us about such matters when no one is here, and we sometimes have only two weeks or 10 days, or are not consulted. I have categorical evidence that the Government have been central in controlling the end result. They make wonderful speeches and create wonderful photo opportunities while at the grassroots my constituents suffer.
Most doctors do not want a primary care trust. Interviews will be held tomorrow for the new chief executive of the primary care trust. I have read the recommendations for the interview procedure, which state that it would be preferable if a nurse were present, although it is not essential, but that at least one doctor should be present. However, it does not seem as though doctors will be involved in that appointment.
After 1 May 1997, Labour said, "We are in a new era now that we have got rid of the shocking Conservatives after 18 years. We know all about their political 76WH appointments, and we are not going to have any of it. Politics doesn't come into it." However, day in and day out, politics dominates all appointments in my constituency. I was presented with a choice of two people, both of whom are active members of the Labour party. I wrote to Mrs. Rosie Varley to explain why I did not consider either of them to be suitable. Knowing about Mr. Brokenshire's report, I said that it was extraordinary that one of the candidates had recently been the subject of a critical report.
It must have been difficult for Ministers in conversations with Mrs. Rosie Varley about how to deal with the chairman of South Essex health authority. Ministers think that Members of Parliament are so lazy and uninterested that they cannot understand what is going on. I made all that known. Before Christmas, I had a most unsatisfactory telephone conversation with the chairman of the region; she listened to all that I had said, but I have categoric evidence to show that it has all been ignored.
On primary care groups and primary care trusts, there has been no improvement in general practitioner support since the vote. Services are substantially worse since the primary care group was established. There are major waits for appointments, surgery and accident and emergency services. There have been severe cuts in community services—for example, one doctor who had 0.6 of a health service visitor now has none at all. There has been a loss of occupational therapists, hearing therapists, dieticians, and of practice-based community staff, who have lost motiviation due to their new cramped and unwelcoming premises. Waiting lists for physiotherapy and for magnetic resonance imaging scans have increased to 26 weeks. We all know that the Government are fudging the issue of waiting lists. It is a disgrace.
Because the wretched Government are obsessed with targets and with trying to kid the people—for the general election next year—that all that they promised has been delivered, everything is being rushed. Either they do not understand the issues—which I think is the case—or they are concerned only with their own political interests. How else can one justify the problems that I have detailed? Morale is very low. The cardiologist at Southend, for example, has funding for only four NHS coronary angiographies a week. The number required is 10 times that, so several people on the list are dying. This scandal goes on and on.
I also wish to draw the Minister's attention to the merger of Thameside and Southend community NHS trust. Members of Parliament were, of course, consulted on that, but if they were Conservative Members, the consultation was a sham. Last year we were invited to talk about the trust and views were expressed that, although there was well-judged support for the merger, it should not be done in such a way as to constitute a takeover of Southend. That was said all along—yet an absolute takeover has occurred. Again, that is an absolute disgrace.
What angers me so much is the disgraceful handling of the appointments. We had a superb chairman of Thameside, Mr. John Vesey, but because the then Health Secretary, the right hon. Member for Holborn and St. Pancreas (Mr. Dobson)—who now wants to be mayor of London—instigated whistleblowing, when allegations concerning the chief executive of the trust 77WH were reported to Mr. Vesey, an investigation followed. A constituent of mine was one of the informants. What happened? The two people who had done what the Secretary of State wanted and became whistleblowers—my constituent and the chairman—were removed. I have reports and papers on it. The person about whom the complaints were made, the chief executive, not only stayed in post but has now been appointed the chief executive of the new combined trust. That is another disgrace.
I have before me the lengthy audit report concerning allegations about a property, 87c Grand parade, being used as an office at considerable public expense, a trip to Paris and taxi expenses. I also have all the evidence on sloppy structures. The Government know all about that, but because it does not fit their agenda, they have reappointed the chief executive.
The appointment procedure was a fiasco. The job was advertised at short notice while people were away; someone who would have been an excellent candidate was told that it was not worth applying because it was a more-or-less foregone conclusion that the existing chief executive would get the job. That hypocrisy will affect my constituents.
