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(b) such other persons or bodies as the Board or the Agency considers appropriate ;
and the relevant Board or the Agency shall report the results of those consultations to the Secretary of State, who shall not make an order under subsection (1) above, unless those consultations establish a substantial body of support for an NHS trust among the staff of the hospital, establishment or facility and the local community it serves.'.
Amendment (b) to the proposed Lords amendment in line 3, leave out consultation' and insert ballot'.
Lords amendments Nos. 42 to 44, 118 to 122, 141 to 145 and 171.
Mr. Clarke : The amendments are concerned with the consultation process on the establishment of national health service trusts when our reforms are implemented, beginning in April of next year. In our discussions of the proposed reforms NHS trusts are often referred to as self-governing hospitals. That is a rather simplified description because the NHS units interested in self-governing status as NHS trusts extend beyond hospitals. As far as I am aware, the hospitals interested range from some of the biggest to the smallest. There is also a great deal of interest in NHS units delivering services to mentally ill people and community-based services of one kind or another. There are even two or three ambulance services that are interested in the prospect of having much more control over the way in which their part of the service is run inside the NHS. This is not the occasion for me to set out again at great length the virtues we see in returning to the NHS much more devolution of responsibility and accountability. That should be given back to those at the sharp end of the service--those people delivering care on the ground--where they have the necessary competence, enthusiasm and ability to discharge those responsibilities properly.
The first NHS trusts will be established in the spring of next year, when leadership will be provided by local people sitting on a board chaired by a leading figure of the locality. That board will comprise executive and
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non-executive bodies on the smaller corporate-type model that we are advocating for health authorities and trusts under the regime. Those boards will put forward their particular plans for the development of their part of the NHS. Shortly after the Bill receives Royal Assent--I should imagine by the middle of nextmonth--applications to establish NHS trusts will come to me and the regional health authorities from local enthusiasts. They will set out what they think they could do to raise the quality of care to their patients in their part of the NHS if given the necessary autonomy to do so.
There are many people in the NHS who will welcome the fact that NHS trust status will give them a much greater control over the day-to-day affairs in their hospitals. There are many who are anxious to get away from the detailed supervision of their affairs undertaken by district health authorities, regional health authorities, my officials and Ministers of whatever party is in power. I believe that a further injection of pride will be given to those local units that take advantage of the opportunity to establish an NHS trust. The staff of those units and all those served by them will have an increased sense of identity with the local hospital-- their local part of the NHS--that is such a great feature of the service we are discussing.
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The Labour party has throughout bitterly opposed NHS trusts for reasons that have, at times, totally mystified me. Once or twice during our proceedings on the Bill I was struck by the irony of the fact that this particular part of the Bill reverses the policy of the National Health Service Reorganisation Act 1973, introduced by the then Conservative Government. By a further irony I was the Government Whip who ensured that we had a majority when we implemented the 1973 Act which introduced the system of area and regional health authorities. That was done in the teeth of the bitter opposition of the Labour party.
That Act brought to an end the long-standing system of local management of the NHS based on the old hospital management boards and similar arrangements throughout the service. Obviously we are not going back to precisely the way in which the health service was run in its first 25 years. We are introducing much more up-to-date and sensible arrangements that are capable of allowing local decisions. Nevertheless, it is right to go back to a system whereby the NHS, as in its first quarter of a century, brings out the best in local management, enterprise and ideas about how best to deliver care to local patients.
In 1972 the Labour party did not have a clue about why it was opposed to the creation of the health authorities. It firmly committed itself to hand the entire service to local government once it came to power. I remember that the then Opposition spokesman was emphatic about that. The Labour party did not reverse Keith Joseph's reforms, but kept them untouched and untroubled by new ideas from 1974 to 1980. Now the Labour party is dying in the last ditch to defend the rights of the health authorities we created, which were introduced to provide detailed supervision of the day-to-day management of every part of the NHS. The Labour party is defending the right of the district and regional health authorities to second-guess day- to-day management even when we identify local
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people who want to take responsibility in their hands through an NHS trust. That is what the debate has been about.The amendments concern the necessary consultation on the establishment of NHS trusts when I receive applications from those promoters who wish to establish such a trust in their area. There is no change of policy behind the amendments and that is why I made a short plea earlier for us not to spend another five and a half hours talking about this, as we did on Report for reasons best known to those who face me in the Chamber.
