House of Commons Hansard Debates for 29 Oct 1992

Mr. John Evans (St. Helens, North) : Is the Leader of the House aware that last Friday British Coal ended coal mining at Parkside colliery in my constituency, and that so far not one word of consultation has taken place? Is he further aware that this morning a mining inspection at Parkside colliery under section 123 of the Mines and Quarries Act unanimously recommended that, unless coal was cut immediately on one face, the chances are that that face will be lost for ever? Will he arrange for a debate so that hon. Members from coal mining communities can test whether the statements made by Cabinet Ministers about genuine consultations, and about Coal Board directors protecting the fabric of the mines, were economical with the truth?

Mr. Newton : I certainly do not accept any suggestion that my right hon. Friend the President of the Board of Trade or any of my other colleagues were, as the hon. Gentleman puts it, economical with the truth. Once again, I shall bring the hon. Gentleman's remarks to my right hon. Friend's attention, and I am sure he will give them serious consideration.

Mr. Tim Devlin (Stockton, South) : As thousands of people in the northern region are still awaiting the outcome of the public inquiry into the incineration of toxic waste, I ask my right hon. Friend to urge the Department of the Environment to make a statement as soon as possible on the future of toxic waste incineration on Tyneside and Teesside. That would be of great interest to thousands of people and to industry in the region.

Mr. Newton : I shall bring that request, too, to the attention of the appropriate Minister--my right hon. and learned Friend the Secretary of State for the Environment.

Mr. Robert N. Wareing (Liverpool, West Derby) : Will the Leader of the House consider initiating an early debate on the National Audit Office report on accident and emergency departments in national health service hospitals? That is a matter of great concern to the people of Liverpool, who now face the disgraceful suggestion that the accident and emergency unit at Broadgreen hospital should be closed. That hospital is close to the M62, an important motorway, and it is also the hospital which services Liverpool airport whenever there is an alert.

Mr. Newton : The hon. Gentleman will be aware that we had a debate on health only a week ago today, and I am not in a position to promise another in the immediate future.

Mr. Barry Jones (Alyn and Deeside) : Will the Leader of the House consider a debate on opencast coal mining? The closure of the deep mines presages the ripping apart of our countryside. My constituents in Buckley wait apprehensively for decisions by the Secretary of State for Wales.

Mr. Newton : I understand that concern expressed by the hon. Gentleman on behalf of his constituents, but in

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view of the other exchanges which have taken place today, I also have a feeling that in our present circumstances any debate on coal mining is more likely to concentrate on deep mining than on opencast mining.

Mr. Andrew Mackinlay (Thurrock) : Will the Leader of the House use his good offices to arrange for a Minister to make a statement early next week on the crisis in the motor car manufacturing industry? That is particularly necessary in view of the fact that Ford, our leading car manufacturer, announced a halt to all car and van manufacture at two plants --including Dagenham, a plant which affects both my constituency and that of the Leader of the House. That announcement has wide implications for the whole economy of east London and Essex, and it will cause great anxiety in homes and small businesses in and around the Dagenham area--in Thurrock, in Basildon and, no doubt, in Braintree, the constituency of the Leader of the House. Will the Leader of the House ensure that a Minister is brought to the House? There is a great fear that we are about to lose one Ford plant in the United Kingdom unless there is a halt and an intervention--morning, afternoon, or evening--by the President of the Board of Trade.

Mr. Newton : I have said in response to many questions this afternoon that the President of the Board of Trade is due to answer questions next Wednesday. I hope that the hon. Gentleman in turn will at least acknowledge that United Kingdom car production has increased by 1.9 per cent. in the first nine months of this year compared with the figure for the similar period of 1991. The increased production, including the increased production for export, in one or two recent months has been some sign of encouragement.

Ms. Liz Lynne (Rochdale) : Will the Leader of the House make time for a debate on the human rights violations happening daily in Indian-held Kashmir?

Mr. Newton : I cannot promise an early debate on the matter. However, I am sure that my right hon. Friends at the Foreign and Commonwealth Office have noted the hon. Lady's concern.

