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representative committees. Those who are clearly second-class citizens are the members of the nursing profession and people who are supplemental to the practice of medicine. Without them, does anyone believe that the practice of modern medicine could continue?

Mr. Ron Brown (Edinburgh, Leith) : I agree with the main thrust of the hon. Gentleman's argument. It is evident that what is happening in Northern Ireland is happening elsewhere in the United Kingdom and certainly in Scotland. Does he understand that we have the same feelings about the cuts that he and his people are suffering? If we support him, it is a matter of solidarity, not necessarily political, but solidarity in saying to the Government that the cuts are not justified.

Rev. Martin Smyth : I take the point that the hon. Gentleman makes.

The real loser appears to be the consumer, whether represented by local councillors or concerned citizens who have given so much of their time in the current district committees. "People First" obviously did not mean people's representatives. Although the stated aim of the Government was to remove political influence on boards, clearly any change of Government will mean that it is much easier to impose governmental political direction on an area board. Even under the present system, a chairman can be removed if he does not follow the ministerial mandate or the Department's diktat. John Simpson, the former chairman of the eastern board, is a perfect example of that. Naturally the Minister will put the best possible gloss on the changes. We have been told that the system of a health committee backing a district health authority works in England, so it should work in Northern Ireland. However, the criticisms levelled at health care provision in England would not convince many that the system has worked. Surely real local interest and commitment would improve it. The abolition of area boards already reduces the input of local councillors as it makes the new boards managerial. The suggestion that the abolition of 16 local district committees with around 320 members and their replacement by four health and social services councils with 102 members would produce better local involvement makes the mind boggle. Perhaps it says something about the numeracy of the Department and the logical processes behind the legislation. The crumb of power to set up sub-committees covering geographic or subject interests might seem attractive. However, in an area where unjustified slurs of second-rate citizenship have been made, for the first time the Government have legislated for second-rate committee members. They can be on a sub-committee but they are not given full committee status.

Why should the Minister appoint the chairman of each council? Why should not the committees, as the legislation says, elect their own chairperson? I know that the explanation offered is that in that way the whistle will be blown quickly and the committees will get started. Is not the reason, as has been suggested, to set the pattern of appointment of those who will obey the master's voice? It should be remembered that each area board and health and social services council deals with, not only

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health matters, as in Britain, but with social services, which are the responsibility of local authorities in Britain. My hon. Friend the Member for Fermanagh and South Tyrone (Mr. Maginnis) underlined the fact that the population of Northern Ireland is comparatively small and sparse. Local identities are cherished and local people should be involved in this task. Even now I appeal to the Minister for a commitment to think again and to take steps to enlarge the councils so that sub-committees thereof can cover the 16 areas as full members representing consumer interests.

I welcome the gesture already made by increasing the size of the Eastern board's advisory council. That in itself justifies the argument that I have set forth, not on a personal basis but on behalf of my party and the association of district committees. I also welcome the commitment to give councils the explicit right to join together in an association.

In conclusion, I should like to raise some practical matters. Who will be responsible for overseeing the precise delivery mechanisms at local level? If health and social service councils are to be more concerned with the nature, range and quality of the services available, surely the precise mechanisms will impinge on the quality of the services. There will be greater costs in providing access points for the public to reach area boards and health councils. There is also the question of unnecessary waste in the service, as illustrated by the provision of temporary cardiac theatres in the Royal Victoria hospital and the transfer of gynaecological services in wards 23 and 24.

I have drawn the Minister's attention to complaints made at a public meeting in Belfast where I was a speaker. They referred to the poor laundry service, threadbare sheets and a toilet without a seat at a teaching hospital. Where was the management or supervision? Is not help required from a local district committee to press the board and Department for adequate provision? The scope of visitation demanded would be too great for such a small council to undertake without the equivalent of district committees.

