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Northern Ireland Social Services (Consequential Provisions)
Madam Deputy Speaker (Miss Betty Boothroyd) : We now come to motion 3--
Mr. Donald Thompson (Calder Valley) : On a point of order, Madam Deputy Speaker. Would it not be more sensible to have the vote now, and then an hour and a half of debate after that?
Madam Deputy Speaker : I think that we will do it in the usual manner.
11.55 pm
The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Jeremy Hanley) : I beg to move
That the draft Health and Personal Social Services (Northern Ireland Consequential Amendments) Order 1991, which was laid before this House on 22nd January, be approved.
The order has, in fact, already been considered by the Joint Committee on Statutory Instruments.
As a result of the changes proposed in the draft Health and Personal Social Services (Northern Ireland) Order 1991, a number of Acts passed by the Westminster Parliament, applying solely to Great Britain or the United Kingdom as a whole, will require amendment. The amendments are purely consequential, and concern--inter alia--extending the remit of the Clinical Standards Advisory Group to Northern Ireland, widening the scope of the NHS contract provisions to include additional Northern Ireland bodies, certain tax matters and parliamentary disqualification. They are contained in a separate Order in Council, the Health and Personal Social Services (Northern Ireland Consequential Amendments) Order--
Mr. William Ross (Londonderry, East) rose--
Mr. Hanley : Of course I will give way.
Mr. Ross : This is a dialogue, not a monologue.
The hon. Gentleman has drawn attention to article 3, which amends the House of Commons Disqualification Act 1975. Surely this is a most unusual way in which to introduce disqualification for membership of the House. Is there not a more reasonable way, involving a list of disqualifications which is published periodically, with the list being amended? Then everyone would know that a matter of real constitutional importance was at issue. It is disgraceful to bury it in a small order like this.
Mr. Hanley : I cannot agree that this is a disgraceful way in which to proceed. The measure is merely a consequential amendment and, as I have said, has been considered by the Joint Committee on Statutory Instruments. There is nothing secret about it ; the item has been published for some time, and the changes will appear in due course in the list to which the hon. Gentleman has referred.
It only remains to say that, being purely consequential, the order will not take up a great deal of time.
Mr. Bob Cryer (Bradford, South) rose --
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Mr. Deputy Speaker (Sir Paul Dean) : Order. Apparently the Minister is not giving way.
11.57 pm
Mr. Roger Stott (Wigan) : Her Majesty's Opposition will waive the right to speak this evening, in order to allow hon. Members from the Province to do so.
11.58 pm
Mr. Roy Beggs (Antrim, East) : I, too, wish to be generous. I welcome the Minister to his post. As a consequence of the time restriction on the earlier debate and the limitation on the debate of this order, I shall confine my remarks to a single issue in the hope that it will be possible to establish whether the Secretary of State, acting jointly with the Northern health and social services board, can remedy the dissatisfaction of my constituents. The board proposes to close acute facilities at my hospital in Larne, to provide acute services for my constituents in an area hospital in Antrim. It will take much hard work by all those concerned, acting jointly, to satisfy my constituents.
Phase one of the new Antrim hospital will be completed in 1993, at a cost of £40 million. Funding may never be found for phase two, as Coleraine has bid for a new hospital on a green-field site. Phase two is unnecessary as it would result in avoidable inequality of provision. There has been widespread opposition to the board's proposals for the Moyle but widespread support for the retention and development of acute services at the Moyle hospital in Larne. That cross-community support is representative of the views of all Church groups, industry, schools, clubs, organisations, GPs in the catchment area and Larne borough council. Fifteen thousand people petitioned the council, and 2,500 letters have been sent to the Department. This is an example of the community acting jointly to protect their own interests. It is necessary, therefore, that those in the Department, the Minister and the board act jointly to protect those interests.
