House of Commons Hansard Debates for 16 Oct 1990

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suggest that we should go from door to door, telling people that they should vote for a particular health authority candidate. We would also be able to learn what the public want, in the way that we do when canvassing in local or general elections.

My plea, more to the next Labour Government and to my right hon. and hon. Friends on the Front Bench than to the present Tory Government, is that we should move towards direct elections, for I am sure that they would be welcomed by the vast majority of our constituents.

10.25 pm

Dame Elaine Kellett-Bowman (Lancaster) : In Lancaster we are lucky in the calibre of our district health authority, whose members include people of wide experience who know the area well. They are led by our exceedingly able existing district chairman, who has piloted huge improvements and innovations so that our local health service is at or near the top of any list of criteria or league table that one cares to use.

I am a great believer in encouraging the state of marriage, and I feel sure that the Government share my views. I am therefore puzzled by the regulations, because, while the Government have removed the advantage of unmarried couples living together in respect of mortgages, and the advantage of unmarried couples living together for social security purposes, they have reinstated in the regulations the disadvantage for a married couple living together in respect of the declaration of interest.

I refer to regulation 13(6) of SI 1330, and to the words "the interest of one of a married couple living together" and to regulation 20(5) in SI 1331, which refers to the situation "in the case of married persons living together."

Why should they be at a disadvantage? I should like an answer. 10.27 pm

Mrs. Alice Mahon (Halifax) : In Committee stage on the National Health Service and Community Care Bill, my hon. Friend the Member for Newcastle upon Tyne, Central (Mr. Cousins) referred to the new district health authorities as a system of management that Queen Victoria would have recognised when she surveyed the crowned heads of Europe, and he was absolutely right. Everything leads back to the Secretary of State, and my hon. Friend the Member for Livingston (Mr. Cook) was also correct when he said that the new set-up is centralisation in an extreme form.

In the case of Calderdale district health authority, off go the two council representatives, who happen to be elected Labour councillors, and the trade union representative, and on come the business men, with only one exception. We have the same chair as before in Alan Templeton, an ex- director of the Halifax Insurance Company. During his chairmanship, he has presided over every cut that the Government have proposed, even using his casting vote to get rid of the NHS's own laundry service, a decision which was followed by a few disastrous years.

The newly appointed vice-chair, Barry George, was vice-chair of the previous district health authority. From

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the positions that he takes, he is obviously a Thatcherite. Until recently, he was employed as an architect. A new member of the authority, Clifford Fee, is a long-time Tory party member. He is a former chair of Halifax Conservative Association and recently retired from the family business. His new post should pay about £250 per meeting, which is a nice little earner for a recently retired business man. We have Dr. Hughes, who was previously a board member and is a fairly reactionary, right-wing medic. When I was a member of the district health authority, he only came alive when there were cuts to be made. He always voted for them.

Another new member of the board is a solicitor, and not someone whom I have heard had any interest in or knowledge of the national health service until his recent election to the board, which has already met and voted through a round of cuts which will lead to the loss of 99 beds. I imagine that the solicitor is a Government supporter because he voted for the cuts without any previous experience, as far as anyone can tell, of the national health service.

The one saving grace is that a woman, Jackie Stark, has been elected to the board. She was the only person to vote against the cuts, and she has spent most of her life working for the voluntary sector. Apart from that one exception, we have middle-aged men with business backgrounds who will slavishly follow any cuts that the Secretary of State suggests.

Today I learned that the latest infant mortality rates in Calderdale were shocking. In Calderdale the rate is 12.6 per cent., in Yorkshire and Humberside it is 9.1 per cent., and in the rest of England and Wales it is 8.4 per cent. The perinatal statistics--deaths in first week or stillbirths --were 12.9 per cent. in Calderdale, 8.5 per cent. in Yorkshire and 8.3 per cent. for England and Wales as a whole. Given those statistics, I must ask myself what on earth this Tory-appointed group of people were doing voting for cuts in beds and cuts in maternity services.

