House of Commons Hansard Debates for 13 Mar 1990

Mr. Kenneth Clarke : I had better intervene now in this mini Adjournment debate, as it were, on Guy's, and Lewisham and North Southwark, because I may not have a chance to do so later. What the hon. Gentleman is saying is relevant because it provides a good vehicle for discussing self- governing NHS trusts.

What the hon. Gentleman says is true of all the London teaching hospitals. They are crowded together because originally they were put here to serve the poor of the teeming London slums. They provided free treatment to

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the residents of those poor districts in exchange for the residents allowing themselves to be used for medical teaching, training and research.

Now, a high proportion of that population in most of London has gone away from the area of the hospitals, so we have extremely up-market, high-tech centres of excellence, with

international-quality surgery being done in the teaching hospitals which were established for another purpose. I accept the hon. Gentleman's underlying point. I am not attracted by the idea, any more than he is, of some of the London teaching hospitals becoming high-tech centres of international excellence that give up their contact with local services. They will not do that because it is more profitable ; as I tried to make clear earlier, the geriatric services will enter into contracts with the NHS that will cover the cost. I understand that those who favour self- governing status at Guy's are contemplating a merger with the Lewisham hospital, although I do not know how that affects the community services associated with those hospitals. Contrary to popular belief, we are leaving it to the local people. However, I have encouraged those in favour of self- government to look at configurations that will ensure that Guy's stays tied in with what I recognise as one of its fundamental objects : serving the local population in Southwark and Lewisham. I shall certainly use that criterion to judge any application that is made, and it will virtually swamp the public consultation to which I committed myself a few moments ago.

Mr. Hughes : Although what the Secretary of State has said may apply most acutely to the London teaching hospitals, I am sure that the same sentiments are felt throughout the country. I was born in the north-west, in Stockport ; no doubt those who use Stockport royal infirmary will feel the same. I was brought up in south Wales, and no doubt those who use Cardiff royal infirmary will feel the same, too. There may be a difference in the degree of feeling, but not in the principle. People want their local hospital to be able to provide the range of services that it provides now, with no prejudice to the least glamorous aspects.

Mr. Peter L. Pike (Burnley) : Indeed, it is not a Guy's issue or a London issue. The people of Burnley certainly want to be treated at Burnley general hospital. They feel that they are entitled to the best possible treatment locally, unless they need recourse to a specialty for which they know that they must go elsewhere.

Mr. Hughes : I am sure that the Secretary of State recognises the feeling on both sides of the House--and I am sure that his friends in Kent and Hertfordshire agree--that, if possible, those who wish to receive treatment locally should be able to.

The system for deciding which hospitals should become self-governing is regarded with great suspicion. I have considerable respect and some affection for--and many dealings with--some of the senior people involved in the Guy's proposal, and I know that they have the interests of the Health Service at heart. I believe that, at the time of the debate on the Health Service in the 1980s, they would have opted for a system of district cross-charging rather than for the Secretary of State's proposals. That would have been a much better idea.

Lord McColl of Dulwich and all the other protagonists--in general terms, that is--have accepted what they see as

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the second-best option, encouraged by a fairly self-evident "carrot": if Guy's goes first it will be looked after. They are clearly attracted by the finance that they would secure for their hospital and teaching facilities as a result of its being the apple of the Government's eye.

What worries ordinary people, however, is that the decision will eventually be made by the Secretary of State, after he has been approached by a mere handful of advisers. We all know that tradition removes Secretaries of State from the direct sentiment of local people. I do not criticise the Secretary of State personally ; he must know that any Minister who runs a Department that spends such huge sums finds it impossible--with the best civil servants in the world--to be as much in touch with local feeling as he would like, as any ordinary Member of Parliament is with the community.

The problem is that the Government will want the scheme to succeed, and will want hospitals to opt out to show that it can succeed, even if there is mass opposition from all but the handful of people whom the system empowers to put the idea on the Secretary of State's desk. That is what is wrong with not testing the argument and allowing the whole community to decide through a ballot.

Mr. Flannery : During the past year we have been unable to discover from the Government exactly who would make those decisions. Members of Parliament from Sheffield had meetings with the health authority and about two months ago, more by way of a slip, it admitted that it was a group of consultants. In the meantime, outside the Northern general hospital, a group of local people set up a table with a petition on it against the proposal. People in the hospital got out of bed, put their clothes on and went outside, down the drive, to sign the petition. People passing and going into the hospital signed the petition and none was in favour of the decision.

