House of Commons Hansard Debates for 27 Jun 1990

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properly. Ballots would inform the consultation process positively and the Government would be daft not to accept them.

If the Secretary of State leaves the consultation uncontrolled, he will get exactly what he has been evincing worries about this evening--distortions and half-truths. That would do nothing but confuse the public, which is not in anybody's interests. It is a basic tenet of democracy when dealing with something as important as the NHS that the Government should do everything possible to achieve full consultation. That must embrace the opportunity of a ballot to the results of which the Government would have to pay attention. 7 pm

Mr. Wilshire : As Opposition Members were so lacking in enthusiasm to accept interventions, before I come to the one point of substance that I wish to add to the debate, I shall say a word or two about their remarks. They need to be commented on as early as possible. The hon. Member for Peckham (Ms. Harman) made three points which Tory Members sought to challenge, but did not get the opportunity to do so. I hope that I wrote down correctly what she said. No doubt she will put me right if I did not. First, she said that self-governing trust hospitals would seek to attract patients by cutting corners. Ms. Harman indicated assent.

Mr. Wilshire : I am grateful to the hon. Lady for confirming that. Once again, she made it clear that she has not the first grasp of the best way to achieve and improve quality in anything. It shows a complete poverty of thinking and a lack of understanding. I can think of no example of anybody who has a choice in buying a product or using a service choosing an inferior one. The only way to attract patients is by offering a better quality of service.

Mr. Eric Martlew (Carlisle) : Will the hon. Gentleman give way?

Mr. Wilshire : I shall give way with the greatest pleasure, even if Labour Members do not like to do so.

Mr. Martlew : Can the hon. Gentleman not think of circumstances in which people choose according to price rather than quality? Why, for example, are there so many Lada cars running round in my constituency?

Mr. Wilshire : That is yet another example of a failure to grasp what we are talking about. We are talking only about the choice of quality of product, because the NHS is paying the bill. The patient does not have to address himself or herself to the price tag, but only to the quality of the service on offer. That is the difference. Yet again, the Labour party demonstrates its complete failure to grasp that elementary point.

Secondly, the hon. Lady, speaking on behalf of the official Opposition, said that it was against the internal market. That suggests that the Labour party has not learnt the first thing in the past 10 years. It is still saying that it is against the internal market in the health service, and therefore against choice. Despite all the wonderful rhetoric in the glossy brochures that it has has been circulating

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recently, it is still peddling the view that the Labour party knows best what is good for patients and that patients cannot be trusted to make a choice.

Mr. Foulkes : We are talking about ballots.

Mr. Wilshire : I hear what the hon. Gentleman says, but I am only quoting the comments of Labour spokesmen. It was they, not me, who said that they were against the internal market.

Thirdly, the hon. Lady said that the staff want their say because they care about patients. Again, I hope that I quote her correctly. Ms. Harman indicated assent.

Mr. Wilshire : I am grateful to the hon. Lady for confirming that. She then elaborated on what she meant rather than what she had said, which was that the staff care about their union membership. It seems that the Labour party is anxious to ensure that people working in the NHS should have it made easy for them to belong to trade unions that care so deeply about patients that they will either organise strikes or work to rule.

Mr. Paul Boateng (Brent, South) : If the benefits of the internal market are so obvious, why will not the hon. Gentleman allow patients to make the choice in a ballot?

Mr. Wilshire : Another problem with Opposition Members is that some of them wander in halfway through debates, having missed what has been said. The best answer to that is either to be here at the beginning or to read Hansard tomorrow morning. I most certainly will not go over that ground again.

The hon. Lady said that staff want their say because they care about patients. Then she explained that what they cared about was union membership. We were further told that they cared about national agreements. We have already made it clear that national agreements are the bane of the life of hospital managers. I know it only too well from the west London area where it is almost impossible, under the current Whitley arrangements, to attract and keep nursing staff. I address this point almost more to my right hon. and hon. Friends than to Opposition Members. If we truly believe that the best people to manage are the managers whom we appoint, we must give them control of the structures being created and of pay and conditions. We must have the courage to say that effective management means managers negotiating with their own staff. It is nonsense for managers in London to be fettered by what is happening in John o'Groats. Management must be devolved down to the hospitals.