I know that the Secretary of State and his Ministers have received representations from a group of people in Calderdale about planning permission for a 40-bed private home for people with learning difficulties. I mentioned the issue when I was on the Committee on the National Health Service and Community Care Bill. That plan is totally at odds with the district health authority's philosophy of care for such people. The group making representations came out of hospital recently and are speaking up on behalf of their friends in Stansfield View, who are totally opposed to the home.

I think that there is a hidden agenda and that Stansfield View will be emptied while 40 people with learning and physical difficulties are still waiting to come out. If planning permission is given--it seems that it will be--they will end up in a totally unsuitable home, situated between a canal and a river, on a rat-infested industrial site. The business men appointed by the Secretary of State will happily go ahead with that, but it bodes ill for the people of Calderdale.

I am disgusted at the deliberate way in which the Government have put their friends into lucrative part-time jobs. I hope that the rest of the country and the people of Calderdale realise that those whom the Secretary of State has placed on the board will earn about £250 an hour and they will make all the wrong decisions.

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10.33 pm

Mr. David Evennett (Erith and Crayford) : I support the regulations, and do not share the concerns that have been expressed by Opposition Members this evening.

Change for change's sake is never a good idea, but change to improve the system should be supported. Following the hon. Member for Halifax (Mrs. Mahon) is always an experience, but her view of democracy in the health service is totally wrong. Democratic control over the NHS is represented by Parliament and by the Secretary of State. That has always been the case and it always will be. We are the guardians of the national health service.

The Opposition spokesman, the hon. Member for Livingston (Mr. Cook), is living in the past. He and the hon. Member for Halifax seem to want to see their old friends, the Labour councillors and the trade union members, restored to the health authority--people who were not elected but nominated on a political basis. By means of the regulations, the Government intend to introduce better management and more management experience into the national health service.

Mrs. Mahon : Will the hon. Gentleman give way?

Mr. Evennett : No. The hon. Lady has had her opportunity to speak. It is high time that she listened to some common sense.

If the management of the national health service is to be improved, new people with management and business skills must be persuaded to offer their services. The NHS is a much valued and much loved national institution. However, we hear much criticism of the NHS in our constituency surgeries. The criticism that is most generally voiced, in both general and specific terms, relates to the local management of the NHS.

Unfortunately, there have been many examples of poor management. Although more money has been poured into the NHS, so that more patients can be treated, the criticism that is expressed--it is a valid criticism in certain areas--is that there has not been more effective and efficient utilisation of resources in the interests of patients. We need good management at all levels in the NHS to ensure that patient services are, and continue to be, first class. How can good management be achieved? Local councillors were not elected to the district health authorities ; they were appointed. Why should local authorities appoint health authority representatives? Of course there must be liaison between local authority social services and the NHS, but we need better management. Therefore, if we can appoint people who are better qualified to serve NHS management at local level, we should do so.

Mr. Geoffrey Lofthouse (Pontefract and Castleford) : Will the hon. Gentleman give way?

Mr. Evennett : Yes, I shall give way to the hon. Gentleman.

Mr. Lofthouse : If we accept that better management is required and that better management should be provided by people with experience of management in manufacturing industry, why is it necessary to go miles away from local health authority areas to pick such people? Does it mean that no suitable people can be found in the area?

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Mr. Evennett : The point is that we want the best people, wherever they may come from, so that they can provide expertise for the management of the NHS.

In conclusion--

Mr. Bob Cryer (Bradford, South) : Will the hon. Gentleman give way?

Mr. Evennett : No, I shall not give way. The hon. Gentleman never listens. If he did so, he might learn something. We have had too many sedentary interventions from him over many years.

We want to improve the NHS. We have put more money into it, and more patients have been treated. What we need now is a better management structure in the interests of patients.

