|Previous Section||Home Page|
Column 182followed up--not merely by a statement from Ministers but by putting it into effect, so that the annual report clearly demonstrates how each function, if it has been necessary, is carried out.
As my hon. Friend the Member for Lewisham, East (Mrs. Prentice) said, we are dealing with the removal of a strategic tier. Many of us believe that strategic matters are best handled by an authority that takes an overall perspective of the issues as they affect the region. A regional perspective is therefore important in several respects. Hon. Members have already referred to mental health. We must ensure that strategic facilities are available. The region plays an important role in that regard at the moment. I was a member of the health authority that contemplated the eventual closure of High Royds, a mental institution on the outskirts of Leeds. That institution is interesting as it sits on a large plot of land which, if suitable planning permission were given, would be extremely valuable. The institution was important to the region from a resource point of view. It was the region's job to allocate resources on a strategic basis throughout Yorkshire; therefore, the enormous accumulation of resources at Menston was an important potential asset, the use of which would have been determined strategically on a regional basis. I come from the Yorkshire region. Even though the Under-Secretary of State for Health, the hon. Member for Bolton, West--who is not in the Chamber at the moment--has described me as a foreigner--
Mr. Gunnell: Yes, but one understands that, in Yorkshire, the definition of a foreigner is very precise. Under the Yorkshire county cricket club's former rules, I would certainly be regarded as a foreigner. Indeed, my hon. Friend the Member for Wolverhampton, South-East (Mr. Turner) would also be regarded as a foreigner.
Mr. Gunnell: No, such accusations have not been levelled at me. I would have to wait a long time and have a more august position than I have at present in order for it to be worth while to make such suggestions.
From Yorkshire's point of view, the division of the large sum of money to which I have referred, and how it is allocated, is very important. Would it be allocated to mental illness, because mental illness requires huge resources? If we abolished the region and there were a great deal of income from a land sale, could we be sure that that money would be used in the area from which it came or, in the absence of regional authorities, would it go into a national pot? From the allocation of resources we know how much can be done within the health service. The allocation of resources is currently a regional function. How will resources be allocated in the health service in future? Will they be allocated through the national health service executive? Will regional policy board members argue for resources for their regions in an executive that considers all the resources and distributes them on a national basis? If savings are made in a particular region, will those resources be allocated within that region?
Column 183Ministers must have already decided what will happen. They must know how they intend to distribute resources. In the absence of regional health authorities, how will resources be distributed? That point could be covered in an annual report which states how that function of the region is determined. Only if we know how the resources will be allocated can we be sure that they will be distributed with roughly the same results as now.
I know that you take an interest in such matters, Mr. Deputy Speaker, because I recall the reception that you gave downstairs. You are obviously concerned about the care of those who suffer mental handicap or mental illness. Yesterday, I launched a report by the Matthew Trust which showed how the trust funded, with very small amounts of money, care for people who were mentally ill and had suffered some other hardship.
The trust was concerned with very small amounts of money, but it was clear that a section of people had somehow fallen through the net of our social welfare system. One might say that it is the health authority's job to ensure that those individuals do not fall through the net. However, one might also say that there is a responsibility at every level to ensure that the safety net that we believe exists--hon. Members on both sides of the House believe that it exists in the welfare state--is made seamless so that fewer casualties fall through it.
Many of the people whom I learned of yesterday suffered from mental illness. Many of them had other handicaps--for example, they had been victims of crime. Those people were falling through the net and they clearly needed help. We must ensure that our strategy is right. If the strategy used to be determined in part at regional level, how will it operate in future?
Regions currently carry out many functions in respect of which we would like a report. When there are local disputes, the arbitration procedures are provided by the region. As we said in Committee, with regard to "The Health of the Nation", regions were given a specific function. Who will carry out that specific task of setting a health promotion strategy in future? Will there be a regional health promotion strategy or will it simply be a strategy set out by the Secretary of State here in the House?
There are clearly regional factors at play if we consider disease across the nation. I believe that there should be regional health promotion. What will happen in that respect? Although I did not attend yesterday's debate on health care in London, I am pleased to hear that the Secretary of State was concerned about centres of excellence. I wrote about the destruction of such centres of excellence and received a letter from the Minister for Health this week. I believe that we can learn lessons from the United States about the preservation of centres of excellence.
