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Column 608helping larger health authorities to assess and meet the health care needs of the population in the way that they relate to other local bodies, particularly family health services authorities and local authorities.
A high proportion of district health authority mergers will help to simplify those relationships by, as the hon. Member for Makerfield rightly said, conterminosity, meaning common borders with other agencies. We do not pretend that they will guarantee success, and there will not be common borders in every case, as the hon. Gentleman pointed out. Common boundaries can help with the integrated purchasing of primary and secondary care and with the task of commissioning care in the community.
Larger authorities will have a more stable population on which to assess the needs of their local populations and they will be better prepared for eventualities in those larger areas. They will be in a better position to place contracts for specialised services and special care groups.
Mergers can offer the prospect of increased purchaser leverage, giving district health authorities more bargaining power and clout in dealing with providers and getting a proper deal for their patients. DHAs must be strong enough to bring the benefits of GP
fundholding--which is a whole new factor in the NHS--to all GPs, whether or not they are fund holders, and to their patients. They will enable purchasing authorities to make the best use of human resources. Purchasing will not require large numbers of people, but it will need a critical mass of highly skilled personnel if it is to be properly performed. In the past, DHAs have suffered from the migration of high-quality staff to trusts, but larger authorities will be better placed to attract and retain the best people to do the job.
Mergers will produce administrative savings and considerable economies of scale, which should be welcome to all hon. Members. By simply reducing the number of contracts, a considerable saving can be achieved. Of the mergers under discussion, that in South West Durham will reduce the number of contracts to be negotiated from 220 to 120. I know that one health authority in the west country has claimed, since merger, to have saved more than £1 million in administrative costs.
Mr. David Blunkett (Sheffield, Brightside) : How can the Minister argue that merging purchasing authorities saves administrative time and money and is valuable in terms of the patient, when the inevitable thrust of GP fundholding is to break up the purchasing arrangements, the larger contracts and the benefits that can be gained from rationalising and quality of scale, and replace them with small purchasing contracts?
Mr. Sackville : The virtues of GP fundholding are obvious. If the hon. Gentleman talks to fund holders and their patients, he will discover the benefits that they are receiving as a result of the change in their relationship with providers. There is no doubt that economies of scale will result from eliminating duplicated posts in health authorities that merge.
Patient benefits can be achieved by linking the planning and development of services with other agencies and by improving the quality of purchasing bodies in order to make them more responsive to local people. The greater pressure on costs will release resources for care. I should
Column 609have thought that, given the new role of health authorities, which will not manage hospitals but will be purchasers, it would be clear that new configurations will be necessary.
I heard nothing of any substance in the speech of the hon. Member for Makerfield. He attacked the proposed changes and his speech was yet another gratuitous attack
Column 610on the health reforms. It may be indelicate to talk about elections now, but before the general election we heard from the Opposition a litany of gratuitous attacks on the health service, which they sought to denigrate. If they continue with their Pavlovian response of persistent attacks on everything to do with the health reforms, it will be clear that the events of April 1992 have taught them nothing.
Column 61110.57 pm
Mr. Alan Milburn (Darlington) : The Minister spoke at length about coterminosity and it is ironic that we should be debating health authority mergers, because this morning the Local Government Commission published its findings about the future of local government services in County Durham. I am delighted to tell the House that the commission recommended a unitary tier council for Darlington. That will restore control that was stripped from the town in 1974 by the then Conservative Government.
Nearly 20 years on, we are debating orders that will, once again, take power from Darlington, this time from its other key public service, the NHS. Just as social services and other services that might impact on health care are to be delivered back to the town, the NHS will be taken out of local hands. That decision is not only illogical but it will create a bureaucratic minefield where patients, once again, will be the casualties. That is only one of the many ironies and concerns that have been revealed by the impact and process of the merger of the Darlington and South-West Durham health authorities.
Together with my right hon. Friend the Member for Bishop Auckland (Mr. Foster) and my hon. Friend the Member for Durham, North-West (Ms Armstrong), I have strenuously opposed the merger from the outset, because we believe it to be a false merger which will do nothing to improve health care in either Darlington or South-West Durham. Our resolve has been strengthened by each twist and turn in the lengthy merger process.
