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Mr. McAvoy : I entirely endorse what my hon. Friend said about the attitude of Greater Glasgow health board. In his intervention the Minister sounded like a parrot mouthing the words of Mr. Peterken. However, perhaps Mr. Peterken is the parrot repeating the Minister's words. I accept that the health board's attitude is disgraceful. Paragraph (d) of new clause 2 allows the commission
"to instruct the Health Board to take such action as they consider necessary"
if such services are not maintained. That brings me to the standards of care operated by Takare that would come under the authority of a quality control commission.
I welcome and endorse the principle of moving frail and elderly people who do not need constant medical care out of hospitals. However, I have considerable doubts about what conditions will apply. In what condition would a resident have to be in order to be admitted to a Takare development? Home care environment is referred to in the Takare documentation, but that can mean different things to different people. I have visited Takare establishments at Preston, Chorley and Oldham. The matrons at those establishments confirmed that on average 75 per cent. of the residents were stroke patients and 75 per cent. were also incontinent.
Such conditions did not square with the board's statements about sheltered housing being suitable for the kind of resident in the Takare establishments. The board described the Takare model as nursing care--that might be a back-handed compliment to Takare. However, the care that I witnessed in Takare units goes far beyond what can be regarded as nursing care.
The type of patient that would be established at a Takare development at Rutherglen must be clarified. From what the matrons told me and from what I saw, there seems to be some confusion about that. There should be no confusion about the care of the elderly. We are here because of those people and they should be elevated to the highest position in society.
I visited the Takare developments as a lay person. I reported back that, as a lay person, I made no criticism of
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the homes provided by Takare. However, I made it clear that I reserved my position on the application of medical and professional criteria.I managed to get hold of a report of the Forth Valley health board. I think it came in a plain brown envelope. The health board sent a team of professionals to assess the Takare facilities. The report stated that commodes were kept in residents' and patients' rooms and that there were no en-suite toilet facilities. It stated that, as far as possible, the Forth Valley health board's nursing home inspection team was trying to discourage such practices in nursing homes. The report states that bathing and toilet areas were rather remote from the main day rooms and were lacking in privacy. It stated that there were no showers and only relatively few assisted baths. It made the professional criticism that there was no structured attempt to introduce health promotion measures in the area. The report confirmed something that I recalled. It stated that there seemed to be a higher number of wheelchairs in use than expected. I recall my quandary as I pondered what kind of resident would benefit from such accommodation.
The report also referred to a strong smell of urine in several, but not all, of the units. The team could not ascertain the cause of the smell specifically. It stated that it may have been due to inadequate nurse- patient ratios. I mentioned that in my submission to the consultation process. The staff worked shifts and a professional view would have to be taken of the system to ensure that that care was the best for the elderly people.
The Forth Valley health board stated that there was no attempt at primary nursing or employing a key worker. As a result, most of the nursing care was task-oriented according to professional criteria, and medical records were poorly designed. It stated that there was no organised database, either current or historical, for the residents. However, the really amazing thing comes in the next sentence, which states :
"It is therefore recommended that the Board pursue more detailed discussions with Takare to determine and explore the viability of future joint ventures."
The logic of that escapes me.
I come now to one more sign of the highly political direction that is given to the boards by the Minister. Under para (e) of the new clause, the quality control commission would be well placed to investigate complaints from patients and to take action on them. I am sure that the quality control commission could play a major role in carrying out such investigations to ensure that the standards that have been established are being met by the health boards. I am also sure that financial criteria would be a key element because we all want value for money, but let us have a close look at this financial involvement. I met an official of the board in September, who roughly outlined the financial arrangements round which the discussions with Takare had centred. When I went down to Takare, I met Mr. Keith Bradshaw, its chairman. Hon. Members might be interested to know that Takare's motto is, "Who cares wins". The House can make what it likes of that.
