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Column 603Richardson, Jo
Robertson, George (Hamilton)
Robinson, Geoffrey (Co'try NW)
Roche, Mrs. Barbara
Ross, Ernie (Dundee W)
Sheldon, Rt Hon Robert
Smith, Andrew (Oxford E)
Smith, C. (Isl'ton S & F'sbury)
Smith, Rt Hon John (M'kl'ds E)
Smith, Llew (Blaenau Gwent)
Smyth, Rev Martin (Belfast S)
Steel, Rt Hon Sir David
Strang, Dr. Gavin
Taylor, Mrs Ann (Dewsbury)
Taylor, Matthew (Truro)
Walker, Rt Hon Sir Harold
Wardell, Gareth (Gower)
Wareing, Robert N
Williams, Rt Hon Alan (Sw'n W)
Williams, Alan W (Carmarthen)
Winterton, Nicholas (Macc'f'ld)
Wright, Dr Tony
Young, David (Bolton SE)
Tellers for the Noes :
Mr. Alan Meale and
Mr. John Spellar.
Question accordingly agreed to.
Clause 42 ordered to stand part of the Bill.
Committee report progress.-- [Mr. Andrew Mitchell.]
To sit again tomorrow.
That the National Health Service (Determination of Districts) Order 1993 (S.I., 1993, No. 574), dated 9th March 1993, a copy of which was laid before this House on 10th March, be revoked.
I understand that with this it will be convenient to discuss at the same time the following motions :
That the National Health Service (District Health Authorities) Order 1993 (S.I., 1993, No. 572), dated 9th March 1993, a copy of which was laid before this House on 10th March, be revoked. That the National Health Service (Determination of Regions) Amendment Order 1993 (S.I., 1993, No. 571), dated 9th March 1993, a copy of which was laid before this House on 10th March, be revoked. We are about to debate orders that relate to the reorganisation of the English national health service. Frankly, the orders do not do justice to the reorganisation proposed by the Government. The Government are reorganising the NHS by stealth and by the back door. The Minister is the Lord Hanson of the national health service. Merger mania, takeovers, corporate raids on funds, asset-stripping, sackings of staff, profit-taking, commercialisation and privatisation are all contained not only in these orders, but in previous orders which have been passed by the House without parliamentary or public scrutiny.
In 1982, the Government introduced proposals for the reorganisation of district health authorities. They created 192 authorities-- [Interruption.]
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : On a point of order, Mr. Deputy Speaker. The orders are tremendously important. It is impossible to hear what my hon. Friend the Member for Makerfield (Mr. McCartney) is saying.
Mr. McCartney : I thank my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody). It is the first time that I have been shouted down in the House before I have got two minutes into my speech. I shall try to provoke Conservative Members a little more as I get further into my speech.
In 1982, the Government reorganised the district health authorities of England, creating 192 on the basis that the previous 85 were too remote, too large, had no control locally of the delivery of service and showed no signs of being consistent with local democracy and local accountability. Yet 11 years on, the Government are by stealth reversing that policy and are reducing the number to between 85 and 90. With the reorganisation, they are removing much of the public accountability and public participation in local health services. Why is that?
Why is the Minister reorganising the national health service in this reorganisation that dares not speak its name? Why, with little local consultation and hardly any parliamentary scrutiny, are the Government undertaking the biggest reorganisation of the health service in England since 1982? It is all about the creation and development of a market in the national health service.
Column 605At a time when the Government are causing bed closures, when there are nearly 1 million people on the waiting lists, when prescription charges are rising, when limited lists are being introduced, when student nurses are being made redundant and qualified nurses are being sacked, when GPs are saying that the community care proposals are a shambles and when charities both locally and nationally are paying for life-saving equipment because the national health service cannot afford it, the Under-Secretary is appointing Conservative after Conservative to chairmanships and non-executive positions on the boards.
The money that is being spent is an absolute scandal--a scandal of major proportions. Let me give the House some indication of the size of the gravy train that the Under-Secretary is driving. Take the hon. Gentleman's own constituency as an example. In Bolton, during 1990-91, £17,100 was available in remuneration for the chair and non-executive members. By 1992, that figure had risen to £49,356. The Parliamentary Under-Secretary of State for Social Security, the hon. Member for Bury, North (Mr. Burt), who is trying to reduce income support for the unemployed, has presided over an increase from £35, 000 to just under £50,000 in remuneration for Conservative appointees on the health authority in his constituency. The Government are introducing income support, using public funds, for Tory party members to run quangos in the national healthupon Tyne, expenditure in respect of chairmen and non-executive members has risen from £46, 000 to £107,469. In Cumbria, the figure has risen from £15,000 to £48,000 ; in Gateshead, from £29,000 to £43,000 ; and in Northumberland, from £31,000 to £63,000.
One can cite area health authority after area health authority--and that at a time when the Government cannot find the money to pay student nurses finishing their courses and are giving them a certificate with one hand and a UB40 with the other. It is outrageous that the Government are spending these rare resources not on primary health care or care in the NHS but in payments to Tory party members to run the national health service.