The regions have responsibility for research and development. Where has that responsibility gone or where is it going? What about a region's responsibility for registration? Responsibility for fundholders and their registration is going to the district health authorities. We have already discussed that, so it is not quite at issue now; if, however, there were an annual report, it could have been made plain that that responsibility had been transferred.
Column 184The responsibility for the appointment of community health council chairs currently rests with the region. Who will have that responsibility in future? The appointment of the chairs of community health councils and of those connected with the councils is very important, especially to local communities. When we come to talk about other health service appointments, we will have the benefit of a paper produced by the Secretary of State only this month which says that responsibility lies specifically with individual regional policy board members. We do not know whether responsibility for appointments to community health councils will also lie with regional policy board members.
A number of questions need to be answered. I would expect that an annual report would be able to say not just what was suggested by the Minister in Committee but where responsibility was exercised and who was exercising it. We need to know what will happen to those people who are working in the regional authority for the north and Yorkshire. We are told that there will be 135 people working initially in Harrogate, with some working in Durham and others elsewhere.
No doubt, some people will be transferred to the civil service. We need to know where those people are and what tasks they will carry out. We also need to know what tasks will be given to those people who have been transferred elsewhere. What will be done at Durham when the building is built? What will be done at Quarry house? Which matters will be dealt with in Whitehall for which the region is currently responsible?
In addition, we need to know about savings. My experience of savings brought about by abolition goes back to my time as leader of West Yorkshire metropolitan county council, when it was abolished. I was told that the abolition of my county, and five other metropolitan counties, would save £50 million. That does not sound much when it is compared with the £150 million that the Government claim will be saved by this change. It was claimed that the saving was one of the motivating factors for removing democracy and abolishing those authorities.
A study carried out three years after the abolition of those councils stated that, although it was not possible to say that the abolition had cost a great deal of money, it was certainly not possible to say that it had saved money. The report, produced by the university of Birmingham, suggested that the change had been financially neutral. I want there to be agreement that the forecasts that the Ministers make will be quantified. We must know where they think the savings will come from, as it is not enough to project a global figure of £150 million.
I can understand that there will be fewer appointments to health boards following the merging of authorities, and therefore I can see where some specific savings will be quantified. I do not believe that those savings will come anything near £150 million, and Ministers must state from where the other savings will come. New clause 2 says that a statement of accounts must be produced before 1 April 1997. that might be a significant month for the Government. They will not be able to last here any longer than that without public approval, but I believe that the public will approve the presence of the Conservative party on the Opposition Benches.
We know that health service reforms are a costly business. It is now a year and a half since the controller of the Audit Commission said that whether the NHS got value for money from its was a "very legitimate question".
Column 185I asked whether the Audit Commission had been allowed to look at the savings projected in the Bill, because that might have thrown an interesting light on the issue. That question was not answered, so I suspect that the Audit Commission has not been brought into the matter.
It would be helpful to look at some aspects of management in the NHS. We know that the management of the introduction of the reforms has already cost the best part of £1 billion. Have we had value for money for that amount? I doubt whether many patients would think that we have; I am quite sure that they would have preferred much less to be spent on management changes and much more spent on patient care. We are talking about the future, and the Bill will bring about changes in the future. We are told the Bill will save £150 million. Hon. Members should ask for that to be demonstrated after the event so that, even if the changes are not justified in any other way, the Government can show that they have produced the forecast savings. The examples which I have been able to raise do not fill me with confidence. I understand the Minister's reluctance to put the new team working for Yorkshire and Humberside in Quarry house. We are told that Quarry house, which is near the centre of Leeds, is not in the middle of the region. I accept that. Harrogate may be a bit better, but that is not the centre of gravity of the region either. That, no doubt, is the argument for going to Durham; but the costs of going there must be regarded in the light of the fact that there is space in the £55 million Quarry house building in Leeds and there is also a building in Harrogate which, for the particular reasons we gave in Committee, will not get the best price in the market at the moment.
Mr. Nicholas Brown: The situation is even worse than my hon. Friend outlines. There is, of course, a fourth building--the northern regional headquarters at Walkergate in Newcastle. Instead of having one headquarters per region, the Government--in their great push for efficiency and savings- -are giving us four.