Mr. Tony Banks (Newham, North-West) : The normal procedure after Second Reading is for a Bill to move into Committee. Although we have had the Second Reading of the European Communities (Amendment) Bill--the Maastricht Bill--it has yet to move into Committee. What is the constitutional position? What is the reason for a debate on a motion next Wednesday? What is the reason other than to try to bolster the Prime Minister?

Mr. Newton : The reason, in shorthand terms, is that there were substantial requests for a debate, including one from the previous Leader of the Opposition, the right hon. Member for Islwyn (Mr. Kinnock).

Mr. Paul Flynn (Newport, West) : Does the Leader of the House think that it would be helpful for our discussion on Monday on the continuing disgrace of the disability living allowance and the disability working allowance if the Government published in the Official Report the answers that hon. Members receive from the chief executive of the Benefits Agency? I had several letters from Mr. Bichard this morning. When will the Leader of the House publish those in the Official Report as he recently

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promised in a written reply? What will the arrangements be? Will the replies be published daily or weekly, and how prompt will publication be?

Mr. Newton : I am grateful to the hon. Gentleman for acknowledging the fact that I have recently announced a move in precisely the direction he had urged. I will try to give him further details as soon as possible.

Mr. Donald Anderson (Swansea, East) rose --

Madam Speaker : Order. Do I understand that the hon. Gentleman heard the business statement? I understood that he was not in his place for the statement. I can call only hon. Members who have been in place for the statement.

Mr. Anderson : My excuse is that I was listening behind your Chair, Madam Speaker.

Madam Speaker : I must take the hon. Gentleman at his word. That being the case, I will call him.

Mr. Anderson : I am the soul of honour, Madam Speaker.

Does the Leader of the House agree that now is the right time to examine the employment effect on the regions of the Government's privatisation policies for Government agencies? In my constituency, for example, we have already lost jobs as a result from the vehicle inspectorate and from the driver information technology centre. Now we have the ultimate madness. It is envisaged that the Driver Vehicle Licensing Agency, which was put in for regional employment reasons, will be closed as a result of contractorisation with the loss of 3, 000 jobs in an area of high unemployment. When will the madness stop? Why cannot we now have a debate on the effects on the regions of the Government's agency proposals?

Mr. Newton : The Government are obviously concerned to look carefully at all the implications of their proposals. I will bring the hon. Gentleman's remarks to the attention of my right hon. Friend the Secretary of State for Transport.

Mr. John McFall (Dumbarton) : Unfortunately, I find myself in the same position as my hon. Friend the Member for Swansea, East (Mr. Anderson). I was at the back of your Chair, Madam Speaker, when business questions started.

Madam Speaker : I said to the hon. Member for Swansea, East (Mr. Anderson) that I had not seen him in his place and he agreed that he was not listening to the statement in his place. I have to take hon. Members at their word and I have to honour what they say. That being the case, I call the hon. Member for Dumbarton (Mr. McFall).

Mr. McFall : Is the Leader of the House aware that the European Commission is in the process of repealing document 170/83 and establishing a new system for the conservation and management of fish stocks? Given that that must be in place by the end of December, and that white fish fishermen, particularly in the north of Scotland, have reached their quotas and face a bleak two months, will the right hon. Gentleman ensure that a debate ensues on the new regulations, which as yet have not even been discussed in the press, never mind in the House?

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Mr. Newton : The hon. Gentleman said that he had been present earlier, and I have no reason to doubt that. I assume, therefore, that he heard what I said to the hon. Member for Moray (Mrs. Ewing), who asked me about the same matter.

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NHS Trusts (Wales)

4.9 pm

The Secretary of State for Wales (Mr. David Hunt) : With permission, Madam Speaker, I should like to make a statement on what I consider to be a significant development for the national health service in Wales, which I believe will bring long-term benefits not only for patients but also for staff and local communities.