I spent about eight or nine hours talking to Mr. Bradshaw and his company. He was a lot more forthcoming with information than the board had been. He told me that at that point the discussions with the
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board had centred round the price of £375,000 for the land. When I pointed out that the district valuer would have to set the price of the land, Mr. Bradshaw said, "I know that, but that is the price round which all the discussions have centred." I asked how he could work out the deal if he did not know the price that he would be paying. He then told me that if the district valuer valued the land at more than £375,000, Greater Glasgow health board would finance the borrowing costs of the capital that would be required to make up the difference.The Minister said that this is a good financial deal for the public, but the board is financing the purchase of its own land by a private company. That is what Mr. Keith Bradshaw said to me. I have it on record at two public meetings that were held in Cambuslang and Rutherglen when Mr. Cleary of the health board was present. I challenged the board to refute what I had said, but as no refutation was made, I hope that no one will suggest that what I am saying about my discussions with Mr. Bradshaw is untrue.
I shall give the House an example of where the quality control commission could crack down on financial standards. For every £100, 000 over the discussion price of £375,000 that Takare would have to pay, the board would allow Takare to load £18,000 per year on to the total cost of the beds in the unit. The health board official told me that, in his opinion as an experienced person, the land might be sold for between £850,000 and £870,000. That is £500,000 more than the discussion price of £375,000. If the board allowed Takare to load £18,000 on to the total cost per unit for each £100,000 over the discussion price, and as £875,000 is £500,000 over the discussion price, we must multiply £18,000 per year by five, which means that £90,000 per year would be loaded on to the price of the beds for ever. Is that a good financial deal for the public? I do not think so.
That land was owned by the royal borough of Rutherglen. It was public land. The former town council sold it only on the basis that the site would be used for an NHS facility for the people of Cambuslang and Rutherglen. I do not accept that that is a good financial deal and nor do the people of Cambuslang and Rutherglen. We also need the commission to oversee incestuous relationships such as are envisaged in that deal. The board would be the licensing authority for one of its main providers of service for the care of the elderly. Is that right and proper?
If that is good business for the boards, there is also another complication. The boards have stated clearly that if this private company ran into financial trouble and had to close the week after it opened, the board would simply buy the hospital back under the contract at the going market price. If the board has the money to buy back the hospital from Takare at the market price, why not use the capital to build an NHS hospital in the first place? It is clear to me that the board is politically desperate to go ahead with the deal.
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The people of Cambuslang and Rutherglen, and, indeed, the whole of south Glasgow, are affected not only by the Bill but by serious proposals relating to services at Victoria infirmary. They are causing a great deal of worry in our area. It is wrong that people should be worried about health.
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Every time that I go to a meeting with Greater Glasgow health board, I leave feeling that I have been through 15 rounds with a political opponent. That was echoed by my hon. Friend the Member for Kilmarnock and Loudoun (Mr. McKelvey). The boards are supposed to represent, reflect and work for the good of the public. Nobody should leave a meeting with one of them feeling that way. I would make the same criticism if Conservative Members left a meeting with their Labour health board feeling that they had gone through 15 rounds. That would also be wrong. It has happened more than once with Greater Glasgow health board. But a new day is dawning and each opinion poll that is published makes that clear.In its haste to push the deal through, the board has run into a few problems with the trading conditions for the sale of the land. There is no doubt that in the absence of a quality control commission, the Minister can do practically whatever he wants. Under his political direction, his political puppets on health boards throughout Scotland and certainly in Glasgow are jumping to his tune.
A quality control commission would have asked Greater Glasgow health board several questions. Why was no company other than Takare involved? Why was a ridiculous price for the land set at £350,000 in negotiations with Takare? Why should the board finance the purchase of its own land? Why was no account taken of the responses to the consultation process, which were overwhelmingly against the proposal?
Mr. Bill Walker : Will the hon. Gentleman give way?
Mr. McAvoy : I shall make one more point and then I shall give way. I am sure that the hon. Gentleman will appreciate the point that I am about to make. The only people who welcomed the proposal in the whole of Cambuslang and Rutherglen were not the local Conservative association, but, lo and behold, the local Liberal association. It saw the chance to obtain a bit of kudos, but its welcome backfired. It will pay the price at the regional elections in May.
