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Foundation Hospitals

5. Mr. Chris Mullin (Sunderland, South): How candidates for membership of governing boards of foundation hospital trusts will be chosen; and if he will make a statement. [116528]

The Secretary of State for Health (Mr. Alan Milburn): The Health and Social Care (Community Health and Standards) Bill states that members of each NHS foundation trust board will be chosen by election. Direct elections will help to ensure that NHS hospitals work more closely with the local communities they serve.

Mr. Mullin : I am grateful for that reply. Although I have no objection in principle to my right hon. Friend's plans to devolve power within the NHS, I still struggle to understand his proposals on accountability. How will candidates be selected? Will they nominate themselves or will they be chosen in some other way, as yet undecided? Is there not a danger that, if we are not careful, we shall end up with foundation hospitals that are less rather than more accountable to the public they serve? I know that that is not what he is aiming at.

Mr. Milburn: My hon. Friend is right about that. The principle is that we want to ensure that local staff and local members of the community have a greater say in how local hospitals such as his own, which have applied to become an NHS foundation trust, are run. That must be right. If we are to achieve more responsive local services, with the best will in the world, that cannot be imposed from Whitehall or from the top down. There has to be a much greater local element of accountability than there has been to date.

On the provision for how people will be elected, obviously, the NHS foundation trusts are a membership-based organisation and we want to ensure, as far as we can, that as wide a swathe of the local community as possible become members of NHS foundation trusts. I think that my hon. Friend is aware that the Bill provides for secret postal ballots from among the members who will be involved in direct elections to the hospital governing board. He is also aware that local members of staff will have an opportunity to be represented on the governing body, so, for the first time, local staff and local members of the community will have a direct say in how the hospital is being run.

Mr. John Redwood (Wokingham): I welcome the Secretary of State saying that he wants to encourage the widest possible membership of foundation hospitals. In that spirit, will he consider extending membership to all people on the electoral roll in the relevant area? If he

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does not want to go that far, will he tell the House what active measures he will take to promote wide membership, which many of us would welcome?

Mr. Milburn: The right hon. Gentleman makes a fair point. It is important that the membership of NHS foundation trusts is as large as possible, representing the local community. There are a number of options, and one is to achieve that through advertising in the local media, which would encourage local people to become members. Alternative options include allowing people to register to become a member of an NHS foundation trust when they register, for example, to vote in a local election.

Mr. Keith Bradley (Manchester, Withington): Can my right hon. Friend explain this to me? If a specialist hospital such as Christie in my constituency becomes a foundation hospital, who will be the electorate for membership of it?

Mr. Milburn: As my right hon. Friend and I have discussed previously, the position of specialist hospitals is somewhat at variance with that of most district general hospitals, for example. [Interruption.] Although the hon. Member for Woodspring (Dr. Fox) laughs, he is the first to say that the NHS is not a uniform service. Indeed it is not. Specialist hospitals have a very different make-up and serve a very different catchment population from district general hospitals. That is why it must be right, as the Bill does, to allow some flexibility in the governance structure.

Specialist hospitals, in part, serve the local community, and members of the local community would have the right to become members of the NHS foundation trust. Equally, the vast majority of users of a hospital such as Christie are drawn not from the local community, but from patients and, due to the hospital's excellent services, those patients come from not only the north-west, but across the whole country. That is why the Bill gives flexibility—precisely so that patients and the public can be represented on the governing body of such organisations.

Mr. Simon Burns (West Chelmsford): Will the Secretary of State reflect on criticism from the Labour-dominated Select Committee on Health? It said that the plans for the constituencies to elect the governing boards would be determined by unelected NHS organisations. As a result, the Committee said that the board of governors would function simply as focus groups, advisory panels or talking shops. On reflection, does the Secretary of State not think that it would have been better to be more consistent in deciding on the constituency bodies that would elect governing boards, and thus to avoid confusion, anomalies, disappointment and a system that prevents the boards from carrying out their functions effectively?

Mr. Milburn: That sounds suspiciously like a return to precisely the centralised control and Government intervention that the hon. Member for Woodspring warned us against a moment ago. The hon. Member for

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West Chelmsford (Mr. Burns) is a member of the Select Committee as well as a Conservative Front Bencher—[Hon. Members: "Surely not!"] Indeed he is.

Mr. Burns: I am multi-skilled.

Mr. Milburn: That is one way of putting it, although I am not sure it is the most appropriate.

