Postgraduate Teaching Hospitals (London) (Hansard, 15 July 1981)

§ Mr. Patrick Jenkin

The order under which the 12 boards of governors of the specialist postgraduate teaching hospitals are preserved ceases to have effect after the end of March 1982, and I felt it was right to decide on the long-term governance of the hospitals at the same time as decisions on restructuring of health authorities in England were taken. The London Advisory Group, having visited all the hospitals concerned, considered this matter in the light of the existing evidence, taking account of the views expressed to it by the boards of governors. I published its 395W report last March. Having discussed the report with the chairman of the boards of governors and others, I have decided to accept most of the recommendations.

The boards of governors of the Hospital for Sick Children, the National Hospital for Nervous Diseases, Moorfields Eye hospital, the Bethlem Royal hospital and the Maudsley, the National Heart and Chest hospital, and the Royal Marsden hospital, will be retained but, in order to bring their governance within the framework of current legislation, I propose to make regulations reconstituting them as special health authorities. My Department will now consult the boards and other interested bodies about the composition of the special health authorities and related matters.

In the case of St. John's hospital for Diseases of the Skin and St. Peter's hospital (Urology), the London Advisory Group recommended that urgent steps should be taken to decide where these hospitals were to be rehoused and that, once the decision had been taken, the process of planning and managing the rehousing should be the responsibility of the appropriate district health authorities. I have decided to accept this recommendation. I believe that it is in the best interest of the Health Service and of the postgraduate hospitals themselves that their rehousing should be the responsibility of the authorities to which they will be accountable. Informal discussions have been proceeding about where St. Peter's and St. John's should be rehoused and it is now practicable to identify the general teaching hospitals with which the postgraduate hospitals should be associated. My Department will shortly consult interested bodies on proposals for the relocation of these hospitals. I do not propose, therefore, to preserve the boards of governors of these hospitals but, subject to the outcome of consultation, to make the appropriate DHAs responsible for these hospitals from 1 April 1982.

The future of the Royal National Throat Nose and Ear hospital, the Royal National Orthopaedic hospital, the Eastman Dental hospital and Queen Charlotte's hospital remains intimately bound up with the future of the associated postgraduate institutes. The University of London has made it clear that these institutes are unlikely to continue to have a separate existence, possibly becoming part of general medical schools; in that case I am convinced that it is right for these postgraduate teaching hospitals to be managed by the DHAs responsible for the main general teaching hospitals associated with the relevant general medical schools. There remain, however, considerable uncertainties both about the timing and the nature of changes in the governance of the postgraduate institutes. I do not, therefore, intend to make changes in the governance of these four postgraduate hospitals at this time. It is important, however, that uncertainties should be ended as soon as possible and I intend to make the appropriate DHA responsible for each postgraduate hospital as soon as the future of the associated institute has been settled. In the meantime, if necessary, I propose to seek the approval of the House to the extension of the boards of governors of these hospital, beyond the end of March 1982.

The London Advisory Group also recommended that the board of governors of Queen Charlotte's hospital should be made accountable to the North West Thames regional health authority during the period before it becomes the responsibility of a DHA. I think it would be 396W wrong to subject the hospital to two changes of accountability in so short a period and I do not therefore accept this recommendation.

For those postgraduate hospitals which are to become the responsibility of DHAs, I accept the view of the London Advisory Group that a committee should be established by the DHA to advise the DHA on the formulation of policies and plans affecting the hospital and specialty; to take a special interest in the general functioning of the hospital and to continue to promote the development of the specialty as the boards of governors have done so effectively in the past; and liaise with the friends of the hospital and voluntary bodies in order to preserve the valuable links with the lay community which have characterised these hospitals. I believe it would also be appropriate for such a committee to have a role in relation to any trust funds of the hospitals or to have a relationship with special trustees where these are appointed; and to have a part to play, under the DHA, in the appointment of senior staff within the field of the postgraduate hospital. While the committee must be appointed by the DHA, I would expect to approve personally the appointment of its chairman and ensure that at least one member should be a representative of the national organisations directly concerned with the specialty of the postgraduate hospital. Such a committee should in time develop close working arrangements with the governing body of the associated medical school. I shall give further guidance to the DHAs concerned on this matter at the appropriate time.

I have also been considering the future management of the Hammersmith hospital. The hospital is very closely integrated with the Royal Postgraduate Medical School and provides a broad range of services for the locality, the North West Thames region and the country as a whole, and will continue to do so. I consider, however, that the general pattern of NHS administration is not entirely appropriate for the management of this complex, multi-specialty, postgraduate hospital. Accordingly I have decided, subject to parliamentary approval, to establish a special health authority to assume responsibility for the hospital with effect from 1 April 1982. I shall be announcing shortly the new district structure for this part of London and the Department will now consider with the bodies chiefly concerned the management responsibilities and funding of the special health authority and arrangements for joint planning and liaison between the special health authority, the new district health authorities and the North West Thames regional health authority.

I accept the London Advisory Group's view that some protection will be needed for the funds of a postgraduate hospital which becomes the responsibility of a DHA. My Department will ensure that allowance is made in national resource allocations for the national roles of the postgraduate hospitals and for a period of three years the funds of the postgraduate hospitals will be separately identified in the allocations to regions and districts. Thereafter, I would expect normal resource allocation processes to apply but I will be ready to review the position if serious difficulties arise.

I have been particularly concerned that changes in the management arrangements for the postgraduate hospitals should not act to the detriment of their staff, when compared with other groups of staff affected by the general restructuring of health authorities. Arrangements which 397W are agreed for protection and early retirement terms for staff of health authorities will therefore also apply to the staff of those BGs which will not become SHAs.