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Mrs. Beckett: I was a little surprised to discover that the Secretary of State intended to speak on Third Reading. As I recall, it is not customary for a Minister who has not bothered to serve on a Standing Committee to take the prime slot in the winding-up speeches. I am no longer surprised, however: it is clear that the right hon. Lady wanted to bore us with yet more of her irrelevant ranting.
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It was right, however, for the Secretary of State to refer to an aspect of the Bill to which I too wish to begin by referring. Although explored in Committee, that aspect has not been discussed much on the Floor of the House. I refer to the merger of district health authorities and family health services authorities to create the new health authorities which alone will replace the existing regional authorities.My party does not oppose the principle of such a merger; in fact, we have advocated it for some time, although we have never suggested that the merged authorities should replace the existing regions. Despite our support for the principle, however, the way in which the issue has been handled casts an interesting light on the Government's attitudes.
First, the Secretary of State indicated in her statement announcing the legislation in October 1993 that mergers between authorities would be permitted by the legislation; in fact, they are to be compulsory. Secondly, to further the programme of mergers, the Secretary of State has taken sweeping powers in the Bill--more sweeping, I understand, than those allowed by any precedent. She has done so despite the doubt that experience of the Child Support Agency must confer on precedents of this kind, and on the idea of taking all the powers in legislation and leaving all the detail to regulations. The third revealing aspect even of this agreed element of the Bill is the way in which elements of the proposals that might arouse discussion or dissent have been withheld. I refer particularly to proposals relating to the shape and geographical spread of the new authorities. Ministers are well aware that the proposals are likely to prove controversial: in fact, they were warned about that on Second Reading by a Conservative Member, the hon. Member for Hereford (Mr. Shepherd). I have given notice to the hon. Gentleman of my intention to quote what he said.
The hon. Gentleman expressed his strong preference, and that of his constituents, for the present structure, whereby a more local health authority--a district health authority--relates to the Department of Health via a regional authority, rather than being structured like the previous, broader health authorities that drew in other elements across the area involved.
We all know that the chances are that boundaries have been drawn up for the new authorities. Many administrators probably know what they are, but Parliament and the people will not be told until it is too late for the House to reject the Bill. The information that we lack about the new merged authorities, however, pales into insignificance in comparison with the information that we lack about the main provision of the Bill, which deals with the abolition of regional health authorities.
The Secretary of State said a moment ago that it was only five years since the last major reorganisation Bill was discussed in the House. That is true --and it was as a consequence of those changes that greater powers were given to the regional health authorities whose abolition the Secretary of State now proposes. It is perhaps in that respect particularly that the Bill reaffirms the Secretary of State's reputation as the Madame Mao of the national health service, proceeding with her continuous revolution. Every element of the Bill takes us further towards the cultural revolution of privatisation that she espouses,
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concentrating power as it does with individual health businesses that have been set up to be ripe for privatisation.The Bill will eliminate any pockets of resistance on the 14 regional authorities by abolishing them--although any lingering doubts about the need for their existence in their present form must surely be reinforced by the fact that so many of their functions are to be retained at regional level and, in the case of mental health tribunals, not just at the level of regional offices but at the level and in the structure of the existing 14 regions.
The Bill will introduce positive vetting of a small group of regional representatives, all of whom are to be hand-picked by the Secretary of State. It will extend the practice of gagging independent medical experts such as the directors of public health. Although the Secretary of State spoke warmly of their role, she knows very well that the regional directors strongly resent the loss of their independence. The Bill will also reduce the rights of medical, nursing and other groups to the degree of representation that they have enjoyed in the past.
The Secretary of State congratulated herself on giving way to our representations and on reinstating some statutory right to consultation in the Bill. Nevertheless, the Bill takes away the role that those representatives have enjoyed in similar authorities in the past. The Bill will end the collection and publication of regional statistics, other than those approved by the Secretary of State. It will concentrate power, presently dispersed through a tier of authorities, in the hands of the Secretary of State.
Just over a year ago, the British Medical Association expressed surprise and concern at the proposals, saying:
"this has not been a consultation exercise in the proper sense of the word".
It said that people had
"been presented with a fait accompli."
It questioned the rationale of the exercise of abolishing regions,
"particularly since the increased size of the new regions will inevitably create communication difficulties which can only serve to undermine efficiency."
It is no clearer now than it was on Second Reading before Christmas why the Government have really brought forward a Bill that has such substantial and damaging effects on the structures and staff of our health service, and that creates so little benefit. It is undoubtedly true that the Bill creates the opportunity for the Secretary of State to implement one recommendation of the Maples report: to create a closed world of health care in which staff, from regional directors of public health to nurses and others working on our hospital wards, can more effectively be silenced and gagged about what is happening in the health service.
