HL Deb 04 December 1990 vol 524 cc5-14WA
Lord Mancroft

asked Her Majesty's Government:

Which National Health Service trusts are to be established.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

NHS trusts are a central element in our plans for reforming the National Health Service and improving the services which it provides to patients. While remaining firmly part of the NHS, trusts will have wide-ranging and significant powers of self-determination which will enable them to deliver high quality patient care and to provide greater job satisfaction to their employees.

The trust initiative has already attracted considerable interest from those working within the NHS. Last year some 86 hospitals and other units indicated that they were considering applying for trust status to become operational on 1st April 1991. Staff from the Management Executive worked closely with these units while they were deciding whether to apply for trust status and during the preparation of their applications. During this period a number of units decided not to go ahead with a formal application for trust status on this occasion.

Sixty-six hospitals and other units formally applied for trust status, and regional health authorities have consulted widely on these applications. My right honourable friend the Secretary of State has now considered these applications and the comments made on them during the consultation period by those consulted and others. In doing so, he has applied four key criteria:

— that the establishment of a trust will give clear benefits and improved quality of service to patients;

— that management has the skills and capacity —including strong, effective leadership, sufficient financial and personnel management expertise and adequate information systems—to run the unit effectively;

— that senior professional staff, especially consultants, are involved in the management of the unit;

— that the trust will be financially viable.

As a result, my right honourable friend has decided to establish the following 56 trusts to become operational on 1st April 1991.

Northern RHA

  • Northumbria Ambulance NHS Trust
  • Newcastle Mental Health NHS Trust
  • The Freeman Group of Hospitals NHS Trust

Yorkshire RHA

  • Leeds General Infirmary and Associated Hospitals NHS Trust
  • St. James's University Hospital NHS Trust
  • Bradford Hospitals NHS Trust

Trent RHA

  • Northern General Hospital NHS Trust
  • Lincolnshire Ambulance and Health Transport Service NHS Trust
  • Doncaster Royal Infirmary and Montagu Hospital NHS Trust

East Anglian RHA

  • Norfolk Ambulance NHS Trust
  • Anglian Harbours NHS Trust

North East Thames RHA

  • Southend Health Care NHS Trust
  • The Royal London Hospital and Associated Community Services NHS Trust
  • The Royal Free Hampstead NHS Trust
  • The Royal National Throat, Nose and Ear Hospital NHS Trust
  • The Royal National Orthopaedic Hospital NHS Trust
  • North Middlesex Hospital NHS Trust

North West Thames RHA

  • North Hertfordshire NHS Trust
  • Mount Vernon Hospital NHS Trust
  • Hillingdon Hospital NHS Trust
  • Central Middlesex Hospital NHS Trust

South East Thames RHA

  • The Guy's and Lewisham NHS Trust

South West Thames RHA

  • Lifecare NHS Trust
  • Kingston Hospital NHS Trust
  • Homewood NHS Trust
  • The St. Helier NHS Trust
  • Croydon Community NHS Trust
  • Epsom Health Care NHS Trust
  • The Royal Surrey County and St. Luke's Hospitals NHS Trust

South Western RHA

  • Weston Area NHS Trust
  • East Somerset NHS Trust
  • East Gloucestershire NHS Trust
  • Cornwall Community Healthcare NHS Trust
  • The United Bristol Healthcare NHS Trust
  • Cornwall and Isles of Scilly Mental Handicap NHS Trust
  • South Devon Health Care NHS Trust
  • Taunton and Somerset NHS Trust

Wessex RHA

  • The Royal National Hospital for Rheumatic Diseases NHS Trust
  • West Dorset Mental Health NHS Trust
  • The West Dorset General Hospitals NHS Trust
  • West Dorset Community Health NHS Trust

Oxford RHA

  • Nuffield Orthopaedic Centre NHS Trust

West Midlands RHA

  • First Community NHS Trust
  • The Mental Health Foundation of Mid Staffordshire NHS Trust
  • The Rugby NHS Trust
  • Walsall Hospitals NHS Trust

Mersey RHA

  • The Wirral Hospital NHS Trust
  • The Royal Liverpool University Hospital NHS Trust
  • St. Helens and Knowsley Hospital Services NHS Trust
  • Chester and Halton Community NHS Trust
  • The Cardiothoracic Centre—Liverpool NHS Trust
  • Broadgreen Hospital NHS Trust
  • Royal Liverpool Children's Hospital and Community Services NHS Trust
  • The Mid Cheshire Hospitals NHS Trust

North Western RHA

  • Manchester Central Hospitals and Community Care NHS Trust
  • Christie Hospital NHS Trust

Establishment orders for these trusts will be made forthwith and the trusts will be established later this month to run in shadow form for a period of some three months before taking up their full responsibilities on 1 April 1991.