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Mr. Hughes : I think that that is right. The Secretary of State must know. I have met no one in favour of the scheme. That is not because they have misunderstood it. I am talking about many well-informed people in the Health Service and outside it. New clause 4 allows the Secretary of State to put his argument that there is a better way to run the Health Service to each local community so that it can judge.

I am not here to defend the technical drafting of the new clause and say whether the electorate is correctly defined. I know that there are problems about that. However, the best electorate are not the people who work in the Health Service, but the people who use the Health Service. I have never understood the argument that it is more important to ballot those who work for that employer because, clearly, they have a self-interest and they are traditionally conservative. We all are about our own professions, and I have the same profession as the Secretary of State.

Mr. Hayes : When a hospital closes, which is far more serious than a hospital taking self-governing status, there is no ballot. The proper way of focusing public opinion is through community health councils. Another point that I am sure has been raised many times in the early hours of this morning--

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Mr. Campbell-Savours : The hon. Gentleman has not been here.

Mr. Hayes : I have not been to bed yet. I have been here listening carefully. I may go to bed in a minute, but let me return to the point that I was trying to make.

How on earth does one determine, in a place like Guy's or Bart's, who has to be balloted? Those hospitals have enormous numbers of people from an enormous area across all sorts of boundaries. It would be administratively impossible. Is not that the real difficulty about the Opposition's proposal?

Mr. Hughes : If the hon. Gentleman had been here earlier he would have heard me answer that point in reply to the hon. Member for Lancaster. One cannot have ballots for closing hospitals, because that is a decision for which one needs less resource. This is not the same situation. This is a decision about whether to change the nature of the relationship between the local hospital and the local health authority. That is perfectly susceptible of a ballot in a way that closing hospitals would never be, because one would never get the assent of a community. No such parallel can be drawn.

The Secretary of State said that he is aware of private polls that show that a majority of people are in favour of the scheme. The rest of us have not seen those polls. I have seen no public polls to that effect. One poll last week showed that 71 per cent. disapproved of the Government's scheme, 58 per cent. disapproved of their hospital becoming a self-governing trust and 37 per cent. of those who said that they were Tory voters said that the electorate should be the local community.

I should have hoped that the new clause would have more appeal after a second glance. It does not say that the ballot is determinative, and it could be criticised for that. It says that there must be ballots, reports of which must be presented to Parliament. The hospital can be allowed to be a self-governing hospital trust only if that report is approved.

If, on reflection and having seen the difficulty that this part of his scheme has given him, the Secretary of State believes that it is worth ruining the chance to improve the Health Service by staying firmly with this proposal, he is committing a grave error of judgment. I hope that he will realise that this proposal is probably provoking the greatest difficulty for him among the public at large. I hope that the Secretary of State will realise that if he is determined to offer the opportunity of separating a hospital from a district, a way forward is to say, "I am prepared, as my colleagues in other Departments did, to accept that the public must have a say." If the public have a say, his Health Service reforms may begin to get more widespread approval. If the public are excluded, people will not believe that the reforms are in the interests of the Health Service and the public, and are just more separation according to Tory dogma and a development of the Health Service from one based on care to one based on cost. That is not what any of the public want.

Mr. Redmond : The Secretary of State mentioned consultation. Is it consultation as a PR exercise or meaningful consultation? Given the track record of Conservative Governments since 1979, I believe that when they say "consultation" it is merely a PR exercise. They intend to take no notice of what the people and various groups are suggesting. A recent example of that occurred

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over their education and student loans policy. The talk of consultation is a charade. I wonder whether the Conservative Government are aware that a vast number of people in this country place a big question mark over what the Government say? When the Prime Minister and the Secretary of State say that the NHS is "safe in our hands", no one believes them or anyone who tries to kid the public.

I passionately believe in the National Health Service and fully support it, as do the vast majority of the public. There is no doubt that, given the option, the public would contribute a little more in taxes or another form, to ensure that they have a viable, efficient Health Service that meets their needs. Regrettably, Tory dogma stops that happening.

For the Government, opting out is not one step but one of a series of steps towards the privatisation of the Health Service. I will oppose it in every possible way because the public certainly want a Health Service, and the House has a duty to provide it.

Mr. Jack Thompson (Wansbeck) : There is another aspect of the opting -out proposition in relation to hospitals. A new hospital is being built in my constituency ; the Secretary of State is coming to lay the foundation stone next week. I shall not comment on what my constituents say that they should do with the stone. I suspect that the new hospital will not get the chance to opt in, but will be opting out from the very day it opens. We can look forward to a future of new hospitals being built that will always be opting out and never opting in.

