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Nhs Trusts

Volume 173: debated on Tuesday 5 June 1990

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To ask the Secretary of State for Health what information he has on how many ballots have been held in hospitals which are considering opting out; and whether any of these have shown a majority in favour of such a course of action.


To ask the Secretary of State for Health what evidence he has of the views of National Health Service staff or patients on the formation of self-governing trusts.

No Government have ever thought it sensible for changes in management of NHS services to be subject to ballots. Applications for NHS trust status will not be invited until Parliament has approved the necessary legislation. Staff and members of the public will then have an opportunity to express their views on individual proposals before any decisions are taken. I prefer the usual process of consultation rather than public referendum on such complicated and specialist issues.

A total of 195 units have so far expressed an interest in NHS trust status, with some 80 stating that they may seek trust status in 1991. That demonstrates the keen interest with which senior NHS staff, including members of the medical and nursing profession, view the prospect of establishing NHS trusts.

In the light of that response, will the Secretary of State tell us the definition of the electorate when such decisions are reached? Surely all categories of staff and existing, past and potential patients must be involved in the decisions as well as the community health councils, which have already been referred to. Has he established any criteria on which he will say no?

Of course, the staff of the National Health Service are a key part of it. They deliver the service and we depend on their dedication. However, we have never operated any type of worker control and the public have an interest in those matters as well. The founding of the National Health Service was not made subject to local ballots and I can recall no change in the 40 years since then that has been made in that way. We shall have a full process of consultation and I will refuse applications unless I am satisfied from all the information that comes in from the consultation that, if granted, a particular application will lead to a better quality of service for patients in that hospital and better value for money for all those interested in the National Health Service.

Is the Secretary of State aware that in ballots held across the country, huge majorities have been returned that are opposed to hospitals opting out of the National Health Service? Is he further aware that almost every organisation connected with the National Health Service—the Health Service trade unions, the community health councils, Health Service charities and voluntary organisations—is equally opposed to hospitals being allowed to opt out of the National Health Service? As the Health Service belongs to the people, why does not the Minister let the people decide by ensuring that there are ballots in every area affected before any hospital is allowed to opt out of the Health Service?

I am against any hospital opting out of the National Health Service. If people go round asking daft questions, they get daft answers, which is not a very positive contribution to running a better National Health Service. We shall have a full process of public consultation on what local people are proposing in the places that go ahead with an application for NHS trust status. The Labour party is bereft of any serious contributions. Instead of putting forward its own ideas on how we might go back to more local discretion and control in running the Health Service, it leaves the whole matter to the ridiculous local ballots being run by councils, unions and other people.

Will my right hon. and learned Friend admit to the House that the drive for NHS self-governing status comes from his Department through the chairmen of the regions and the chairmen of the districts, all of whom are party political appointments? Will he state genuinely to the House that if it is the view of local people, and especially if it is the view of consultants, doctors, nurses and paramedics working in a hospital, that they do not wish to go for self-governing status, he will refuse that application?

I do not only not admit, but I strongly deny my hon. Friend's allegation and his ridiculous travesty of our appointment process—[Interruption.]

If the appointments were party political, I should have complaints from the Opposition about them. The applications for self-governing status are coming from people concerned with the hospitals and units themselves. It is rather absurd that when, in effect, we go back to a system very similar to the old hospital management boards, which gives back far more local control at the sharp end of delivery over how the Service is run, we are opposed in this way. I well remember the Labour party fiercely fighting the establishment of the district health authorities and the regional health authorities, which it now says should run the Service. Eighteen years ago, the Labour party argued vehemently that it was wrong to take away local control of hospitals. I have undergone a conversion in those 18 years and I am inclined to think that the Labour party was right. The trouble is that the Labour party just opposes any change at any moment.

On a point of order, Mr. Speaker. I asked a question and the Minister did not——

Order. That is not a point of order. If the hon. Gentleman were asking to raise the matter on the Adjournment, that would be different.

On a calmer note, does my right hon. and learned Friend agree that if there is a proposal for a management area change and then the idea of a self-governing trust, it could cause extra delays, and that, if there is an erosion of services and facilities, as at the Royal National Orthopaedic hospital, there is a danger of that hospital's future being severely threatened? Will my right hon. and learned Friend pay attention to that and say what he intends to do about it and when our colleague the Minister for Health will visit the hospital?

I have visited that hospital and I certainly recommend my hon. Friend the Minister for Health to visit it if she has the opportunity. I understand the need to resolve some of the uncertainties surrounding the future of the Royal National Orthopaedic hospital. I shall certainly ensure, and I am sure that my hon. Friend the Minister of Health will too, that nothing connected with NHS reforms causes further delay or creates fresh difficulties for all those who work in that excellent hospital.

Does not the Secretary of State recognise that he could sidestep all questions on local ballots if he would simply agree to a timetable that first put the proposals to the general electorate so that electors who had no opportunity to comment in the last election will have an opportunity to vote on them in the next one? I warn the Secretary of State that, if he persists in bulldozing through the proposals for opt-out without giving local people any voice, the next Labour Government will take back all those hospitals into local health authority control.

I have had a look at the draft manifesto that the Labour party prepared for the next election. It seems to be so vague on management issues that I came to the view that it was voting to make no changes in particular to whatever it inherited if and when it got back into power. I am absolutely astonished that the hon. Gentleman is now committing himself to making no changes to the way in which the National Health Service is run, without submitting any proposals that he might have for local ballots in the future. If we ever had a Labour Government, it might reduce the dangers of dangerous action, but I do not think that a Labour Government would adopt such a foolish process.

Does my right hon. and learned Friend accept that a growing number of senior doctors, nurses and paramedics in the two district health authorities in my area are growing increasingly excited at the thought that they may have an opportunity to shorten the administrative hierarchy that constantly second-guesses their judgments, frequently to their detriment?

I am interested to hear what my hon. Friend says. I know that quite a lot of those who are interested in NHS trust status are, among other things, looking forward to being free of the day-to-day control of their district, region or other parts of the system. There certainly is widespread enthusiasm. I disapprove of all the ballots, whatever the electorate is. It is a selective way of looking at the interests of everybody who has a common interest in the NHS—it does not belong to the staff. So far, five of the ballots among consultants have been in favour and seven have been against. I hope that everybody will wait until they have a proper application and then go through a sensible process of consultation, making whatever representations they want. That will enable me to make a better-informed judgment in the end, which is in the interests of the Health Service and its patients.