We shall be setting the external financing limit for each trust shortly. In doing this, we shall take account both of the overall resources available and of the plans which trusts have set out. Inevitably this will involve difficult decisions, as it will not be possible to meet all trusts' capital aspirations next year. As has been made clear in the past our first priority will be to ensure funding for those schemes which trusts could otherwise expect to be funded from regions' capital programmes next year had the trusts remained under health authority management.

We believe that the following eight applicants all have the potential to become successful trusts and hope that in time they will do so.

  • Newcastle General Hospital
  • The City and Hackney Health District
  • Harefield Hospital
  • North West Hertfordshire Priority Services Unit
  • St. Thomas' Hospital
  • Bromley Priority Health Services Unit
  • Bromley Acute Services Unit
  • Mid Downs West Unit (Crawley Hospital)

However, my right honourable friend considers that in view of the very significant management tasks they face it would not be right to establish them now as trusts, with the substantial responsibilities as well as benefits which trust status confers. It is appreciated that this decision will come as a deep disappointment to them. My right honourable friend is writing to each of them today setting out the reasons for this decision and hopes that, if they are able to demonstrate that they have satisfactorily addressed these issues, he will be able to establish them as trusts to come into operation in April 1992.

Following recent changes to the project management team of the potential trust the sponsors of the proposed North Devon Healthcare Trust believe that it would be preferable to defer the establishment of the trust at present. They remain committed to trust status but believe it would be sensible to give the new management team more time to establish itself and win local support. There is no doubt that the proposed trust has the potential to deliver benefits to local people, but my right honourable friend agrees entirely that it would be sensible for him not to establish the trust at present.

The sponsors of the proposed Brighton Hospitals Trust have also asked that their application should be deferred. My right honourable friend has agreed to this request. There is no doubt that Brighton has the potential to be a successful trust in the future.

Meanwhile, we are already embarking on the process of responding to the many expressions of interest in a second wave of potential trusts to become operational on 1st April 1992. There is great interest in this. My right honourable friend has today agreed that the following 111 hospitals and other units, which have expressed interest in Trust status, can proceed to work up applications to become trusts on 1st April 1992.

Northern RHA

  • Cleveland Ambulance Service
  • Darlington Health Services
  • Gateshead Community Unit
  • Gateshead Mental Health
  • Northgate Hospital Northumberland
  • North West Durham Hospital and Community Services
  • North Tees Acute and Community Services
  • Royal Victoria and Dental Hospital Newcastle upon Tyne
  • South Tees Acute Hospital Services

Yorkshire RHA

  • Airedale Health Services
  • Bradford Mental Health and Community Services
  • Harrogate Health Services
  • Northallerton Health Services
  • Scarborough Health Services

Trent RHA

  • Barnsley Community and Priority Services Unit
  • Bassetlaw Hospital and Community Services
  • City Hospital Nottingham
  • Doncaster Community Development Unit
  • Doncaster Priority Care Services Unit
  • South Sheffield Hospitals Unit
  • Chesterfield and North Derbyshire Royal Hospital
  • Nottingham Community Unit
  • Nottingham Mental Health Unit
  • Children's Hospital Sheffield
  • South Lincolnshire Mental Handicap Services
  • South Yorkshire Metropolitan Ambulance Service
  • University Hospital Nottingham
  • Weston Park Hospital, Sheffield

East Anglian RHA

  • East Suffolk Community Unit
  • Huntingdon Acute Unit Hinchingbrook Hospital Huntingdon
  • Huntingdon Community Unit
  • Papworth Hospital, Huntingdon
  • West Norfolk and Wisbech Community Unit

North West Thames RHA

  • Barnet Community Health Services
  • Barnet General Hospitals
  • Ealing Community Health Services
  • East Hertfordshire Acute, Priority and Community Services
  • Harrow Acute Unit—Northwick Park Hospital
  • Harrow Community Services
  • Hillingdon Primary and Community Health Services
  • North West Hertfordshire Mental Handicap
  • South Bedfordshire Community and Mental Health Services
  • South Bedfordshire General Hospitals
  • Parkside Mental Health Unit