Mr. Gunnell: I thank my hon. Friend for that comment. It was remiss of me to have had such a Yorkshire-biased point of view. I ignored the building in Newcastle. [Interruption.] The Speaker admonished Members for going from one constituency to another. I was wondering whether the sacred turf of the Hawthorns in West Bromwich was in her patch, because hon. Members go there from time to time. The questions about the costs of change and why there must be an increase in expenditure for a new building in Durham have been unanswered. Thanks to my hon. Friend the Member for Newcastle upon Tyne, East (Mr. Brown), I can say that there are three buildings which are being neglected while a new one is built. That is the antithesis of the suggestions which Ministers usually come up with. There is a strong case to ask Ministers to accept new clause 2, and to be prepared to publish the financial results of their activity. 5.30 pm
Mr. Kevin Hughes: I have the feeling that I have been here before. The two new clauses are about accountability, and we explored the Bill's lack of accountability in Committee. We talked about democracy, openness,
Column 186accountability and consultation but we have not yet had a proper answer from the Minister of State on any of those issues. That does not surprise me, given his response when asked to define a hospital. If he cannot define what he means by a hospital, how on earth can we expect him to give us straight answers about democracy, openness, accountability and consultation? Is it really too much to ask a Minister what the Bill means and what the Government mean by accountability, openness and democracy?
The two new clauses are basically no different from what we have discussed in the past. My hon. Friend the Member for Don Valley (Mr. Redmond) referred to the secret service that operates in Doncaster. He and I share the same regional health authority and trusts, so we can both speak with experience about the lack of openness in our area. Other colleagues have a similar experience in their areas. We have the Doncaster Health Care trust; the district health authority, which is being merged with the family health service authority, piloting what the Bill is about; and the Doncaster Royal and Montagu Hospital trust. Of the three, the Doncaster Royal and Montagu Hospital trust-- [Interruption.]
The Minister might like to listen to what I am about to say because Opposition Members do not often sing the praises of a trust. Of the three, the Doncaster Royal and Montagu trust is the most open and accountable, and invites local Members of Parliament to talk about what it is doing and proposes to do. That is significantly different from the other trust and certainly different from the district health authority.
New clause 1 seeks to have a report laid before the House. It says:
"It shall be the duty of the Secretary of State to lay before both Houses of Parliament an annual report on the activities of the regional offices of the National Health Service Management Executive".
Those reports must be a valuable feature. What possible harm could they do? Do not we need to know what is happening in our health service? Do not we need to know about the overview of the new regional bodies? Let us not forget that people employed in those bodies will be civil servants. Will the Minister come to the Dispatch Box and justify why we should not have such a report? I see no reason whatever.
The Minister said earlier that hon. Members table too many parliamentary questions and waste public funds. If we had those reports and could find out what was happening, hon. Members might not need to table so many parliamentary questions. Who knows, the reports may even contain a definition of a hospital. If the Ministers do not know, somebody in the national health service executive may know what constitutes a hospital. I might table a parliamentary question later today asking the Minister to define a hospital, because he did not answer that question in the Chamber this afternoon. I find it incredible.
Let us not forget that the new bodies, which will be made up of civil servants, will still have a strategic role to play in overviewing their regions. It is important that we have that overview and a report on what is happening. Without a report, how will we know what those people are doing? Although they will report back to the Secretary of State, if a report is not laid before Parliament, we shall not know what is happening in our regions.
Apart from the Secretary of State, who will monitor the new regional bodies? Will they monitor themselves? A lot of self-monitoring seems to go on in the health service. After all, to be appointed to one of those bodies, it takes
Column 187just a nudge and a wink. My hon. Friend the Member for Don Valley mentioned the Freemasons and he may not have been too far from the truth, because the new trust boards and the district health authorities are like secret societies. No one seems to know how people are appointed to them. A nudge and a wink, a word here or there, and suddenly someone with no experience whatever in the health service is appointed. So long as they are a friend of a friend--they might happen to be a friend of the Tory party or a friend or relative of a Tory Member--they are appointed. We have been round that circle before.
New clause 2 is about accountability for expenditure in the health service. Again, I see no good reason why we should not have such accountability and why we cannot be told how taxpayers' money is being spent. How on earth are we to scrutinise whether taxpayers are getting value for money? Is the health service to be left to monitor itself?
My hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) discussed the £150 million--or is it £60 million?--of savings that the Bill will make. Nobody seems to know whether savings of £150 million, £60 million or somewhere in between will be made. One reason why the Minister does not want us to have the financial report proposed in new clause 2 is because he does not want us to see that somebody somewhere- -perhaps him--got the figure wrong along the way. If we have that report we may discover the truth, which I suspect is that savings of neither £150 million nor even £60 million will be made. It is hard to keep a straight face when the Government say that they will save money when they have been responsible for increasing spending on administration in the health service to figures as long as telephone numbers. It is unbelievable how spending on administration has risen.
The two new clauses are about accountability and openness. We have been round that circle many times and will undoubtedly be round it again because we never get straight answers and Ministers seek to avoid the issue. In my opinion, the Government do not want openness, they do not want democracy and they certainly do not want accountability.
Let me tell the Minister that people such as those whom I represent want openness, accountability and democracy in the health service; they want to know how their money is spent. The two new clauses will give the power to their Members of Parliament to obtain the answer to that question for them.
Mr. Nicholas Brown: Rather perceptively, my notes are headed "NCI", which I assume must stand for "No Conservative in sight". The British public are entitled to draw the pretty obvious conclusion from the fact that not a single member of the Conservative party has come here today to take part in an important debate to defend the Minister's point of view, except for the Minister himself. I acknowledge that the Minister is here. He is ever present--apart from during the opening stages of the Bill, when he was unable to take part, and was helpfully described by the Parliamentary Under-Secretary of State, the hon. Member for Bolton, West (Mr. Sackville) as being ill-tempered and plague-ridden. It is not a description that I recognise of the Minister but, in fairness, his hon. Friend obviously knows him better.
Column 188The Minister no doubt hopes to cut an heroic figure among his parliamentary colleagues, standing alone at the Dispatch Box, holding back the forces of socialism, but the only nationalisation that is being undertaken here today has been undertaken by him, as he nationalises the functions of the regional health authorities by taking them in-house, under the direct control of the state, centralised under his direct personal control, inasmuch as the Secretary of State will allow him to exercise such control. Our amendments are modest. They merely seek to hold the Minister accountable for his actions. Specifically, our new clause 2 seeks to hold the Minister accountable for the public money that he spends. That appears to me to be a perfectly reasonable proposition to put before the House. It has not originated in the ranks of the parliamentary Labour party alone. As my hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell) rightly said: it is a perfectly sensible suggestion of the Audit Commission.
If the Government claim value for money, they have at least a duty to prove the point. Our new clause 2 would require them to do exactly that, no later than April 1997. We might not have felt it necessary to bring new clause 2 before the House had the Minister been more candid in Committee. Not only did he not appear to know the answers to the questions about the amount that he was spending, the amount that he was saving and the ultimate cost or saving to the taxpayer, but he offered us a moving feast of different figures.
In the first week--I accept that it was not the Minister's fault but that of the Under-Secretary, the hon. Member for Bolton, West--we were told that the savings would be £150 million, but the Committee was treated to that figure without any context. No doubt we were all supposed to be overawed by it and to think that it represented good value for money. We then discovered that the figure for savings in Wales was to be £3 million. My hon. Friend the Member for Cardiff, West (Mr. Morgan) calculated that, if one took the figure for Wales and applied a population factor to obtain an equivalent figure for England, one would obtain a figure of £50 million.
The Minister then told us that the true figure that the Government anticipated for eventual savings for England was £60 million. Therefore, more money was to be saved from England, per head of the population, than was to be saved in Wales.
The Minister knew enough about the figures to treat us to that information, but he was unable to tell us how the figures were calculated. He may have made them up, which is always a possibility, I suppose, or perhaps he had no intention of being candid with the Committee--he wished to keep the information to himself. I hesitate to suggest that his reasoning might have been that the information was commercially confidential, but nowadays, given the direction in which the national health service is going, frankly, one never knows. The Minister has not shared the information with the Committee. Labour Members believe that he should be required to share it with the House.
The Minister boasts about a saving. On Second Reading, the Bill was accompanied by a money resolution. That money resolution was permissive; its purpose was not to facilitate the saving of money but to facilitate the spending of money, so the Minister is effectively saying to the House that he will need to spend money on implementing the legislation.