The Moyle hospital report shows clearly that my constituents in east Antrim are being treated differently from others in Northern Ireland and in the Northern health board area and are being discriminated against. The policy being pursued by the Northern health and social services board--
Mr. Deputy Speaker : Order. I am sorry to interrupt the hon. Gentleman. I realise that he was not able to speak in the previous debate, but I am finding it difficult to relate his speech to the consequential amendments. Perhaps he will draw my attention to the part of the consequential amendments to which he is addressing his remarks.
Mr. Beggs : I refer you, Mr. Deputy Speaker, to article 7(5) on the need for those involved to act jointly and to article 7(2) on the functions of the boards, which cover the board's policy on Moyle hospital in my constituency.
The policy being pursued does not coincide with the policy of the Government, of the former Prime Minister or of the former Secretary of State for Northern Ireland. "Strategy for the Development of Health and Personal Social Services in Northern Ireland"--HMSO 1975--made a clear declaration
"To promote, having regard as appropriate to consideration of parity with Great Britain the health and social welfare
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of Northern Ireland. Provided on a co- ordinated and accessible basis and delivered in a manner that is acceptable to individual and communities."The right hon. Member for Finchley (Mrs. Thatcher), when Prime Minister, advised :
"Do not take as much to the centre as you can, but take as much to the periphery as you can."
We in Larne are right on the periphery. The right hon. Member for Bridgwater (Mr. King), the former Secretary of State for Northern Ireland, said :
"It is my abiding aim that all sections of the community in Northern Ireland enjoy equality of opportunity and provision of services."
Many patients in east Antrim are already almost 20 miles away from acute services. It is unreasonable to expect them to travel 36 to 38 miles for acute services at Antrim.
The Moyle hospital services a large coastal area, including the isolated glens of Antrim and Islandmagee. In-patients and out-patients have access to a comprehensive range of services. Approximately 95 per cent. of all patients referred to Moyle hospital are treated there efficiently and effectively.
Statistics produced by the Department of Health and Social Services show a steady increase in activity at the Moyle hospital. There was a 21 per cent. increase in operations carried out in the period 1984 to 1988.
The highest activity level of all hospitals in the Northern health and social services board area is recorded at Moyle hospital in Larne, but the board proposes to close the hospital's acute facilities. I pay tribute to the staff at all levels for the success achieved by Moyle hospital. The present policy must be reappraised independently. Future provision should be determined now and not after the proposed changes have been implemented.
Lord Skelmersdale and the NHSSB provided further evidence of discrimination against the population of east Antrim by giving assurance to an NHSSB member and the chairman of the new Coleraine hospital campaign group that the appraisal team studying acute hospital provision for the Coleraine triangle would have total freedom to assess all hospital needs for that area.
That contrasts sharply with the response to requests from the Moyle action committee that its report, produced with professional and objective advice, would be accepted by the Minister, principal officers at the Department and the NHSSB as an official option appraisal, that it should be considered by an impartial team and not by a partially discredited four-man NHSSB team that was already committed to the Antrim area hospital concept.
It was indicative of how meaningless consultation had become when no request was made for the Touche Ross report which should have been scrutinised alongside the Moyle hospital report. Over £40,000 was spent to produce that credible report and that was paid for largely by voluntary subscriptions and by support from Larne borough council.
Experts will confirm the belief that the NHSSB has used poor planning methodologies and did not seriously consider alternative patterns of provision. The NHSSB's proposals for Moyle hospital are doomed for the following reasons : they are based on out-of-date planning criteria ; the patients will choose not to use the new Antrim hospital and will instead travel to the large teaching hospitals in
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Belfast ; and the Antrim hospital will receive no income from east Antrim when it needs funds and when finance follows patients. General practitioners in east Antrim have established referral patterns to Moyle hospital in Larne or to Belfast. East Antrim GPs will in future accept patient choice and refer them to Belfast hospitals if Moyle hospital ceases to be an option.The retention of high-quality local acute services at Larne is justified on the basis of population, remoteness of parts of the coastal area, the importance of local heavy industry, of which there is the greatest concentration outside Belfast, the demand for accident emergency services, the continuing growth of tourism and traffic through Larne harbour and, finally, but by no means least, to meet the wishes of the patients and the medical profession. The lives and limbs of patients will be put at risk if the present proposals are implemented. Costs to the community and to the NHSSB would be shown to be too high to justify transferring acute services from Moyle to the Antrim hospital if only the board would give the report an impartial appraisal.