I want to put on record what happened when I took to the Department and the board a problem at a residential home. I was told that they had investigated it and that there was no substance in the complaint. In due time the home was closed. I discovered later that one of those giving advice in that area to the Department and the board was a general practitioner who was on a retainer fee of £3,000 a year to service a home. That was the independent advice.

In the Minister's statement to the media announcing the draft order, he said :

"Boards will normally be expected to provide members or officers to speak to the council or to answer questions relating to specific issues."

What would be considered abnormal and therefore prevent such representatives going to health and social service councils? In the light of the travesty of democracy perpetrated on the people of Northern Ireland and the numerous questions which the draft order leaves unanswered, I will be advising my hon. Friends and all right-thinking Members to vote against it.

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11.16 pm

Mr. James Kilfedder (North Down) : This is a sad evening for me and a sad day for democracy and for the health services in Northern Ireland. We have before us a draft order which is specialised, complicated and detailed. We have 90 minutes in which to debate it. In opening the debate, the Minister took just over a quarter of that time. [ Hon. Members-- : "Shame."] It is a shame. It is a disgrace that the representatives of the people of Northern Ireland have to give their names to a debate which is not a debate and to a consideration of an order which is not a consideration.

The people of Northern Ireland will feel that we are failing them if we do not register our protest at the contempt with which the Government are treating them. Indeed, the Government are treating the representatives of all the political parties with contempt. We are taking part in a charade if we consent to the order. That is why I will join the other hon. Members from Northern Ireland in the No Lobby.

As was pointed out by the hon. Member for Belfast, South (Rev. Martin Smyth), we had an excellent hospital and health service under the old Stormont Government, no matter what criticisms there may have been. I am sure that the hon. Member for South Down (Mr. McGrady) would agree that the hospital service was in excellent condition then, but that it has deteriorated ever since. The order will lead to further deterioration. Certainly there will be a deterioration in democracy and in the rights of patients. Surely patients must come first.

When we are told by the people of Northern Ireland to put their points of view here, it is right for them to know just how limited we are, because the order, if taken as a Bill, would have had a Second Reading, a Committee stage, a Report stage and a Third Reading--many hours over several weeks with plenty of time given to its consideration. We are being denied that tonight.

All I can do in the time available to me is to relate the order to my constituency, the North Down area. I echo the hon. Member for Leicester, South (Mr. Marshall) : we have a manifestation of a lack of funding for the services in that area. We need an improvement in services, but the order will not bring that about. For example, Bangor is a town with an ever- growing population. It has a higher percentage of elderly people than most other parts of the Province. Will the Minister investigate the disposal of the board's budget? Less money per head of the population is spent on hospital and social services in Bangor than in any other area in Northern Ireland. Time after time I have protested in the House about the way in which the Government have whittled away at the hospital services in North Down. Every protest I have made has been met with the answer that enormous sums are being spent in the Eastern board area, which includes Bangor, Holywood, Dundonald, Belfast, the Ards and other parts of County Down. Belfast obtains a large slice of the budget of the Eastern health board. I make no complaint about that. The hospitals in that area deserve sufficient funds to provide an adequate service to the people of Belfast. My complaint is that insufficient funds are provided, for example, for the Bangor hospital or the Ulster hospital, which should be regarded as a North Down hospital, but is not.

I am angry at the way in which the Government are undermining the health service in Northern Ireland. The

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board, which is the servant of the Government and the Northern Ireland Office, must take responsibility for implementing the Government's decisions and cuts. The board has undertaken several reorganisations and operational plans, but each one, despite a blaze of publicity about providing a better service, has meant a further attack on the local health service.

It would be wrong to say that everyone suffers. No expense has been spared on the Eastern board's headquarters. Even the carpet was specially woven with the initials of the Eastern health and social services board. Why they had to have their initials on the carpet, I do not know. Certainly, the people of the area would prefer to see the money spent on their hospitals and social services.