NHS trusts are now seen as the natural organisational model for delivering health care. The pace of change in Wales matches that in the rest of the United Kingdom. I look forward to Welsh trusts taking full advantage of the opportunities available to them to gear their services to the needs of their patients and to deal with the issues raised by the application process and during public consultation. My announcement is confirmation that doctors, nurses, other professional groups and managers increasingly recognise that Government policy towards the NHS benefits patients by allowing for the provision and management of services locally. NHS trusts will remain firmly within the national health service ; to suggest otherwise is a grave distortion. Accordingly, I have today signed orders to establish a further 13 NHS trusts in Wales on 16 November. The orders also provide that the trusts will commence formal operation on 1 April 1993. By that date, and taking account of the Pembrokeshire NHS trust, some 65 per cent. of acute health services, and 60 per cent. of community health services in Wales, will be based on NHS trusts.

Let me make it clear that my decision to establish further NHS trusts was reached by Ministers only after the most careful consideration of each representation received on the individual applications, all of which were subject to an extensive and wide-ranging consultative exercise lasting three months. Hon. Members from Wales were invited to comment on applications relating to their constituencies. In addition to community health councils, health authorities, family health services authorities, GP practices, local voluntary organisations, and, of course, staff at the health units and ambulance services were among the important range of interests that had the opportunity to make known their views on the proposals contained in the applications.

The views expressed during consultation have received close attention, alongside the individual merits of each application, and I have maintained my undertaking that I would not approve any application unless I was personally convinced that patients would benefit from the move to NHS trust status. My decisions reflect that commitment.

I shall shortly be announcing details on the chairmen and non-executive directors for the trusts that are to be established, and I make it clear to the House that my guiding principle is that individuals will be selected for the personal contribution that they can make to a trust.

I now refer to the application from the east unit of West Glamorgan health authority, which includes the plan for a new hospital for Neath and Port Talbot. I remain determined that there will be a new hospital on that site and I expect that the health authority will shortly let the contract for the next stage of infrastructure. Indeed, I am looking to further improvements in services in the area beyond the provision of a hospital and I am therefore inviting the authority, in consultation with the adjoining authorities of East Dyfed and Mid Glamorgan, to review

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the appropriate balance between primary and secondary care into the next century, taking into account the remarkable advances being seen in medical technology and medical practice.

I will be looking to the authority to take independent advice and to have the review substantially completed and to report back to me by the end of March 1993. Because of the importance of awaiting the outcome of the review, I feel it prudent to defer the application for NHS trust status. I know that that will come as a disappointment, but I stress that the application is only deferred.

Turning now to the expressions of interest which have been submitted, the fact that I have invited 14 applications carries no commitment that subsequently I will approve any application or, indeed, that any application has to be submitted. The position remains that the decision whether formally to apply to become a NHS trust is a matter for local determination. There is not, and will not be, any pressure from Ministers in the Welsh Office.

My decisions on whether to invite further applications from three of the health units in South Glamorgan is dependent upon the outcome of the authority's review of unit management structure and services. When that has been agreed in discussion with the prospective applicants, I look forward to receiving updated proposals for implementation as soon as is practicable.

The applications will need to be submitted formally in the early summer of next year and, as was the case this year, every submission will be subjected to a consultation exercise, normally for three months. No decisions will be reached until I have had the opportunity to consider the representations received, alongside the specific proposals for trust status. I would expect to announce the outcome on the applications in the autumn of next year.

Mrs. Ann Clwyd (Cynon Valley) : Despite what the Secretary of State for Wales has said, the statement is a further step down the route towards the American health care system in this country. Everyone in Wales knows exactly what that means. Conservative Members may shake their heads and claim that that will not happen. However, they do not recognise that a growing number of Tory Members support a private insurance system of care in the United Kindgom. In the meantime, what do the Government do for the national health service? They cut public spending, with further cuts ahead. They underfund and privatise community care. They commercialise and privatise the NHS. Where there should be more care and better care, the Government offer us competition. Where there should be service, we have the internal market, the GP fund holder, a two-tier health service and nurses out of a job.