10.37 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye) : I echo the concern expressed during the passage of the Bill, both on the Floor of the House and in Committee, and also tonight about regulations of this nature that are the consequence of the Bill having been passed. The hon. Member for Livingston (Mr. Cook) referred to the number of business men who have been appointed. We should not be surprised about that. The thrust of the reforms is to put the NHS on a more business-cum-private footing. From the Government's point of view, therefore, it is entirely consistent that business men should be put in charge of the NHS. As has been acknowledged, however, certainly on this side of the House and to a certain extent by Conservative Members, the sad thing is that all too often the business men and others who have been appointed have no direct local contacts. That is inappropriate when we are talking about the management of the NHS. Why is it, one wonders, that people have so often been moved in from other parts of the country to serve on district health authorities? I suspect that the reason is partly that, in some parts of the country, the political complexion is such that it may not be as easy as the Secretary of State would wish to find people of both his and his Government's cast of mind to serve on the authorities. Therefore, people have to be shipped in from elsewhere.

There is a more practical reason. If someone lives in a local community and is facing pressures and having to take difficult decisions--if he is the subject of letters in local newspapers, of people phoning him at home and of people making their concerns known to him when he is shopping--that is something of a strain. It is much easier to take cold-blooded decisions resulting in cuts, closures and a diminution of the health service when someone does not have to face the people whom his decisions will adversely affect. That is one of the reasons why the thinking of the Secretary of State in making these appointments is so clear.

Mr. Cryer : Is there a possible third reason--that if, as is unlikely, the Tories are re-elected, they have in place, free from any local accountability, a remote character ready to take the next step of privatising the national health service?

Mr. Kennedy : I would be straying a bit wide of the regulations if I answered that, but given the motives and the means that this legislation have given rise to, one

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cannot, being as generous as possible to the Government, dismiss the possibility of such a change following under a future Tory Administration. That should be said loud and clear ; I welcome the hon. Gentleman's intervention.

It is regrettable that, in addition to the other examples that have been given of the trade unions and local authorities, the Government resisted an amendment moved in Committee--their track record on these appointments confirms how useful that amendment would have been--to improve the comparatively meagre number of nurses who have been appointed. At the time of the original Griffiths management report and the recommendations that flowed from it, the Government were reluctant to concede a central role in the management of the health service to the nursing profession. They conceded it in due course, which was welcome.

Further down the line of management, that absence of guaranteed or direct nursing input has been replicated in the appointments that have been made. The Secretary of State was given lists of nominees by the regions from which to choose non-executive members. Nurses appeared on those lists, and some of the executive members are nurses, but the regions of Wessex, Yorkshire, South West Thames and North West Thames have no nursing representatives on the new bodies. That is not good for the health service, especially when the thrust is towards a business or management-orientated health service to deal with such items as throughput, which, as any nurse could advise those bodies, is not a mark of success. If people are discharged from the hospital sector into the community before they have recovered, their chances of recovery may be damaged and another statistic may be added to the admissions column a few weeks later. Throughput is not a categoric or sufficiently illuminating indication of success in the health service. Nobody would be better advised to tell a health authority that than a nurse, but all too often nurses have not been appointed.

The classic example of a lack of local knowledge occurred recently. We all know the very tragic circumstances that gave rise to the by-election campaign in Eastbourne. The Conservative candidate is known to us as the former Member for Glanford and Scunthorpe. He was recently adopted, and at this stage his knowledge of Eastbourne is not full and detailed. That was borne out by his statement during the campaign pointing to the success of one of the local hospitals. A photograph of that hospital was subsequently produced which showed it to be a pile of rubble.

That highlights the dangers of having people who do not have sufficient local knowledge expounding the virtues of the health service in a given locality. It was a classic example which considerably embarrassed the local campaign and, I suspect, the Conservative party nationally.

Mr. Rhodri Morgan (Cardiff, West) : It was a successful demolition.

Mr. Kennedy : As the hon. Gentleman says, it was a successful demolition. It remains to be seen whether a phoenix will rise from the ashes. One lives in some doubt about that.

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The new system is unrepresentative and undemocratic. It will put more and more power in the hands of central Government at the expense of local communities. For that reason, we shall be joining the Labour party in opposing the regulations.