I have looked up the Second Reading debate when we first presented the Bill to the House. On 7 December 1989 in column 502 of the Official Report I first made it clear that there would be public consultation whenever an application for an NHS trust was made. On 7 December we had the first debate on consultation, ballots, and so on. No doubt the Opposition will rehearse those arguments as we proceed tonight.
In the past few weeks the hon. Member for Livingston (Mr. Cook) has claimed that things have changed since December and that my timetable has slipped. The hon. Gentleman has been whistling in the dark with some enthusiasm in the hope that the introduction of the reforms will be put back. I recommend the hon. Gentleman to read column 505 of the Official Report of 7 December where I first made it clear that the pattern of service in the first year of our reforms would generally reflect the existing pattern of service, because most people wanted to persist with that existing pattern. The opportunities for change will begin in April of next year. Ever since I produced the White Paper and advocated the reforms, I have made it clear that, thereafter, the changes will evolve steadily with everyone learning from experience. They will take advantage of the greater opportunities that the reforms offer to change the service, raise the quality of care and improve the value for money for the taxpayer from the huge sums of money that the Government are not committing to the NHS.
Our response to the repeated concerns that have been expressed in the House and in another place about how the consultation should be run and whether we really meant what we had repeated time and again--that there would be public consultation--was put into the Bill in another place. The amendments collectively ensure that a full process of public consultation will be undertaken.
Returning to what I said a few moments ago about the likely state of progress, if we obtain Royal Assent in the next few days, I shall formally invite applications for NHS trust status. My current expectation is that in the next month the people who believe that they will be ready to form the first NHS trusts in April 1991 will put in their applications. I do not have an exact figure, because it is essentially a matter for local initiatives, but I should expect more than 70 applications from the part of the health service for which I am responsible in England. Thereafter, in accordance with the amendments, the regional health authorities will carry out a process of public consultation with every relevant interest, including the community health councils, that appears on the face of the Bill.
Mr. George Foulkes (Carrick, Cumnock and Doon Valley) : Will the Secretary of State give way?
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Mr. Clarke : I shall give way to the hon. Gentleman, but I stress that the numbers to which I referred relate to England and not to Scotland.Mr. Foulkes : I appreciate that the Secretary of State was talking about the figures for England. However, he will agree that the principles remain the same north and south of the border. The new Ayr hospital is being set up in my constituency and the local health board informs me that there has been an expression of interest in self-governing status. From where does the Secretary of State expect that expression of interest? About whom is he talking and what groups does he expect to come forward with such proposals? If the vast majority of senior doctors and consultants in an area are against NHS trust hospitals, would he consider it viable to go ahead? I am asking not whether it would be acceptable or possible but whether it would be viable.
Mr. Clarke : The applications that I am expecting will come from groups of people comprising local clinicians, local nurses, local managers and perhaps local figures such as business people who may have had previous experience of the health service who, as a group, will put forward a proposition for the local NHS trust management of a particular unit. The formal applications will identify who is putting forward the proposals. I expect that most of them will identify the prospective chairmen and the people who would like to be members of the board. Most importantly, the applications will be the documents on which the consultation will be based and will set out proposals of that group for the management of the unit and the development of its services. It will set out the case for saying that that group should manage the unit with NHS trust status rather than continuing with the present direct management by the district health authority in England or the health board in Scotland.
