Column 699Wigley, Dafydd
Williams, Rt Hon Alan (Sw'n W)
Wright, Dr Tony
Tellers for the Noes :
Mr. Peter Kilfoyle and
Mr. Don Dixon.
Question accordingly agreed to.
That the draft Airports (Northern Ireland) Order 1993, which was laid before this House on 9 December, be approved.
Mr. Richard Ottaway (Croydon, South) : On a point of order, Madam Deputy Speaker. I regret to say that I missed the last Division and the reason for that is simple. My office is on the farthest point of Millbank and, as I came straight out of my office after the Division bell went, the lifts were not working properly. I had to walk all the way down the stairs. I came straight here, to find that the doors were locked. Can I ask you to inquire into whether it is practical for Members who have to come from Millbank to do so within eight minutes?
Mr. Ray Powell (Ogmore) : Further to that point of order, Madam Deputy Speaker. I also noticed that tonight two Members rushed through the counted Lobby when the doors were being closed on our side. As I was the Whip responsible for the counting on the Opposition side, the doors were closed, and therefore Members on the Opposition side were denied the opportunity to vote and made no attempt to walk through the counting area. I hope that the hon. Members who had gone through the counted area in the Aye Lobby were not included in the vote, because it denied the right to Members coming in late to the Opposition Lobby.
Madam Deputy Speaker : Yes. It is obviously not in my personal knowledge because I cannot see what is happening. If, however, doors are open and people walk through them, obviously they will have been included in the vote. I cannot make further comments without greater knowledge than I now have. I thank the hon. Member for mentioning the point.
That the draft Health and Personal Social Services (Northern Ireland) Order 1993, which was laid before this House on 9th December, be approved.
My noble Friend Baroness Denton, who has responsibility for health and personal social services in Northern Ireland, introduced the order in another place on 31 January and it is my pleasure to introduce it to the House this evening.
The purpose of the draft order is to enable health and social services trusts in Northern Ireland to carry out certain statutory functions which, at the moment, are the legal responsibility of the health and social services boards. The order is a local solution to a local problem. Hon. Members who were present at the Northern Ireland Committee debate on 20 January may recall that some of the issues involved were mentioned on that occasion.
It may be helpful to the House if I comment briefly on the background to the order and the present organisation of the services in the province. Both those points are important if one is to have an understanding of the need for the legislation.
In Northern Ireland, health and personal social services were integrated into one structure in 1973. We have therefore had an integrated service for more than 20 years. During that period, the services have been provided by four health and social services boards. That integrated system has served Northern Ireland well through 20 turbulent years and the people of the Province are--quite justifiably--proud of that unique service. The draft order seeks to preserve that integration and to enable services to continuee Government's reforms for health and social services provided for the separation of the purchase and provision of services. The Health and Personal Services (Northern Ireland) Order 1991 redefined the role of the four boards as being responsible, primarily, for assessing the needs of their populations and commissioning services to meet those needs. The order provided for units to be established as health and social services trusts-- fully independent of board management, but wholly in the statutory sector.
However, although the 1991 order enabled trusts to be established and allowed boards to contract with them for services, it did not permit trusts to carry out certain functions associated with those services, except for mental health functions, for which specific provision was made. Those functions flow from a range of existing legislation, such as the Children and Young Persons Act 1968 and the Adoption Order 1987. Some are sensitive powers, involving the restriction of civil liberties--the taking of a child into care, for example. That legislative weakness prevents some units, such as those providing personal social services, from becoming fully operational as trusts. The order is concerned with putting that right. In bringing forward the order, we have aimed to provide a legal framework for the discharge of functions by trusts which ensures clarity about where responsibility lies and
Column 701secures full accountability for the work undertaken by trusts. Within that framework, the order enables boards, with the approval of the Department of Health and Social Services in Northern Ireland, to delegate certain statutory functions, which will be specified by the Department, to health and social services trusts. The functions involved were set out in the explanatory document published last summer, along with the proposal for legislation. A copy of the draft regulations dealing with them were placed in the Library when the order was laid on 9 December.