Mr. Redmond : There is no need for me to comment because my hon. Friend's point is self-explanatory and well put.

When the Secretary of State lays the foundation stone, perhaps consideration should be given to putting him in a time capsule. He is unique and will be worth a bob or two in years to come.

When I was a Labour member of Doncaster council I served on the Doncaster health authority, and became its vice-chairman. The chairperson was Celia Wilson. She left no one in doubt that she was a Conservative, but her brand of Conservatism was vastly different from the Government's. Tony Dale was the secretary--again, not a Labour supporter--but he was a first-class administrator and was committed to the Health Service. David Eaves, the treasurer, was also committed to the Health Service.

The Government talk about value for money and an efficient Health Service. David Eaves and Tony Dale helped to provide the foundation, the core services and the efficiency of Doncaster health authority. It has one of the lowest administration costs in the country. The major part of its funding is used to ensure that nurses can provide the necessary care for patients. The administration costs are kept down.

Doncaster is a jewel in the provision of health care. But because it has been so efficient the Secretary of State cannot kid me that he is not making a decision on that authority until later in the year. He has already made his decision about Montagu hospital because of political dogma. It is a tragedy and it makes a mockery of his statement.

I am not a gambling man, but I will bet the Conservative Whip £1-- [Interruption.] I am not sure whether I am allowed to do that in the Chamber, so I shall make my wager outside. I am convinced that the Secretary

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of State has already made the decision about the published list. He referred to the Whitley council. I served on that council, and I carefully studied the various disputes--especially the ambulance dispute. The blame--

Mr. Speaker : Order. The hon. Gentleman is going a little wide of the debate.

Mr. Redmond : I accept that, Mr. Speaker, but the Secretary of State mentioned the benefits of the Whitley council in relation to wage negotiations. Having sat on a Whitley council I am aware of the manipulation by the Secretary of State for Health. It is kidding people to say that the Whitley council can make its own judgment. It cannot.

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The Bill is one of a series of steps towards the privatisation of the Health Service. Everyone is convinced of that. That is one reason why the Government are opposed to the new clause.

Mr. Hayes : On a point of order, Mr. Speaker. It is a very serious matter. I have just returned from St. Stephen's entrance where I saw the shadow Health Secretary in a seated position, with electrodes on his head and surrounded by men in white coats. That may confirm some of the suspicions many of us have had for a long time. Might it be appropriate for the hon. Gentleman to make a personal statement?

Mr. Speaker : He looks healthy enough to me.

Mr. Redmond : If the hon. Member for Harlow (Mr. Hayes) had been in the Chamber as long as we have, he would have heard the explanation. It shows that he was not in the Chamber for the whole debate, which is unfortunate.

I said that the Bill is one of a series of steps towards privatisation. Since 1979 various Secretaries of State have shifted every health authority chairman who has voiced opposition or even raised a question about Government proposals. They have been replaced by the nodding brigade. How can people believe the Conservative Government when they fill the health authorities with people who will not say that enough is enough?

Doncaster health authority has a fair mix from the community. The chairman, who was appointed recently, supports the Conservative party. That was no surprise ; we expected it. There is a Conservative majority built into the authority. One problem for the Government is that occasionally the consultants say, "Stop." When the health authority discussed opting out, the two consultants decided that they wanted nowt to do with it, and the health authority decided not to support the opting out of Doncaster royal infirmary and the Montagu hospital.

One reason why the people do not trust the Government is that since 1979 there has been a regrettable lowering of standards, despite what the Prime Minister says at the Dispatch Box about more money, more nurses and more of everything. I wish people would go into wards and open their eyes instead of looking through blue-tinted glasses. Since I finished with the health authority, when I became leader of Doncaster council, my sister has had three major operations, my brother has become a diabetic and my brother-in- law has had two strokes which have left him blind. Unfortunately, I am at that age when many of my friends and colleagues are falling ill and requiring

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treatment at Doncaster royal infirmary, the Montagu hospital or even at Hull and Sheffield hospitals. Standards are lower. No one would praise nursing staff more than I. However, I do not want to single the nurses out. They are part of a team including ancillary workers, from the porters to the people who type and send the notifications of appointments. If one visited a ward now, one should not see a highly qualified nurse dashing round serving cups of tea to the patients. That should be someone else's job. We should not train nurses to perform skills and then employ them as charladies. That is really disgusting. I am convinced that we should ensure that nurses are paid for nursing and not for mashing cups of tea and serving lunches and dinners from a trolley.