Mr. Walker : The hon. Gentleman has presented an interesting financial scenario. Does he think that it could properly be investigated by a body that already exists--the Public Accounts Committee of the House?
Mr. McAvoy : I shall certainly consider that suggestion. I shall consult on it. I assure the Minister that the battle is not over. There is a long way to go yet.
The quality commission would also ask why the board was willing to subsidise a private company to purchase its own land. If it is willing to buy the development back if the company collapses, why not use that money to build a hospital?
I am sure that a quality control commission would do a job for the vulnerable and elderly in my constituency by ensuring the highest standards of care for a generation which deserves them.
Mr. Michael Forsyth : I apologise for intervening again. I intervened earlier but the hon. Gentleman did not answer my question directly. I want to be clear about what he wants me to do. Does he argue that the Takare proposal, which will provide a facility for the elderly in his constituency, should not go ahead? Does he want that facility to be provided? Will he answer yes or no?
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Mr. McAvoy : If the Minister is asking me what I should like, I should accept his resignation across the Table. I have already made it plain that my community wants an NHS hospital. He can release finance for that to go ahead.
Mr. McCartney : As an English Member, I apologise to my Scottish colleagues for intervening in the debate. I have listened with interest. Yesterday I received an anonymous letter from a representative of private care owners in my area asking me to look into an allegation that a company called Takare was about to get a contract from Wigan health authority, without tendering, to remove mentally ill patients from Billinge hospital in my constituency. I have been asked to investigate why the health authority is involved with a company in relation to such important services without it tendering or consulting. I had no knowledge of the company until this evening when my hon. Friend said that it was alive and well in the Greater Glasgow health board area. It may have some considerable friends at court. Perhaps we can consult about the matter later this morning.
Mr. McAvoy : My hon. Friend's intervention confirms that there is an organised pattern to the company's activities and that arouses concern.
Mr. Harry Ewing (Falkirk, East) : Is my hon. Friend aware that at the beginning of his speech the Minister asked whether my hon. Friend was in favour of this facility at no cost to public funds, but after my hon. Friend had given the cost to public funds the Minister dropped that part of his question? It is significant that the Minister changed his question.
Mr. McAvoy : That was noticeable and I am grateful to my hon. Friend for pointing it out. The Minister is blackmailing Cambuslang and Rutherglen in exchange for future facilities. We know the type of facility on offer. There is no guarantee about what type of service there will be or for how long it would be there. We know the NHS in Cambuslang and Rutherglen. Those are the standards and the hospitals that we want. I serve notice on the Minister that the battle is not over.
Sir David Steel (Tweeddale, Ettrick and Lauderdale) : Without in any way endorsing the details of the new clause, I broadly support its intention, which is to insert in the Bill some measure of concern about the future quality of our NHS in Scotland. I am wholly in sympathy with that objective.
Inevitably, each hon. Member who has participated has spoken about the effect on the quality of the service in his or her area and I shall be no different. It is well known that in the Borders we have the good fortune to have a new district general hospital of which we are proud, although it came 10 years after the date when it was first supposed to be completed. As it is the general view in our area that we have a good NHS, there is great concern that the Government have unnecessarily upset the morale, structure and funding of that service.
Although many representations have been made to the Minister since the Government issued the original consultative paper, his reaction has always been that people do not understand our proposals, give them time, it is all part of a propaganda campaign by the British Medical Association and if only they will study our proposals, listen to our speeches and consult, they will agree. All I can say is that at the end of the process, having
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listened to all the speeches and having had a visit from the new business chief executive of the NHS in Scotland, those who work in the service are as worried as they were at the beginning.Mr. Michael Forsyth indicated dissent.
Sir David Steel : It is no good the Minister shaking his head. On Sunday afternoon my hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) and I were summoned to a meeting by a representative collection of NHS consultants, administrators, GPs and nursing staff. Their overriding message was that they were deeply concerned that the Bill would lead to the fragmentation of an otherwise wholly accepted, well integrated NHS. It is no good the Minister shaking his head. I was at the meeting and he was not.