The merger to create the new South Durham health authority did not arrive on the scene from nowhere on 1 April, but had a lengthy gestation period. It was conceived in secret and delivered by a mixture of manipulation and deceit. Members of Parliament were even denied the chance to debate the merger before it came into being on 1 April--an issue which has already been raised by one of my hon. Friends.
The saga of South Durham health authority dates back to 25 April last year when the Northern region health authority published proposals for a new set of consortium arrangements to purchase health care. Seven consortium arrangements were to be created covering the 15 district health authorities in the north, including one for South Durham, covering the Darlington and South-West Durham health authority areas.
Early in March last year I received the first in what was to be a series of leaks from a well-placed source inside the region's NHS, which showed that the new consortiums were envisaged as staging posts to full-blown health authority mergers. My source was able to state which senior managers were to be moved into which posts in order to facilitate the merger. The leaked predictions were to be proved uncannily accurate. The game of management musical chairs involved Darlington's chief executive, Geoff Nichol, and South-West Durham's David Ryan disappearing off the scene to allow a newcomer, Tony Jameson, to take over as chief executive of the joint authorities. When the story appeared in the local paper, The Northern Echo, a regional health authority spokesman went out of his way to dismiss the document as pure speculation. He said that the possibility of a merger had not even been discussed. I did not want to leave anything to chance and immediately wrote to the regional health
Column 612authority chairman, Peter Carr--as a good prospective parliamentary candidate should. I received a clear reply from Mr. Carr on 26 March. He said :
"there is no regionwide blueprint. There is no timetable. Any new consortia management arrangements that are developed would remain accountable to the existing statutory health authorities." By the end of the next month, Geoff Nichol and David Ryan had left their posts, but the region's head of communications, Dr. George Forster--a man who will frequently appear in the course of the saga--told the other local paper, the Darlington and Stockton Times :
"as for merger well it is just not on the agenda".
In the same newspaper on 23 May, the same Dr. Forster greeted the news that Tony Jameson had arrived in Darlington with a categorical assurance that
"the new appointment of Mr. Jameson is for the post of district general manager of Darlington. He is not being employed to run the joint purchasing function."
However, the following week, Dr. Forster had gone strangely quiet. Perhaps that was not surprising as, by that time, Mr. Jameson had been appointed as acting chief executive in South-West Durham as well. My right hon. and hon. Friends and I have the highest regard for Mr. Jameson, so when he said in a newspaper interview that "the regional health authority has a view that a smaller number of districts in the region is a desirable arrangement",
naturally we all felt concerned.
Our concerns were heightened when, in the middle of July, The Northern Echo received a leaked copy of a memorandum written by Mr. Jameson. It informed senior managers and district health authority members that a proposed merger of Darlington and South-West Durham health authorities would be discussed at the regional health authority meeting on 28 July. All that happened before the two districts had had a chance to meet on 22 and 24 July to ask the region to back the merger proposal. Mr. Jameson's memo had blown the regional health authority's cover about there being no blueprint and no timetable.
It is little wonder that, by that time, the very idea of public consultation was dismissed as an elaborate sham. Ministers connived in a fait accompli to ensure that a merger was forced on Darlington and South- West Durham.
That view is enforced by an examination of the regional health authority's treatment of the responses that it received. I have no doubt that the Minister will say that a majority of the responses were in favour of the merger. However, he will omit to say that the overwhelming majority of the favourable responses came from NHS organisations. Such is the loyalty to the centre in the NHS nowadays that they could not be expected to rebel.
Even when dissent was expressed, it was discounted. The regional health authority managed to count a letter from a consultant paediatrician as expressing no comment in overall support or opposition, despite its clear view :
"I fail to see how the new larger authority will benefit the people The people wish to keep their own services locally. Travelling for many is not easy. Transport is expensive."
Others were not consulted at all. Darlington MIND, an important local voluntary organisation providing services for the mentally ill, has never been consulted about the proposed merger and the 2,000 people who signed a petition organised by myself and my right hon. Friend the Member for Bishop Auckland were counted as one response.