Mr. Foulkes : Is the Secretary of State aware that in Ayrshire, and I am sure elsewhere, there was no local spontaneous request for NHS trust status? The only reason anything is happening is that Don Cruikshank, on behalf of the Under-Secretary of State for Scotland, came and stirred things up. The managers of the hospital were promised that they would get phase 2 only if they were to consider trust status. They were then offered free the services of a consultant firm who will put up a package and stimulate interest in it. Interest is being stimulated centrally by the Minister and not locally. The proposal is being strongly opposed locally. It is being imposed from the centre by the Government without any local interest or support whatsoever.
Mr. Clarke : I do not know this Don Cruikshank, but he sounds a very enterprising fellow.
Mr. Foulkes : He runs the health service in Scotland.
Mr. Clarke : I am not responsible for the Ayrshire hospital. I would advise the inhabitants of Ayr to wait and see who is really promoting the reforms and what they say. I cannot gainsay what the hon. Gentleman says, because, as he knows, I do not have direct contact with the health board in Ayr--that is the responsibility of my hon. Friend the Under-Secretary of State for Scotland--but I know from my experience in England that opponents of NHS trusts have been given the most extraordinary descriptions of what is happening. The debate in the country has often
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been based on wild claims by the Labour party and local trade unions which will be gainsaid in July when real applications and promoters set out their plans. We are putting on the face of the Bill our commitment to consultation on our reforms and the nature of that consultation when we move on to much more sensible discussion. So far, people keep carrying out ballots among consultants and staff and local authorities organise ballots among members of the public based on daft literature giving daft descriptions of what they say is going on in the hospitals. I shall come on to some of the daft literature in a moment, as most of it is being put out by the hon. Member for Livingston. In July, for the first time people will be putting forward proposals for improving their local hospitals and, as I said on Second Reading, wanting serious local discussion on the issues involved and the future quality of care and access to services for the local residents if NHS trust status was approved and went ahead with a particular collection of promoters.Mr. Thomas Graham (Renfrew, West and Inverclyde) : Does the Minister realise that it has been proposed that the local hospital in Inverclyde should opt out? Why is he frightened of democracy and the right of local people such as the people of Inverclyde to conduct a ballot? There is a demand for a ballot. I thought that a ballot represented the process of democracy. The Conservative party is in government as a result of that process, so it should not be frightened of giving the local people of Inverclyde the right to a ballot to decide whether they want anyone other than the health board to run their hospital.
Mr. Clarke : I am grateful to the hon. Members for Renfres, West and Inverclyde (Mr. Graham) and for Carrick, Cumnock and Doon Valley (Mr. Foulkes) for bringing me up to date on the process in Scotland. I am delighted to hear that applications for self-governing status are likely to flood in north of the border and that there is interest in Ayr and Inverclyde. We have no lack of confidence in ballots. I propose to argue yet again the case against reducing serious plans for local health care to semi-political yes/no ballots among selected groups organised by the local Labour party.
Mr. Graham : That is insulting.
Mr. Clarke : It is not insulting. The hon. Gentleman was not here for the speech of the hon. Member for Livingston, who made it quite clear what his approaches will be when local enthusiasts put forward proposals next month for self-governing status. Was he interested in the quality of care? Was he interested in the health service? Did he want to have discussions about the details of its management? He said :
"We shall treat every consultation on opt out as though it were a by- election."
The Labour party has taken that approach to health reforms for the past 12 months. So far it has not produced one serious proposition to reform or improve the national health service. The Labour party's policy could be written on the back of a postage stamp. I regret that, since we first brought forward our proposals, the Labour party has joined some of the professional trade unions, as well as the TUC affiliates, in inventing ridiculous scare stories which they can exploit locally to win votes for the Labour party. I warn the Opposition that, if their reaction to local doctors, nurses, managers and people committed to the
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health service putting forward proposals is to run around behind front organisations such as Save our Hospitals, Health Emergency and other groups, trying to terrify patients into voting for the Labour party against illusory fears, it will rebound on them very badly. Several Hon. Members rose --Mr. Clarke : I shall give way in a second.