When it came to appointing the chairman of the new combined trust, no one was consulted. It was the usual two-week period of consultation. The choice was between two people, one from Thurrock and the other from Southend. I said that, because Thurrock would be heavily represented, I wanted a Southend chairman. Was it a surprise, Mr. Deputy Speaker, when yet again my input was wasted and the person from Thurrock was chosen—a person who had only a few months' experience of the national health service?
We have a primary care trust in Southend that the doctors do not want, with a chairman who has been the subject of a critical report. Thurrock and Southend have been merged, and we have a chief executive who was the subject of another critical report and a chairman from Thurrock. As it stands, only one person on the new merged trust will come from Southend.
I pay tribute to the British Medical Association, the NHS Confederation and the others who have briefed me. The information that I have shared with hon. Members this afternoon has come from the many doctors and local practitioners who have approached me on the matter.
I feel uncomfortable at what I have had to say today. Three weeks ago, I was here on another matter; I thought that I had dealt with it fairly, but I got absolutely nowhere. However, as a result of that debate, I received a letter the very next day from the Prime Minister, and the matters that I had brought to the attention of the House are now being dealt with.
I am sick to death of dealing with a Government who say that they are democratic, who say that they want to embrace the whole community and who say that they want to listen, but who listen only to their supporters. I have clear evidence that if the Government were being even-handed, and if they did not take account of the fact that they were dealing with a Conservative Member of Parliament, they would act in the best interests of my constituents in matters of health care. They clearly have not done that.
§ The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart)I congratulate the hon. Member for Southend, West (Mr. Amess) on securing this debate on the health authority appointments and structures in Essex. As the Minister with responsibility for non-executive appointments, I am pleased to have the opportunity to address the issues that the hon. Gentleman has raised. I know that the hon. Gentleman feels aggrieved that his views on recent appointments in south Essex were not taken into account. However, he is mistaken to believe that.
It may help if I say how the national health service non-executive appointments are made. The preliminary sifting and interviewing of candidates are overseen by an independent person whose role is to ensure that the procedures comply with guidelines issued by the commissioner for public appointments. As well as the independent member, interview panels normally include two NHS representatives from outside the area of the organisation involved, typically the chairmen of health authorities or health trusts. That panel decides which candidates should be included on a regional register of those judged suitable for appointment. When trust and health authority vacancies arise, the regional chair recommends to Ministers preferred and alternative candidates who are either on the regional register or serving as non-executives and eligible for reappointment. For chair appointments, the interview panel usually includes the regional chair and an independent member. The panel decides which candidates have the qualifications and abilities to carry out the role of the chair. The regional chair has ultimate responsibility for the shortlist of names that goes to Ministers for consideration.
The Secretary of State is responsible for deciding the criteria for candidates. Ministers, acting on behalf of the Secretary of State, are responsible for the final decision on who should be appointed. Ministers can become directly involved in the initial sifting and interview process only if the correct procedure has not been followed or when there is evidence of unfair discrimination. That is properly and strictly in accordance with the guidance issued by the commissioner for public appointments, which we are required by law to follow. There is no scope for Ministers to substitute names of their choosing. They can ask the regional chair for alternative names, but only when they have good reason for believing that none of the recommended candidates should be appointed. Ministers are obliged to inform the commissioner if a complete slate of recommended candidates is rejected, and they must specify their reasons for that decision.
Members of Parliament are consulted by the regional chairs on the names that they are planning to recommend to Ministers for chair appointments. Their comments are passed on to Ministers and they, not the regional chair, take them into account before reaching a decision. I was struck by the hon. Gentleman's choice of words when he referred to being given the "choice" between candidates. Along with other hon. Members, he was asked for his opinion, but Members of Parliament do not have the right to choose. Their views are part of a range of views that are sought in the selection process. As with Ministers, Members of Parliament are not able to substitute names of their 79WH choosing for those recommended by the regional chair, nor can they provide additional names. That would run counter to the clear guidance produced by the commissioner for public appointments.