The hon. Member for Walsall, North (Mr. Winnick), whom I am glad to see back in his place, challenged me to respond to what might happen in my constituency. I can tell him what happens there. I have not held a ballot, but a petition is going the rounds. The organisers of the petition tell me that there are 20,000 signatures on it opposing what is being suggested. I accept that the petition is not about self-governing trusts, but it will make the point and allow me to answer the hon. Gentleman's challenge. The petition suggests that my constituents are against closing two hospitals and building a new hospital in a completely inaccessible place. Clearly, they would be against that, would they not? The only snag is that the

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organisers failed to tell my constituents that so far there are no details of where the new site will be. Yet 20,000 people oppose the new site because it is inaccessible.

Mr. Winnick : Obviously, I cannot comment on that local issue because I do not know the details, but no doubt there is another side to it. Would the hon. Gentleman be willing to hold a ballot about whether the hospitals in his borough should become self-governing, if the questions were approved by both sides and if the Electoral Reform Society carried it out? Would he object to such a ballot?

Mr. Wilshire : I am happy to put it on record that I should be absolutely delighted to have a ballot in my constituency ; it will be called the general election. [Laughter.] To meet the hon. Gentleman's requirements, I am happy to put it on record that I shall fight the general election and put in my manifesto, as I am sure my party will, that we believe in this Bill, which will then be an Act, and in self- governing trusts. We shall put that to the electors. Last time they gave me 60 per cent. of the vote and I have little doubt that they will be enthusiastic to return me again. If the hon. Gentleman manages to be returned, he will have his answer.

Dr. John Reid (Motherwell, North) : Why does not the hon. Gentleman answer the straightforward question that has now been put to him twice? He knows that general elections cover a whole range of topics. As he stressed the need for patients to choose quality, will he be prepared to give patients in his constituency the chance to choose quality by a ballot on these proposals? Yes or no?

Mr. Wilshire : My patients and electors will be given the chance to choose the quality of their present Member. That is what the democratic process is all about.

The hon. Member for Sheffield, Hillsbrough (Mr. Flannery) said that the Conservative party had voted against the national health service in the past and therefore all Conservatives are against the national health service. I was slightly more than a gleam in my father's eye when the vote to which the hon. Gentleman referred took place. No doubt he can tell me what year the vote took place, but I do not believe that I was out of my pram-- [Interruption.] I am sure that some hon. Members think that I have not learnt much since. However, I should be extremely grateful if the hon. Member for Hillsborough would stop trying to suggest that because the Tory party did something some years ago, I must be in favour of transporting people who steal sheep. That is what he seemed to be arguing. I am not in favour of that.

Mr. Flannery : Sadly, the hon. Gentleman is conveying to us the impression that he has not really got out of his pram yet. The Conservative party has always been against the national health service and voted against it. The British Medical Association has had the grace to say that it has changed its mind and that it now supports the NHS. However, the Conservative party is still, by its actions, proving that it is completely against the health service.

Mr. Wilshire : The hon. Gentleman has made the other point that I wanted to make against him. Not only does he insist that, because something happened 50, 100 or 200 years ago, those of us who were not involved are, by definition, of the same mind. He has just shown that he does not understand that, and he has also claimed to be a mind reader. He suggests that he knows what the

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Conservative party believes. More importantly, he tried to put words into my mouth by suggesting what I believe. I have always believed in the national health service and I am sure that I always will. I have always done everything possible to further it. It is a gross misrepresentation to suggest that an Opposition Member knows what Conservative Members think.

The hon. Member for Wakefield (Mr. Hinchliffe) would not give way either, so I must respond to him now. He said that self-governing trusts would make central planning impossible. He is yet another member of the Labour party who has failed to understand the principle of how to get quality services. He suggests that command planning from the centre is the best way to run a public service. He obviously has not learnt any lessons from what has happened in Russia or in eastern Europe over the past 12 months.

The hon. Member for Wakefield also thought that it was grossly unreasonable or, dare I say it, somehow morally wrong that his constituents should be expected on occasions to be treated in a private hospital.

Mr. Hinchliffe : It is morally wrong.

Mr. Wilshire : I am glad that that is on the record. Obviously his view of Labour policy is that it should abolish the private health service.

Mr. Hinchliffe indicated assent.

Mr. Wilshire : I am most grateful to the hon. Gentleman for nodding. A Labour Member has now said in the House that he wants to abolish the private health sector.