Acute beds may be closed in North Down, hospital facilities may be slashed and the Crawfordsburn hospital may be closed, but the bureaucracy of the Eastern health board will ensure that it does not suffer. It would be interesting to see how the salaries of headquarters' staff have climbed over the years. Perhaps the Minister would make a statement on the total salaries paid today to staff at headquarters compared with that 20 years ago and compared with the expenditure on hospital beds in the area.

I have long argued for a new hospital for the North Down area. In view of the Government's attitude in the past few years, I know that it is unrealistic to expect them to provide one, although it is needed. I call on the Government tonight to respect the needs of the people of North Down by renovating and revitalising the Bangor hospital and by providing a casualty department and other medical facilities for this important area with its high-density population. The board proposed to close the Connor surgical wing at Bangor hospital, which consists of 16 beds, on the excuse that the occupation rate of all the surgical beds in the hospital was low. As a result of the clamour and protest that I made about that proposal, however, the board changed its mind. The chairman stated that the board decided "after careful consideration" that 18 of the 24 beds in the ground floor surgical ward should be temporarily closed. Why was such "careful consideration" not given in the first instance when the board originally decided to close the Connor wing? Even now I do not trust the board when it says that the beds will be closed temporarily.

There is a long waiting list for operations in Northern Ireland. I do not want the Minister to tell me how long the waiting lists are in England--I am not interested in that. It is up to the Members representing the English constituencies to attack the Government on those delays. I represent the people of Northern Ireland and they are right to complain about the long waiting lists. I do not blame the specialists, the consultants or the doctors at the various hospitals. They are doing the best job possible and I should like to put on record that we have among the finest consultants and doctors in our hospitals in Northern Ireland who specialise in, for example, cancer, heart disease and burns. I also pay tribute to our nurses who do an excellent job.

The waiting lists in Northern Ireland are far too long and I do not believe that the order will do anything but lengthen them. Those lists are a disgrace, because no account is given to the pain and suffering or anxiety that is caused to the person awaiting hospital treatment.

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Mr. Beggs : Does the hon. Gentleman agree that each of us from Northern Ireland could have kept this debate going for three hours? We could provide examples of widowers who have come to our advice centres and appealed to us to try to persuade the Minister to make more money available to reduce the long waiting lists for heart surgery in Belfast. They have made that appeal because they have lost wives who may have been on those lists for up to 18 months, but missed the opportunity of an operation. Those men and their families do not want another husband to lose their life-long companion in such circumstances.

Mr. Kilfedder : I agree with my hon. Friend, who rightly speaks with compassion on this matter.

I am aware that other hon. Members want to participate so I shall conclude by mentioning the important issue of home help services. In doing so I am aware that I have not dealt with all the other matters that should be considered.

I agree with the hon. Member for Leicester, South (Mr. Marshall) that the home-help service has been cut. I know of cases in which, if that service has not been taken away completely, it has been cut to half an hour on one or two days a week. That is disgraceful. It is in the best interests of elderly people for them to stay in their own homes for as long as humanly possible. To do so, however, they need the services of home helps and district nurses. It is wrong that such home help services are no longer provided as they once were. The order will not help the health services in Northern Ireland and I intend to vote against it.

11.28 pm

Mr. Eddie McGrady (South Down) : I am grateful for the opportunity to contribute to the debate.

When the Minister introduced the order he said that it was the most significant piece of legislation on health and social services since 1972. So, after 29 years, we are reorganising our health and personal social services with a 90-minute debate. I add my voice to that of other hon. Members representing Northern Ireland who have said that that is a total disgrace.