The trusts are run like private sector companies. Although it is true that they are not in the private sector now, they have the potential to be lifted into it at the whim of a Minister. It will not be long before hip replacements are advertised in the medical appliance section of Exchange and Mart.

The statement is a further nail in the aspirations of our national health service, which is still the envy of the world despite all the Government's attempts to destroy the vision and inspiration of Aneurin Bevan.

The Secretary of State for Wales is now trying to persuade the Welsh people that the trusts, which are not accountable to local people, are for their benefit. From

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England, we hear reports of throat-cutting commercialisation and cuts in services and staff, but not in waiting lists. The experiences of some of my hon. Friends are not happy experiences. These are the newspaper headings that are only too commonplace in their experience of trusts :

"NHS Trust mishandled injured baby case"--

not the Morning Star --

"Heart patients wait as budget runs out one month early"-- not the Morning Star, and

"Four heart patients die for lack of money".

The North Middlesex hospital NHS trust recently announced cuts of £1.7 million and told its patients that, instead of two meals a day, they would get one meal and a snack and, after 6.30 pm, no evening drink. Is that what we must expect of our more caring, more efficient, health service as trusts become the order of day, or is it simply yet another example of trusts putting financial savings before patient care?

Why must Wales always be a post office for the Department of Health? That was a finding that we made when I was a member of the Royal Commission on the national health service, the only true look into the national health service since it started. Why must we always ape England in the provision of health services? Why does the Secretary of State not deal instead with the many hospitals in Wales at which no waiting list surgery is being done, leaving patients in pain and discomfort?

My hon. Friend the Member for Pembroke (Mr. Ainger), who has vigorously opposed the trust in his area, has taken up the very pertinent matter of NHS trust executive directors' salary packages. Will the Secretary of State assure us that the details of salaries and other payments to senior managers and executive directors of trusts in Wales will be published in future? Certainly, the Pembrokeshire NHS trust seems to be very good for those with a passion for German sports cars but not so good for the patients in Pembrokeshire.

All who care about the NHS in Wales--that is, all my hon. Friends--will be anxious about the service that will be provided in future. We all know about purchasing and providing, but who does the strategic planning? The only strategy that the trusts seem to have is how to make money, not how to provide for the needs of the community.

The Government believe in governing by leak, just like their leaks on the pit closures. First of all, they leaked their plans to the Western Mail . The Western Mail had all the details about the trusts yesterday. That is another discourtesy to the House. Why does the Western Mail seem to have a list of the hospitals that are to be new trusts? The list in the Western Mail includes the Royal Gwent, Newport, Singleton, Swansea, West Wales, Carmarthen and the Princess of Wales hospital in Bridgend. Perhaps the Secretary of State for Wales will provide us with the list and tell us the number.

The Government are not really concerned about discussing. Opposition Members greet with a wry smile the Secretary of State's declarations on discussion. We cannot believe that he believes in proper consultation and providing for the health needs of Wales. After all, we should not be too surprised at that because the Secretary of State for Wales, the right hon. Member for Wirral, West (Mr. Hunt), with an English constituency, simply fails to

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understand the passion and the feeling with which we who represent the majority of the people of Wales defend our national health service.

The Secretary of State must understand that we will continue to campaign to prevent the creeping commercialisation of our national health service. We will continue to win the support of the people of Wales because they believe that health is safe in our hands. We created the national health service and we will fight to protect it.

Mr. Hunt : That was a quite disgraceful response. To attempt to be taken seriously on the national health service but to talk about throat- cutting commercialisation is to trivialise the very important issues involved.

The hon. Lady may want to go back to all the arguments that we rehearsed during the last general election when we had much misinformation about the national health service. Indeed, the Labour party thought that it would win the United Kingdom election on that misinformation. It did not win the election because its lies were exposed. The idea that the national health service was being privatised when we were talking about non-profit-making national health service trusts was seen by the public as the nonsense that it undoubtedly was. The hon. Lady should consult some of her hon. Friends. Some Labour Members work closely with national health service trusts in England. I am aware of them in my own area. I find that the trusts put the interests of patients first and improve patient care.