I did not serve on the Standing Committee of this Bill and I have not been closely involved with it. I have no intention of going over the general ground. However, those hon. Members--including some Conservative Members-- who are against self-governing trusts appear to be in favour of ringfencing. I do not want to pre-empt the ring-fencing debate, but hon. Members who are against self-governing trust hospitals, but claim to be in favour of ringfencing, are deploying a very curious train of thought.

7.15 pm

When I served on a health authority, we safeguarded community care and the community health budget, bearing in mind the fact that the great debate in the health service has always been the demands of the acute sector against the demands of community care, by ringfencing them. I understand the ringfencing argument to be about protecting community care. If Opposition Members are in favour of protecting the community budget by ringfencing it, why are they against what is in effect the ringfencing of acute district general hospitals by allowing them to become self-governing trusts? I believe that one of the greatest assets of self-governing trusts is that the remainder of the budget which is outside the acute sector is protected and care in the community is safeguarded. I should have thought that, as they support ring-fencing, self-governing trusts would appeal to Opposition Members.

Dame Elaine Kellett-Bowman (Lancaster) : If my hon. Friend had the misfortune to live in the Lancashire county council area or to be in charge of community care there, he would find that it blows every penny that comes its way on the least important things. That council is quite different from my local health authority, which is highly efficient-- [Interruption.] The two horses are of a completely

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different colour. Lancashire county council is profligate, but the local health authority is very good and efficient, as are the hospitals.

Mr. Wilshire : I am sure that my hon. Friend's comments will be noted in Lancashire.

I want to challenge Opposition Members and one or two of my colleagues about ringfencing. If hon. Members are against self-governing trusts and they vote that way tonight, bearing in mind the fact that the trusts are the best way to ringfence the acute sector, I fail to see how in all conscience they can vote in favour of ringfencing something in local government. The two arguments do not hang together. I believe that Members must be consistent and I will explain later, if I catch your eye, Mr. Deputy Speaker, why ringfencing in local government would be nonsense.

Mr. Bradley : I will try to bring the debate back to the issue of opt-out. I will also be brief, because we have suffered long rambling speeches from Conservative Members. The Conservative party has tried to get as many of its Members as possible to speak to talk about specific issues that affect their constituencies.

Like my hon. Friend the Member for Wakefield (Mr. Hinchliffe), I have received hundreds of representations from my constituents opposing the proposals for opt-out. I have not received one letter in favour. That is particularly significant, because the world-famous Christie hospital is in my constituency. Local people are very proud of that hospital and they have raised thousands of pounds for it. I strongly believe that Christie hospital is at the top of the list of hospitals which the Government want to see opt-out as soon as the Bill becomes an Act.

We must consider what has been happening to the opt-out proposals during the Bill's passage through the House, and in that context I want to refer to Christie hospital. The management of Christie, at a very early stage, expressed an interest in opting out. However, the management only consulted some consultants in the hospital. The Secretary of State said tonight that he does not believe that the consultants should be the sole custodians of views about whether a hospital should opt out and that there should be more consultations with staff. In Christie, no other staff were consulted. Similarly, the local community and local representatives such as the community health council were not consulted. The issue was not even drawn to the attention of South Manchester health authority because the authority did not believe that it should have a say in whether the hospital should have expressed an interest.

It is absolutely clear that hospitals are seeking opt-out status because of the financial crisis in many health authorities. The financial crisis facing south Manchester health authority is the reason why Christie hospital is expressing an interest in opting out.

The Secretary of State recently crept into south Manchester to look at what was going on. The headlines in the local paper stated that all that the people of south Manchester ever did was moan about the state of the health service. Well, they have plenty to moan about. In the last few years, we have had ward closure after ward closure ; waiting lists have been growing and staff have not

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been recruited because of lack of money. Now, Christie hospital has admitted for the first time that it cannot open a crucial ward because of lack of money. As the Secretary of State has said, the unit manager of the Christie hospital is the local enthusiast--he is the only local enthusiast--who has put forward proposals for opting out. He admitted in an article in the local health paper that "a Unit such as Christie with potential for growth and development of cancer services must recognise that for the foreseeable future there will be no growth monies available from Regional funds. From April 1990 the budget of the North West Region begins to reduce and this will inevitably mean that already hard pressed district Health Authorities"

such as south Manchester--

"will encounter further financial problems".