Unlike the narrow, blinkered proposals of the NHSSB, the Moyle hospital report has provided alternatives for consideration that will eliminate inequalities and save capital expenditure which would have to be incurred if phase two of Antrim hospital proceeds. By comparison, modest expenditure at Moyle hospital will enable our local hospital to meet the needs of most patients for the foreseeable future and utilise expertise that is already available in Belfast. The proposals in the report will save public expenditure and, at the same time, protect local services. I seek the support of the House to protect and to develop acute services at Moyle hospital and secure proper provision of hospital services, in keeping with Government policy, for my constituents.
I hope that those brief remarks will encourage an impartial reappraisal and that the Minister will seriously consider ensuring that no final decision is made until there has been an impartial analysis and until, if necessary, the strategic team with responsibility for the report has an opportunity to make further representations to him. I repeat that he should grasp the nettle and face up to his unique opportunity as a newly appointed Minister to provide a more cost-effective, equitable and acceptable acute hospital service to my constituents.
Several Hon. Members rose--
Mr. Deputy Speaker : Order. I remind the House that this is a very narrow, technical order. I have allowed the remarks of the hon. Member for Antrim, East (Mr. Beggs) to go rather wide because he was interrupted almost in the middle of his first sentence in the previous debate. I remind the House again that we are discussing whether the amendments are made necessary by the order that has just been pased. Remarks must therefore be directed to that comparatively narrow point.
Mr. Peter Robinson (Belfast, East) : On a point of order, Mr. Deputy Speaker. Are we entitled to argue that there should be further consequential amendments if we believe that they arise from the order that has already been passed?
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Mr. Deputy Speaker : That will be in order, as long as it is strictly related to the order now before us.Mr. Cryer : Further to that point of order, Mr. Deputy Speaker. Rather than speak in the debate, I can dispose of the point by raising a point of order. The Minister invoked the fact that the instrument had been before the Joint Select Committee on Statutory Instruments to indicate some sort of endorsement of the order. However, you will know, Mr. Deputy Speaker, that the Joint Committee can consider only technical matters--for example, whether the order is ultra vires or whether the Minister has made an unusual use of powers. We are not allowed to report to the House on the merits of the order. Therefore, the fact that it has been before the Committee does not imply any endorsement of the merits of the order.
Mr. Deputy Speaker : I am sure that the House is grateful to the hon. Gentleman, who is the Chairman of the Committee, for making that point clear.
12.11 am
Mr. Ken Maginnis (Fermanagh and South Tyrone) : I join hon. Members who have expressed concern about the way in which the legislation has been brought before the House--by Order in Council. Those of us who try responsibly to represent the views of our constituents are precluded from doing so by time constraints.
In the previous Order in Council, which we debated for an hour and a half, there are about 21 pieces of Northern Ireland legislation which require consequential amendment and which are listed under schedule 5. We are now debating the consequential effect on other legislation relating to health and personal social services. I do not believe that it is possible in a short period fully to appreciate the consequences of 27 other pieces of legislation. The National Health Service and Community Care Act 1990, like many others that are listed, demonstrates how the administration of health and social services is dependent on the right blend of bureaucracy and community participation. It is to the relationship with that Act that I draw the attention of the House. I do not believe that we have here a proper blend between the administrators--the bureaucrats--and those who are responsible for ensuring that the health and social services are run for the benefit of the consumer.