The order allows trusts to carry out those functions and makes provision for schemes to be agreed between trusts and boards on the way in which the functions are to be carried out.
Since the proposal for legislation was published last June, many people have voiced concern about its effect on services, particularly in relation to the protection of children. Some have expressed doubts about the accountability of trusts within the new arrangements. Questions about fragmentation and inequality of provision have also been raised.
My noble Friend Baroness Denton and her predecessor Lord Arran considered very carefully the concerns raised and devoted much time and effort to explaining the issues to people. It is fair to say that many of the concerns stemmed from a misunderstanding about the role of trusts and about the new role of the boards to which I have already referred. Perhaps I can clarify these points for the House. Health and social services trusts are state bodies established firmly within the health and personal social services in Northern Ireland. They are fully accountable for all that they do and they are closely monitored by the Department and by the boards. They are not independent companies and are bound by the same guidance as governs the operation of boards at present.
For their part, the boards--freed from any involvement in the day-to-day management of the services--can concentrate on improving the health and social well-being of their populations through the contracts they agree with trusts and setting the agenda for them in terms of quality of service, standards of care and equity of provision.
The Government accept that people have anxieties and concerns. They are genuinely held, but they have not been ignored. Regardless of which side of the debate one is on, we have one thing in common : concern for the welfare of children and other vulnerable groups in our society.
Rev. Ian Paisley (Antrim, North) : Will the Minister discuss the financial implications of the proposal? The matter has been raised in the Lords and it has also been raised by many people in Northern Ireland. According to the figures that we have been given about the 12 trusts, the chairmen of the trusts will receive £15,000 a year and each of the five board members will receive £5,000 a year. We have been told that that amounts to between £1 million and £2 million which will be required to finance the procedure. Would not that money be better used to keep the present structure, which has provided such a good service to the people of Northern Ireland?
Column 702The right way to achieve that is by making a clear distinction between purchaser and provider. Of course, the members of those boards and the chairmen will be remunerated, but the costs will not be substantial when one considers the huge scope for securing improvements in value for money and better service delivery to patients. The figures quoted by the hon. Member for Antrim, North (Rev. Ian Paisley) must be placed in the context of total health spending in the Province.
Mr. Eddie McGrady (South Down) : Surely the point made by the hon. Member for Antrim, North should be pursued on the basis that the 12 new quangos are in addition to the existing personnel who will be retained in the various boards dealing with personal and social services? There must be an enormous increase in the establishment costs appertaining to this exercise.
Mr. Smith : I was not seeking to suggest that there was not an increase in costs. I accepted the figures given by the hon. Member for Antrim, North. However, I said that I thought that that cost was fully justified in securing better value for money and better quality of service for patients and other users of the social services. I strongly believe that to be true, just as it is true in the rest of the United Kingdom with regard to the Government's national health service reforms.
Before the interventions, I said that the thing that we have in common is our concern for the welfare of children and other vulnerable groups in our society. For that reason, the trusts and boards concerned have been working very hard to establish procedures that will ensure that those who are entrusted with the discharge of statutory responsibilities at local level will be clear about their role and fully accountable for all that they do.
Baroness Denton has, for her part, met representatives from the British Association of Social Workers to hear at first hand their concerns. She has visited units which are preparing for trust status and she has talked to people who are directly involved in providing services and who are preparing the ground. From the conversations that my noble Friend has had with managers and professionals alike, and on the evidence that she has seen, there can be no doubt that the schemes being developed between boards and trusts will address clearly and comprehensively the key issues that have been raised. Under the terms of the draft order, they will have to be approved by the Department of Health and Social Services.
