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When people take the time and trouble to read the Government's proposals they will clearly see their value. Therefore, the BMA's reaction and subsequent campaign has been disappointing and short-sighted. It is not impressive when doctors ask their patients to write to their local Members of Parliament to say that they are against the Government's proposals when the doctors do not even know what the proposals are. If a professional has a point to make he or she should jolly well put it directly and not go through a third party.

The proposed changes in the White Paper have been misrepresented and distorted by a number of individuals whose motives are difficult to understand or accept. So many good things are happening in the Health Service at the moment. In Basildon the acute unit managers and clinicians have been concentrating on improving the service, particularly where waiting lists are at their longest. An additional consultant general surgeon was appointed at the beginning of 1988 and this appointment, together with funds being made available from the Government's waiting list initiative, is reducing the waiting lists for general surgery.

An additional weekly cystoscopy session was started in July of this year so that patients who otherwise had to go on an out-patient waiting list could be treated locally. As a result of these and other initiatives which, in some cases have used funding from the Government's waiting list fund, in the year to September 1989 there has been a 20 per cent. reduction in the waiting lists for general surgery.

The effective use of nursing time is increasingly important and the district is one of three authorities in the country piloting "Excelcare", a nurse management computer system, which is proving a success in saving trained nursing time. In partnership with neighbouring authorities, Basildon and Thurrock district has put forward proposals for the appointment of two other consultants for funding from the Government's allocation for extra consultants posts. They are required to improve oral surgery and ophthalmic services locally. A body scanner, which was opened by my right hon. Friend the Member for Braintree (Mr. Newton) two years ago, has enabled 2,000 patients each year to be diagnosed locally, rather than having to travel to other centres.

The authority is actively seeking partnerships with other organisations. Abbeyfield Housing provides 24 continuing care residential places in the district. A complete review of services for the elderly is being undertaken in conjunction with Partnership in Practice. New services--providing both residential and day support--are being set up in the community for the mentally handicapped. The authority is purchasing a large house to provide 13 young chronically sick residents with normal accommodation.

I am delighted to say that numbers of nurse recruits have improved. We are recruiting student nurses from Ireland, midwives from Malaysia and registered nurses from Spain. I am also delighted to say that a creche has been opened in a bid to encourage the retention of staff and the early return of those who leave to bring up families. The authority has reviewed catering services and, due to a review of the most modern traditional cooking methods, has decided to update its facilities.

The Minister has been briefed on the numerous service quality initiatives which have been undertaken. The authority is finding that, in occupational health, working with external customers is helping to increase services to

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staff. The service continues to expand its commercial activities and build on the base created by its initial contracts. The authority has won the contract for occupational health for the local police force in Essex. It is currently negotiating with two large multinational companies about the promotion of health at work campaigns which it wishes to undertake.

The authority has vigorously pursued opportunities to ensure that cost- effectiveness is achieved in the provision of ancillary services. Competitive tendering procedures have been followed for the delivery of domestic services--catering, laundry, ground maintenance and portering. A number of substantial income-generating projects have been introduced, and a comprehensive business strategy is now being worked on. Resource management provides clinicians and managers with information on their workloads and the associated cost of those extra burdens.

The implementation of the scheme is being spearheaded by a steering group led, I am delighted to say, by the chairman of the consultative staff committee. The consultants have already embarked on medical audit activity, and meet regularly to review individual cases. The authority welcomes the introduction of the new funding arrangements, which will reflect more accurately the demographic pattern of the local population being served, especially in view of the expected increase in the number of elderly people : I believe that the number of people over 75 will have increased by 10 per cent. at the end of the century. The population of the district is, however, expanding rather more rapidly than we anticipated. I very much hope--as I know the health authority does--that that extra burden will be recognised when the new arrangements for financial allocations are set. The matter of bed supply is one of which I know my hon. Friend is aware. He had a constructive meeting with the community health council, and I believe that some progress was made. Let me also pay tribute to the community health council's excellent work in ensuring that a sensible and convenient location was fixed on for the local screening of women.

The health authority managers are committed to providing a framework for services in Basildon and Thurrock that will meet local needs, and, on that basis, have indicated an interest in self-governance. The authority has long worked in partnership with the community in many ways, and wishes to continue that close relationship in developing the proposals further. The managers believe that there may be considerable opportunities within the framework of the White Paper, which will enable existing plans to be achieved and ensure that the integrity and quality of services are further enhanced.

The consultants have been more cautious, but a number wish to explore these matters in more depth. Managers welcome the opportunity to determine local arrangements rather than having nationally prescribed models, and believe that the quality of care and supportive services can best be improved by those means.