Mr. Forsyth : I take the point that the right hon. Gentleman has made about what happened at his meeting, but he said that there was as much concern now as there was at the beginning. That cannot be true, because even the BMA has withdrawn the allegation that it made that patients would not be able to get the drugs that they required because of the proposals. To date I have had 28 expressions of interest from doctors who wish to become budget holders. A number of hospitals-- [Hon. Members :-- "How many? Name them."] Four hospitals have shown an interest in self- governing status. The right hon. Gentleman is wrong to suggest that there is the same concern now as there was at the beginning.
Sir David Steel : I was telling the Minister about the mood of medical opinion in the Borders area. I am talking not about public opinion generally, but about the experience in the Borders, where there is a good Health Service, which we wish to retain as it is. The Minister says that practices have applied for budgetary status and that hospitals have applied for opting-out, but I challenge him to say whether any of them is in the Borders. I am pretty certain that they are not. Silence speaks more loudly on this occasion. Mr. Bill Walker rose --
Sir David Steel : The hon. Gentleman may have flown over my constituency in Concorde, but I trust that he will allow me not to give way for the moment. I have only just started and I want to spell out some of the anxieties of people in the Borders, since the Minister doubts me. He will have a chance to reply to the debate. First, all hon. Members who represent Scottish constituencies know that there is no question but that there has always been a different ethos in the National Health Service in Scotland from that south of the border. General practitioners in my area find that as people come from the south, either for employment or to retire, they ask to go on to a private practice list. The GPs look at them and say, "What on earth are you talking about? We don't do private practice". They say that generally in that part of Scotland everyone is treated the same. Those people may have come from a part of England where it is different, but we do not do that in Scotland. Gradually people realise that they can get decent health care without getting
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involved with private medicine. The medical profession expects that to continue in Scotland. The Bill is driving a coach and horses through that principle.GPs point out that the Government have allowed a 5 per cent. increase in the cost of supplies and services in the current year, but that inflation in those areas is about 8 per cent. Therefore, there is a cut in the health board budget. The board has not been fully compensated for the funding of pay awards and for the regrading exercise, which has been a long, tedious and time-consuming exercise.
The result is that for the coming year the local area health board is £500,000 short of its budget. It has had to look around for savings to meet that shortfall. The first thing that it is proposing to do--it will cause an almighty row--is to renege on the undertakings which it gave about reopening the cottage hospitals at Selkirk and at Galashiels. That will cause a public outcry. It is no good the Minister saying that there are no cuts in the Health Service, because people can see with their own eyes that there is a difference between the service that the public expects and what it will get because of the shortfall in funding.
When the chief executive met much the same group that I met--or at any rate some of the consultants--he was asked about the future of the gastroenterology service in the Borders. Could he guarantee that it would continue? He said that the service could go if it proved non-competitive. What does that mean? As far as we can make out, it means that if a particular specialty, at present provided as part of a comprehensive Health Service in the Borders region, does not pay its way in accounting terms because there are not enough patients, that specialty might be closed and the patients transferred to Edinburgh. From an accountants' point of view, sitting in St. Andrew's house, that might make sense.
That brings me back to the whole question of the quality of the Health Service. What about patients who have to make a journey of 50 or 60 miles to hospital to be treated? What about their relatives? What about the quality of the service that they have come to expect? It cannot be an accounting exercise ; it cannot be thought of just in terms of pounds, shillings and pence, as the Government propose. Last year the orthopaedic service in the Borders general hospital was estimated to cost £30,000. The outturn was £69,000--more than double. These were mainly hip and knee joint operations. The increase in the demand for such operations has been colossal throughout the last decade or so. Ten years ago hip operations were rare ; it was pioneering work. The elderly now expect such an operation to be provided. It is regarded as a facility. As the outturn was £69,000, the health board, due to its straitened budget, said to the hospital, "Next year you must budget for £48,000." If that is not a cut, what is?
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In the Government's plans for the Health Service great stress is laid-- probably inevitably ; I do not quarrel about it--on computerisation. The vaccination programme in the Borders has been computerised. However, general practitioners have been told that the programme must be stopped for nine months because the cost of the vaccine cannot be afforded. What sense does it make to set up a sophisticated programme and then to say that it cannot be used because the vaccine cannot be afforded?