Previously, in the area of democracy and public accountability, the health and social services boards at least appeared to have some independence in the role they played. However, as those boards came towards the end of their life, it became more and more obvious that they were merely extensions of the Department of Health and Social Services. In that respect, what we are now faced with presents us with no great change. To meet the requirements enshrined in all these consequential provisions we should have had some properly firmed-up proposals in relation to the health and social services councils. But there are no such proposals. The whole matter of the councils has been treated in the most vague and offhand manner. Having lost our district health committees, where the voice of the consumer was heard, we cannot be assured that we shall have an effective means of making that voice heard in the future. No one--certainly not anyone who has had experience of the health and social service boards-- believes that these proposals will adequately achieve that purpose.
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Beyond naming the councils and making provision for district council representation, the legislation is vague and lacking in detail. It allows the Department to make of the councils what it will. They are not the voice of the consumer, but rather a shadowy means of representation that, it is safe to say, will be dominated by their chairmen, who will be powerful people appointed by the Minister to direct the energies of the councils as he and the Department wish. Enabling measures of the kind that are enshrined in the order can give the public no confidence that their views will carry any weight in the management process.Mr. Hanley : The whole point of the new councils is that they should add weight to the process. The fact that three of the councils will have 24 members and that the eastern council will have 30 indicates that a very large number of people from a very wide cross-section of the population will be included. Surely no chairman will have such sway. Perhaps the hon. Gentleman, as chairman, would have that sort of power, but I am sure that no other human could achieve it.
Mr. Maginnis : I cannot accept the Minister's assurance. It is obvious that if the health and social services councils were to have a real authority and effect on how the boards operated, they should have been given an authority parallel to the authority vested in Select Committees of the House of Commons. They should have been able to operate as consumer watchdogs and their role and authority should have been clearly defined in the wider context of decision making and management arrangement within the health and social services.
Mr. Peter Robinson : In view of the Minister's intervention, does the hon. Gentleman find it difficult to understand how the Minister could tell the House earlier that it was necessary to reduce the size of the health and social services board because it was unwieldy to have as many as 30 members? I think that I quote the Minister correctly and that Hansard will show that I do. Yet the Minister now tells us that the health and social services councils can be unwieldy and have that number of members. Does not the hon. Gentleman find it strange that the Minister gives power and authority to people who are not elected representatives and puts them on a pedestal above those who are elected representatives? What effect will that have on the body politic in Northern Ireland?
Mr. Deputy Speaker : Order. I remind the House that we are not dealing with the previous order. The House has dealt with that. We are dealing with this one, which involves consequential amendments.
Mr. Maginnis : I am grateful to you, Mr. Deputy Speaker, for reminding me of that, but you will understand our difficulty. We do not have--I am sure that you do not have--all the consequential legislation in front of us. Therefore, we must try to recall the effects that some of the amendments will have. I am trying to deal with the spirit of the legislation, which will be affected by these consequential matters.
I should have thought that health and social services councils ought to reflect the plurality of interests in the provision of services. If professional care staff are to be prohibited from membership, adequate arrangements must be made to permit them to advise health and social services councils of their views about services and their
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assessments of service needs and proposed policies. I hope that the Minister will be able to tell us how he envisages that professional opinion will be expressed and will manifest itself through the system. There is no point in allowing doctors and nurses to manage the hospitals unless they can influence those who have financial control.Mr. Hanley : Will the hon. Gentleman give way?
Mr. Maginnis : I am sure that the Minister will answer me in some detail at the end of the debate. Perhaps I could pose some other questions for him to answer later.
Health and social services councils should be adequately resourced to enable them to conduct in-depth scrutinies of services and general policies as they affect consumer interests. The independent authority and status of the councils is not addressed but should surely be guaranteed in recognition of the council's monitoring and representative roles and in order to secure public confidence. Should not the health and social services councils have the right to receive appropriate information to allow them to discharge their function and to require the attendance of board officers to provide information? Where is that established either in the original order or in any of the consequential amendments? I have not been able to find it properly detailed anywhere. While the role of the health and social services councils should be to concentrate on matters of general public interest, there should be arrangements for council members to raise individual local or specific concerns with the board or appropriate board officers.