10.45 pm

Sir Michael McNair-Wilson (Newbury) : I welcome the revision of the membership of the regional and district health authorities, and of the family health services, as much as anything because the previous membership of those bodies, even if drawn from a wider catchment, were remarkably out of touch with the areas and the populations that they claimed to represent. How rarely do I remember any of those authorities holding a public meeting in my constituency to explain the problems they were up against. The whole question of public accountability by those bodies has not left much of a mark on me. One of the weaknesses of these authorities always seemed to lie in the fact that, apart from the officers, most of the members were not sure what job they were meant to perform or whom they represented. In those terms, to have a more businesslike approach or, as my right hon. and learned Friend the Secretary of State said, to make a more effective decision-making team seems to make good sense and to be wholly welcome.

However, business efficiency and effective decision-making, although important--no one would dispute that every health authority requires that expertise--may be too narrow an approach. Nobody disputes the need for the NHS to be able to draw on business acumen and, as the internal market develops, that ability will become ever more important. However, what requirement is there for the new, non-executive officers to be NHS patients? That question has already been asked by the Opposition.

I believe that the members should be not only directors but consumers of the authorities if they are to have a valuable input into the discussions of those authorities. The regulations seem to have the single drawback that they lay too little stress on the voice of the consumer or on how the new bodies are to be accountable to the communities they serve. They are appointed for four years, but not by local people. Is their sole remit business efficiency? If so, what proposals are there for giving the voice of the patient some way of being heard?

Community health councils have also been mentioned. I suggest that, up to a certain point, they can fulfil the job of being the consumer's voice. However, if we want them to succeed as the consumer's voice in the newly shaped national health service, surely one of the non-executive members should be the chairman of the local CHC or there should be room for co- opted members on the new bodies. After all, if we are concerned with business acumen, and with restructuring and reshaping the national health service to give it a more businesslike approach to its massive task and to the huge funds it handles, we should follow big business down the road of having either a customer relations director or a customer relations manager among those who are non-executive, co-opted members.

In welcoming the changes, I believe that there is still a gap in what has been proposed. We should give the patient's voice rather more time to be heard than seems to be possible with these proposals.

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Mr. Ian McCartney (Makerfield) : I promise you, Mr. Deputy Speaker, that I shall take only a couple of minutes. I saw you raise your eyebrows when I rose, and I know that a number of hon. Members wish to participate. I am glad that you can take a joke.

I am probably one of the few hon. Members who knows the wrath of the Secretary of State. In his earlier office of Minister for Health, he sacked me from my local family practitioner committee. Conservative Members will probably say, "That is the only good decision that he has made at the Department of Health." I was sacked purely and simply because I had been put on the committee by the local authority and was asking pertinent but awkward questions about the administration of the committee. The right hon. and learned Gentleman could not find a local authority member with whom to replace me because there were no elected Conservative representatives in our area at the time. He left the position vacant rather than making a fresh appointment from among the local authorities. The Secretary of State has a long history of attempting to remove from authorities people with political views that he does not like, including some of the most efficient and hard-working people in the national health service, who have been withdrawn from service over the years.

The present regulations represent the final nail in the coffin of public accountability and public and local representation in the national health service. My authority, which looks after 340,000 people, has the following criteria : one must not live or work in Wigan, and if one is a member of the local authority or a community group that has comments to pass about the running of the health authority one will be excluded. Amazingly, when the present chairman of the health authority was appointed he said that he knew nothing about the running of the authority but that he was a quick learner. Since then, Mr. Hague has, indeed, learnt quickly. He has learnt about hospital closures because he is constantly closing hospitals. He has learnt about privatisation through his wholesale closure of hospitals and as he has privatised care for the elderly and the mentally ill. He knows something about contracts. At almost every health authority meeting, when the first item on the agenda is reached, the "public interest" is invoked, a resolution is passed and the public are thrown out. The authority then proceeds to talk about contracts for companies such as Takare. In privacy, the authority may change the whole system of contracts so that Takare is the only company that can apply for and obtain contracts. In private, the authority consistently acts against the public interest.