Column 613We are used to health Ministers manipulating the figures. I understand that they have their own interests to serve, but this is statistical jiggery-pokery on a grand scale.
In the headlong rush towards merger, local views have been trampled underfoot. No doubt the Minister has a defence for the merger and I can guess what it is. He will say that it makes financial sense and that there are administrative savings to be made. That is a bit rich coming from a Government who have managed to treble the number of managers and administrators in the NHS since the introduction of its market reforms. Even if that were true, Mr. Jameson, a notable local authority, said in The Northern Echo on 2 May that changes in administrative numbers will be achieved through redeployment ; in other words, redeployment to the provider units. It is a question not of cutting bureaucracy but of moving bureaucrats around. The Minister knows that there will be no major savings.
The Minister will also say that those who oppose the merger are worrying unnecessarily because changes among purchasers have no impact on the services that the patients receive from providers, yet provider services are already being merged in Darlington, and South-West Durham. Chiropody and speech therapy are merged services. There will be community services opt out across the two districts and, most seriously, there is still a question mark hanging over the future of Bishop Auckland general hospital.
There is a strong feeling in South-West Durham that the Minister has in mind running down the general hospital to the level of a cottage hospital. That view has been prompted by the long delays in announcing the go-ahead for the phase 3 development, despite the prompting of my right hon. Friend the Member for Bishop Auckland. The Minister has a chance to end the speculation tonight by giving the green light to that development. I hope that he will grasp the opportunity with both hands.
The result is simple. The new South Durham health authority is more remote and less accountable. It has only five non-executive directors, all appointed by the Tory Secretary of State, where there used to be 10. There will be only one joint consultative committee, so weakening links with the voluntary sector. There are doubts about the future of the two community health councils because the regional health authority document indicated that they were safe, but only for the time being.
I hope that the Minister is listening and that he will take the opportunity of giving a cast-iron guarantee that the future of the two CHCs is safe, regardless of anything else. His failure to do so will leave people in Darlington and South-West Durham with the clear impression that in the new model market NHS the views of local communities count for absolutely nothing.
The Government have clearly decided to let purchasers go the way of providers, so that takeovers and mergers become the order of the day. The new philosophy seems simple : biggest is best. The latest proposal to emerge from the regional health authority is not just for South Durham health authority or North Durham health authority but for a new purchasing consortium--where have I heard this before?--for the whole of County Durham. Twenty years on, we have gone full circle ; we are back to the old area
Column 614health authority structures which were discredited because they were remote, monolithic bureaucracies, out of touch with local people.
We have a more centralised, less accountable health service than ever before. It is also a more secretive organisation. Yet it would be as well for Ministers to remember that the NHS remains a public service. It belongs to the people. It is not the private property either of unelected bureaucrats or of Conservative Ministers, making decisions over the heads of local people.
The process of creating a merged South Durham health authority has been a shameful one. It has been undertaken by stealth. It has relied on misrepresentations, false denials and back-door deals. In a town where there is a proud tradition of public services being run locally, there is understandable and genuine anger about how the community in Darlington has been kept in the dark about the future of its NHS. It is for those reasons that I ask the Minister not only to rescind the orders but to announce tonight an independent inquiry into the South Durham merger. The people of Darlington and South-West Durham deserve no less.
Mr. John Greenway (Ryedale) : I agree with one thing that the hon. Member for Darlington (Mr. Milburn) said. Like him, I strongly support community health councils. When the debate was held in north Yorkshire about whether the four district health authorities should merge into one purchasing authority, one of the chief concerns was what that would mean for the future of the community health councils. Both the York and Scarborough CHCs do an excellent job of feeding to officials in our hospitals the feelings of local people about their needs in relation to service provision.
It was only when the Secretary of State for Health made it clear that the community health councils were safe and were not to be merged along with the DHAs that support for the central purchasing authority in north Yorkshire came from the grass roots. I hope the Minister will acknowledge that point.