Earlier today, the Minister was sniffy about his claim that the Bill would make no real difference to the information available, but I should like to give the House examples, first, of the Department's way with statistics, and, secondly, of its way with other information. Those examples cast doubt on the Minister's assurances. In a press release published on 13 February, the Minister publicised information about the role of junior doctors. He referred to a questionnaire that was sent to them in July last year. It asked how the new roles were affecting their work. The press release says that 17 per cent. of junior doctors felt that their hours of work had
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reduced. Clearly, it did not seem pertinent to the Minister to say that that presumably meant that 83 per cent. did not feel that their hours had been reduced.The press release draws attention to the fact 40 per cent. of junior doctors were experiencing more satisfaction in their work, which presumably means that 60 per cent. were not experiencing more satisfaction in their work. That is an interesting example of how the gloss on a piece of information can somehow subtly change its meaning.
Apart from the issue of the statistics that the Department publishes, and how they are described, there is the issue of the new open government code proposed for the national health service. A report in December drew attention to the views of the Campaign for Freedom of Information on that matter. The campaign pointed out that, if that code of practice went ahead, information that would have to be disclosed today by the Department of Health could in future be withheld by health authorities and national health service trusts. It says that the new code
"repeats the failings of the central `open government' code, but omits its positive elements"--
if such there be. It draws attention to the fact that the code allows
"all information on commercial or contractual activities to be withheld-- not merely information which could prejudice such activities, as in the central government code."
Every piece of information that can be described or classified as relating to commercial or contractual activities may be withheld. In this new health service for which the Secretary of State takes such credit, just about everything comes under commercial and contractual activity.
It is almost certainly the case that the major reason for the Bill is the control of information, but is it the only reason? We can dispose of the Government's excuses without too much difficulty. They claim that the Bill has been introduced because of their pressing desire to reduce bureaucracy and to create savings.
On Friday, I received a parliamentary answer from the Department. It shows not only that the number of general and senior managers employed has soared far beyond what could be explained by the reclassifying of people as managers, but that the salary bill for such posts has gone from £156 million before the health changes to £600 million last year. Most of that burgeoning growth in numbers and costs has taken place not at regional health authority level--the Minister of State admitted today that the number of staff employed at regional level has fallen--but because of the division of trusts into individual businesses.
There is yet another reason why there is no need for us to take the Government's claims seriously. They are hellbent on introducing locally determined pay. They have been pressing the pay review body for years to accept that that is Government policy and it must be the framework within which their own recommendations are made. Introducing local pay will mean hiring a fresh army of negotiators and administrators for every single trust. The BMA estimates that introducing it for doctors alone would cost £40 million at least, which would wipe out every penny of the savings that the Government claim have inspired the Bill. So they cannot be in it for the money. There are other potential reasons apart from secrecy. There were 14 regional health authorities with a minimum of about 140 board members. The clear pattern of the
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Government's appointments is that those selected must be hand-picked Government loyalists. Perhaps there are not 140 people left in Britain who still loyally believe in the Secretary of State's health service changes.That view is strengthened by the fact that the 14 RHA are being replaced by eight regional offices in which the voice of the people is heard through eight individuals appointed by the Secretary of State. Rumour has it that those eight will soon be six. Perhaps even they are showing dangerously independent tendencies. I wonder whether finding even six reliable followers will soon be too much for Madam Mao. How long will it be before we have a gang of four?
The other possible reason for the abolition of regional health authorities lies in the reaction of the Secretary of State's shock troops in the trusts. In the document "Managing the NHS", published by the Office of Health Economics, William Laing says:
"Accountability of Trusts to central government has also been exercised through RHAs. Controversy arose because many NHS Trust chairs claimed that RHAs were attempting to exercise excessive and inappropriate control over Trust's operational activities." Perhaps they still believe in the national health service. Mr. Laing goes on:
"The issue of who should monitor Trusts has now been resolved by the government's decision to abolish regional health authorities." Dr. Jeremy Lee Potter-- [Interruption.] Yes, the former Conservative voter, as he has said himself--recently said:
"at the root of the NHS changes lies political dogma." What really matters is where that dogma-driven change will lead. The Minister of State accused me today of claiming that the health service is being fragmented and that it is being centralised. He is correct: I did make both those claims, and both are justified. A total of 500 individual health businesses delivering health care is fragmentation by anyone's standards.