That is why the hospital is going down the road of opting out. The consultants are fed up with the lack of resources. They are prepared to go along with the proposals as long as they believe--as I do--that the first hospitals to opt out will be stuffed full of money by the Government to show that such hospitals can be successful. I believe that the Government will go forward to the next general election on that basis.

For its "consultation", the management has produced a glossy magazine--

Mr. James Pawsey (Rugby and Kenilworth) rose--

Mr. Bradley : No, I shall not give way.

Mr. Pawsey rose--

Mr. Bradley : I shall not give way to the hon. Gentleman, because he has only just walked into the Chamber.

The management has produced a glossy new magazine to try to justify its opting out, which states :

"we would still be required to treat a similar number of patients, but we would have no guaranteed funding because the service contracts would be held by South Manchester Health Authority."

That is what the management have told the staff. However, in a written answer the Under-Secretary of State for Health has stated that, whether the contract is held by the NHS trust or by the directly managed hospital in south Manchester, the money will go to the hospital where the patient has been treated. Therefore, the management are not telling its staff the truth about the way in which the funds from the contract will be allocated.

The management then ask how they should continue the consultation process. As I have said, they have already drawn up a document, which they are ready to throw at the Secretary of State at the first opportunity, which states that the staff should try to borrow a copy of the document from the administrator so that they may know what is going on. They can then attend a series of public meetings at which only the general manager will be allowed to speak. Instead of having a show of hands at the end of the meetings to determine the views of the staff in the hospital, the general manager himself will assess the consensus and judge the feeling of those in the room. The general manager--the local, the only, enthusiast--will determine whether to submit a formal application.

That is the way in which consultation is taking place, and that is why we in south Manchester say, on behalf of Christie hospital, that we want a ballot. We want the staff to be able to express their view. We cannot believe that the Government are not prepared to accept the idea of ballot,

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which is what they argued for in education and housing. The hon. Member for Ealing, Acton (Sir G. Young) said that he does not support ballots on the opt-out of hospitals, because where there have been ballots on, for example, education and housing, they have proved popular.

I ask the House to consider whether one single school has opted out in Manchester. Has a single council house moved to the control of a private landlord? The answer is no, because people in Manchester know the value of the public sector and of public provision. They know the value of local accountability for those services. That is why the people of south Manchester want hospitals that are directly managed by local people, which are locally accountable and which are properly funded within the public sector.

Mr. Quentin Davies (Stamford and Spalding) : It was not my original intention to speak at this point. However, I feel that I must do so to give the hon. Member for Peckham (Ms. Harman) some assistance in a vital matter. All of us who know the hon. Lady know that she would not have the slightest intention of deliberately deceiving the House, but I fear that if an important passage in her speech at the beginning of the debate stands without correction, she may succeed in deceiving the House, albeit unwittingly and by strong implication rather than explicit statement.

When the hon. Lady was talking about ballots, which are the central issue of the debate, she said that, notwithstanding the extremely compelling technical reasons against holding ballots to determine public opinion about the proposed changes in the administrative arrangements for hospitals, it is right and reasonable that such ballots should take place. When she dealt with the sensible if obvious point that in 1948 the Labour Government did not introduce any specific ballots on their own administrative arrangements for hospitals, which were contained in the National Health Service Act 1946, she replied. "Ah, but the difference is that at that time we had had a general election."

The clear implication of the hon. Lady's statement was that there had not merely been a general election, which there had been in 1945 and which the Labour party won--just as we won the election three years ago--but that, in its manifesto or otherwise, the Labour party had made clear its proposals for the administrative arrangements for hospitals that it would incorporate into any national health service Bill that it might introduce. The hon. Lady implied that when the public went to the booths in the election of 1945, they knew exactly what administrative arrangements for hospitals they were voting for. She suggested that that was unlike what happened with the Conservative in 1987.

In case any hon. Member has forgotten, I remind the House that no such thing occurred. The Labour party's 1945 manifesto did not make any reference to the administrative arrangements that it was proposing to introduce for hospitals. Indeed, no statement on that subject was made during the whole of the campaign that summer. That was for the very good reason--this is why I can be dogmatic on the point--that, at that stage, the Labour party itself had not decided on the administrative arrangements.