I invite the Minister to visit Malton. If he wants to see a fund-holding practice that works in conjunction with a small community hospital, he will see none better than in Malton. The last time I talked about Malton in a health debate someone interrupted to suggest that the hospital would close within six months. That was three or four years ago and the hospital has gone from strength to strength. During the recent local election the usual rumours about the future of the hospital were flying thick and fast. I have made strenuous inquiries and I cannot get a handle on any of these rumours- -only a flat denial from the chief executive of the Scarborough health trust that it has any plans to cut services at Malton hospital.
Apart from seeing the wonderful fund-holding practice and how the hospital works, the Minister, I hope, will come to Malton to issue a warning to the health trust, just in case it is thinking of curtailing any services. It must think again. Although I fully support the merger of the four district health authorities in north Yorkshire--with the four hospitals now all health trusts, it makes a great deal of sense for north Yorkshire to constitute one purchasing authority--I have been anxious that that
Column 615should not lead to any diminution of funding for each of the trusts. Scarborough health trust is facing a shortfall of £1 million.
Mr. Greenway : Well, from my discussion with the chairman of the Yorkshire health authority and his officials, it seems to me that the money that once went to Scarborough is going to other health trusts and health districts in the Yorkshire region, most of which, I have to say, are represented by Opposition Members.
We accept that somebody has to make a strategic judgment about where the resources are needed, but if savings are to be found in the Scarborough health trust, I hope that my hon. Friend the Minister will agree that the way to find the £1 million savings is by having a really forceful campaign against waste and bureaucracy within the NHS, not a campaign to curtail things like maternity service provision at Malton hospital.
I am glad that my hon. Friend nodded and I give him the good news that I read in my Yorkshire Post on the train this morning that that is precisely what the chief executive of the Scarborough health trust plans to do, to attack waste and bureaucracy. I put it to my hon. Friend and the House that he has a clear interest in ensuring that we attack bureaucracy, because he wants, as I and every hon. Member should want, to demonstrate that the Government's health reforms lead not to more bureaucrats, administrators and waste, but to more patients being treated. We have had more patients treated in north Yorkshire over the past 12 months under the Government's health reforms than any member of the Opposition thought possible. The hon. Member for Sheffield, Brightside (Mr. Blunkett) asked why we needed any kind of larger purchasers, and why not leave it to the GP fund holders. There is an obvious answer to that : we still require some authority to take a strategic view of the needs of each area.
My hon. Friend knows, representing as he does a seat in Lancashire, what a big county north Yorkshire is. Clearly, in some areas, there is scope for asking whether every district hospital needs to provide every medical facility. Do they all need an eye unit, for example, or a cardiothoracic unit, and so on? The answer, obviously, is no, but I ask him to bear in mind that north Yorkshire is a very large county. Travel is difficult. People have long distances to travel already to the district facilities. I hope that he and his officials will bear that in mind when considering the funding requirements of the county.
To sum up, if we are to launch this attack on waste and bureaucracy, we have to accept that we need more competent, professional people, capable of managing this huge national health service, with all the people that it employs. If by merging health authorities we can cut some of the waste, there can be no argument against agreeing that if we now have four health trusts working successfully in north Yorkshire, there should be one central purchasing authority, subject to the caveat that I have made about taking into account the size of our county. I hope that this will not lead to some changes which, in the long term, we might regret.
Column 61611.18 pm
Ms Liz Lynne (Rochdale) : It is not very easy to talk about a reduction from some 200 health authorities to 90 in such a short space of time, so I will confine my remarks to a few general points. With boundary commission changes imminent, why were not regional health authorities told to await the decisions on local authority borders? Would not it be more sensible, if we are to merge authorities, for them to be coterminous with local authorities, as the local authorities have now been given community care responsibilities? I cannot see how the Government can expect collaboration across set co-operation.
Then there is the sheer size of merged authorities. The Minister told us in the debate in January that one reason for the changes was that the purchaser would need to take advantage of bulk purchasing power. Did not the Government realise, when they dreamt up their reforms, what would be the logical outcome of the market? Purchasers would need to become bigger and bigger in the face of competition and more and more remote from the community.