I shall refer briefly to two other important issues which, although not technically part of the legislation, are intended to underpin it. Trusts which will be providing personal social services will need to have access to expert advice and guidance in providing those services and carrying out the functions that I have mentioned. To ensure that they have that, we are making it a legal requirement for any trust providing those services to appoint a qualified social worker as an executive director. At the same time, we will make it mandatory for each health and social services board to appoint a director of social services if they have not done so already. Guidance on the roles and responsibilities of both posts will be issued.
Those changes taken together represent a significant strengthening of the structures involved in the delivery of personal social services in Northern Ireland. Chief
Column 703executives of trusts have gone to great pains to build in safeguards for existing social work structures, both organisationally and professionally within trusts.
Mr. Smith : I cannot give the hon. Gentleman a figure, but I should have thought that he would welcome the fact that we are to appoint professionals as executive directors. That directly meets the concern that the management should incorporate at least one person with direct knowledge and a qualification as a social worker.
Mr. Andrew Mackinlay (Thurrock) : What consultation has the Minister initiated, and what observations has he received, in respect of the trade unions which represent the employees in the area of social work about which we are concerned?
Mr. Smith : Well, my noble Friend met association representatives. I will let the hon. Gentleman know later whether she met trade union representatives. However, since her appointment, my noble Friend has gone out of her way to meet those who are principally concerned about the implications and consequences of the order.
The order contains three other changes to Northern Ireland health and social services legislation. First, it amends existing law on the audit of health and social services bodies. The law in that area is no more than adequate at present and the order is designed to modernise and strengthen it. Secondly, the order amends the law on the registration of pharmaceutical chemists by requiring people seeking registration to satisfy prescribed conditions as to character, health and other matters. That will bring Northern Ireland legislation into line with that in other countries. Finally, the order repeals an existing provision in relation to the employment of nurses which is no longer needed because of changes in the way in which nurses are recruited and trained.
The proposals are about ensuring that our services in the area are structured and organised in a way that maximises their capacity to respond to the needs of people quickly and effectively while at the same time safeguarding the interests of the public and those vulnerable people in our society who need the protection of the state. I commend the order of the House.
Mr. William O'Brien (Normanton) : The Parliamentary Under-Secretary of State referred to the Northern Ireland Committee's debate of 20 January. I should like to refer to some of the points that were made by the Minister of State on that occasion. We have been told that the people of Northern Ireland are proud of the existing system. If that is the case, why do the Government want to change it? If the people of Northern Ireland are satisfied with their system, what is the need for this order? I put it to the Under-Secretary and to the House that the intention of the
Column 704legislation is not to improve health and social services but to fulfil the political dogma of the Conservative party, which is intent on dismantling the national health service.
The Under-Secretary of State referred to a debate that had been held in another place. Hon. Members will know that on that occasion an amendment calling on the Government to withdraw the legislation was defeated only very narrowly. It cannot be right to plough on relentlessly against such opposition from the upper House and against the opposition that will be expressed tonight by Labour and Northern Ireland Members. This order is premature. It should not be before the House, and we shall oppose its substance and the principles that underlie it. I hope that Ministers, rather than driving hon. Members into the Lobbies, will wake up to common sense and withdraw the order.
This legislation, which delegates statutory responsibilities to further private quangos, should not have been introduced in advance of legislation affecting the care of children. The first piece of legislation mentioned in schedule 2 is the Children and Young Persons Act (Northern Ireland) 1968. It is totally unfair and unreasonable that this order should be introduced before the House has had a chance to debate the forthcoming amendment to the legislation on children. We want to know how Parliament will be able to influence the scrutiny of child care in Nothern Ireland. That information will not be forthcoming in advance of the amending legislation to which I have just referred. The order that we are debating now ought to be withdrawn if the Government believe that people should have a say in matters of serious significance to Northern Ireland.
These trusts, to whose creation the Minister of State referred during the meeting of the Northern Ireland Committee on 20 January, will do nothing to improve health care in Northern Ireland. The Minister said :
"The creation of social services trusts is of particular significance. The management freedoms which come with trust status are designed to devolve decision-making to those responsible for delivering services, offering them the opportunity to be imaginative and responsive to local needs.--[ Official Report, Northern Ireland Committee, 20 January 1994 ; c. 4.]