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A consultant told me that she had paid out of her own pocket the £100 that was necessary to buy a nebuliser for an elderly patient who could thus be allowed to go home, thereby releasing a badly needed hospital bed in an elderly patient unit. No money was available for that small item of equipment.These are not fictitious pieces of propaganda, dreamt up by a central organisation ; they are complaints by people who are operating the service in the way that the public expect it to be operated. No general practitioner in the Borders wants to move to a system under which he has to limit his practice budget. At the end of a long meeting last Sunday it was said that that was not what any of them had gone into medicine for.
If the Government were to ask people whether they would be prepared to pay more for the Health Service, the answer would be yes. The Government believe that, because expenditure on the National Health Service has inevitably increased, and will inevitably increase, no matter which party is in power, it must be cut, and that more and more of that expenditure should be borne by the private sector. The Government are changing the National Health Service into a national health business. That is not what is wanted.
If we cannot impede the Bill's progress, at least we should insist that some sort of external quality control commission should be added to the new system so that it can assess what facilities the National Health Service is failing to provide. That is what people want to know. The Government ought to remember that this is a service, not a private enterprise profit-making organisation. If they did, they would get back on the right tracks.
Mr. Harry Ewing : I detect some unrest among hon. Members. It is not something for which I apologise. The fact that the debate has continued into the early hours of the morning reflects the concern of Scottish Members of Parliament--particularly on this side of the House--about the direction in which the National Health Service is moving and has moved in Scotland, particularly since the hon. Member for Stirling (Mr. Forsyth) became Minister with responsibility for health in the Scottish Office.
Over the past two or three years, one of the saddest features of the Health Service in Scotland has been the way in which, by and large, we have moved from a consensus approach to confrontation. The one thing that is absolutely certain is that this is doing the Health Service, those who work in it and in particular those who use it, no good at all.
The right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) referred to the Borders district general hospital. I was accompanied by the right hon. Gentleman when, as Health Minister, I went to purchase the cricket ground on which that hospital now stands. We had tremendous problems not only with the purchase of the land but with a certain Professor Trevor-Roper, about whom I still have nightmares.
Sir David Steel : He is now a Lord.
Mr. Ewing : Yes, he is now in another place. I remember well all the restrictions that he placed on the building of the Borders district general hospital.
I mention that only as a means of getting back to a point made by the hon. Member for Tayside, North (Mr. Walker)--the hospital building programme. It is the only point on which I shall take the hon. Gentleman up. It is the
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very nature of politics that progammes started under one Government are continued and completed by a succeeding Government. [Laughter.] The hon. Member for Tayside, North is laughing. I hope that he will contain himself for a moment.During the period of office of the 1974-79 Labour Government Monklands district general hospital and Inverclyde royal hospital were opened. North Ayrshire district general hospital could have been opened, but because of a serious defect in the ventilation system of the operating theatres we refused to accept it from the contractors. The biochemistry unit at Glasgow royal infirmary was opened during that period, and the foundations for the major reconstruction at Stirling royal infirmary were laid. The massive expansion at Raigmore hospital at Inverness was begun during the period of the 1974-79 Labour Government. A host of projects that had been started by the hon. Member for Dumfries (Sir H. Monro) were picked up first by my hon. Friend the Member for Aberdeen, North (Mr. Hughes), then by the late Frank McElhone, and then by me. Likewise, projects that had been started by me were picked up by Sir Russell Fairgrieve. The projects that were announced by the hon. Member for Stirling last week will not be opened officially by him ; the official opening will be carried out by my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith). That is in the nature of hospital building.
Mr. Bill Walker : I hope that the hon. Gentleman did not get the impression that I was suggesting that there had been no programmes during the period of the Labour Government. That would have been nonsense. I was making the point that the Labour Government, at the behest of the IMF, had to make savage cuts in their capital spending programme. If the hon. Gentleman is saying that that did not happen, he is contradicting the record.