The National Association of Health Authorities--an association of health authorities in England and Wales--is in favour of our reforms. Opposition Members will recall the Vale of Glamorgan by-election which they won by making a great deal of health service reforms. It was quite clear in Glamorgan that at that early stage, the Labour candidate and those helping him had persuaded the public in Glamorgan that our health reforms meant that they would have to pay for their treatment. That sort of by-election campaign is distasteful and discredits the Labour party. It should not repeat it on the consultation process on the NHS trust. I have my hands on a document that makes it quite clear that it intends to repeat that scurrilous behaviour.
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Mr. David Winnick (Walsall, North) : Is the Secretary of State aware that, given his position, he is quite right to be cautious and wary of balloting or any form of democracy, rather like the leaders of the old eastern Europe countries? Is he aware that in my borough, where the Manor hospital is on the list, there was a household referendum organised by the council with questions approved by the health authority that is keen--at least the full-time administrator and Tory chairman are keen--on opting out? That authority agreed that the questions were fair. In the referendum, 78 per cent. said that they were opposed and 17 per cent. were in favour. Given those figures, is it not clear that the reason the Secretary of State does not want balloting is because he knows very well that he would lose by a landslide majority?
Mr. Clarke : As I said on 7 December, we shall have public consultation when we have the local plans and sensible local discussion. The eventual decision must wait for production of those plans so that their quality can be evaluated. In Walsall and elsewhere, the Labour party has jumped the gun before the proposals have been made so that it can describe them as it likes. Some Labour local councils have money coming out of their ears because of the community charge that they have levied. They have spent much of their charge money on political propaganda and telling the local population that their hospitals are under great threat. They then carry out ballots on the issue. Money has been wasted on political propaganda by elected councillors in places such as Redditch and Walsall. The National and Local Government Officers Association is pouring money into groups such as Health Emergency and Save Our Hospitals a long time before anybody knows what is proposed for local hospitals. That is what lies behind those ridiculous ballots. That may be repeated--we have been promised that it will in the summer. I think that there will be a proper process of public consulation. The public are concerned about their health service. Sensible people will read the documents and discover what is proposed. I hope that they will make
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proposals about what they would like to see in the service. The Labour party's campaigning will be seen as irrelevant and something that tries to exploit fear.The Labour party thinks that this is all about a by-election and wants to reduce the issue to the organisation of local ballots. When the health service was first set up by my great predecessor, Nye Bevan, it was a controversial change. No ballot of any kind was organised in 1948. In the 1945 general election both parties were committed to the national health service, but setting it up was controversial--doctors voted 9 : 1 against Nye Bevan and his suggested contract. Quite rightly, he took no notice of the 9 : 1 ballot because he discussed the matter seriously in the House and got his majority. In the intervening 40 years, no Government have ever thought it sensible to organise a ballot, among whatever electorate, on the details of the management and financing of local hospitals. Let us take the example of a medium-sized firm in the constituency of the hon. Member for Walsall, North (Mr. Winnick). Locks and chains are no longer made in Walsall, but let us imagine any modern and thriving town. No one would believe that changes in the management of a local firm should be the subject of a ballot organised by Walsall council, subject to leafleting by local trade unions. Whatever products are made in Walsall, I dare say that they are less important than the services given by the national health service. There are few things more important than the health care given to our population by the national health service. Therefore, we should have the highest standards of management, efficiency and value for money in the NHS. We should not reduce its management to a political circus for the benefit of Opposition Members who want to fight by-elections on the back of it.
Mr. Derek Fatchett (Leeds, Central) : I have heard the Secretary of State make that argument before, and I have never found him convincing. I remember the Secretary of State in one of his previous roles in the Government--as Secretary of State for
Employment--advocating the extension of ballots in connection with trade unions and industrial relations. He seems to cut his cloth conveniently according to which job he holds. The Secretary of State says that management issues should not be subject to ballots. He also says that key social and political issues should not be subject to ballots when they affect important services such as the national health service. How does he square that with the way he voted on opt-out schools, where a ballot must take place on the management of the school and a resource that is of great importance socially--of equal importance to the national health service? Is it just that the Secretary of State finds it convenient to cut his cloth in one direction for the health service, because he knows that he will lose the ballot, and in another direction on opt-out schools?