On 19 April 1993--less than 12 months ago--I asked the Secretary of State for Northern Ireland
"what Department will make the necessary assessments under the community care reforms for people applying for residential and nursing home care in Northern Ireland?"
The reply was as follows :
"Health and social services boards, through their units of management, are responsible for carrying out an assessment of need for any individual who lives within their area who requires community care services, including residential care and nursing home accommodation."--[ Official Report, 19 April 1993 ; Vol. 223, c. 18. ]
Are we to take it from what the Parliamentary Under-Secretary of State has said tonight that that answer will no longer apply and that assessments will now be made by those administering the trusts? In other words, will what we were told 10 months ago be changed by this order? Is this what the Government call forward planning and forward thinking?
Rev. Ian Paisley : Does the hon. Gentleman agree that a right that public representatives enjoy under the current law--the right to question a course of action--is to be removed? Does he agree that the distancing of public representatives from the boards that is taking place already will be increased, thus reducing opportunities to question and to call to account?
Mr. O'Brien : The hon. Gentleman is perfectly correct. The democracy that is necessary in the administration of Northern Ireland's health and personal social services is being further diminished. Local communities will have their input into the question of quality of service reduced further.
The foreword to a document published last year by the Eastern health and social services board says :
"The future role of the Eastern Health and Social Services Board is to purchase services to meet the health and social care needs of its resident population within the boundaries of Government policy. Chief among these must be the needs of the population illustrated, as far as possible, by objective information, the views of the people themselves, the views of general practitioners and others. Professional advice, particularly from those in the caring professions, must also continue to influence the decisions of the Board in the purchase of health and social services care." In other words, we are witnessing a reduction in the management of the services. Through this order, the people of Northern Ireland are being offered less time spent on patient care and--much worse--pressure on a service that is already under pressure. The Eastern health and social services board has declared its future role as being the provision of services in line with Government policy. This order will reduce the role of the health and social services boards and will result in lessened health and community care services for the people of Northern Ireland.
There will be no difference in the lines of responsibility. The health and social services boards are currently responsible to the Minister and the Department. The new trusts, too, will be responsible to the Minister and the Department. Indeed, the Minister of State told the Northern Ireland Committee :
"The vast majority of functions to which the hon. Gentleman referred are already carried out by the board staff at local level. The only difference is that the staff carrying them out in future will, in many cases, work for trusts instead of boards, but they will essentially be the same people carrying out the same jobs."--[ Official Report, Northern Ireland Committee, 20 January 1994 ; c. 32.]
If the same people will be performing the same jobs and be responsible to the same Minister and boards, why is the order needed? It will only add to the expense of managing Northern Ireland's health and personal social services.
The trusts will be fully accountable to the Department for the discharge of delegated functions, but what will happen with training? At present, the requirement for personal social services training through a working partnership with employers and education institutions provides positive training at all levels. Since 1990, qualifying and post-qualifying social work training throughout the United Kingdom has been delivered through partnerships between employers and teaching institutions. In Northern Ireland, such partnerships currently operate at area health and social services board level, not unit trust level. The Minister should address that point in considering the provision of qualified people. Will trusts be responsible in future?
The people of Northern Ireland do not want the changes that the order will bring. Will the Minister confirm that 95 per cent. of those asked for their opinion of the order opposed it? The order will extend the Tory obsession with privatising and commercialising health and social services care. The Government are using the language of the market place to sell ill health and rationalise the sick. That philosophy underpins the order.
Mr. O'Brien : I assume that they were Government supporters, as is usually the case. Ninety-five people out of every 100 canvassed totally opposed the order. I hope that the Minister will take note of the wishes of the people of Northern Ireland.
The Government seem intent on creating more managerial posts and bureaucracy, rather than more hospital beds. Nothing better illustrates that than the creation of 12 management units providing personal social services. The order will bring Northern Ireland in line with some of the sweeping changes already made in other parts of the United Kingdom.