Mr. George J. Buckley (Hemsworth) : My hon. Friend is making an important point. However, with due respect, we are talking about the control of hospitals, not the services within them. In relation to the points about the Government systematically changing chairmen, does my hon. Friend suggest that the Government are practising a form of nepotism in that they are securing positions to control the hospitals so that their clandestine actions in relation to privatisation will meet no resistance? Are the Government doing that systematically as a step towards the privatisation programme for which they have no mandate?

Mr. Redmond rose--

Mr. Speaker : Order. I remind the House that we are considering National Health Service trusts.

Mr. Redmond : My hon. Friend the Member for Hemsworth (Mr. Buckley) is absolutely right. The Government could guarantee the Conservative supporters.

Doncaster royal infirmary and the Montagu hospital have expressed an interest in the trusts. The two unit managers--Nicholson and Turner-- covertly or in some other way, decided together with a small clique to write to Trent health authority and to the Secretary of State. Since then they have spent a fair amount of time--which is money--and a fair amount of real money as well, pursuing an issue that I believe was outside their terms of contract. They are employed by Doncaster health authority, not by Trent health authority or by the Government. However, they connived with one or two other people in the authority to express an interest.

When we tried to discover the names of the people who had expressed an interest on behalf of the people of Doncaster, the Secretary of State informed us that he did not know who had expressed that interest. There is a saying--which is not racist--"They kid niggers in Africa." That is what the Secretary of State is trying to do. He is trying to kid us. He knows the names that were submitted from Doncaster.

When the Secretary of State was pushed because we wanted to know the facts and started to apply pressure, we were told that the unit managers had expressed an interest, that the consultants had carried out a ballot among themselves and that they supported the expression of interest. However, it turned out that the chairman of the consultants--of the medical panel--had done his own

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thing and consulted one or two cronies. Having consulted a minority, he decided that he would follow the example of the Secretary of State and allow the minority to dictate to the majority. Although there were no proper consultation, the proposals went ahead. My hon. Friend the Member for Livingston (Mr. Cook) referred to Doncaster council, which paid for a MORI poll to ascertain the opinion of the people of Doncaster. A survey was carried out, in which MORI, not the council, posed the questions. MORI decided, "That is the problem ; these are the questions." When asked, the overwhelming majority of the people decided that they wanted nothing to do with the Secretary of State's proposals on opting out. The community health council also decided that it would not go along with that expression of interest. I have already said that Doncaster health authority has decided not to support the two unit district managers.

Montagu hospital had been earmarked years previously for a geriatric hospital. It was said that the accident and emergency unit would close, that the operating theatre would be lost and that it would become a geriatric unit. Regretfully--for the Government and Trent--the local people fought like blazes and reversed that decision. We now have some fine operating theatres and good improvements, although we still have some way to go. If we had listened to the pundits and to the whiz kids all that time ago, Montagu hospital would simply have been a geriatric unit, but now it provides the services that I have mentioned. It is one of the hospitals that will opt out. Does the House think that the people of Mexborough and the Don valley will stand idly by?

Against that background, I hope that the House will reject the Government's proposals. I have said that I am totally committed to the NHS. I am a blood donor, but hate to think that some of my blood might go to a hospital that has opted out. New clause 4 should be accepted, as should the idea of ballots and referendums--whatever one likes to call them. I hope that the House will support new clause 4.

Mrs. Wise : The Select Committee on Social Services made a recommendation on balloting, which is the subject of new clause 4. The paragraph with which I am concerned in our eighth report, which was issued in July, begins with some sentences that were agreed by the whole Committee :

"The proposal for self-governing hospitals within the NHS is controversial. The Government is pressing ahead very fast with its plans, despite the fact that the basic cost accounting systems needed to provide the foundation for the establishment of trading in the NHS generally, and of self-governing hospitals in particular, have not yet been fully developed. Unnecessary haste with one aspect of the planned changes may make it impossible for others, including the planned budgets experiment, to work."

That was accepted without any attempt to amend it. The paragraph continues, and this was the subject of an unsuccessful amendment to delete the passage :

"If self governing hospitals are to be implemented, they should be phased- in like GP budgets. If this is to be a consumer-oriented revolution, as the Secretary of State claims, the first such hospitals should be set up in districts where there is only one district general hospital serving that area and where customers in the district, i.e. the local population, have indicated through a ballot that they support the hospital becoming self- governing." That is the very point at issue in new clause 4. The recommendation was approved by a majority of the Select

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Committee. It was not done on the spur of the moment. The Select Committee devoted two full sessions to examining the resourcing and structure of the NHS.