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Dame Elaine Kellett-Bowman : Does my hon. Friend accept that Christie hospital does not belong to its staff? It belongs to the people of the north-west and it would be extremely difficult to ballot all those people. I must advise the House that in some specialties, 49 per cent. of the patients dealt with by my local health authority are out of district, mostly from Cumbria. On average, it is 29 per cent., but the proportion is 49 per cent. for some specialties. Who exactly does the Labour party expect us to ballot? It is not possible to find a constituency to ballot on these things, although that is what Opposition Members are suggesting.

Mr. Davies : I agree entirely with my hon. Friend's helpful comment. There are strong reasons for not having ballots, and no doubt Labour was right in 1948 in not holding specific ballots on that issue.

The hon. Member for Peckham suggested that there was no need for ballots, not because technicallly they are not feasible or were otherwise undesirable, as my hon. Friend the Member for Lancaster (Dame E. Kellett- Bowman) suggested, but because the public already knew in 1948 what the arrangements would be and voted accordingly.

Mr. Robert Litherland (Manchester, Central) : Will the hon. Gentleman give way?

7.30 pm

Mr. Davies : No. I am sure that the hon. Gentleman will be able to catch your eye later, Mr. Deputy Speaker.

The truth is quite contrary to the hon. Lady's argument. When the electorate went to the polls in 1945, it had every reason to suppose that whichever Government was elected--Conservative or Labour--they would introduce a national health service along the lines of the Willink White Paper of 1944. I was not alive at the time, but I am sure that you, Mr. Deputy Speaker, will remember as though it were yesterday that when that White Paper was produced by the then coalition Government, it set out a plan for the health service that contained almost all the features that were eventually incorporated in the Labour Government's national health service in 1948, with one vital difference, in that the Willink White Paper did not propose hospital nationalisation. In 1945, without giving any warning to the electorate, Labour introduced the nationalisation of hospitals, with none of the specific ballots that, according to the hon. Member for Peckham, it would have been reasonable to expect Labour to hold. I could make a powerful political point, because the facts I have set out could explode the sincerity of all that has been said about ballots by Labour Members this evening. However, there was a more positive reason why I rose to speak. It was to help maintain the integrity of the debate by giving the hon. Member for Peckham an opportunity to set the record straight and to make it clear that there is no difference between the attitude towards ballots taken by Labour in 1948 and that of the Conservative party in 1990.

Mr. Redmond : The majority of people in the Doncaster health authority area are totally opposed to the opting out that is supported by a small minority. The Secretary of State continues to display arrogance and conceit. He ought to be present, because I do not want to say anything behind his back. I welcome the Secretary of State back to

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his place, and repeat that his arrogance and conceit continue. Thank God, people fought to get rid of that kind of dictatorship during the second world war. They will fight again to do so. If the Secretary of State is so convinced that he is right, the simple answer is for him to ballot the people. If he wants to be doubly sure, why does not the right hon. and learned Gentleman convince his master to call a general election? I am convinced that the vast majority of people are wholly opposed to the Government's reforms for a two-tier system, which will lead to privatisation. The Secretary of State condemns local authorities that utilise local money to sound out people's opinions. Doncaster is Labour-controlled, but it not only stated its opposition to the reforms--which the Secretary of State might argue was party political propaganda--but consulted local people. The Secretary of State says, in effect, that consultation may take place but that he will ignore it.

The pity is that the Secretary of State did not spend the millions of pounds used to promote his views and to hold meetings throughout the country with unit managers and other interested parties on consulting the public, which would have been a far better use of that money. The Secretary of State spent millions promoting his voice and his master's voice against local authorities who spent a few pounds. He ought to be interested in freedom and democracy. The iron curtain has gone, but the dictatorship that used to exist behind it now exists in this country. The Government use the phrase "the enemy within", but the enemy within now are Conservative policies that seek to undermine our social fabric.

Whom will the Secretary of State consult? What criteria will he set and how will a local authority determine whether its application to opt out meets them? The right hon. Gentleman said that he will ignore consultants and any other group that consults its members or holds a ballot and then opposes the reforms. That is the kind of dictatorship and arrogance that he uses to bulldoze opposition.

The Government imposed a guillotine on this important debate, and now Ministers intervene time and again. If the Secretary of State wanted to explain his policies, the Government should not have guillotined debate but fully utilised the time available to explain their proposals. The right hon. and learned Gentleman has failed to convince the majority of the public.