North East Thames RHA

  • Basildon and Thurrock Acute Services
  • Basildon and Thurrock Community
  • Essex Ambulance Service
  • Mid Essex Acute
  • North East Essex Acute
  • North East Essex Mental Handicap Unit Turner Village
  • North East Essex Mental Illness (Severalls Hospital)
  • Oldchurch and Rush Green Hospitals
  • Royal London Homoeopathic Hospital
  • Harold Wood Health Services
  • Southend Priority Services

South East Thames RHA

  • Bexley Acute and Community
  • Bexley Mental Health and Mental Handicap Services
  • Brighton Community and Mental Health Services
  • Camberwell Provider Unit
  • Dartford and Gravesham Acute Unit
  • Thameslink HealthCare Trust
    • WA11
  • Eastbourne Community Services Unit
  • Hastings Provider Services
  • Lewisham Community Services
  • Maidstone Acute and Community Unit
  • Maidstone Mental Handicap
  • Tunbridge Wells Mental Handicap Services
  • Queen Victoria Hospital East Grinstead
  • West Lambeth Priority Services

South West Thames RHA

  • East Surrey Acute and Community
  • East Surrey Mental Illness and Mental Handicap
  • Frimley Park Hospital
  • Merton and Sutton Mental Handicap and Community Unit
  • Mid Surrey Mental Handicap
  • Mid Surrey Mental Illness
  • North West Surrey Acute
  • North West Surrey Community

Wessex RHA

  • Bath Mental Health Unit
  • Bournemouth and Christchurch Acute Unit
  • Poole Acute Unit
  • East Dorset Community Services

Oxford RHA

  • Aylesbury Vale Priority Care Services Unit
  • Horton General Hospital
  • Kettering Priority Services Unit
  • Milton Keynes Acute and Maternity Services Unit
  • Milton Keynes Community and Mental Health Services Unit
  • West Berkshire Mental Health Unit
  • Wexham Park Hospital
  • Wycombe Health Services

South Western RHA

  • Avon Ambulance Service
  • Cornwall and Isles of Scilly Acute and General Services
  • Gloucestershire Ambulance Service
  • Plymouth Community Unit

West Midlands RHA

  • Coventry Walsgrave Health Services
  • East Birmingham Acute
  • Good Hope Hospital
    • WA12
  • Herefordshire Community Services Unit
  • South East Staffordshire Community and Mental Health Unit
  • South Warwickshire Community and Handicap Services Unit

Mersey RHA

  • Aintree Hospitals Trust (Walton and Fazakerly)
  • Liverpool Obstetrics and Gynaecology Unit
  • Mersey Regional Centre for Radiotherapy and Oncology
  • St. Helens and Knowsley Community Unit
  • Southport and Formby Acute Hospitals Unit
  • Mersey Regional Centre for Medical and Surgical Neurology
  • Macclesfield Acute Services
  • Macclesfield Community Services

North Western RHA

  • Burnley Provider Unit
  • Oldham Acute and Community Services
  • Rochdale Acute and Community Services
  • Wrightington Health Services

These expressions of interest do not commit the hospitals or other units to apply for trust status.

The following four expressions of interest have been received from colleges of nursing.

Colleges of Nursing

  • Avon College of Health Studies
  • South West College of Health Studies
  • Normanby College of Health Care Studies
  • Portsmouth Education Services

We shall be considering further how best these colleges can achieve the flexible management arrangements they desire in the future.

The scale of the response to the trust initiative shows the very real enthusiasm of those working in the NHS to take advantage of the benefits of trust status and, over time, we expect to see trust status becoming the natural model for all units providing patient care.

Delighted as we are at the real success of the trust initiative, it should be emphasised that it forms only a part, albeit a very major part, of our overall programme of reform of the NHS. That programme is making steady progress. When trusts become operational they will do so as part of a radically changed NHS, in which there is a clear separation between purchasers and providers of care and a system of contracting which will begin to achieve a closer match between resources and needs and will help to drive forward further improvements in quality and value for money. The first wave of GP fund-holders will be able to exert greater influence over the care their patients receive. Medical audit will be in place across the NHS. These developments, put in place in a relatively short time, taken together, will represent an immense achievement by those working in the NHS and will enable the service as a whole to deliver significant improvements in patient care.