Mr. Clarke : I am glad that I eventually persuaded Opposition Members with my arguments on trade union ballots. I remember that they were against them, said that scabs would interfere with the proper running of trade unions, and restrict their right to take industrial action against whoever they pleased. With teeth clenched and holding back their wilder colleagues, Labour Members now say how much they welcome the introduction of ballots for trade unions, so that strikes can be organised only with the consent of union members. I hope to
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persuade the hon. Gentleman with my arguments today. We have just agreed to debate these amendments for eight hours--I know that we are covering some familiar ground.Education involves a tightly knit group of users. We are not talking about ballots of staff alone. It is not just the teachers who make the decisions, because they do not own the school. We do not run workers' co-operatives in education or health. But there is a defined group of people at any one time --a set number of pupils--who receive the service. They are the only ones directly receiving the service and their parents are the ones who are offered a vote on education. In the health service there is hardly any unit or hospital where the catchment area is so predictable. We do not have hospitals that serve only the people who live in the same borough and do not take people fom outside. Plainly, the staff are not a group of people who can decide about management because the hospital does not belong to them. With the greatest respect to consultants--who are probably the key staff and deliver the service--the hospital does not belong to them. Consultants are always described as though they are some sort of amorphous, block body. There is a huge difference between consultant orthopaedic surgeons who have beds and admit patients, consultants who may be academics with contracts, anaesthetists and radiographers. Consultants are not a set body of people with one collective set of interests and views.
The public served by a hospital come from anywhere. If any of us were to be ill tomorrow in this Chamber we probably would not have the first idea to which hospital we would be admitted. Therefore, there is no electorate among whom we could organise the ballot. The health service is such a giant organisation and so complex that it is not patronising to say that scarcely any member of the public understands how it is managed and financed. One problem is that it is such a chaotic system that not everyone inside it knows how it is managed and financed.
The idea that the document proposing how it should be run in future should be based on some electors who answer a simple yes/no question about the development of services in their district, guided as they will be by the sort of rubbish put out by the Labour party in leaflets while consultation is being carried out, is bad. It would be irresponsible to run a great national service such as the NHS in that way. The Labour party is irresponsible and has no ideas for the service. Its members see this as an opportunity to make mischief and win votes by terrifying old people about the service that they are likely to get.
Mr. Alun Michael (Cardiff, South and Penarth) : The Secretary of State appears not to have learnt the lesson of the Vale of Glamorgan by- election when there was a thorough discussion about the health service and the nature of the health service that people want. Our excellent candidate, and people such as my hon. Friend the Member for Livingston (Mr. Cook) and others who thoroughly debated the health service, received a positive response and people responded positively to our proposals for the health service. As we seem to be educating the Secretary of State about what is happening outside England, let me bring him up to date on the position in South Glamorgan. At present, the South Glamorgan health authority is scrabbling for cuts worth £7.2 million--
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Madam Deputy Speaker : Order. The hon. Gentleman is intervening. Whatever else we do in this Chamber, we do not fight by-elections all over again.
Mr. Clarke : As the hon. Gentleman knows, I am not responsible for the South Glamorgan health authority. Welsh Question Time would be a better place to raise such matters.
Let me move on to the kind of consultation that we envisage. I have described what I want.
Mr. Tony Favell (Stockport) : I have not had the advantage of listening to the Committee's deliberations. As my right hon. and learned Friend knows, I am a simple fellow and I should like a simple answer to a simple question. Will the patient be better off with a self-governing hospital or with the great bureaucratic trail which, in Stockport, for example, goes from the hospital to the Stockport district health authority to the North West regional health authority to the Elephant and Castle to the Treasury and then all the way back down the trail?