Column 189No doubt the Minister's argument is that he spends money now to save it later. That is a perfectly reasonable argument to make; we simply require him to justify it, and we are entitled, as is the country, to draw our own conclusions from the fact that the Minister cannot justify it, or at least has not done so so far.
If the Minister is unwilling to justify that argument, are we not entitled to draw some conclusions from the fact that he wishes that information to remain secret? Whatever it is, it is not good conduct; it is not good public administration; it is not parliamentary accountability. Indeed, the Minister is not even able to outline which functions will remain at the regional level, which will be devolved to local level and what the costs will be. If savings are to be made, I think that we are entitled to assume that some functions will be performed less well, perhaps not even performed at all. What functions? So far, the Minister has not said.
The case for new clause 2 appears to be well made in terms of parliamentary accountability and the good management of public finances alone. There is, however, an even stronger case to explore further--as we seek to do in new clause 1--the strength of the arguments that lie behind the Minister's nationalisation of the functions of regional health authorities.
The purpose of our new clause is to place on the Secretary of State a duty to lay before Parliament an annual report on the activities of the regional offices of the national health service executive in respect of the duties that will be transferred to them from the abolished regional health authorities. We are simply saying that the Secretary of State should be accountable to Parliament.
If the Government think that they are justified in proceeding in the way they suggest, let them explain their actions to the House. That appears to me to be a perfectly reasonable stance for any publicly elected representative to take. I am surprised that the Minister does not embrace the opportunity to boast about his achievements, instead of running away from the opportunity. That fills me with doubts and uncertainties about his true motivations. Worries have been expressed by my hon. Friends. There are anxieties that the regional offices of the national health service executive will not have the resources or the expertise required to exercise effectively a range of functions--a subject that we explored in Committee, but which it is right to explore again with the Minister, as we received no satisfactory answers. Our fears are more deeply felt because, although staffing levels for those regions are to be similar, the size of the regions are not to be similar.
My hon. Friend the Member for Morley and Leeds, South cited the specific case of the North and Yorkshire region, as the Minister likes to think of two regions that have been added together. The Minister speaks to the House about efficiency savings. Those efficiency savings will not be found easily in the headquarters building.
As my hon. Friend the Member for Morley and Leeds, South said, there is spare space in Quarry house in Leeds. The region has as an objective the sale of the existing headquarters at Harrogate. There is also an existing headquarters building at Walkergate in Newcastle, and, as
Column 190if three headquarters were not enough for one region, the region intends to build a fourth new building in Durham city to add to its property holdings. I think that people would like the regional health authority to add to the primary and secondary health care it provides, not to its steadily burgeoning portfolio of office buildings. We believe that the strategic regional overview of providing and purchasing decisions made by health authorities, GP fundholders and NHS trusts will be carried out in a thin and an episodic manner. My hon. Friend the Member for Lewisham, East (Mrs. Prentice) raised concerns about services which may not be purchased enthusiastically as priority services in the Government's new marketplace, but which are nevertheless important. My hon. Friend referred to HIV/AIDS and drug dependency units, and my hon. Friend the Member for Morley and Leeds, South made a similar point about mental health care. Those important areas may be downgraded rather than given the attention that they rightly deserve in the Government's new structure. Although the argument stands true across the country, as we debated yesterday, I believe that there is a special and specific case for a region-wide overview of health care services in London. That case is extraordinarily well made, and the structures we will be invited to put in place later today will do absolutely nothing to help achieve it--although the Government seem to acknowledge the case for regional structures, albeit nationalised ones, elsewhere in the country. Our proposed new clause requires the Minister to report to the House about the outcome of the structural reorganisation. We want to know about the savings, the safety nets and the important functions that are perhaps not being monitored and carried out as well as they should be. I think that it is perfectly reasonable for Members of Parliament from London to draw certain conclusions about a structure which is perfectly all right for regional planning areas but which is not all right for the nation's capital. The Minister's report--if there were to be one--would provide hon. Members with useful evidence for any case that they may wish to make.