The thrust of much of the district's endeavours over the past four years has been towards a cohesive and forward-looking organisation, with a strong emphasis on services for consumers and on the whole idea of partnership. General management has been the vehicle for progress, and a district with shared objectives and values across the range of services has been the result. Elements of the

self-governance proposals have been foreshadowed

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in some of the district's forward thinking. The benefits and freedom that self-governance would confer on the whole organisation would constitute a major stimulus in developing business plans and marketing strategy to the advantage of all types of patient. Self- governance, I believe, would allow Basildon to contain both the service integrity and the management integrity of the district at a time of major cultural change to the service--for instance, the change in pattern from the care that we now enjoy in South Ockendon hospital. The trust would provide acute and associated services, comprising local acute services and community support services. Consumer choice would be enhanced by the creation of the trust. Local people waiting to use local services would in most cases select a local specialist of their choice, but would be free to select a specialist working within a neighbouring local trust or in London. Competition within the local acute services would be enhanced by operating within a market in which similar services in neighbouring districts are also operating in a trust framework. There would be a clear distinction between the service purchase function at the district tier and the service provision function of the trust and the other local agencies.

The local service already has some particular strengths which will contribute to the success of the Basildon and Thurrock self-governing trust. These are scope, service quality, management capability, financial management, doctors in management and information systems. I reassure my hon. Friend the Minister that although siren voices have been raised against the White Paper, it has received a warm welcome in many quarters. Basildon and Thurrock health authority already provides a maginificent district service. With the additional proposals that I have put before the House that service will be built upon and will continue to improve.

2.45 pm

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : I congratulate my hon. Friend the Member for Basildon (MrAmess) on his success in the ballot. The debate gives us the chance to look at Basildon and Thurrock health authority's response to the White Paper "Working for Patients". In addition, it enables us to look at Basildon's plans for the future, and in the few minutes available to me I should like to look more generally at the White Paper implications for the future role of all district health authorities.

One would sometimes believe from reading the popular newspapers that the National Health Service was universally in crisis. It is heartening to listen to my hon. Friend painting a picture of a district getting on with running and improving the National Health Service in Basildon and Thurrock. That is a much fairer picture of the National Health Service throughout the country. I am especially pleased to see in her place my hon. Friend the Member for Maidstone (Miss Widdecombe). She is a member of the Select Committee on Social Services and is sometimes a lone, sane voice in that Committee on some issues. She and my hon. Friend the Member for Basildon and I sometimes find ourselves together late at night in the Chamber debating abortion. The question is, when shall we three meet again?

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As my hon. Friend the Member for Basildon said, I visited Basildon and Thurrock health authority on 6 September to address a meeting of health professionals from the district. I was very interested in the constructive and useful discussions that took place on the different aspects of the White Paper. Such meetings with the health professionals involved in the day-to-day running of our National Health Service are a valuable source of information and comment as we develop the plans for future health provision in this country. Following the meeting, I took the opportunity to look round two of the wards at Orsett hospital and I met some of the nursing staff and the patients there. I was very impressed with the high standards of care that the medical staff provides. I join my hon. Friend in congratulating and thanking Mr. Ken Sharpe, the general manager, for the leadership that he provides to a most excellent management team. In addition to the positive response to the proposals in the White Paper, Basildon and Thurrock has taken constructive steps to tackle waiting lists. Under the 100 consultants posts initiative the district has submitted a bid for a consultant urologist. As my hon. Friend said, there is also a joint bid with Southend health authority for a consultant aural surgeon. While I can make no announcement now on the subject, my hon. and learned Friend the Secretary of State for Health expects shortly to make a statement about the first appointments under that initiative. I can give no assurance to my hon. Friend that it will include Basildon and Thurrock because the direct decisions are not my responsibility. In any case, there will shortly be an announcement.

As my hon. Friend said, the district is establishing departments of general surgery and orthopaedics. I understand that this will enable the consultants to improve their control over workload by use of a computer system which will maintain departmental records and monitor progress. Funding for this programme has been obtained from North East Thames regional health authority under the acute sector productivity scheme. With funding obtained to purchase the necessary equipment to enable increased throughput, the district has been providing additional weekly cystoscopy sessions since July, as my hon. Friend said. I am very pleased about that.

I have already mentioned the initiative undertaken by the district to tackle waiting lists, and its positive response to the White Paper proposals in general. These are representative of the forward-looking approach of the health authority and medical staff and their attitude to change. Change in the Health Service is largely about attitudes of mind, not only those of the nursing and medical staff, but those of management at district, regional and national level. It is not about competence, experience and skill.

I welcome the authority's initiative in joining forces with the Abbeyfield Society in providing a unit that will care for 24 highly dependent elderly people who can no longer be cared for at home. I hope that such joint ventures will be built on within the authority and will serve as an example for other health authorities for similar joint ventures. I do not believe, as I am sure that my hon. Friends do not believe, that the NHS should have a complete monopoly of ideas in the care for the elderly. District and health authorities should work genuinely in partnership with the private and voluntary sectors in providing geriatric and general care for the elderly.