Mr. Clarke : My hon. Friend's question makes it clear potentially where the answer lies if the NHS trust is well judged and the right local people have the right local plans. The first part of his beguilingly simple question is the key for all members of the public. When I, as Secretary of State, look at applications for NHS trusts, I shall make the final decision on the basis that he suggests in the first part of his intervention : is a self-governing trust likely to improve the service to the public and will it be in the interests of the NHS to have that degree of local freedom? I hope that we shall then have non-political, serious, local discussion involving those who work in the service, those who are served by it and anyone who has a sensible proposition to put forward.
The Labour party will apparently join in that three-month public consultation. It does not always join in. Often it joins in behind the shield of organisations with names such as Hospital Alert, Health Emergency and Save Our Hospitals, into which the public's community charge has been tipped. The BMA is also promising a great campaign. The BMA and the Labour party ran a pretty silly campaign last summer and they appear to be saying that they will run the same one this year.
The Labour party's document "A question of trust" contains its manifesto for opt-out ballots. Yet again, it shows that all these months in it is still proposing to go round this summer putting out exactly the same myths. I have never used the phrase "opting out" to describe the proposals, because it does not describe them. The hon. Member for Livingston and his hon. Friends continually talk about hospitals opting out of the NHS. The hon. Gentleman has the courtesy to agree that that is his case. He is not on the stumps now ; he is in the House of Commons. He knows that nothing will leave the NHS. NHS trust status has nothing to do with a hospital leaving the NHS. It is local management within the NHS and it is utterly untrue for him to sit there rah-rahing in words that he uses on the platform, saying that such hospitals will be leaving the NHS.
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The treatement will be free. I have already mentioned the Vale of Glamorgan by-election where electors were clearly told that they would have to pay for treatment.
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That has all been repeated in the document. It uses weasel words. Anyone reading about the opt-out ballots that the Labour party is running will see the heading"Treatment will not be accessible".
I will not read what follows, but there is nothing that describes the reforms which remotely justifies that statement. Then it says of treatment,
"It will not be free."
That is an utterly disgraceful assertion.
The Labour party has pressed for public consultation and the amendments, which it will not vote against, give the public the consultation that it has demanded, but its response is to issue guidance which will result in anyone following it not telling the truth when he tries to get Walsall council or some other band of idiots to hold a local ballot and get a negative answer.
Mr. Robin Cook (Livingston) : The Secretary of State takes exception to the term "opt out", but he will confirm that, after he has made an order, such hospitals will be run by a board of directors which will own the property and have full legal title to it with the freedom to sell such part of the property as it chooses. That board of directors will hire and fire everybody employed in the hospital and be responsible for balancing the hospital's books by trading in services and being responsible for raising every penny by selling the services. That board of directors has the freedom to go to the City of London and borrow on the private market. Under the Bill, the board of directors has the freedom to make profits and retain profits year to year. There is no material particular in the ownership and structure of such hospitals which differs from any Nuffield or BUPA hospital.
If the Secretary of State is so confident that the statements in that document are weasel words which cannot convince anybody, why is he so afraid to let the local people decide? Does he not understand that the arguments that he has been advancing for the past half an hour are precisely the same arguments that Wellington used against the Reform Act 1832--that elections were too complex, that they could not be reduced to simple decisions and that people were not sophisticated enough to understand the issues? Why does he not have the courage to put his policies to the decision of the electorate?
Mr. Clarke : The hon. Gentleman repeats on the Floor of the House the kind of nonsense that he puts about outside and--here I congratulate him--without the trace of a smile or a flicker of his beard, although he must know that the NHS trusts that we are talking about bear not the slightest resemblance in any serious particular to a BUPA, Nuffield or any other private hospital. The land for which they are responsible will remain NHS land. Local NHS managers will be empowered, as local managers are now, to sell up to certain limits, but above a low limit they will require the consent of the Secretary of State before they dispose of land. The patients will be NHS patients, not paying a bean for the service, receiving it free. Contrary to another untruthful statement in the document, the staff will all be NHS employees. They will be public servants receiving public service pensions. They may agree with their local management to vary from the national pay rates in the NHS, but they will be NHS staff. The board will not have any shares in anything, because there will not be any private capital. No profit will be made. Nothing will be distributed to anybody. It will not be a commercial undertaking.