Just over a decade ago, the Government abolished the area health authorities and gave as their reasons for doing so that AHAs were too large to be managed effectively and that authority members were necessarily remote from the patient in the hospital and in the community. They said that what was needed was a pattern of operational authorities similar to single district authorities. Now, we are told that the functions of the authority have changed, with its operations reduced, as it no longer provides services or manages hospitals, so it is no longer viable in its old form.
However, the strategic role of the authority has not changed. It is still expected to assess and provide for the health needs of the local community and to play a role in enhancing primary care through an ever-more integrated set of relationships with local social services and community health councillors, and in improving its population's health. Most importantly, it is a purchaser of care for the local community.
In January, the Minister told us that the reason for the mergers was the savings that could be made on administration, which would be worth several hundreds of thousands of pounds over time, but he could not be more precise. I am sure that he could achieve similar savings elsewhere in the NHS if the sole objective were to provide a service without taking into account need and quality of care. As a large majority of the changes have already taken place, will the Minister assure the House that the health authorities will at least be accountable and sensitive to the public health needs of their different communities ? One way to ensure that would be to have directly elected health authorities, for which we have been calling for a number of years, instead of what we have now--political appointees.
Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : It is a disgrace that a matter of such importance should be debated only because of action by the Opposition parties. However, that is in line with the outrageous behaviour of
Column 617the Government towards the NHS. They have split up the service into non-viable units and made trusts the centrepiece of their policy, when they know that the trusts do not have the money to deliver the services. What is more, they have now produced these orders. The system began on 1 April. The Department of Health made no attempt to pass the correct information to any of the services concerned and many of those services do not have the software in their expensive computers to run the contracts that the Secretary of State tells us are the purpose behind the way in which she wants to operate the NHS. It is an outrage that incompetent, overweeningly arrogant behaviour can produce a result that will lead to total chaos and will add enormously to the expense.
There is a case for the National Audit Office to look at the operation of computers not just in one health authority but throughout the NHS. It is clear that, under the aegis of the Government, many private computer companies are getting away with enormous sums of money under the guise of offering a better contracts system. If the order goes through, retrospectively many health authorities will have to amend their contracts. That will cost them not only time, but an enormous amount of money.
If the Minister thinks that I am exaggerating, let him break the habit of a lifetime and speak to the people who work in the service. They will tell him time and again that, far from relating to "coterminosity", the order relates only to chaos and incompetence. Let me point out to the Minister that, in Crewe, coterminosity does not relate to
"the borough of Crewe and Nantwich ; the borough of Congleton (except the parishes of Congleton, Hulme Walfield ... the district of Vale Royal Macclesfield Aston, Dutton, Frodsham"
and various other areas.
The Secretary of State, through her minions, is destroying the existing administration of what was one of the best and most cheaply administered health systems in the world--a system that spent only 6 per cent. on administration. Under the present Government, it is not only tripling the number of administrators, but doing so in a grossly incompetent and irresponsible manner. If the people had the opportunity to know what secretive, impossible and unfortunate deals they were doing, they would be taken by the scruff of their necks and thrown out tomorrow.
I had the unfortunate experience of listening to two of those non-elected gentlemen. They were on a train, explaining how they would rearrange the health service in my area : their plans included building a large, very specialised surgical unit in the north of the country, because it had always been the dream of one of these Conservative party nominations.
That is what the Government have made of the health service. I know that they will not be ashamed of themselves ; but if the Minister seriously thinks that he can do this in secret, he underestimates the House of Commons.
Ms Hilary Armstrong (Durham, North-West) : I support the effective speech of my hon. Friend the Member for Darlington (Mr. Milburn). I came into the Chamber expecting a very different performance from the Minister. Earlier today, we were told that the Prime Minister had
Column 618instructed Ministers to act differently-- that they were to be less arrogant and to listen more. This evening's display from the Minister demonstrates that, although he may have listened, he has heard nothing. He has heard none of the objections put to him during the process of merging authorities ; he has not heard--and, indeed, seemed not to understand when my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) drew attention to it--that 10 May is later than 1 April and that there is a gap of some six weeks within which authorities have been acting without parliamentary approval. Moreover, he clearly had not listened to, or understood, anything about what is going on in the areas that he is now merging.