In general, the role of the councils should be seen as equating with that of a parliamentary Select Committee. While the activities of a Select Committee relate to a Government Department, the activities of the health and social services councils would relate to the policies of the boards. The scrutinising powers of the councils should therefore be equivalent to those of a Select Committee. Unless we have an assurance from the Minister that he will take seriously the demise of district committees and ensure that the health and social services councils can effectively--I emphasise
"effectively"--replace them, we will have to go back to our constituents and tell them that they have no control as consumers over the services provided.
Rev. Martin Smyth (Belfast, South) : I note my hon. Friend's argument on the consequential order. Does he accept that if the health and social services councils are given the powers of a Select Committee to deal with boards, there is a greater argument for a Select Committee of the House to scrutinise the Department of Health and Social Services and the Northern Ireland Office?
Mr. Deputy Speaker : Order. I hope that the hon. Member for Fermanagh and South Tyrone (Mr. Maginnis) will not widen the debate to cover a matter which is not related to the order.
Mr. Maginnis : I have to concur entirely with my hon. Friend. For far too long we have drawn the short straw. Tonight is the saddest example that I have seen in eight years in the House. Here we are, dealing with something which affects every member of the community in Northern Ireland from the moment of birth--
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Rev. Martin Smyth : And before it.
Mr. Maginnis : Indeed. From before birth to the moment of death we are dependent on the hospital service. I cannot think of any other service, including education--I came from the education service--in which it is so important to have the confidence of the community and with which the community should feel comfortable and at ease. The Minister lauded the idea of 30-member councils. Many of us know that the larger a committee, the less effective is its work because it is impossible for every member to play a part. If I recall correctly, my health and social services board, the Southern board, recommended that councils be restricted to 16 or 18 members, and certainly not more than 20. If the Minister had taken that advice, he might have been able to find some way of accommodating the people who selflessly and generously gave of their time in district committees in the past, albeit perhaps not with the same status. Many feel brushed aside and that their services over many years have not been appreciated. It will become increasingly important to have small groups of people closely allied to individual hospitals who can reflect to members of the health and social services councils what happens on a day-to-day basis.
The amending legislation deals with value added tax, income tax and corporation tax. They are all important, yet we have not heard from the Minister why they are important. I doubt whether many people who listen to the debate understand the relevance.
I am greatly disturbed that the individual units of management will be encouraged to raise funding privately. I am talking not about hospital trusts, but about raising funding for a hospital, whether through franchises of shops in the entrance to the hospital or ordinary charitable fund raising. There has been no explanation of how that money will be handled. For the more assiduous and energetic fund-raising team in a particular unit of management, will it mean the withdrawal of resources provided directly from the Department? It might have been more generous if the Minister had thought of some sort of pound-for-pound scheme which would reward industry in this respect. It might have reassured the consumer if he had known that such money would be kept in an account separately from other funds and used to enhance the service rather than to replace money which should rightly come from the Government.
There are many deserving charitable causes and in Northern Ireland the community is noted for its response to charitable appeals. How is the ordinary small but worthy charity to compete with large, well-organised units of health management where professional fund raisers can be employed? We may well diminish the good work that is carried out voluntarily by people who work for the good of the community.
Those thoughts have occurred to me when I have looked at the order. Although it lists consequential amendments, we do not and cannot judge the effect of the changes simply because we have had neither the time nor the information from the Department early enough for us to judge the effect of what we are supposed to accept here tonight for the benefit of the people of Northern Ireland.
This is a sad state of affairs. I hope that we are not going to have to continue to legislate in the dark or in semi-darkness, not quite knowing what we have got and not quite knowing where we shall be led.
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Rev. Martin Smyth rose --Mr. Deputy Speaker : Order. I shall call the hon. Gentleman, but I remind him that he spoke in the previous debate. However, I am sure that he will not cover the ground that was debated in the previous order.