All candidates for the appointments must be able to demonstrate a strong personal commitment to the NHS and the needs of the local community. Candidates are considered solely on their merits and the contribution that they can make, not their politics. The hon. Gentleman referred to allegations of political bias that have been made by Opposition spokesmen in the past few years. In response to those allegations, the commissioner for public appointments announced last July that she would scrutinise the NHS appointment process. She rightly stated:
it is clearly in the interests of all concerned that the appointments process in the NHS is above suspicion.The Government entirely agree with that sentiment.We welcome the scrutiny and have given the commissioner every assistance in the work involved. The results are expected shortly and we shall make a statement on the report. However, it is worth noting that, after previous annual audits of NHS appointments, the commissioner has been substantially content with the integrity of the system. In the 1998 annual report, the then commissioner wrote that his audit of NHS appointments had found
no evidence of Ministers intervening to ensure the advancement of their nominees.He went on to say:patronage on behalf of individuals is clearly not an issue.Now that I have established the principles of the appointment process, I shall refer to specific constituency issues raised by the hon. Gentleman. He must be only too aware of the additional demands placed on the NHS in Southend by the area's large elderly population and the fact that it has the largest area of social deprivation in south Essex. Southend has specific health needs, and the Government investment programme demonstrates our commitment to meeting them. The aim of everyone interested in health care in the area must be to work together to tackle those needs and inequalities and thereby raise the health status of the residents.One of the steps taken to achieve those goals is the development of the Southend primary care group to primary care status, which will take effect on 1 April. It provides an unparalleled opportunity for local stakeholders, including family doctors, nurses, midwives, health visitors, social services and the wider community that they serve to shape services so as to provide better health care and to work to meet the needs that I have identified. I know that the hon. Member for Southend, West has reservations about the move to trust status and that the local medical committee GP ballot did not show an overall majority of support for the move to trust status. However, it appears that the reasons for that result are varied and are not unrelated to the timing of the ballot, which did not allow the PCG to visit all the general practitioners' practices, to explain the objectives and overall vision of the primary care trust or to address the concerns of individuals before they were asked to vote.
80WH I turn to the Brokenshire report and to Katherine Kirk, the chair of the health authority, who is now appointed to take over the PCT. The report makes clear the strained relations between the chair and chief executive of South Essex health authority. However, as it points out, those problems must be considered in the context of the exceptional circumstances in which the new South Essex health authority board was launched. The board faced a huge agenda of change which was made all the more difficult because all but one of the serving non-executive directors left, which resulted in a continuity problem. The report suggests that more could perhaps have been done properly to induct the new board members.
Importantly, the report states that many of the difficulties mentioned have been addressed. South Essex health authority, of which Katherine Kirk is currently chair, performed well throughout the year. It is on target to achieve financial balance and its in-patient waiting list target. In addition, it coped well with significant winter pressures, working closely with NHS trusts and other agencies to deliver its winter plans. The report refers also to a lack of focus in responsibility and roles, which is probably the crux of the matter. I hope that the hon. Member for Southend, West will be reassured to know that the regional office is keen to ensure that new PCT chairmen are given appropriate induction, training and development opportunities. In addition, they will have specific development opportunities and added learning facilities to help them fit into their roles.
I am extremely disappointed to learn that the merger of the community trusts, which was supported by all parties, is being promoted as a takeover by Thameside community trust, with the implication that it is at the expense of Southend community trust. I find the view of the hon. Member for Southend, West all the more baffling considering that the appointment process has not yet been completed. To date, the chairman and two non-executive directors—one from each existing trust—have been appointed, and at least another three remain to be appointed. They have been and will be chosen from the whole pool of locally approved candidates. Those already on NHS boards will be considered alongside those on the regional register.
It was made clear that the chairman would be expected to provide evidence to the regional office to show that the support of local GPs for the PCG move to trust status had increased when approving PCT status. The chairman will also be responsible for ensuring achievement of the PCT objectives, in particular that of improving the resident population's health and health services in the key areas specifically outlined in the consultation process.
The hon. Gentleman's objections on the abolition of fundholding related to community involvement and to working together. It is, however, exactly those things that the new PCT will provide. The local community now has a tremendous opportunity to move forward and open a new chapter in health care in south Essex.
I urge all involved to put the differences of the past behind them. Everyone needs to grasp this opportunity to develop and improve health services. Local residents will be the losers if we fail.