Mr. O'Brien : The proposals contained in that document are significantly different from those in the order. We argue for more local input into the future provision of social services. The order will deny local input in health and personal social services care in Northern Ireland. If the Minister accepts our proposals, he should withdraw the order.
The Minister would be the first to agree that there is a vast difference between the regions. In other parts of Britain, social care for the elderly and mentally ill and children involves considerable local input through local authorities. If the Minister has read "Health 2000", he will know that we intend to continue with that approach. In England, locally elected representatives have a say in care provision which directly affects the quality of life of the elderly, children and the mentally ill.
Funding is equally important. It is abundantly clear that in the English regions local authorities are underfunded in the provision of community care. Although it may be the Minister's intention to allow individuals who want to do so to live independently or
semi-independently, his promises will be empty if back-up resources are not available to provide the services that the elderly and mentally ill require. Caring for such people in the familiar surroundings of their own homes costs money. If the Government intend to offer wider choice and genuine opportunities to the weaker members of Northern Ireland society, they must be prepared to underpin their stated intentions with adequate resources.
In extending choice, will the new community care trusts in Northern Ireland be instructed, as English local authorities are at present, that a fixed proportion of their funding for the care of the elderly must be directed at providing private care? If so, will the Minister explain how the top-up payments required of close relatives will be obtained? Can the Minister give an assurance that families caring for an elderly parent or other relative who enters a private nursing home will not be turned out of their homes so that the houses can be sold to provide the top-up money required for private nursing care for those whose mental or physical disposition requires it? That is an important matter which the Minister should address. Many people are concerned about the demand for top-up payments for families who live in private sector homes.
Column 707In extending the new choice, to which the Minister referred, will he give some indication of how the elderly will be looked after with regard to the financial provisionsin private nursing homes? Will he also give some indication that those who work in the voluntary sector in Northern Ireland, many of whom have a sound record of developing new and important welfare initiatives, will be allowed to continue providing those initiatives? Will they be encouraged to develop those initiatives and innovations in community care into the next century? Will voluntary workers be given the same incentive to do their work under the trusts as they have under the health boards? I make that point specifically because the National Health Service and Community Care Act 1990 has no equivalent in Northern Ireland.
Therefore, I return to the issue of accountability. The Minister, Baroness Denton, recently stated in another place :
"Accountability is to boards, to the Department and then to me." In other words, accountability is restricted by Government influences. Baroness Denton also said :
"There is a line to the social work person on the board of the trust ; a dotted professional line,"
and added :
"If something should go wrong, the trust will be fully accountable and responsible."--[ Official Report, House of Lords, 31 January 1994 ; Vol. 551, c. 1152] :
Some red lights are flashing and the Minister should explain what Baroness Denton meant.
We should again consider what the Minister said in the Northern Ireland Committee. He said :
"The trusts will be fully accountable to the boards and, ultimately, to the Department for the discharge of delegated functions,"--[ Official Report, Northern Ireland Committee, 20 January 1994 ; c. 32.]
There is some conflict between the views expressed in Committee and in another place. Therefore, the Minister should clear up some of the misunderstandings that have developed because of the debates on this order. I am afraid that those vague attempts at reassurance do nothing to make the position concerning accountability and ultimate responsibility any clearer.
Will the Minister tell the House who will finally be responsible for the taking of children into care? Who carries the professional responsibilities? Will it lie with the health and social services board or the trust board? Will it ultimately lie with the director of the board or the executive director of the relevant trust? Is the Minister ultimately accountable for the taking of children into care? As I pointed out, we ought to have debated the children's order before the order before us was presented to the House. Since we are seeking to amend the children's order, the Minister should answer those significant questions.