There is a separate issue about training, including the co-ordination and strategic planning of nurses' training. In any market with a purchaser- provider split, it is often difficult to see what driving force will require the purchasing--that is the language that we must use these days-- of nurses' training. The Royal College of Nursing has expressed some concerns. It believes that the ever-increasing demand for trained nurses will not be met, and it has pointed out that, since 1987, the number of training places for nurses in the national health service has been cut by 33 per cent. If that trend is being driven not by planning but by the marketplace, it is likely to continue.
Similar fears have been expressed about the operation of cancer registries and the organisation of cancer screening programmes. That important regional function will be nationalised by the Minister and carried out directly by his Department. It will be supervised by him personally, but I am not sure how reassuring that will be for those who expect the programme to be provided by a regional health authority with clinical decision-making and health care priorities--not driven by the political imperatives which drive Ministers.
Column 191My hon. Friend the Member for Stockport (Ms Coffey) drew attention to very important regional level public health initiatives. Where will they figure in the Government's marketplace? The Minister is effectively nationalising the people in charge, as the Bill transfers regional directors of public health from the employment of the NHS to the civil service. Regional directors will be not officials with a duty of responsibility to the general public but civil servants with a duty of responsibility to the Minister which, as we have discovered time and again in this place, is quite a different matter. The British Medical Association has written to all hon. Members who served on the Committee expressing its concern that the resulting restrictions will curb the necessary freedom of public health officials to speak out, even if it is inconvenient to the Government. It is very difficult for civil servants to do that, because it constitutes a breach of the Official Secrets Act. I suspect that the Minister would be the first to invoke such legislation if it were in his interests to do so.
That is the sort of behaviour that one would expect of a former vice- chairman of the Conservative party. I see that the Minister is flinching; I thought that he would take it as a compliment, but he obviously considers it an insult to be accused of being an official of the Conservative party.
Mr. Brown: I am reminded by the hon. Member for Altrincham and Sale, who graces us with his presence, that the Minister was a deputy chairman of the Conservative party. The hon. Gentleman is clearly taking a close interest in health care provision, and I will move on to facilities for the elderly later. The hon. Gentleman has told me that he has reached the age of retirement, and I for one will miss him very much, because he is my pair. I think that the laws of supply and demand may work against me in the next Parliament, so I will miss him more than he thinks.
Before turning to those important considerations, I raise again the question of the siting of junior doctors' contracts. As the Minister would be the first to acknowledge, junior doctors are the cornerstone of secondary health care. The Committee spent some time trying to explore with the Minister where the contracts of junior doctors would be located--would they be held by individual trust hospitals or by a consortia of trust hospitals, or would they be nationalised along with other regional functions and held by the state?
It was clear to me at the beginning of the Committee process that the Minister did not know the answer to that question. By the end of the process, he had told us that the contracts would be held at a regional level for the time being, and that the situation would be considered further. The BMA was concerned that, if the contracts were held at trust level, the necessary rotation of junior doctors would be affected, and training might not be completed.
It was clear to Committee members that the Government toyed with the idea of having a consortia of hospital trusts--a consortia of providers--hold the contracts. From the Government's point of view, it is perfectly rational to consider that proposal. Junior doctors are providers of health care, and it fits with the Government's purchaser-provider philosophy that the contracts should be held by the provider. When the
Column 192Government wish to sell off the hospitals to the private sector, the doctors and their contracts will go with them. Having the state hold the contracts at a regional level cuts across the market-based philosophy which is behind the rest of the Government's health care reforms.
The Government may be retreating from the original structures that constituted their great vision in the mid-1980s when they embarked on this stupidity. That is one possible explanation for their change in approach. We require the Secretary of State to come back to Parliament with a report which sets out whether the restructuring has succeeded. That is the key proposition in new clause 1.
My hon. Friends have raised correctly--although I accept that it is tangential to the main thrust of the argument--the question of involving universities and medical schools in planning decisions. Moneys are transferred from the Department of Education to the Department of Health. The Bill removes the statutory position which was enacted only recently.
The National Health Service and Community Care Act 1990 enabled universities and medical schools to participate in planning and decision- making at regional level. It is perfectly right that we should seek from the Government an explanation as to how the new interface is to work and to require, as we do in new clause 1, the Government to report to Parliament about the effectiveness of the new arrangements.