Part of my constituency covers part of Wear Valley district council, which was in the South West Durham health authority area. It is a very mixed area : although very rural, it contains a number of industrial villages--or villages that used to be industrial--in which there are severe health problems. It has very little in common with the population covered by the Darlington authority. No member of the health authority now lives remotely near the area that I represent ; no member has any contact--through business, through the voluntary sector or in any other way--with my constituents who are now covered by the new authority. I have been unable to discover the voting habits of the people concerned ; if they are Tories they are very exceptional in our area, but I am sure that the Minister has spent a long time looking for them.
The Minister has demonstrated that he knows and understands little of the area's needs. His justifications for merger do not hold up in our area. Financial reasons only justify it, yet, as my hon. Friend the Member for Makerfield (Mr. McCartney) said, they are undermined by the Government having spent vastly greater sums on the members of these smaller and unaccountable authorities than they did on the members of larger authorities, who were accountable because those authorities were elected.
Arrogance, lack of attention to democratic procedures and centralisation are the hallmark of this order. It is about time that the Government began to listen to and heard what the electors are saying. If the Minister thinks that we are wrong, why does not he put it to an election?
It being half-past Eleven o'clock, Mr. Deputy Speaker-- put the Question, pursuant to Standing Order No. 14 (Exempted business). The House proceeded to a Division--
The House having divided : Ayes 187, Noes 235.
Division No. 261] [11.30 pm
Adams, Mrs Irene
Ainsworth, Robert (Cov'try NE)
Anderson, Donald (Swansea E)
Anderson, Ms Janet (Ros'dale)
Beith, Rt Hon A. J.
Column 619Benn, Rt Hon Tony
Bennett, Andrew F.
Brown, Gordon (Dunfermline E)
Brown, N. (N'c'tle upon Tyne E)
Campbell-Savours, D. N.
Clarke, Eric (Midlothian)
Clwyd, Mrs Ann
Cook, Frank (Stockton N)
Cook, Robin (Livingston)
Cunningham, Jim (Covy SE)
Cunningham, Rt Hon Dr John
Davies, Bryan (Oldham C'tral)
Davies, Rt Hon Denzil (Llanelli)
Donohoe, Brian H.
Dunwoody, Mrs Gwyneth
Eagle, Ms Angela
Field, Frank (Birkenhead)
Foster, Rt Hon Derek
Gilbert, Rt Hon Dr John
Golding, Mrs Llin
Grant, Bernie (Tottenham)
Griffiths, Nigel (Edinburgh S)
Griffiths, Win (Bridgend)
Hill, Keith (Streatham)
Home Robertson, John
Howarth, George (Knowsley N)
Hughes, Kevin (Doncaster N)
Hughes, Robert (Aberdeen N)
Hughes, Simon (Southwark)
Jackson, Glenda (H'stead)
Jackson, Helen (Shef'ld, H)
Johnston, Sir Russell
Jones, Barry (Alyn and D'side)
Jones, Jon Owen (Cardiff C)
Jones, Martyn (Clwyd, SW)
Kennedy, Charles (Ross,C&S)
Kennedy, Jane (Lpool Brdgn)
Khabra, Piara S.
Lloyd, Tony (Stretford)
Lynne, Ms Liz
McCrea, Rev William
Marshall, David (Shettleston)
Marshall, Jim (Leicester, S)
Martin, Michael J. (Springburn)
Michie, Bill (Sheffield Heeley)
Mitchell, Austin (Gt Grimsby)
Moonie, Dr Lewis
Oakes, Rt Hon Gordon
O'Brien, Michael (N W'kshire)
Paisley, Rev Ian
Pike, Peter L.
Powell, Ray (Ogmore)
Prentice, Ms Bridget (Lew'm E)
Prentice, Gordon (Pendle)
Quin, Ms Joyce
Reid, Dr John
Robertson, George (Hamilton)
Roche, Mrs. Barbara
Ross, Ernie (Dundee W)
Smith, Andrew (Oxford E)
Smith, Llew (Blaenau Gwent)
Steel, Rt Hon Sir David
Taylor, Mrs Ann (Dewsbury)