I remind the Minister that the patients and citizens charters, which were launched in a blaze of publicity and have all but fizzled out, emphasised the rights of people to personal services and related needs. How will the citizens charters apply in Northern Ireland? Will the Government make it compulsory for the new trust boards to employ approved social workers to care for the mentally sick and for people with disabilities? Will it be mandatory for the trust boards to employ qualified people in accordance with current legislation or will it be another sacrifice of the standards of so-called safety and efficiency? Will deregulation involving the provision of health and community care apply in Northern Ireland, reducing the quality of service?
Column 708There is a genuine and, in our view, justified concern in Northern Ireland about the future provision of personal social services and health care. Since the Conservatives came to power in 1979, one in five hospitals have closed and since 1981, one in three beds in hospitals have been lost. Those figures speak for themselves, but even worse is the £500,000--I am being a little generous to the Minister compared with the figure given by the hon. Member for Antrim, North (Rev. Ian Paisley) earlier--which will be required in order to pay the additional appointed chairman and non-executive members of the trust. That clearly shows that it is not the provision of beds and hospitals or of social workers that is the priority of the Government, but ensuring that bureaucracy in Northern Ireland is built higher and higher.
Salaried Government placemen, instead of treatment for the sick of Northern Ireland seem to be the order of the Minister's presentation. The order does nothing to redress that situation and the national health service has never faced a greater threat than it does today. I urge the House to reject the order, but I also appeal to the Minister to withdraw it before we enter the Lobbies in the light of the points I have made in my short address.
Sir James Kilfedder (North Down) : I listened to the hon. Member for Normanton (Mr. O'Brien) with great care. He spoke with sympathy and great knowledge of the needs of the people of Northern Ireland. I shall not repeat what he said because I could not do so with the same eloquence.
I intend to vote against the order for a number of reasons, but, because of the lack of time, I cannot list them all. However, all the reasons are valid and they are all important to the people that I represent. The order will be opposed by every representative of Northern Ireland. In view of such unanimity across the political divide in the Province, and in view of the considerable time that the Government spend urging the Northern Ireland politicians to co-operate, they should reward such united opposition to the order by putting it to one side. I join the hon. Member for Normanton in appealing to the Minister to withdraw the order as a gesture of good will to the Ulster people and to the united front presented by Ulster politicians.
According to press reports, the Secretary of State is about to launch--or, perhaps, has launched--another political initiative that entails the creation of a Northern Ireland assembly with power. The ideal time and the proper place for the discussion of the order before us is in such an assembly. In fact, the assembly, when established, will have to examine the health and social services provision in Northern Ireland and may wish to alter radically the present system.
I shall also vote against the draft order because it epitomises the lack of full democracy in the Province. Unlike other parts of the United Kingdom, we are denied the fundamental right to table amendments and to have a proper debate on Second Reading, in Committee, at Report and on Third Reading. Our debate is limited to 90 minutes, which means that I shall have to cut my speech short to allow other hon. Members from Northern Ireland to take part. In addition, I shall vote against the order not only because I want it to be rejected, but as a protest--the only
Column 709form of protest that is available to me, as a believer in parliamentary democracy--against the undermining of health and social services provision in my constituency.
I have often made speeches in the House condemning Eastern health board's imposition of major cuts on Ulster hospital in Dundonald, Ards hospital and Bangor hospital. Bangor hospital servecology ward and a casualty department. Having applied pressure, I was promised that services would be improved, but that promise has not yet been fulfilled. In the name of the people of Bangor and surrounding areas, I again demand the restoration of a fully equipped community hospital.
The order will lead to the creation of 12 trust boards for social services. There is no need for those boards, for reasons already catalogued by the hon. Member for Normanton. They will be costly manifestations of the bureaucracy that now dominates Northern Ireland. The Minister has admitted that the chairman and non-executive members will receive what I consider to be substantial salaries for the number of hours that will be put in--money that is desperately needed for the elderly, the young, the mentally handicapped and others who require community care.
Who allocates these lucrative posts to chairmen of trusts? Over the past year or two, we have seen examples in Northern Ireland--