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The hon. Gentleman makes my case by getting up and giving us a fantasy vision of an NHS trust as some kind of private hospital when he knows, or should know after hundreds of hours of debate, that what he has just described is nonsense and a travesty of our descriptions of how to run the NHS better with the right local promoters.Mr. Andrew Rowe (Mid-Kent) : Will my right hon. and learned Friend confirm that there have been informal discussions with one of my local district health authorities about the real possibility that the whole district might become self-governing, which clearly demonstrates the rubbish being talked by Opposition Members?
Mr. Clarke : I am grateful to my hon. Friend. Many people in the service are enthusiastic. We have always promised full public consultation on proposals. The amendments put in statutory form the public consultation that we promised, and they should have allayed all the serious fears. There are no serious fears on the Opposition Benches ; there is mere political opportunism that if Labour Members misdescribe the proposals enough they might win a few votes for the Labour party in the course of the public consultation process. That will be irrelevant to the public consultation process. There will be a serious discussion about how best to improve the local health service.
I invite the House to agree with the Lords in the relevant amendments to ensure that public consultation has a statutory foundation and that we can put our repeated promises into effect.
Ms. Harriet Harman (Peckham) : If the Secretary of State is as confident as he seems to be that these proposals are minor, technical, managerial matters which seem to be engendering a new breed of people whom he describes as local enthusiasts, why does he not agree with our amendments? Why does he not agree that there should be a ballot, or that after consultations have been held a hospital should opt out only if there is support for it to do so?
When the right hon. and learned Gentleman talks about not taking seriously local people's views about whether their hospital should opt out, he underplays the importance of opting out, implying that it is a minor, technical change. Yet elsewhere he stresses that the creation of opted-out hospitals is one of the key proposals, and so it is. That is why people want, and are entitled to, a say in whether their local hospitals opt out of the local national health service. Our amendments, which the Secretary of State will oppose--
Mr. Keith Mans (Wyre) rose--
Ms. Harman : I shall give way later ; I want to develop my argument.
Our amendments would give people at local level the right to stop their local hospital opting out of the local NHS by a decision of the Secretary of State. Under the Bill, all hospitals will be forced to compete for patients in the internal market-- [Hon. Members :-- "And why not?"] Patients will lose choice because the quality of care will suffer as hospitals cut corners, competing to win contracts by reducing their costs. The internal market will affect all hospitals--
Mr. Mans rose--
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Opted-out hospitals are to be the leading edge of the internal market. They are to be the market leaders, as the Secretary of State would describe them in his salesman's jargon.To play this role, opted-out hospitals are to be cut loose from their local communities. No longer will they be directly managed by the local district health authority ; no longer will they be an integrated part of local hospital and community services. There has been much talk of the freedom that will be bestowed on opted-out hospitals--the freedom to drop uncompetitive services if they are expensive and do not bring in enough revenue, for instance. These will be services such as those provided for the long-term chronically ill, geriatric patients and the mentally ill.
Opted-out hospitals will have the freedom to divert services to private patients--[ Hon. Members :-- "Not true."] I suggest that hon. Members read the Bill, because I am basing my comments on it. Opted-out hospitals will have the freedom to divert services to private patients to stoke up their income. They will have the freedom to bid for contracts and perhaps draw in patients from other district health authorities by offering waiting times so as as to get bigger contracts from neighbouring health authorities.
Mr. Jerry Hayes (Harlow) : Would the hon. Lady be kind enough to be straightforward and tell us precisely where in the Bill all her allegations or even the suggestion of those allegations come from? She knows very well that what she has just said is wholly inaccurate, because district health authorities--and, if need be, the Secretary of State--will be able to intervene if there are local eccentricities of the kind that she suggests.