It is the framework to which those businesses relate that is the real giveaway. That framework now consists simply of area health authorities which cannot possibly come together to present an alternative strategic view as the regional health authorities used to do. Within that framework, the individual trust will concern itself solely with its own business and the individual health authority will concern itself solely with its own area. Apart from that, we shall be left with a structure about which the BMA says that, instead of a "management tier . . . independent of" the Executive at national level, there will be an "increase in centralised control". In the document "Managing the New NHS" the new arrangements are described as a "single corporate structure". That structure will be without a countervailing voice, without any pretence of any democratic input, and every appointment within it will be made by and at the hands of the Secretary of State.
The Secretary of State, like the Government and like the Bill, becomes more discredited daily. We shall vote to reject the Bill tonight, and if and when the British people
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are next given the opportunity, if they vote to preserve and enhance their health service, they will vote to reject this Government.Mr. Malone: On behalf of my right hon. Friend, Madam Mao, may I present compliments to Polly Pot on the other side of the House, and make this simple point?
The Labour party has opposed a Bill that will reduce bureaucracy, and create savings that can be spent on patients. That shows precisely where the Labour party stands on the issue. It always has, and always will. The Labour party is always for the vested interests of the producer, not the consumer--the patient, whom the Bill is designed to serve. I hope that the House gives it a Third Reading tonight.
Question put, That the Bill be now read the Third time:-- The House divided: Ayes 285, Noes 243.
Division No. 81] [10.00 pm
AYES
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Ainsworth, Peter (East Surrey)Aitken, Rt Hon Jonathan
Alexander, Richard
Alison, Rt Hon Michael (Selby)
Allason, Rupert (Torbay)
Amess, David
Arbuthnot, James
Arnold, Jacques (Gravesham)
Arnold, Sir Thomas (Hazel Grv)
Ashby, David
Atkins, Robert
Atkinson, David (Bour'mouth E)
Atkinson, Peter (Hexham)
Baker, Rt Hon Kenneth (Mole V)
Baker, Nicholas (North Dorset)
Baldry, Tony
Banks, Matthew (Southport)
Batiste, Spencer
Bellingham, Henry
Bendall, Vivian
Beresford, Sir Paul
Biffen, Rt Hon John
Bonsor, Sir Nicholas
Booth, Hartley
Boswell, Tim
Bottomley, Peter (Eltham)
Bottomley, Rt Hon Virginia
Bowden, Sir Andrew
Bowis, John
Boyson, Rt Hon Sir Rhodes
Brandreth, Gyles
Brazier, Julian
Bright, Sir Graham
Brooke, Rt Hon Peter
Brown, M (Brigg & Cl'thorpes)
Browning, Mrs Angela
Bruce, Ian (Dorset)
Burns, Simon
Burt, Alistair
Butcher, John
Butler, Peter
Butterfill, John
Carlisle, John (Luton North)
Carlisle, Sir Kenneth (Lincoln)
Carrington, Matthew
Carttiss, Michael
Cash, William
Channon, Rt Hon Paul
Chapman, Sydney
Clappison, James
Clark, Dr Michael (Rochford)
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Clarke, Rt Hon Kenneth (Ru'clif)Clifton-Brown, Geoffrey
Colvin, Michael
Congdon, David
Conway, Derek
Coombs, Anthony (Wyre For'st)
Coombs, Simon (Swindon)
Cope, Rt Hon Sir John
Couchman, James
Cran, James
Currie, Mrs Edwina (S D'by'ire)
Curry, David (Skipton & Ripon)
Davies, Quentin (Stamford)
Day, Stephen
Deva, Nirj Joseph
Devlin, Tim
Dicks, Terry
Douglas-Hamilton, Lord James
Dover, Den
Duncan, Alan
Duncan Smith, Iain
Dunn, Bob
Durant, Sir Anthony
Dykes, Hugh
Eggar, Rt Hon Tim
Elletson, Harold
Evans, David (Welwyn Hatfield)
Evans, Jonathan (Brecon)
Evans, Nigel (Ribble Valley)
Evans, Roger (Monmouth)
Evennett, David
Faber, David
Fabricant, Michael
Field, Barry (Isle of Wight)
Fishburn, Dudley
Forman, Nigel
Forsyth, Rt Hon Michael (Stirling)
Forth, Eric
Fox, Dr Liam (Woodspring)
Fox, Sir Marcus (Shipley)
Freeman, Rt Hon Roger
French, Douglas
Fry, Sir Peter
Gale, Roger
Gallie, Phil
Gardiner, Sir George
Garnier, Edward
Gill, Christopher
Gillan, Cheryl
Goodlad, Rt Hon Alastair
Goodson-Wickes, Dr Charles
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