Mr. Ewing : The hon. Gentleman was not in the House at that time. Let me tell him that at no time--even when the Labour Government went to the IMF--was any Scottish hospital or health centre that was under construction restricted or delayed. If the hon. Gentleman examines the record he will find that my comments are absolutely accurate. The Minister mentions Health Service expenditure from time to time. Sometimes politicians distort the record--I suppose that I am as good at it as anyone else--but if Government Ministers check the record they will find that throughout very difficult times during the period of the Labour Government there was constant growth of 1 per cent. in real terms. All this talk about Health Service spending being cut is rubbish.
But that is not what the new clause is about. I can sense that you are becoming a bit concerned, Madam Deputy Speaker. I am astonished that the Minister seems to be poised to resist the new clause. I wish that this measure were not necessary. The hon. Member for Dumfries has been here throughout the debate, so I do not complain because he is not here at the moment. If he were in the Chamber, he would confirm what happened when he reorganised the Health Service. Three wings--the hospital board wing ; the preventive medicine side, which was run not by the Health Service but by the education authorities ; and the family practitioner wing--were brought together into a co-ordinated Health Service. That was done by
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agreement on the Floor of the House, with little whipping on the legislation. The treatment of health care in Scotland occurred through the ages.The Minister announced last week the setting up of a body above the health boards in order, he said, to impose the Government's policy on them. If that is the purpose of that body, it must be
counterbalanced. That would be done by the very body which the new clause would set up. There must be a counterbalance for patients. If one body acts on the Minister's behalf and imposes Government policies where sometimes they would be resisted by health boards, there must be a consumer voice. It would be in the quality control commission that is suggested in the new clause, as amended by the amendment tabled by the hon. Member for Moray (Mrs. Ewing). I have listened with great interest to hon. Members who have waxed eloquent about the standard of health care in their constituencies. I cannot do the same, but that is not a criticism of the doctors, consultants, nurses or anybody else who works in Falkirk royal infirmary. The problem is the net result of the constant transfer of facilities and services from Falkirk royal infirmary to sustain Stirling royal infirmary in the Minister's constituency. [Laughter.] The Minister laughs, but let us see how he laughs off my next remarks.
The ear, nose and throat department was transferred from Falkirk royal infirmary to sustain Stirling royal infirmary. My constituents have to travel many miles from their villages to see their children who are having their tonsils removed or to see their old folk when they are having eye operations. That must be measured in terms of quality control. The quality of health care that my constituents have to put up with must be measured against the inconvenience and trouble to which they have been put because the department has been moved 15 miles along the road to Stirling royal infirmary.
Hospitals are accredited for training purposes by the royal colleges. Stirling royal infirmary is not recognised as a training hospital for consultant anaesthetists because it does not carry out the range of anaesthetic work necessary for people to qualify. The Forth Valley health board is trying to correct the problem, not by getting more patients into Stirling royal infirmary--which could be done--but by transferring work from Falkirk royal infirmary to provide the necessary range at Stirling royal infirmary. Before we know what is going on, facilities will be transferred to Falkirk and our hospital will be downgraded.
My hon. Friend the Member for Falkirk, West (Mr. Canavan) has to tolerate such problems. They should be measured by a quality control commission. Such a commission would be able to prove that we could get more patients into Stirling royal infirmary. I have an interest in that hospital, too, and I have a high regard for it. I had close contacts with it during my 13 years as a Member of Parliament representing a constituency that includes Stirling.
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The hon. Member for Dumfries referred to a survey that the Minister commissioned about a year ago, yet the Minister has referred to that survey only once. It covered a host of experience of patients in our hospitals. It covered what they thought of meals, of visiting hours and of the
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facilities available. One aspect of that survey--the number of patients being referred to hospitals outside their health board area--was very interesting. In each of the health board areas in Scotland, the average was 3 per cent. to 5 per cent. That can be accounted for easily by the need to refer to the specialist centres. No one would argue that we should have such specialist centres in every health board area, but in the Forth Valley health board area the figure was 17 per cent.The Minister knows better than I do that general practitioners in the landward area, which is the western part of the Forth Valley health board's area--in the Minister's constituency--are referring patients to Edinburgh and Glasgow for general examinations which should be carried out at Stirling royal infirmary. Any treatment arising from those general examinations should also be performed at Stirling royal infirmary. We are talking about measuring quality of service to patients, and about the quality of health care that should be provided to the community. We must take into account whether such health care is there at all. For many years in Falkirk, we have enjoyed such health care provided expertly by good people at Falkirk and District royal infirmary.