The newly appointed chairman of Doncaster health authority, the newly appointed unit manager and the newly appointed district nursing officer all support opting out. They are the people that the Secretary of State has connived to put in place so that he may claim that Doncaster supports his proposals, when that is false. If the Secretary of State wants to be true to himself, he should return to the Dispatch Box and announce that he is withdrawing this ludicrous and uncaring Bill.

Mr. Jim Cousins (Newcastle upon Tyne, Central) : In the northern region, the dwindling list of hospitals that want to opt out is down to five, and they are located in the city of Newcastle. The opting out and trust proposals that would affect the citizens of Darlington and Tynemouth, which are among the shrinking band of Tory seats in the northern region, have also been dropped. That is an

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interesting sign that the Government are not confident about the little lifeboat that they have launched for the national health service.

We in Newcastle are confronted with opting out by all four of the city's major hospitals, but we are told by the Secretary of State that they do not anyway belong to us, as patients or as citizens--yet he is apparently content for them to belong to a small band of self-appointed people. No one knows who they are or what credentials they have. He is happy about that. As the proposals for NHS trusts are tested, the credentials of the people who lend their names to those trusts will be closely tested.

The Secretary of State, in one of his throwaway remarks that will come back to haunt him, described local councils as a bunch of bandits. We suspect that that description far better suits the type of people who will self- recruit, self-appoint and keep the NHS trusts in their pockets for ever.

My hon. Friend the Member for Peckham (Ms. Harman) was absolutely right to highlight the process that is going on in Newcastle in the four hospitals that are the subject of opt-out proposals. She said that there is a whispering campaign of bribery and blackmail and that promises of promotion, pay increases and extra resources for particular facilities are being made to grease the wheels and smooth the process of opting out. We must have ballots so that such below-the-line rumours and whispering are forced above the line so that they are on the record and publicly known.

I note that the ministerial team are furiously engaged in a discussion about this matter. The unit general manager in Newcastle may be promising a Westminster or a Wandsworth to the people who work in those hospitals, but it is much more likely that the Minister will be gifting them something more like a west Lambeth. Promises to run those hospitals on Westminster or Wandsworth lines will prove to be a mirage ; west Lambeth will be the reality. That is not good enough. Such major proposals cannot be forced through on the basis of false promises.

The Government's proposals are fundamentally wrong because of the false expectations that they are arousing in some people's minds. The proposals will be undone not by anything that we do in this House tonight, but by what the Secretary of State does or fails to do. If people proceed with the trusts, they will find that they have been cheated. Those people, above all, will remember the proposals with regret.

My hon. Friend the Member for Livingston (Mr. Cook) said that we shall fight against the proposals as though we were fighting a by-election. I understand what my hon Friend means, but by-elections have a date at which they must terminate. In cities such as Newcastle we shall not fight against the proposals in that way ; we shall persist with the scrutiny with rigour and record all the promises, the whispers and the rumours. We shall never forget them. The hon. Member for Spelthorne (Mr. Wilshire) is apparently willing to say to nurses in west London that if NHS trusts are accepted they will be free of the NHS pay scale and paid more. With what? Do the Government propose to issue some kind of NHS junk bond with which to pay the money? The answer is no.

All those false promises will be placed on the record. It is much better to force such a corrupt and unacceptable method of doing public business into the open so that such practices can be properly recorded. Whether or not the Government decide to do that, the job will be done. Such

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practices will be recorded and will not be forgotten. They will bounce back again and again in the lifetime of the Government.

Mr. Fatchett : I agree with what my hon. Friend the Member for Newcastle upon Tyne, Central (Mr. Cousins) said in his excellent speech.

During the debate, one Conservative Member after another--when the Government have found it possible to get people into the Chamber to support the Bill--has said that the opt-out proposals are self evidently popular. They have said that there is no argument about the nature and potential success of opt-out hospitals. If that is so, why are Conservative Members so afraid to put that proposal to the electorate so that the people can have a voice? They are running away from the issue.