Because of the limit on time, I can only sketch a broad canvas. The order cannot be amended in any respect. It deals mainly with general practitioner services and acute hospital sector services. It makes only passing reference to long-stay hospitals and community health services which care primarily for the mentally ill and handicapped, the elderly and the physically handicapped. Demography proves that these sectors are growing in number and imposing more demands on services. Yet all these aspects find little place in the order. As with the legislation for England, Scotland and Wales, this order must be seen in its political context--of the dogmatism that subscribes purely to the profit motive and privatisation, in the wrong belief that only those can bring about efficiency and cost- effectiveness. The funding crisis in the national health service has provided the political opportunity to apply these so-called theories to the health services, in spite of the fact that public opinion in poll after poll has shown itself dogmatically opposed to such changes. Even 66 per cent. of taxpayers are prepared to take their money out of their pockets and put it into the public coffers to sustain a better health service.

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If the Minister is critical of some of the comments about cuts that he will hear this evening, let him examine the budget of the Eastern health and social services board for the fiscal year 1989-90. He will discover there, dramatically exposed, the consequences of short funding--in respect of home helps and the geriatric and psychiatric divisions, all of which have contracted.

I should like to be more parochial tonight and to discuss the deprived area of Down and its need for a hospital, but I dare not stray because of the limits on our time.

My party certainly does not oppose a review of the health services. Comprehensive and equitable provision of health care, funded from taxation, is an integral part of our political philosophy, and we accept that there is a continuous necessity for any Government to decide what proportion of national resources should be devoted to health. Equally, however, we are concerned that such provision should be responsive to need, and it should deliver high-quality care and be as efficient as possible in the use of the resources allocated to it.

We do not believe that the radical proposals for the so-called "internal health market" will retain equality of access, improve the quality of care or release resources for better distribution. The patient will have less choice of hospital, and some of the proposals raise distinct fears about the long-term future of a comprehensively publicly funded service, as well as short-term fears about the effect of diverting resources away from patient care and towards the reorganisation of management structures and financial procedures. The order appears to concentrate on devising financial and administrative structures to encourage hospitals and GPs to compete for patients. It fails to identify the most important problems facing the health service in the 1990s, among which are chronic under- funding, the growing number of elderly people, and the persistent inequalities in health and health care as between different levels of income. The order does not deal with the importance of income, education or even housing in the prevention of much ill health.

The problem of unnecessary and expensive prescribing by GPs would be better dealt with by medical audit, education and encouragement than by indicative budgets. The new contract for GPs which provides incentives to have large lists will reduce the quality of care, especially in the socially deprived areas.

We are opposed to budgets for general practitioners, because every decision that a doctor makes on patient care will have two elements--the normal and expected one of clinical diagnosis, and the new one of the financial implications of any treatment the patient might need. That will be damaging to patient-doctor relationships, and will lead to larger practices, longer waiting lists, the doctor not being able to give patients enough attention, further deprivation of the poor, and a lower standard of service to the rural areas. My party is opposed to self-governing hospitals, which will be responsible only to the Department of Health and Social Services. Such hospitals will make it impossible for regional health boards to plan comprehensive services. These hospitals will have every incentive to concentrate on the highly profitable sectors of care rather than on serving the local community and the chronically sick. The freedom to set their own pay levels, to borrow on the commercial

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market and to deal in assets cannot fail to have a deleterious effect on the other board hospitals in the area. We shall end up with a system of two-tier hospitals.

I support the comments of other hon. Members representing Northern Ireland constituencies about the new management advisory structures. I was greatly concerned to see that the order allows for the removal of local elected councillors from the new health boards, which will have no elected representatives. Northern Ireland already has a rather weak system of local government, and this move further erodes local democracy. It is essential to have strong representation from the councils in the area, and they should have adequate resources to monitor the services. The local district health committees, close as they were to the problems, had great difficulties coming to grips with the assessment and interpretation of factors. How much more difficult will it be for the four area boards?

One of the great achievements of the NHS is that it has been a national service, and that essential facilities and therapeutic skills are available to people wherever they live. I am strongly opposed to the ending of the national pay negotiations, which ensured that the doctor, the nurse, the radiologist and the cleaner were paid the same wherever they worked. The introduction of local pay negotiations will inevitably lead to a loss of skilled staff from the peripheral areas and to a worsening of employment conditions for the unskilled who will have to remain. I ask the Minister to note some of the anomalies that will appear as a result of the order.