I tell the Minister, in the kindest possible way, that we are in no mood to give up that care lightly. The Forth Valley health board's option appraisal is still to be published and the Minister has, in many ways, pre-empted that option appraisal by references to facilities at Stirling royal infirmary, which we shall not debate tonight, but will keep for another time. However, if there is any suggestion that Falkirk and District royal infirmary should be downgraded and that more services should be transferred, thus reducing the service to our people, the Minister will have a fight on his hands.
I found the speech of my hon. Friend the Member for Glasgow, Rutherglen (Mr. McAvoy) very disturbing. I cannot for the life of me think how a self- respecting Minister of any political party could go within 10 miles of a deal such as the one my hon. Friend explained to the House tonight. Even without this debate and even without the new clause on which to base it, my hon. Friend's speech could have stood on its own. He raised a very serious issue. The hon. Member for Tayside, North talks about the Public Accounts Committee examining the matter far better than it would have been examined by the Select Committee on Scottish Affairs. The issue that my hon. Friend the Member for Rutherglen raised is so serious--I do not say this lightly and I am not given to calling for public inquiries--as to require the closest public examination.
Quality control is about the availability of a service. If a service is not available or if it is taken away, we would examine that closely. That is why I shall support my hon. Friends in the Lobby tonight.
Mr. Michael Forsyth : We have had a long debate and it may be for the convenience of the House if I intervene now.
The hon. Member for Glasgow, Cathcart (Mr. Maxton) some hours ago made a number of points when moving the new clause. I echo the remarks of the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). I too was puzzled by the organisations that the hon. Member for Cathcart suggested should be consulted about the membership of the proposed body. He did not mention the Royal College of Nursing, the British Medical
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Association and other professional bodies. That was surprising, given his concern about the Health Service. It was revealing about his real intentions.I will not respond to all the points that the hon. Member for Cathcart made about competitive tendering, which he insisted on calling privatisation, despite the fact that he acknowledged that three quarters of the contracts had been awarded in-house. I noted his comments about standards. If he was critical of standards, they cannot have been the standards of specification in the contracts. He must have been referring to the execution of the contracts, and I took that to be an attack on the performance of the in- house teams. The hon. Gentleman said that fines were being levied in respect of some contracts. Given that the whole process of competitive tendering is about defining the level of service required, ensuring that that service is subsequently delivered and implementing the procedures for fining private contractors where they fall below standard, I should have thought that that met the requirements that the hon. Gentleman was putting forward in the new clause for the proper policing of standards in the NHS.
It is not possible to impose fines and take sanctions where contracts are held in-house, which is in by far the majority of cases, but in the light of the hon. Gentleman's remarks I will look again at the procedures that are in place for policing the standards of performance of in-house contracts and the activities of the boards in seeing that that which was promised when the contract was awarded is delivered.
I found it remarkable that in the history that the hon. Member for Cathcart gave of the process by which competitive tendering was embarked on in Scotland at no point did he say that nearly £60 million had been released as additional resources for health boards.
Mr. Brian Wilson (Cunninghame, North) : Nobody believes it.
Mr. Forsyth : I answered a parliamentary question--it is available in the Library--which set out all the additional services that the boards had bought with the savings resulting from that process. Simply saying "Nobody believes it" is not a way of substituting for the facts.
My hon. Friend the Member for Dumfries (Sir H. Monro), in an excellent contribution--one of the few which addressed the issue in the new clause-- highlighted the fact that the new clause would result in substantial additional costs for the NHS, money that would be diverted from patient care. It could be financed only at the expense of less progress being made on reducing waiting lists and not extending the range and quality of treatment available to patients. As my hon. Friend pointed out, the whole point of the White Paper proposals and the Bill is to try to bring about a separation between the role of health boards as purchasers and as providers. The role of ensuring the highest standards of quality and policing the quality of service is that of the health boards. The idea that we should set up a new organisation to take over the role of health boards is extraordinary, a point that was also made by my hon. Friend the Member for Tayside, North (Mr. Walker).