The 13 units are : Clwyd acute north unit, which is at Llanllwyd hospital ; Clwyd acute south unit, which is at Wrexham Maelor hospital ; Clwyd community and mental health unit ; Powys health unit ; south Gwent acute unit ; Gwent community and mental health unit ; Llandough hospital health unit ; Ogwr health unit ; west unit, which is, of course, Singleton hospital in Swansea ; Llanelli/Dinefwr health unit ; Carmarthen Dinefwr health unit ; Ceredigion health unit ; and the Gwent, Powys and South Glamorgan joint proposal for the ambulance service. The hon. Lady will see from that list that the list that she saw in the Western Mail was incomplete.

The hon. Lady said that it would be possible for hospitals to transfer out of the national health service into the private sector. That is not possible under the law of this land. I make that absolutely clear. The hon. Lady also mentioned Pembrokeshire. Pembrokeshire has done extremely well. Its NHS treated 6 per cent. more in-patients and 25 per cent. more out- patients in the first four months of operation. That is the truth.

The hon. Lady referred to strategic planning. The national health service in Wales is proud to have not only the finest people working in the service but the finest executive of any service. It has published a strategic intent which I believe is the envy of many other parts of the United Kingdom, Europe-- [Interruption.] --I was asked about the strategic intent--and the world. I recently met representatives of the World Health Organisation which complimented me--I was proud to receive the compliment as Secretary of State--on the way in which the health service in Wales applied itself to the strategic intent of putting the service in Wales on course to be on a par with the best in Europe and to go into the 21st century, adding years to life and quality life to years. We were the first part of the United Kingdom to have that strategic intent.

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I remember the hon. Lady being involved with the Royal Commission on the national health service. That royal commission reported in 1979 after many years of a Labour Government. What did the hon. Lady and her colleagues on the royal commission say about funding? On 25 October 1989, she said :

"The Royal Commission reported that we had a good and comprehensive health service but that it was grossly underfunded".-- [Official Report, Welsh Grand Committee, 25 October 1989 ; c. 88.] That was thanks to the Labour Government. What has happened since then?

The picture is different now. At that time, my predecessor pointed out to the hon. Lady that in cash terms the funding of the national health service in Wales had trebled. I am happy to tell the House now that funding has quadrupled. We have had to put right the inequities of those years of Labour government. In 1979, less than £500 million was spent on the national health service in Wales ; we now spend £1, 946 million. That is a fourfold cash increase. The increase in real terms is 67 per cent.

I shall explain that in simple terms. In 1979, the national health service in Wales spent £171 for every man, woman and child. We have now increased that figure to £675. We have remedied the underfunding of the national health service to which the hon. Lady drew attention.

Mr. Jonathan Evans (Brecon and Radnor) : Will my right hon. Friend confirm that, in some of the consultations, the responses that he has received--even from those people who may not have been convinced by some of the applications--have not shown the hostility to NHS trusts that we have heard from the Opposition Benches? Will he confirm that in the Powys area-- a large part of which I represent--there is much support for what Powys health authority has done for health promotion and there is much trust in that NHS trust application?

Mr. Hunt : I could not agree more with my hon. Friend and I am grateful to him for putting the record straight. One of the key criteria for becoming an NHS trust is that the application must demonstrate realistic and achievable measures to improve patient care. That is what is going to happen.

Mr. Alex Carlile (Montgomery) : Does the Sectetary of State recognise that there will be anger in rural mid-Wales at the dismemberment of the Powys ambulance service into some enormous centralised and independent organisation? Does he accept that he has a long way to go to persuade staff in Welsh hospitals that what he has decided for Powys health authority will benefit the patients? Will he give an undertaking that the Welsh Office will advertise for chairmen and non-executive directors of trusts, so that the selection can be made from a cross-section and is not confined largely to members of his party?