The reorganisation involves centralisation ; it is leading to services being planned by people who do not know their own populations and who do not live in their areas. The Minister is creating purchasing giants because he wants to ration care in the national health service. He wants to create offices of health regulation by replacing public health officers and appointing health commissioners, 50 per cent. of whom have no medical qualification whatever. He is replacing qualified medical staff with consultants and accountants whose responsibility is not to prepare and deliver a local health care service on the basis of need, but to ensure that purchasing is the main drive of health care in the regions. There will be no public accountability whatever. The new organisations are to be run exclusively by political appointees. After last Thursday's election debacle, the Government will have hundreds more ex-councillors to appoint to those positions.
Finally, I want to ask the Under-Secretary about London. He argues that we should have conterminosity
Column 606--the hon. Member for Ribble Valley (Mr. Evans) is surprised that I managed to pronounce that properly--and that the reorganisation is about trying to ensure that districts are amalgamated and that there is a commonality of boundaries with local authorities. Why is it then that, for Kingston, Esher, Richmond, Twickenham and Roehampton, there is no conterminosity? The Government have broken it up. They have divided the new health authority between four or five district councils. I believe that the reason is that the right hon. and learned Member for Putney (Mr. Mellor) has an interest in a particular hospital there. He is concerned--
The right hon. and learned Member for Putney obviously wants to ensure that the boundaries suit the Government politically rather than suit the national health service.
Mr. Taylor rose--
Mr. McCartney : I know that the hon. Gentleman comes from Esher, but he has an opportunity to put the case in the same way as I am trying to put the case. Perhaps for once he will speak in the House on health service matters and put the case.
The Government owe it to the House to explain why, in the areas that I have mentioned, they are getting rid of conterminosity and replacing it with politically biased boundaries irrespective of the health care needs of the borough.
It is absolutely essential that there is more public debate about the proposals. It is clear that the orders that the Government intend in the weeks and months ahead to propose further major reorganisation of district health authorities, uprooting local accountability, destroying the commonality of each community, removing local purchasing and replacing it with big takeovers and mergers. In some areas, local authorities will also lose the opportunity to co-ordinate community care in a rational way.
Local community health councils will be under threat from the Government when the Government remove the coterminosity of the boundaries as a result of the major changes and takeovers that are taking place. That has already led in many areas to the closure or partial closure of hospitals as big organisations drive down the cost of health care at the expense of services to the local community. I ask my colleagues not only to speak against the orders but to vote against them in the Lobby.
The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville) : It is always a pleasure to follow the hon. Member for Makerfield (Mr. McCartney). When he hits that top C sharp and holds it for 10 minutes it is a marvel of oratory and Conservative Members know that he is destroying whatever case he is trying to put to the House.
The debate gives me an opportunity to discuss with the House the merits of mergers of health authorities and the benefits that they give to patients and the health service. Most people know about the remarkable changes that have been made on the provider side of the health service.
Column 607Trusts are undoubtedly one of the great success stories of the health service and probably the greatest single radical change since its inception.
Rather less well known, and perhaps more important, is the new position and role of health authorities as purchasers. Purchasing is a new concept not entirely understood by Opposition Members, as we have just heard, but it is enormously important. In case the hon. Member for Makerfield has not noticed, health authorities will not manage hospitals in future ; that will be the duty of trusts. Purchasers will have an entirely new role. They will assess the health needs of their area.
Mrs. Dunwoody : Would the Minister like to tell us whether this system went live on 1 April and whether, if that is so, almost all the authorities on his list are trying to implement illegal contracts?
Mr. Sackville : I do not recognise the constitutional validity of what the hon. Lady says. The Opposition are praying against orders to merge health authorities which became effective on 1 April. The new merged health authorities will set standards for care in their areas. They will target the resources allocated to them by the regional health authorities. They will demand value for money through the contracts that they set with providers. Lastly, they will monitor quality. But they will also have a wider remit. They will also be the bodies that influence the health agenda in each area. The vision for that was set out in "The Health of the Nation" White Paper. Health authorities will be encouraged to form healthy alliances with other agencies, such as local authorities and voluntary organisations, and even with private sector companies to influence and improve the health of their populations.
Mr. Harry Cohen (Leyton) : How can the new health authority in Redbridge and Waltham Forest, in my area, improve the health of the people there when it will suffer a £13.5 million cut over the coming five years? The first £2 million cut was implemented this year. That authority, local Members of Parliament and the local public have not been consulted. The Minister talks of a new role for those health authorities. Is this not another way of telling the public that they cannot get the treatment that they need?
Mr. Sackville : On the contrary : they will be in a position better to marshal the resources at their disposal, for reasons I shall explain. Health authorities now have a formidable brief, so we need to develop and strengthen NHS purchasers.
Mr. Mike Gapes (Ilford, South) : There has been a terrible dispute between Redbridge health authority and the Redbridge health care trust in recent weeks, and only in recent days has the authority taken contracts to the trust. That has resulted in a massive problem financially, including a potential £400,000 deficit for the new trust. Is that some of the co- operation about which the Minister is talking?
Mr. Sackville : I have no doubt that in many areas there will be certain constructive tension between purchaser and provider, and that is an example of the contracting system. Indeed, it is one of the strengths of the system.
I shall not delay the House long because other hon. Members wish to take part in the debate. What are the benefits of mergers? They will play an important part in