How is the consumer's choice to be extended when he can choose only his doctor, and not the services that the doctor has contracted for, either in consultancies or in hospitals? How far will competition be allowed to develop, and which units of provision will go out of business? If there is only one hospital in an area, will it retain its monopoly? A new self- governing hospital will have a privileged position on borrowing and staffing. Is that fair competition, as the Minister called it?

Competition seems to be the bedrock of this order. Is there hard information, or will there be in the foreseeable future, on the comparative prices and quality of service delivery? I do not think that there is the equipment to do that now or soon. All that I can see is a huge increase in management costs, rather than improvements in the services to patients. The average 5 per cent. administrative costs that we have will escalate rapidly to the 20 per cent. average in the USA. That will deprive the patients of resources that should be directed to them.

11.39 pm

Mr. Peter Robinson (Belfast, East) : I have been left with four minutes, of which I am told that the Minister would like five so that he can reply to the debate. He will clearly not get his five and I shall have little time to do anything more than protest about the farce that the debate has become.

The Minister need not be in the least bit sad about not being able to reply to the debate because it is he and his Government who are in control of the timetable of the House and they could have given the House adequate time to debate this important issue.

Apart from constitutional matters--this is close to a constitutional matter --there is no more important matter

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for the House to discuss. To debate major changes in health and social services in an hour and a half is impossible.

I am happy to congratulate the Minister on his appointment. I have known him for some time and his personality and ability will enable him to make a great contribution to health and social services in Northern Ireland. But he has drawn the short straw tonight in having to bring this kind of legislation to the House in the manner in which he has been asked to do so.

The legislation will in effect hand over complete control of health and social services to non-elected individuals--people who are not accountable to anybody in Northern Ireland. The previous health and social services board had some form of accountability in Northern Ireland to ensure that a number of district councillors were appointed to those boards. Schedule 1 of the Health and Personal Social Services (Northern Ireland) Order 1972 specified the number that there should be on the board. Now the Minister's grand reform of health and social services in Northern Ireland will wipe away the elected representatives from the board, ensuring that only the Government's yes men will get to the top of the administration. To make it worse, the Minister has ensured that 50 per cent. of those who will control health and social services in Northern Ireland will be his employees. If ever there were people who would jump when the Minister says jump, it is those whom he employs. Those who pay wages control loyalty. I rather suspect that the order will push forward health and social services in Northern Ireland by ensuring that there will be no resistance or objection to the way in which those matters are dealt with.

The net effect of the order is bureaucratic incest. The officers of the board are themselves allowed to elect further officers to the board. The order is supposed to be for the good of health and social services in Northern Ireland but it will not contribute to their betterment. It is unhealthy and I suspect that it will result in a bad service to the people of Northern Ireland.

11.42 pm

Mr. Roy Beggs (Antrim, East) : I am grateful to be called, Madam Deputy Speaker. I think that I am the only hon. Member present who attended throughout an earlier debate in the House on health matters. I was not called on that occasion and--

It being one and a half hours after the commencement of proceedings on the motion, Madam Deputy Speaker-- put the Question, pursuant to Standing Order No. 14 (Exempted business).

The House divided : Ayes 137, Noes 107.

Division No. 54] [11.43 pm

AYES

Alexander, Richard

Alison, Rt Hon Michael

Amos, Alan

Arbuthnot, James

Arnold, Jacques (Gravesham)

Arnold, Sir Thomas

Ashby, David

Baker, Nicholas (Dorset N)

Baldry, Tony

Bellingham, Henry

Bennett, Nicholas (Pembroke)

Bevan, David Gilroy

Blackburn, Dr John G.