Mr. Hunt : That was a cheap point. The best possible people will have to run the NHS trusts. That is why I have been receiving suggested names from Opposition Members, and why I am considering them carefully. Everyone in Wales knows that we are looking for the best possible people. If Opposition Members think that any people are not being considered, I want to hear from them immediately.

Mr. Carlile : What about the ambulance service?

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Mr. Hunt : I am just coming to that, but I must deal with the hon. and learned Gentleman's cheap point. I am determined that the best possible people will be involved in NHS trusts. Approved NHS trusts are committed to improving the ambulance service. That is one of the key points in the applications before me. The NHS trusts are at the forefront of health service reforms, to make the service directly responsive to patients' needs. That is what the trusts will put at the forefront of their objectives.

Mr. Rod Richards (Clwyd, North-West) : Does my right hon. Friend recognise that the splendid decision that he announced today will be welcomed by everyone in Clwyd-- [Interruption.] --by everyone who is sensible and wants the quality of the NHS to improve?

Mr. Hunt : I sometimes wonder why the clear evidence that my hon. Friend has laid before the House is not appreciated on both sides. I shall give some further statistics. In Wales, we are treating 500,000 in- patients, which is an increase of 38 per cent. during the years that we have been in Government, or another 132,750 in-patients, and the number of out-patients has risen by 29 per cent., which is another 122,700. Day cases have increased by 227 per cent. Those are excellent figures and a tribute to the quality of people working in the health service in Wales.

Mr. Nick Ainger (Pembroke) : When the Secretary of State says, "Let's put the record straight", is he aware of what has been going on in the Pembrokeshire NHS trust during the past seven months? He does not refer to that. He says that he assumes that the staff will welcome his announcement because of the benefits that it will bring. Is he aware that, seven months after the beginning of the trust in Pembrokeshire, not one trade union has been recognised ; that the Royal College of Nursing is in dispute with the management of the trust over the application, without consultation, of a local pay spine ; that the United States naval facility has entered into a contract with the trust for private ante-natal care ; and that the German army has entered into a private contract with the trust for dental care? After seven months of operation, when I receive a letter from the chairman of the Pembrokeshire NHS trust, in reply to my letter concerning the car leasing agreement, to which my hon. Friend the Member for Cynon Valley (Mrs. Clwyd) referred--

Madam Speaker : Order. I regret the fact that questions on the statement are becoming a debate. I remind hon. Members, as well as the Secretary of State, that we want to have questions and answers. That is what statements are all about. We are not in debate. May I have a question from the hon. Gentleman?

Mr. Ainger : May I have the Secretary of State's reaction to the statement by the chairman of the Pembrokeshire NHS trust, in response to my question about the car leasing agreement and salary structures of the executive directors, that that was quite common commercial practice in relation to car leasing deals?

Mr. Hunt : The purpose of the reforms is to take decision-making closer to the people and to have decisions taken locally. I am not going to try to second-guess the national health trust in Pembrokeshire. I do not judge anyone on his or her property or on the car that he or she drives ; I judge people on what they are going to do for the

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national health service in Wales. The Pembrokeshire NHS trust has treated 6 per cent. more in-patients and 25 per cent. more out-patients. That is a pretty good record.

Mr. Walter Sweeney (Vale of Glamorgan) : Will my right hon. Friend accept congratulations from the Vale of Glamorgan on the tremendous strides that have been made in health care in the past 13 years? Will he acknowledge that we have a particular interest in the future of Llandough hospital and that we look for further improvement in that already great hospital as and when trust status is acquired?

Mr. Hunt : I am glad that my hon. Friend referred to Llandough, because that is one of the applications that I approved today. If I may reiterate a point that fits in very neatly with the points which my hon. Friends are making, approved NHS trusts are committed to attacking waiting times and waiting lists, improving the ambulance service, providing local mental illness and mental handicap services, improving local hospitals, improving individual community care programmes and increasing day care facilities.

We look forward with great optimism to their achieving many of those targets in the years ahead.

Mr. John Morris (Aberavon) : I welcome the Secretary of State's determination to have a new hospital at Neath and Port Talbot, a determination which I have long shared.