A Mr. Robertson, the retired chief executive of Robertson's jam, is to be appointed to the family health services authority. At least the health service in Wigan can look forward to jam tomorrow. Mr. Robertson is somewhat coy when it comes to whether he lives in the borough. The press statement sent to local Members of Parliament says that he lives somewhere in Cheshire. The members of the health service authority representing the professions also live anywhere but Wigan--in Cheshire, in Lancashire, in Bolton and in other parts of Greater Manchester but not in the local community.

I should have no personal objection to the Conservatives even controlling the health services authority if they lived in the borough and if they used, and were accountable for, its services. But that is plainly not the case. The Government are a centralising Government who are taking for themselves complete political control of

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the health service by means of appointees who do not live in or care for the local community and who do not care for the national health service. Many of those appointed have been appointed for one reason--their sole objective during their two or four-year term is to privatise as much of the health service as they can, preferably before the next general election. That is why I welcome the statement by my hon. Friend the Member for Livingston (Mr. Cook), that at the earliest possible opportunity Messrs. Robertson and Hague et al will be sacked and replaced by people who live and work in the community and who have a commitment to the national health service.

10.54 pm

Mr. Frank Haynes (Ashfield) : I am a bit surprised that the Secretary of State for Health has left the Chamber. He should be ashamed of himself. He should be here listening to what we are saying because the Opposition totally disagree with his proposals. Indeed, one or two observations have also been made by Conservative Members-- [Interruption.] Ah, the Secretary of State must have heard me because he has just returned to the Chamber.

We know what is going on. We know what the Secretary of State is doing. He frittered around with transport before he came to social services and I remember well what happened. The Secretary of State has made a mess since he took over his flaming job. He is now moving towards more closures for the national health.

The Secretary of State need not frown because I shall put him in the picture. He is coming to my constituency on Saturday for "Europe Week" and he will stand on a platform with the Conservative candidate for the next general election. [Interruption.] That is not a big joke. It is a serious matter. I warn the Secretary of State that he is going to get an earbashing on Saturday.

The Secretary of State obviously has some influence on cuts and the way in which a local health authority should spend its money. The Secretary of State knows where the King's Mill hospital is because he lives just down the road in Rushcliffe. I do not know what his constituents think about him there, nor do I know what people think of him in the city of Nottingham after what the Secretary of State has done there.

The Secretary of State must be aware of the finances that have been made available for Central Nottinghamshire district health authority. He has appointed people to carry out his dirty work. That is what it is all about. There will be no come-back. They sit around the table and tell the manager what she has to do--and the manager is a lady in Central Nottinghamshire. That wonderful lady has done a first-class job since she was appointed, but she will not be able to do the job that she should be doing because the Secretary of State has appointed all those bosses from all over the damn place and has sacked the real link with the community.

The Secretary of State talks about community care and he gets the Prime Minister to say the same things. They say that they care about the facilities that are provided in the community. At the Victoria hospital in Mansfield there are a number of bungalows provided for the mentally handicapped. They were built so that the parents of mentally handicapped children could have some respite. The children could move into the bungalows to allow the parents some freedom, a change and a rest. Two of those

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bungalows are to be closed, yet the Government talk about caring for the community. They could not care less. One of my colleagues made a good point earlier : every step that the Secretary of State has taken with regard to the NHS has been a step towards privatisation.

Mr. Kenneth Clarke : I am sure that the hon. Member for Ashfield (Mr. Haynes) will agree that I cannot leave it to my hon. Friend the Under- Secretary of State for Health to answer all that.

I am glad that I shall be meeting the hon. Gentleman in the Asda carpark at Sutton in Ashfield on Saturday. The hon. Gentleman's predecessor used to campaign with me for Europe and I hope that the hon. Gentleman will join me on Saturday. I hope that he has heard that the Labour party has undergone a conversion and the party's policy is now also in favour of "Europe Week". I look forward to visiting King's Mill again. I know it extremely well.