Bonsor, Sir Nicholas

Boscawen, Hon Robert

Bottomley, Peter

Bowden, Gerald (Dulwich)

Bowis, John

Brandon-Bravo, Martin

Brazier, Julian

Brooke, Rt Hon Peter

Brown, Michael (Brigg & Cl't's)

Bruce, Ian (Dorset South)

Burns, Simon

Burt, Alistair

Butterfill, John

Carrington, Matthew

Carttiss, Michael

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Column 1061

Channon, Rt Hon Paul

Clarke, Rt Hon K. (Rushcliffe)

Coombs, Anthony (Wyre F'rest)

Coombs, Simon (Swindon)

Davies, Q. (Stamf'd & Spald'g)

Davis, David (Boothferry)

Day, Stephen

Douglas-Hamilton, Lord James

Dover, Den

Durant, Sir Anthony

Dykes, Hugh

Evennett, David

Fallon, Michael

Favell, Tony

Fishburn, John Dudley

Fookes, Dame Janet

Forsyth, Michael (Stirling)

Forth, Eric

Fox, Sir Marcus

Franks, Cecil

Freeman, Roger

French, Douglas

Gale, Roger

Goodlad, Alastair

Greenway, John (Ryedale)

Gregory, Conal

Griffiths, Peter (Portsmouth N)

Grist, Ian

Ground, Patrick

Grylls, Michael

Gummer, Rt Hon John Selwyn

Hague, William

Hamilton, Hon Archie (Epsom)

Hamilton, Neil (Tatton)

Hanley, Jeremy

Hannam, John

Hargreaves, A. (B'ham H'll Gr')

Hargreaves, Ken (Hyndburn)

Harris, David

Haselhurst, Alan

Hayes, Jerry

Hayhoe, Rt Hon Sir Barney

Hayward, Robert

Hind, Kenneth

Hordern, Sir Peter

Hughes, Robert G. (Harrow W)

Hunter, Andrew

Irvine, Michael

Jack, Michael

Janman, Tim

Jones, Gwilym (Cardiff N)

Jones, Robert B (Herts W)

King, Roger (B'ham N'thfield)

Kirkhope, Timothy

Knapman, Roger

Knight, Greg (Derby North)

Knowles, Michael

Knox, David

Lawrence, Ivan

MacGregor, Rt Hon John

McNair-Wilson, Sir Patrick

Malins, Humfrey

Mans, Keith

Mawhinney, Dr Brian

Maxwell-Hyslop, Robin

Mayhew, Rt Hon Sir Patrick

Montgomery, Sir Fergus

Nicholls, Patrick

Norris, Steve

Patnick, Irvine

Pattie, Rt Hon Sir Geoffrey

Riddick, Graham

Rossi, Sir Hugh

Ryder, Rt Hon Richard

Sackville, Hon Tom

Shepherd, Colin (Hereford)

Shersby, Michael

Skeet, Sir Trevor

Smith, Tim (Beaconsfield)

Speller, Tony

Steen, Anthony

Stern, Michael

Stevens, Lewis

Stewart, Andy (Sherwood)

Summerson, Hugo

Taylor, Ian (Esher)

Taylor, John M (Solihull)

Thompson, D. (Calder Valley)

Thompson, Patrick (Norwich N)

Thurnham, Peter

Tracey, Richard

Twinn, Dr Ian

Viggers, Peter

Waller, Gary

Wardle, Charles (Bexhill)

Watts, John

Wells, Bowen

Wheeler, Sir John

Widdecombe, Ann

Wilkinson, John

Winterton, Mrs Ann

Winterton, Nicholas

Wood, Timothy

Woodcock, Dr. Mike

Yeo, Tim

Young, Sir George (Acton)

Tellers for the Ayes :

Mr. Sydney Chapman and

Mr. Tim Boswell.

NOES

Adams, Mrs. Irene (Paisley, N.)

Allen, Graham

Archer, Rt Hon Peter

Armstrong, Hilary

Ashton, Joe

Barnes, Harry (Derbyshire NE)

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