8.45 am

When the vote was taken, those who supported the recommendation were not all Labour Members. They were two Labour Members, two Conservative Members and an Ulster Unionist Member. The House will agree that that was a fair spread. Three Conservative Members opposed the recommendation. Of those three, only one had served on the Select Committee during the whole of the inquiry. If we take away the vote of another member of the Select Committee who was not present during the whole inquiry, and my vote on the grounds that I am Labour so I would vote that way, the remaining members, all Conservative, supported the recommendation by three to one. Conservative Members of the Committee who took part in the whole inquiry, supported the idea of a ballot by three to one.

Ms. Primarolo : Did the Select Committee refer to the position that arises when an entire district health authority prepares to opt out as is the case with the Bristol and Weston health authority? The authority seeks to take all hospitals out.

Mrs. Wise : Some anxiety was expressed on that point from time to time, but most of us thought that it would be improbable. Although we want to retain an integrated service, that method of remaining integrated would, I think, not meet with much favour on the Select Committee.

I have compared the provisions of the new clause with the recommendation of the Select Committee. The new clause is both more cautious and more comprehensive than the Select Committee's recommendation. It is more cautious because it does not give the last word to the ballot of the population. It gives the last word to the two Houses of Parliament.

The new clause is more comprehensive in ways which have merit. It accepts the notion of a ballot of the population. That is crucial. I hope that my hon. Friends on the Front Bench have been influenced by the deliberations and recommendations of the Select Committee. But my hon. Friends have gone further. They have met the Government's argument that perhaps the electorate would lack expertise. The new clause remedies that by making sure that there would be a ballot of the staff. That provides expertise from clinicians and those working daily in the hospital concerned, which is a valuable addition. My hon. Friend the Member for Livingston (Mr. Cook) explained in detail how the new clause takes account of the district health authorities' views also, and requires that they be made known to the House. That point would not necessarily have commended itself to me immediately, but my hon. Friend was convincing. The new clause draws in administrative expertise. Because his speech was rather too short, my hon. Friend did not explain that the new clause also brings in the views of any relevant CHCs. The Government have not paid attention to that. Indeed, it has scarcely been touched on. Perhaps the Government do not want CHCs' views to be made known because the Association of Community Health Councils has already made clear its strong reservation on the whole matter.

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Mr. Flannery : Does my hon. Friend agree that clearly, whoever is balloted, the Government believe profoundly that they will be defeated in every single aspect of democracy? Therefore, to subvert that, they must have recourse to diktat. Diktat is now the order of the day because they have smelt defeat if they engage in democracy.

Mrs. Wise : I fear that my hon. Friend is right.

My hon. Friend the Member for Livingston referred to various ballots which have taken place. I shall quote from evidence to the Select Committee, particularly choosing bodies for the range of interests that they represent. They are not trade unions. There was considerable unanimity on this point across a wide range of organisations.

The Maternity Alliance is a broad organisation devoted to the needs and wishes of pregnant women. It pointed out :

"Within many hospitals' obstretric units women are now getting more choice about how they give birth but choice about where they do so has been restricted by closures, usually of smaller units. This has meant that many women now have to travel further for their maternity care. The Maternity Alliance is concerned that, under the new proposals, the economics of competition and the creation of self-governing hospitals will further concentrate services." It points out how that would be a drawback for women :

"A more patchwork service would mean more travel."

It expands on that point, but I shall not detain the House. I recommend the evidence to the House.

Mrs. Mahon : In Committee I moved an amendment to include maternity services in core services. As my hon. Friend the Member for Livingston rightly said, core services have disappeared from the Bill. The Government refused to include them. That shows their lack of commitment to a comprehensive Health Service.

Mrs. Wise : My hon. Friend makes a good point. Undoubtedly not only the Maternity Alliance but bodies such as the Royal College of Midwives have expressed grave reservations about the fragmentation likely to result from these proposals.

Even allowing for our wholly disproportionate reliance on hospitals for childbirth, pregnancy and childbirth necessarily involve the community, then the hospital and then the community again. Fragmentation would be extremely dangerous--and I use that word advisedly--for the care of expectant mothers.