My hon. Friend the Member for Lewisham, East raised the separate issue of membership of health authorities and the Minister repeated the assurance which I understood him to have given in Committee: that, if a medical school or a dental school was involved, the appropriate person would be considered for membership of the health authority. 6 pm
The Minister told us something about the structures of the health authorities and the nature of the people who are to serve upon them, but from my point of view and that of other members of the Committee, that was not enough. He did not tell us about the rest of the composition of the health authority.
Which other professionals are to be involved and how are the laity to be chosen? Who are they to be? Perhaps Conservative Members are absent from the debate because they are encouraging their friends and relatives and people of equal virtue to fill in their application forms to apply for the new lay posts. Perhaps they have a head start on the rest of the nation, and are trying to get in before the Nolan committee reports. Who knows? I would accept any explanation that the Minister was willing to give the House--perhaps "accept" is putting it too strongly: I would at least listen to it charitably.
In any event, new clause 1 would require the Minister to report to Parliament on how the structures were working and to defend his decisions when they turned out to be perhaps politically motivated or even sordid.
The Committee was worried about the co-ordination of vocational training for general practitioners--again that is not easily purchased in the marketplace--and who would undertake responsibility for GP fundholders. We did not think it right that that function should be handed over to health authorities. That could not be done easily, as health authorities are responsible for the non-fundholders, and in the Secretary of State's new quasi-market, fundholders
Column 193and health authorities are supposed to be competing purchasers, no longer co-operating but fighting over patients-- presumably the ones who are not ill, as they are the ones who are worth having in the new marketplace.
Finally, the question has been raised and not satisfactorily answered as to how on earth hon. Members are to get parliamentary questions answered. The Minister already says that information is not held centrally, and hints that it is available somewhere. We have welters of answers saying exactly that. He suggests that we are not getting answers because we are not framing the questions properly. In the spirit of all-party co-operation, I sought from the Minister advice as to how to phrase questions. The example I cited was, how should I phrase a question to discover how many hospitals there were in the country--hospitals for which he is directly responsible to the House? I asked the Minister how many hospitals there are, how many had closed and how many he is planning to close. He said that planning to close a hospital was a hypothetical question. One assumes that there is still some planning in the Department of Health, and that not everything has been thrown to the market.
Mr. Kevin Hughes: Perhaps, when he is tabling questions, my hon. Friend ought to go back to basics and ask the question, what is a hospital? [Interruption.] If he starts from there and he gets an answer to that question, he may be able to progress to other questions to which he would like answers.
Mr. Brown: My right hon. Friend the Member for Derby, South (Mrs. Beckett) advises me that the answer to such a question would probably be that the information is not held centrally. The perfectly reasonable information that I was trying to extract from the Minister was: how many hospitals are there in Britain, how many have closed, and how many is he planning to close?
Perhaps, in a certain sense, planning is hypothetical, but Ministers have shared their plans with the House before in a candid way and in a spirit of openness and willingness to discuss, perhaps even learn and to listen to suggestions from others. In my experience, however, whenever the Minister suggests closing a hospital, the local halls fill up with citizens who are worried that their hospital will be taken away and most people are against it, which seems more rational that the Minister might expect.
Not only is he unwilling to share information with us about which hospitals he is planning to close: he goes further in trying to conceal information by saying, as my hon. Friend for Doncaster, North (Mr. Hughes) has just pointed out, that he cannot answer the question, "What is a hospital?" That is Jesuitical in the extreme. The Minister gave us no definition of a hospital. The Minister of State is supposed to hold an important office in the national health service, and he does not know what a hospital is. If the Minister does not know what a hospital is, how much confidence can we have in the rest of his legislation? Surely the Minister's lack of knowledge on a pretty fundamental and elementary point cannot reassure my hon. Friends or, indeed, Conservative Members.
How reassured is the hon. Member for Altrincham and Sale (Sir F. Montgomery) that the Minister of State does not know what a hospital is? I have heard the hon. Gentleman
Column 194speak eloquently about hospitals in his constituency. The hon. Gentleman has never had any difficulty in defining what he wanted kept open and wanted the Department to support rather than do down. The same is true of many Conservative Members. Surely they should join us in the Lobby tonight and support our proposition, which at least holds the Minister of State to account, and might even in future require him to explain what a hospital is.