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When I visited Orsett hospital, I was impressed with the nursing initiative "Excelcare", which is a nurse management system. Such a system is a method, often supported by a computer system, to enable the nursing managers to manage the workload of the nursing staff in a particular ward. It plans the nursing requirements based on the dependency levels of the patients who are either in the ward or are expected in the ward shortly. This is a good example of how information technology can help to save nurses' time. It means that care for individual patients can be better planned and better divided, and it can also lead to a more efficient deployment of staff. I know, because I asked them, that the nurses involved are enthusiastic about the system. I am a great believer, when visiting hospitals, in seeking the advice not only of the district general manager and the management team but of the nurses and doctors on the wards. I ask them what benefits have accrued and are likely to accrue through improving management systems and particularly with the greater introduction of information technology.

I hope to make a statement next month on information technology which will set out our short-term plans--that is to say, our plans up to 1 April 1991, which is the commencement period for which we are planning in our Health Service reforms and the creation of the internal market. My statement will also set out the resources that the Government plan to make available for the survey period--the three-year period beginning on 1 April 1990. I shall also hope to cover our longer-term strategic thinking so that we can set in the proper context our thinking about the resource management initiative, the hospital information support systems and the district information support systems. Following the completion of our review with the joint consultants committee, I hope to make a further announcement towards the end of this year about our plans for the extension of the resource management initiative. My hon. Friend's district is particularly interested in that.

On behalf of the senior management team, earlier this year the district general manager of Basildon and Thurrock health authority submitted an expression of interest in self-government. Like all expressions of interest, it was made without prejudice on either side. Individual sponsors are free to withdraw their expressions of interest, and my right hon. Friend the Secretary of State will make the decision on which units should be allowed to become NHS trusts only after they have done extensive preparatory work and after discussion and negotiation with interested parties, including the staff. This initiative can be taken forward only with consensus support from all those involved.

We welcome the expressions of interest, albeit preliminary, from Basildon and Thurrock. It is a positive response to the propopals in the White Paper and is based on the recognition by the people who run the district that the creation of an NHS trust can enhance the quality of services available to local people. They have recognised the opportunities that trust status will offer to strengthen and improve services.

Efforts are already being made to improve the services provided in the district. Consultants are proceeding to implement medical audits, and I am delighted that that is happening in the district and throughout the Health Service. That is a positive response by consultants. Work has already commenced on information systems and resource management and the district is making efforts

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also to continue the closer working relationships that have been established with local general practitioners. It is essential that district health authorities and hospitals should develop over the coming months a close working relationship with general practitioners to ascertain their referral patterns and their proposed changes for the future.

To approve an application for NHS trust status, my right hon. and learned Friend the Secretary of State will need to be convinced that the size and structure of services in the proposed trust are sensible and manageable. Both the regional health authority and the Department are willing to offer help and advice, but the process of applying for trust status is entirely voluntary and it is now up to Basildon and Thurrock to decide whether they wish to prepare an application. We do not envisage that the first group of trusts, which we hope to designate with the permission of Parliament once legislation has passed through this place, will be the only group. There will be a continuing process. No significance need necessarily be attached to a potential first group of trusts. We hope that there will be a second group, followed by a third, a fourth and so on.

The proposals set out in "Working for Patients" will mean that money will travel with the patient where general practitioners and patients choose treatment from elsewhere. In future, hospitals will be free to offer their services to different health authorities and will receive NHS funds for the patients that they treat.

In the past, DHAs had to handle both the operational management of services as well as to establish the health needs of the population. One of the key principles of the White Paper is to enable DHAs to concentrate on ensuring that the health needs of their population are met. We do not underestimate the challenge we have set DHAs, but we believe that they have been given the opportunity to play a major role in actively improving the health of their population. We want to help, not hinder and stifle, local initiative. We have set up projects with 11 DHAs and four regions to look at the issues involved in a systematic way, and we hope that the results of this work will provide useful guidance for all DHAs including Basildon and Thurrock. We expect the first fruits of work to be available in the early part of 1990.

In the few minutes that remain to me I shall deal briefly with the mergers of districts. I must emphasise that we do not want management attention diverted from key White Paper proposals by a widespread restructuring exercise. Merger of health authorities is not a prerequisite for any hospital to become self-governing. We may be prepared to consider a limited number of proposals where it makes sense for authorities to merge if a hospital becomes self-governing. However, such a case would need to be first considered by the regional health authority and then submitted to Ministers. The case would be subject to full public consultation and the Secretary of State and his ministerial colleagues would need to be very certain of its merits before approving it.

In other words, the message that I deliver to my hon. Friend the Member for Basildon and through him to the district health authorities is that we shall be considering carefully the merger of districts. We see such mergers being the consequence in some instances of the establishment of self- governing trusts or NHS trusts. We shall give the matter serious consideration. We do not underestimate the complicated procedures that have to be followed to

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establish the merger of DHAs, but in some instances the case will be compelling. Proposed mergers will receive our serious consideration.

I am pleased that the Basildon authority is developing its patterns of service care for the future in line with the

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spirit of the White Paper. I congratulate the authority, the management, doctors and nurses. I thank also my hon. Friend for his constant interest, his support for the White Paper and, above all, the time and trouble that he takes on behalf of his constituents. Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.

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