Mr. Rogers : My hon. Friend rightly mentioned that women now have to travel considerable distances for their children to be born, because of communication difficulties, and that is a real problem in the south Wales valleys and particularly in the Rhondda valley. I am glad that we have been joined by the shadow Secretary of State for Wales and the shadow Health Minister for Wales, because I hope that they will be able to correct that situation when they come to power. One of the greatest things that can happen to a person in Wales is to be born in the Rhondda. That is not only considered to be a distinction ; it is a distinction. However, women in East Glamorgan have to travel to be delivered of their children ; due to Government cutbacks children cannot be born there. In a tribal area such as the south Wales valleys such an issue is of considerable importance. I know that the shadow Secretary of State for Wales will put this issue high on the agenda when we win the election next year.

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Mrs. Wise : The Medical Women's Federation said :

"Implementing change without consulting those on whom the burden will fall flies in the face of good management practice and demonstrates a discrepancy between this Government's self image and its behaviour."

The federation went on to make even less complimentary references to the Government, but in deference to the fact that they are having a hard time today, I shall not quote any more.

The Royal College of General Practitioners, speaking about independent hospital trusts, said :

"The College feels that the proposals for independent hospital trusts will seriously affect the level of services for patients and training. The creation of self-governing hospitals will de-stabilise future community care and may lead to a fragmentation of services." Perhaps that is the sort of evidence that has led the Government to believe that it would be highly dangerous for medical opinion to be consulted and to be laid before the House ; the Government think that they will lose.

The Health Visitors Association is concerned about another aspect that has been somewhat neglected. Community services as well as hospitals can opt out of control by the community through the district health authorities and that is an extraordinary proposition.

The Health Visitors Association is deeply worried about that because, by definition, health visitors are in the community. It said :

"A possibility not touched on in the White Paper and Working Papers (except implicitly in the references to health authorities being empowered to buy services from the private sector) is that a private company could bid for the contract to provide all or part of the community nursing services. While the Government's stated intention is for careful regulation and monitoring of contracts and their performance, the Association believes that specific safeguards are needed to prevent vested interests from developing services in directions detrimental to the interests of clients. An infant formula manufacturer, for example, should not be able, by any act or omission, to create conditions within the health visiting service which would adversely affect the quality of unbiased information and advice about infant feeding."

That is a matter of great concern, which the Government have not referred to at all. They are not privatising the NHS--I will concede that--but they are blurring the edges and the interface between it and the private sector, which will result in a most peculiar and uncontrollable hybrid.

The Health Visitors Association has proven knowledge of and a proven interest in the matter. It would welcome the opportunity to ensure by means of a device such as new clause 4 that its concerns were put directly to the House.

The association also referred to the integrated nature of the service. It said :

"Integrated child services ensure close links between the nursing and medical staff, in and out of hospital, concerned with a range of provision for children with special needs, and in relation to child protection. Where these aspects of hospital and community services were no longer to be managed by the same agent, the Association fears that these links could be jeopardised, particularly if they added to the hospital's costs."

The last phrase--

"particularly if they added to the hospital's costs"--

contains a considerable sting. It will determine what a hospital does. I agree with the association that the kind of services to which it refers, which are so important to children, would be jeopardised. The Division of Social Responsibility of the Methodist church also submitted evidence. I accept that the term "social responsibility" might invalidate the Methodist

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church's evidence in the eyes of Conservative Members, but that will not apply to the public. The Methodist church's response to the Select Committee's report was :

"NHS Hospitals may opt out of Health Authority control. They will be managed by business-oriented Trusts, which may trade with other institutions, private and public, hiring their own staff at their own rates."

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The Secretary of State compared this reorganisation with the 1972 reorganisation--again by a Conservative Government. I was not predisposed towards that reorganisation, but it bore no relationship to these proposals. The Secretary of State relies on people not having read the documents relating to his proposals. The Methodist church referred to the relationship with the private sector and said :

"There is no reason to welcome the expansion of the private sector ; countries with a larger proportion of health care provided privately do not always enjoy better health care than does Britain. The White Paper envisages the NHS working much more closely with the private sector. In view of the proposals to bring senior clinicians more closely into management, this implies a very serious conflict of interest. Consultants are likely to have a fairly dominant role under the new proposals, and would be chiefly responsible for buying services from the private sector, that is, from their own medical businesses. This is seen as corrupt when it occurs in the Local Authority context, and will place a heavy policing burden on the Audit Commission and on Health Authorities.

The deep suspicion arises, however, that the plans for hospital trusts are designed to make large-scale privatisation possible." That is not a Labour party document ; it is a document from the Methodist church's Division of Social Responsibility.

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