Ms. Harman : In Committee we proposed amendments on all these points which would have prevented opted-out hospitals being cut loose from their local communities, and the hon. Member for Harlow (Mr. Hayes) among others, voted against them. We proposed amendments that would guarantee local access to core services for the elderly, for children and for psychiatric patients, but they were voted down. We tried to put safeguards in the Bill, but the Conservatives voted them down--
Mr. Mans rose--
Ms. Harman : I shall carry on for a bit.
It has been suggested that opted-out hospitals will have the freedom to bring in patients from Europe. The location of St. Thomas's hospital at the channel tunnel terminal is seen as a wonderful opportunity to provide services to patients from Europe. But that is not how people living near St. Thomas's, who want to use the hospital see it. They know that they will lose. When opted-out hospitals exercise their muscle in the market place, local people will be the losers. If they are unfortunate enough to need one of the services that have been dropped as uncompetitive, they will no longer be able to turn to their local hospital--they will have to go elsewhere. The so-called guarantee of local access to certain key services described as core services, which had pride of place in the White Paper, has no place in the Bill.
Mr. Hayes rose --
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Ms. Harman : Local people have no guaranteed right to those core services in an opted-out hospital. In Committee, the Government voted down our attempts to guarantee local access.
Mr. Hayes rose --
Ms. Harman : The hon. Gentleman was there ; he knows that they voted down our guarantees of local access to services for children, the elderly and the mentally ill--
Mr. Hayes rose --
Ms. Harman : I have already given way once to the hon. Gentleman, and I know that he will seek to catch the Chair's eye later. If private patients prove more lucrative than local NHS contracts-- [Interruption.] I hope that the hon. Member for Harlow will listen to what I am saying. He seems to be getting agitated.
If private patients prove more lucrative than local NHS contract patients, local people will lose out to patients under contract from BUPA, to which the opted-out hospital could be selling its services--or the French equivalent might even come first. If a neighbouring consortium of district health authorities which had formed themselves into a purchasing consortium wanted to place a large contract for a large throughput of patients, to win that contract an opted-out hospital could agree terms which gave patients under that contract preference over patients from the local district health authority. There is nothing in the Bill to stop that. There is no reason why opted-out hospitals should not act in that way as they will no longer be part of the local health authority. That is the whole point of opting out.
Mr. Kenneth Clarke : Perhaps I may reassure the hon. Lady. The only proposals in the service for consortia of district health authorities for purchasing purposes are coming from district health authorities which contain self-governing units. Local district health authorities would put together what is usually called their purchasing roles--I prefer "planning roles"--to put themselves in a stronger position to stipulate the quality and sort of care that they want from the self-governing hospital in their territory.
Ms. Harman : The Secretary of State does not understand how his internal market will work. Consortia of local district health authorities coming together to increase their purchasing power need not buy contracts only from their locally managed hospitals or even from their local opted- out hospitals. They could buy contracts with other local opted-out hospitals. The right hon. and learned Gentleman's argument does not, therefore, negate what I have said. The situation is exactly as I have described it : large purchasers can arrange contracts with opted-out hospitals in such a way that people coming under the contract offered by the consortium of district health authorities would receive care in preference to local people.
Opted-out hospitals will not look to their local communities because the chairman will be appointed by the Secretary of State. The Secretary of State's appointees in the regional health authority will appoint the non- executive directors. The chairman and non-executive directors--direct or indirect appointees of the Secretary of State--will appoint the non- executive directors, so the
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focus will be on the Secretary of State, not on the local community. That is why local people whose hospitals are targeted for opting out see it as a threat and want to have a say.All the talk about local enthusiasts springing up all over the place is nonsense. People who work in hospitals want to have a say because they care about the services that they help to provide and because they feel that they know about patient care. They also want a say because they would no longer be employed by the district health authority under Whitley terms and conditions. The Secretary of State said that those people would still be national health employees and that hardly anything would change. We spent many hours in Committee discussing clause 6. I remind the Secretary of State that that clause provides for the transfer of staff from health authority to national health service trust employment. Without their approval, they would no longer be employed by the district health authority but by the opted-out hospital. Of course they should have a say.
6 pm
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