12.34 am
Rev. Martin Smyth (Belfast, South) : I appreciate being called. I recognise that your task, Mr. Deputy Speaker, is as difficult as our own because of the decision of the Government managers not to meet the simple request to have a longer debate on the main order. I have no intention of repeating what I said in the earlier debate, save to say that the Minister was unable to answer the debate because of the time allotted to it. We are therefore still in the dark about the impact of the order.
I want to draw to the Minister's attention two minor points which may nevertheless have some impact. I should like that clarified. I appreciate that the Minister said that the orders had already been before the Joint Committee on Statutory Instruments, but it is important to be clear about their implications.
Paragraph 3(a) contains the words :
" or any member, not being also an employee' ".
Does that mean that if a person is not an employee but is on the board he or she would be disqualified from standing for Parliament? Does it mean that, if such a person was an employee of the board, he would be allowed to stand for Parliament, but would subsequently be required to resign?
Why does the order state :
"in the entry beginning Chairman of a Health and Social Services Board' after Chairman' there shall be inserted or any member, not being also an employee' "?
We require some elucidation on that.
In the amendment to the Vehicles (Excise) Act (Northern Ireland) 1972, provision is made that
"A mechanically propelled vehicle shall not be chargeable with any duty under this Act at a time when it is used or kept on a road by a health and social services body"
How much money will be saved to the authorities as a result? Where will that money go? The Minister will be aware that problems have arisen about providing transport to day centres, and the like. In my constituency people have been denied the opportunity to go to the local day centre, Orchardville, because of a lack of funds and services.
The thrust of the orders seems to be a move towards care in the community, and encouragement has been given to voluntary and community groups. Will the vehicle excise allowances made in the consequential order be extended to those groups?
12.38 am
Mr. David Trimble (Upper Bann) : In common with other hon. Members who have spoken in the two necessarily linked debates, I welcome the Minister to the Dispatch Box. On future occasions we hope that he will be able to deal with matters in a more acceptable manner. We must record that the hon. Gentleman has made a bad start. However, that is not necessarily the Minister's fault, as he is not responsible for the legislation--its gestation occurred before his arrival at the Northern Ireland Office. Moreover, the Minister is not responsible--at least, that is what we hope-- for the way in which the Government Whips have dealt with the debate.
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Also like some of my colleagues, I cannot avoid referring to the way in which this legislation is being dealt with. This important measure, in the form of an Order in Council, can be debated for a mere 90 minutes, and it cannot be amended. It is not well appreciated how much procedures such as this bring this House into disrepute. While these debates attract little attention in the House, they attract attention in Northern Ireland, where people will watch them. Parts of them will be broadcast there and referred to in the press. The people of Northern Ireland will get glimpses of the House and see the acres of green Benches surrounding me.I am conscious of this problem because, during the by-election that I fought last year, in the course of my doorstep canvassing I told people that, if they elected me, I would go to Westminster to represent their views. Time after time, electors asked me what the point was, and whether the Government would listen. Now they can see images of tonight's debates, in which we have had no chance to debate the legislation properly or to amend it.
I have seen few scenes more ludicrous than the earlier debate, in which hon. Members with weighty matters to discuss were unable to speak. I entirely sympathise with the view expressed by the hon. Member for Belfast, East (Mr. Robinson) and I deplore the sad treatment of my hon. Friend the Member for Antrim, East (Mr. Beggs). It was outrageous of the hon. Member for Calder Valley (Mr. Thompson) to ask, at the beginning of the debate, whether we could hold the vote first and the debate afterwards. It is bad enough having to deal with an Order in Council without the Conservative party demonstrating its contempt for the House, and, by implication, for Northern Ireland Members.
The second, consequential order, running only to a couple of pages, is allocated as much time for debate as the previous, much lengthier and more important order. I commend the hon. Member for Wigan (Mr. Stott) for waiving the opportunity to speak to enable more of us to participate. We are grateful to him for that.
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