As my hon. Friend the Member for Dumfries said, the NHS today in Scotland is better than it was a year ago, and I agree with him that in a year from now it will be better still, particularly as a result of this measure becoming law.
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The hon. Member for Roxburgh and Berwickshire, in an intriguing split with his right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel), informed us that his constituency in the Borders had an excellent health board and nothing to complain about. In fact, he interrupted to say, "If it ain't broke, don't fix it." Apologies for the grammar, but I agree with the hon. Gentleman. He is right : the Borders has a brand-new hospital and an excellent Health Service. Nevertheless, his right hon. Friend subsequently listed a series of complaints.My hon. Friend the Member for Dumfries rightly spoke of the importance of dialysis being available within easy travelling distance of patients, while at the same time acknowledging the difficulties of providing such facilities in rural areas. I am happy to assure my hon. Friend that we are keen for progress to be made in that regard. Unlike Opposition Members, we feel that, if it is possible to provide them more cheaply by involving the private sector, it should be done : we have no ideological baggage to prevent us from acting in the interests of patients. The hon. Member for Glasgow, Rutherglen (Mr. McAvoy) smiles. [Interruption.] I will deal with his allegations in a moment, but let me ask him for the third time whether he is asking me to prevent Takare from providing that facility in his constituency.
Mr. McAvoy : Let me repeat for the third time what I said. I, as Member of Parliament, and the whole community of Cambuslang and Rutherglen do not want the deal, because of the lack of principle and because of the financial details. Will the Minister confirm, for the first time tonight, what I have said about the financial details of the proposed deal with Takare or will he take this opportunity to tell us the details, in the interests of truth?
Mr. Forsyth : What I will say is that the Greater Glasgow health board's proposals were examined in detail by my officials, who believe that they represent value for money. They required the approval of the Treasury, which--after examining them in detail--is also satisfied that they represent value for money. The hon. Gentleman has made a series of allegations which I shall certainly pursue, but I take if from what he has said that he does not wish to see the Takare facility in his constituency.
The hon Member for Moray (Mrs. Ewing) made a number of points, but she was particularly worried about a reduction in the number of local health councils. The Bill provides for the provision of more than one health council where it is considered necessary, and when the Grampian health board's proposals are presented we shall bear her views in mind.
The hon. Member for Aberdeen, North (Mr. Hughes), who made the same point about health councils, very fairly explained the divergence of view between him and the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). He mentioned the work of the Mental Welfare Commission. May I add that we also have the Scottish Hospital Advisory Service, the Health Service Commissioner and a number of other agencies, all of which would provide for the functions proposed in the new clause.
The right hon. Member for Tweeddale, Ettrick and Lauderdale spoke of the difficulties with his orthopaedic service. I am not familiar with the budget, but it may have
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been inflated by the waiting list initiative which has resulted in a considerable reduction. In the Borders, with a new hospital, the waiting list is more or less at base level.The right hon. Gentleman's example of the nebuliser is precisely the kind of thing that the reforms are designed to change. He explained the frustration of doctors who found that for the sake of £100 they could not get a patient out of hospital. That is ridiculous. The principles of money following the patient and the devolution of management responsibility at hospital level are designed to cut precisely the kind of red tape about which the right hon. Gentleman was complaining.
2 am
The hon. Member for Falkirk, East (Mr. Ewing) said that one Government may commission a hospital but the credit for it will be taken by the Government in power when it is built. This Government have presided over the biggest capital investment programme in the history of the Health Service. The Labour Government cut the hospital building programme. In reply to my hon. Friend the Member for Tayside, North, the hon. Gentleman said that no project that was being built was delayed. What he did not mention was all the projects which were not started and which were delayed because of the Labour Government's incompetence.
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