Mr. Haynes : On a point of order, Mr. Deputy Speaker.

Mr. Clarke : No, after the hon. Gentleman has heard me out on King's Mill.

Mr. Haynes : On a point of order, Mr. Deputy Speaker. In my contribution I have not mentioned Europe-- [Interruption.] Wait a minute--except for "Europe Week." That is all. That is what the Secretary of State is coming to. That is all I have said about Europe.

Mr. Deputy Speaker (Mr. Harold Walker) : Order. I very much--

Mr. Clarke : The last time I visited King's Mill hospital was to open a major extension that the Government had financed. I look forward to the expansion of services in Central Nottinghamshire health authority. To which of the new appointments to Central Nottinghamshire health authority does the hon. Gentleman really object? He is a fair man. He is not as partisan as he likes to make out on the Floor of the House. He knows perfectly well that we have appointed people who are interested in a better health service in central Ashfield. Would he please not lark about trying to claim that he seriously objects-- [Interruption.] The hon. Member for Livingston (Mr. Cook) has to go in for jobbery because he needs votes to be elected to the national executive. The hon. Member for Ashfield (Mr. Haynes)--I nearly said my hon. Friend the Member for Ashfield--knows perfectly well that he does not really object to any of the people whom I have appointed to Central Nottinghamshire district health authority.

Mr. Haynes : He has got a bloody neck. He really has got a neck to make a comment of that sort.

Mr. Deputy Speaker : Order. That sort of coarse language is uncharacteristic of the hon. Gentleman.

Mr. Haynes : I withdraw it, but I still mean it. I have not been laughing. The Secretary of State is still laughing--he has been laughing throughout the debate. He thinks that this a damn joke. This is a serious matter. We are all complaining about the rundown of the national health service in our own areas, and now the Secretary of State has appointed bosses who jump to attention when he says so. He is pouring money into their pockets. No doubt they

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will get an increase pretty soon-- [Interruption.] A part-time job with a damn good salary to go along with it, but to do his dirty work.

The reason why ward closures are taking place is that people are frightened of overspending by the end of the financial year. The reason why people are overspending is that this Secretary of State has cut services in the Central Nottinghamshire district. That is having a serious effect on the Ashfield constituency. I wanted to get up and say it, and I have said it.

11.2 pm

Ms. Joan Walley (Stoke-on-Trent, North) : I shall be very brief, as time is passing by all too quickly in this important debate. My points are about North Staffordshire district health authority. We do not want business men who have no knowledge of the local area or of local services wheeled in to deal with the management of the national health service. My hon. Friends have made it quite clear that there is a hidden agenda--that the changes are taking us one step nearer to the privatisation of the national health service.

Nurses who have been recruited in north Staffordshire and nurses on Project 2000 ask me whether I realise that they are afraid that there will be no jobs by the time they finish their training. What do business men know about decisions that are made behind the scenes by the Government? It is absolutely impossible to train the number of nurses who are needed.

A further point to which I object very strongly is that, having reduced the numbers on the district health authority, we now have to wheel in ex- members of the district health authority to deal with nurse regradings. They are paid in the region of £40 a day. Why cannot some concern be introduced? Why could we not have had people who are prepared to do that work, have knowledge, put in the time and visit all the different facilities in the area?

The community health council in north Staffordshire has made it clear that it thinks that it is totally out of order that it can no longer as of right sit on the district health authority. That is entirely wrong. We have heard so much about the interests of consumers, or patients, but there are moves afoot for the health authority to meet behind closed doors and for business men to run the NHS.