The Secretary of State told us that the enthusiasm for the proposals would come from a small group of independent-minded people, some of whom would be local business people with or without experience of the NHS. The Secretary of State has now invented another category of person capable of running the NHS with his approval--someone with no experience of it, that is to say, someone who has spent all his life as a patient of the private sector and who supports it. That is the person who the Secretary of State believes is capable of running the NHS. We do not want such self-appointed people running the NHS, but those who represent the public and who are concerned about the NHS and have its interests at heart. 7.45 pm

The Secretary of State has tried to be emollient and I know that that is difficult for him. I understand why the chairman of the Conservative party said that the right hon. and learned Gentleman needed some advice on public relations. In his attempt to be emollient, the right hon. and learned Gentleman said that he would consult and listen, but at no point in his speech did he tell us what the test would be before he said no to a particular trust proposal. The answer is simple--if the proposal is backed by a small group of Conservative party supporters and Conservative central office wants it, it will go through.

Let us consider a local example dear to my heart and to that of the people of Leeds--St. James's hospital, now nationally known as Jimmy's after the television programme. What will happen to that hospital? What test would the Secretary of State use to determine whether that hospital should opt out? The health authority, the consultants, the community health council, the non-medical staff and the public of Leeds have said no to that hospital opting out, so on what moral grounds could the Secretary of State approve a decision to allow it to opt out? Yet as there is a Conservative party nominee in the chair of the health authority and the unit manager is a close advisor of the Secretary of State, I suspect that there is no question but that the decision on that hospital opting out will go ahead roughshod without any reference to public opinion.

My hon. Friend the Member for Peckham (Ms. Harman) spoke of bribes and blackmail. It is interesting to consider what has happened in Leeds Western health authority in relation to the general infirmary. The district general manager, without the approval of the health authority, appointed an outside consultant to write a report on the future of the general infirmary. That report was commissioned and paid for by one of the key

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ideological advocates of the opt-out proposals. The report's sole conclusion was--surprise, surprise--that it would be in the interests of the general infirmary to achieve opt-out status. The report also stated that, if the hospital continued in its current state, with its current fabric, it would not be fit to be judged a modern hospital. Rumour after rumour has come from the chairman of the authority and the district general manager. That has been passed on to the consultants, the staff and the public. The message is clear : "If you do not opt out, the money for phases 1 and 2 of the general infirmary will not be forthcoming". Those are the tactics of the bully boys who have gone into the gutter in desperation to force their proposals through.

The obvious conclusion from the debate is that the Conservatives have no confidence in their proposals. They are driving them through for pure ideological reasons, and that will be part of their down fall. We look forward to campaigning on this issue, because we know that we speak for the public on the NHS.

Mr. Foulkes : I shall take just a couple of minutes to show from our experience in Ayrshire that the Government's proposals represent one of the biggest cons ever perpetrated on the British people. The chairman of the health board confirmed in December that throughout Ayrshire there was no interest in opting out. The Under-Secretary of State for Scotland, one of the ideologues of the Government, could not stand that, so he instructed the health board to manufacture an interest. The administrator in north Ayrshire was against the proposal and said that there was no interest. What happened to him? He was moved sideways to a position where he had no influence.

The administrator in south Ayrshire decided to go along with the health board. He used bribery, saying that phase 1 of the hospital will come about more easily under NHS trust status, and the hospital agreed to consider it. The consultants voted on it and, as 89 per cent. of them were against opting out, they decided not to consider it. In spite of that, the unit administrator went ahead with the proposals and a working party has now been set up to look into the possibility of opting out. The Scottish Office is paying for consultants to carry out a business plan. That demonstrates the way in which they are considering the proposal. It is not a care plan or a feasibility study, but a business plan.

We know what will happen next. That business plan, which will be prepared by the end of August without any of the necessary information being available, will be accepted by the health board nominated by the Tory Ministers. They will agree to that plan and put it up to the Secretary of State and of course he will accept it. There is no demand for it in Ayrshire, yet it will be forced on the people of Ayrshire. It is absolutely clear that, if there were a ballot, the people of Ayrshire and Arran would reject it overwhelmingly. That is why all Opposition Members who represent Ayrshire constituencies support the amendments to the Lords amendments. Although we support such ballots, one ballot that would end all such proposals once and for all--and we would much rather have that ballot as quickly as possible--is a general election.

Mr. Kenneth Clarke : We have had a long and rather animated debate on a proposal that we have discussed many times before. Those who may be listening to our heated exchanges might be surprised to reflect on the fact

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