Mr. Malone: We had an admission from the hon. Member for Doncaster, North (Mr. Hughes) that we had run round the same course many times before during the debate. That was two hours ago. He said that we had already run round the course 47 times. Let me say to the hon. Member for Newcastle upon Tyne, East (Mr. Brown) that we gave up running round it and started to ramble across it at will during the past 30 minutes or so.
I shall concentrate on new clause 2, which I did not deal with in my opening remarks, as it was not touched on by the right hon. Member for Derby, South (Mr. Beckett). If Opposition Members were looking for proof that the savings from the Bill will actually be delivered, I am sorry to tell them from a reading of their amendment they will not get it from that.
The amendment seeks to compare spending in 1995-96 and 1996-97. As I made clear in Committee, the savings will be made over a slightly longer time scale into 1997-98. We made all the figures perfectly clear in Committee, but I shall return to them for the purpose of absolute clarity during my short wind-up speech.
Savings are already being made from slimming down regional health authorities in preparation for the transition to regional offices. For example, RHA core staffing has already fallen from nearly 7,900 in July 1992 to about 2,600 in March 1994. Savings are also being made from the integration of the work of DHAs and FHSAs, and in total we expect savings approaching £60 million to be made in 1995-96. There is no great mystery about what will happen thereafter. By 1997-98, when the new structure is fully implemented, the savings will rise to nearly £150 million net per year.
Opposition Members asked how those savings are to be broken down. More than £100 million-worth of the total saving results from the abolition of RHAs and the consequent reduction and overlap of work between the central Department and the regions. The remainder is due to the replacement of DHAs and FHSAs with health authorities. As for savings in departmental running costs, savings secured from the elimination of functions that currenty overlap between regional health authorities and the NHS executive will also contribute to the saving of some £50 million in the running costs of the Department of Health to be made by 1997-98.
The hon. Member for Morley and Leeds, South (Mr. Gunnell) raised a point that was also raised in Committee, asking whether savings would stay in the region concerned. In the case of certain savings, the answer is yes. All RHA spending, except the amount to be transferred to the Department of Health administration vote for the running costs of the regional offices, will have been devolved to the districts in the region, and will form part of their baselines before decisions are made about allocations to health authorities for 1996-97.
Column 195That relates to the direct part of the spending; as I said in Committee, any other savings that accrue will be available for general health needs. They will be spent on patients, and will be allocated in the normal way.
New clause 2 is intended to ensure that savings are delivered. The annual departmental report--which, as I said earlier, is a Command Paper and is laid before Parliament--describes in detail the Department's expenditure and activities, including all its responsibilities and all major developments during the previous year. In future, it will also include the effects of the abolition of RHAs. It will be possible to quantify savings, and the House will have an opportunity to consider them in detail.
The hon. Member for Don Valley (Mr. Redmond) apologised for not having been present at the beginning of the debate; no doubt, if he ever returns to the Chamber, he will apologise again for not having been present at the end.
The hon. Gentleman referred to his own experience of the health service, and described it as extremely good. Let me point out that it is no use Opposition Members always saying that the health service in general is useless--as they do in the House--and then, when narrating their own experiences, saying that it is good. I hope that their experience of the service is coloured by what happens to them when they have to use it.
The hon. Member for Lewisham, East (Mrs. Prentice) made a point about London planning. Health care in London--which was debated at length yesterday--is currently changing: the existence of the London implementation group, which was created to serve a time-limited purpose, is drawing to its conclusion. The hon. Lady feared that there might not be enough drive to ensure proper provision and a proper strategy for London's health care, but I assure her that there will.
I should point out to the hon. Lady that the organisational structure of London's health service is now much simpler than it was; its former complexity led to the establishment of the implementation group. The four regional health authorities have become two, and, as part of the move to the new, streamlined regional structure, they now incorporate the work of the former outposts.
All but one or two providers of health care will be trusts by 1 April, including most of the former special health authorities. The health authorities have been brought together to form commissioning agencies, responsible for assessing needs and ensuring that the right balance of services is available in both hospital and community in each area. We also expect a considerable increase in the number of GP fundholders in inner London, with an extension of the 14 per cent. of the population who are already covered to some 24 per cent. by 1 April.
The role of the London implementation group is now largely completed, except in the case of primary health care: the primary care support force and the primary care
Column 196forum will remain. There is, indeed, a proper London perspective on health matters, and a much simpler structure which will enable that perspective to be implemented.