In north Staffordshire, a health profile report has been commissioned by the Stoke-on-Trent city council. It has identified huge amounts of ill health within Stoke-on-Trent. How can key decisions on health be made if there is no link between those who have been democratically elected? How are we to deal with the great problems posed by ill health under such undemocratic arrangements? I do not want the NHS to be run on entirely commercial lines. 11.5 pm

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell) : Although no one would realise it after listening to the contributions of Opposition Members, the regulations are designed to demonstrate the Government's commitment to improving the delivery of the national health service and to ensure that the health care that the British people enjoy from the NHS will continue to improve. The regulations are part of the programme which gives effect to the Government's commitment to more effective management within the NHS. That is understood by my hon. Friends the

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Members for Erith and Crayford (Mr. Evennett) and for Newbury (Sir M. McNair-Wilson), and I thank them for their support.

The NHS is a vast organisation--it is the largest employer in Europe. It is not a business, and we do not pretend that it is. It is, however, a huge organisation, and it can and should benefit from more business-like management, more effective management and by securing the best use of the resources that are devoted to it by the taxpayer on behalf of the patient. That is the purpose to which the motions are directed.

Mr. Lofthouse : If that expertise is required, why is it that a member of the Pontefract health authority is the managing director of the Rockware glass group--his factory is on the border of my constituency and an adjoining one and he lives in Rotherham--and another is a doctor's wife who lives in Wetherby, which is 20 miles away? I do not have the full list of the members at my disposal. Is there not a doctor's wife or a business man within the Pontefract health authority who has the expertise to do the job?

Mr. Dorrell : The hon. Gentleman is advancing an argument which was introduced on several occasions by one or two of his hon. Friends. If the purpose of the health authority is to secure the good management of health resources within its area, why does he consider it vital that every member of it should have what he deems to be the right postcode? That would not seem to be the critical factor when someone is nominated to serve on the health authority.

I must tell Opposition Members who feel so strongly about postcodes that their view is not shared by the majority of those who are involved daily with the management of the NHS. I have heard less adverse comment about the commitment to a more effective, slimmer and more efficient health service than about all the other principles that come within the NHS reforms. It is hardly a secret that the reforms have generated a degree of interest and controversy. Even the hon. Member for Livingston (Mr. Cook) could not make a leak out of that.

Within the national health service, this set of proposals is almost entirely uncontroversial. It is only Opposition Members, who are so consumed by the conviction that every decision in the NHS management should be regarded as political, who see this as a controversial initiative.

The hon. Member for Livingston has not answered in his mind the fundamental question--what a health authority is there for : is it a political forum or a management organisation? Is it there to hold an interesting debate about the quality of health care and the ideas of its members about health care in a particular area, or is it an organisation charged with the effective use of health service resources in a particular locality to produce the best health care it can for the patients who live there? I have no doubt what the answer is, but the hon. Gentleman does not seem to have sorted it out in his mind.

Let us consider the charges that he levied against the regulations this evening. He said that there was no representation as of right on the health authorities for the local authority of the district. That is correct, but there is no representation on the health authorities for anyone else

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either. They are not there as representational organisations--that is not their function, but the function of the community health council within the context of the health service.

When we are asked to whom the health service is accountable, the answer, as my hon. Friend the Member for Erith and Crayford correctly said, is that, since the day of its inception, the health service has been accountable to Health Ministers, not local bureaucracies, in whatever form they have existed during the history of the service.

Mr. Morgan : That is splitting hairs.

Mr. Dorrell : To talk of parliamentary accountability is not splitting hairs ; it is an important matter.

Mr. Morgan : When the Minister describes the health authorities as management organisations, he surely forgets that health authority members also acted as lay representatives when anybody was appointed to a senior position in a hospital. They were also asked to take particular care of one hospital and acted as lay representatives on grading appeals for nurses. Surely, if they are management organisations, numbers on them are suddenly reduced from 20 plus to five and the position is not thought through, we are then confronted with the problem of what to do with functions other than those of the business whizz kid management organisations, that the previous health authority members carried out.

Was there ever better evidence of a Government proposal that had not been thought through than this evidence that they are going back to the ex- members of health authorities that they have just sacked and asking them to do for money what they previously did for nothing when sitting on grading appeals for nurses?

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