Will he expand on his cryptic Whitehallese when he referred to a further improvement over a wider area? Will the right hon. Gentleman give an assurance that those are plus words and not minus words and that they mean something beyond the provision of a hospital--not a diminution in capital, the time scale or any specialty at Port Talbot or intended there? Why was Port Talbot singled out? Does this mean a cut at Port Talbot or not?

Mr. Hunt : No, it means exactly what it says. I should like to make some points to the right hon. and learned Gentleman, who was a distinguished predecessor. There is no community hospital programme in West Glamorgan--that is an important point. Elsewhere in Wales, progress is being seen in community care. That is evident. There is a significant move towards day care provision : the twofold increase in West Glamorgan compares with a fivefold increase in Mid Glamorgan and a fourfold increase in East Dyfed. So my statement means exactly what I said : I want to look at further improvements in provision of services in the area beyond the hospital provision, and that is why I have asked for this review.

Mr. Nick Hawkins (Blackpool, South) : Does my right hon. Friend agree that the hon. Member for Cynon Valley (Mrs. Clwyd), who leads for the Opposition, in responding to this statement this afternoon--

Madam Speaker : Order. The Secretary of State is not responsible for what the hon. Lady says. The statement should be questioned.

Mr. Hawkins : Thank you for your guidance, Madam Speaker. May I rephrase the question in this way? Does my right hon. Friend agree that we have heard a great deal this afternoon which has attempted to blacken the work of the NHS trusts in England and which has been used as examples?

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Will my right hon. Friend confirm that the experience of the trusts in England has been that waiting lists have been cut dramatically and that "commercial management", which the Opposition think are dirty words, is bringing efficiency to the NHS? The Opposition are concerned about restricted practices and preserving the jobs of those in the Confederation of Health Service Employees and the National Union of Public Employees, not about improving medical standards for patients.

Mr. Hunt : I am grateful to my hon. Friend for making the point about NHS trusts in England, where throughput has increased, waiting lists have been cut, new equipment has been introduced early and capital expenditure is ahead of schedule. That has been a great success story and we in Wales are determined to share in that success.

Mr. Alan Williams (Swansea, West) : The Minister says that he wants to take decision-making closer to the people. Will he explain how 13 unaccountable quangos, packed with Welsh Office placemen, take decision- making closer to the people? If he is concerned about decision-making and the people, why, in a parliamentary answer to me last week, did he say that of 90 representations that he has received in relation to the Singleton trust, only 19 were in favour?

Mr. Hunt : I read through all the representations and I take them into account before I reach a decision. The whole purpose of creating NHS trusts is to make them more accountable and to take decision-making closer to the people. We shall see the results and the benefits as the NHS trust movement in Wales evolves.

Mr. Denzil Davies (Llanelli) : On the subject of accountability and bringing decision-making closer to the people, will the Secretary of State give an assurance that the chairmen and non-executive directors of the trusts will live in the areas that their trusts service?

Mr. Hunt : As I have said on many occasions previously, I shall take great care in selecting the people who will be involved. I shall not rule anybody out, because that would be wrong. The right hon. Gentleman's point is valid, but the important thing is to have the best possible people.

Mr. Ieuan Wyn Jones (Ynys Mo n) : The Secretary of State will be aware that, every time the Conservative party has laid its plans for hospital trusts before the people of Wales, they have been decisively rejected, both at by-elections which Conservatives lost during the last Parliament and during the general election. If the right hon. Gentleman and his right hon. and hon. Friends believe that the people of Wales want trusts, why does not he put it to the test and call for a ballot in each of the areas so that the people of Wales have the final decision on the trusts?

Mr. Hunt : Neither I as Secretary of State nor my right hon. and hon. Friends are prepared to walk away from the need to make decisions in these areas. The key decision which we have made is to increase funding substantially for the NHS. I have already made it clear that, since we took office in 1979, cash for the NHS in Wales has been increased fourfold, and that is 67 per cent. more in real

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