Obviously we will consider the Select Committee's recommendations extremely carefully. Indeed, we are already doing so in Committee. It must be right, however, for local people to have a greater say in the running of their hospitals.

There is a straightforward choice. We can do what we have done for so many years under both Conservative and Labour Administrations, and presume that if we parachute people on to the governing boards of NHS hospitals we will create more locally accountable services; or we can do what we propose to do, and ensure that the democratic principle, which is good enough for social services, also applies to the way in which we run our health services, so that people have an opportunity to decide who is running the local hospital.

Primary Care (Elmet)

6. Colin Burgon (Elmet): What expansion of primary care facilities are (a) under way and (b) planned in the Elmet constituency. [116529]

The Minister of State, Department of Health (Jacqui Smith): A significant amount of investment is being undertaken in East Leeds primary care trust—some of it at the Allerton Bywater and Kippax health centres in my hon. Friend's constituency, where new facilities are planned for the coming year. Other PCT investment will improve and expand primary care facilities in the area, and increase the range of services available to local people.

Colin Burgon : I am glad to learn that, as we speak, work is in progress in my home village of Allerton Bywater. Perhaps my hon. Friend has been furnished with the list including Wetherby and Swillington, whose health centres are also to be improved. Does she agree that, although hospitals may be considered more glamorous, we should never lose sight of the fact that the facilities provided by PCTs, and those who work in them, should be a Government priority when it comes to investment?

Jacqui Smith: My hon. Friend is absolutely right. For most of us, PCTs are the front door to the NHS, and it is from them that we and our families receive most services. It is through them that the NHS has an impact on our lives. That is why the extra £1 billion that the Government are investing in primary care over the next three years is so crucial. It will have an impact on my hon. Friend's constituency and on the constituencies of all Members, regardless of whether they voted for the money in the first place.

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Primary Care Trusts

7. Mr. Andrew Stunell (Hazel Grove): If he will make a statement on NHS primary care trusts' deficits at the end of 2002–03. [116530]

The Secretary of State for Health (Mr. Alan Milburn): Audited accounts for primary care trusts for the year 2002–03 will not be available until the autumn. Local health services, however, received an average cash increase of just under 10 per cent. for that financial year.

Mr. Stunell : What comfort can the Secretary of State give Stockport PCT, which reports that it is rolling forward a deficit of £2.5 million into the current year and is now committed to a programme of £6 million of financial reductions in that year? My constituents face reductions in access to magnetic resonance scans, ophthalmology services and minor surgery, and my GPs face a £600,000 reduction in their prescribing budget. Will the Secretary of State ensure that Stockport's health service has the resources that it needs to restore those services to my constituents?

Mr. Milburn: My understanding is that at the end of this financial year, Stockport primary care trust will deliver a balanced budget. Secondly, over the next three years it will receive increases of 9.13 per cent., 8.88 per cent. and 8.57 per cent. Those are cash increases for the local PCT—which, of course, is a lot more than the Liberal Democrats ever promised for the health service.

Dr. Howard Stoate (Dartford): The extra resources given to PCTs are very welcome indeed, and as my right hon. Friend will know, the GP contract is out for voting among GPs. That is an important part of the Government's plan for improving primary care, but I ask him to reassure my GP colleagues that the GP contract really is a step forward in improving recruitment and retention, and to ensure that the extra resources given to PCTs really will find their way through to GP surgeries. The worry remains that some of the money given to PCTs never gets as far as it should, and that GPs and their patients do not get the benefit that they ought to.

Mr. Milburn: My hon. Friend makes an extremely good point, and I know from my discussions with GPs and primary care organisations that this issue is a real cause of concern for them. However, there are guarantees that the money will get through—presuming, of course, that GPs decide to vote yes in a ballot that the British Medical Association will be holding. My hon. Friend will be aware that the new contract negotiated between the NHS Confederation and the BMA represents a real step forward not just for GPs but for NHS patients—not least because it guarantees a 33 per cent. increase in funding for primary care services. Such funding is long overdue and will make a real difference to GP surgeries throughout the country.

Dr. Andrew Murrison (Westbury): The Secretary of State will know that many of these debts and deficits are the result of past mismanagement by a small number of

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NHS trusts and health authorities. Does he think that the burden of that should be borne by local service users or spread more evenly over the whole of the NHS?

Mr. Milburn: The hon. Gentleman raises an important point. As he is aware, the way out of the financial difficulties that arose in his own area, for example, was for it to borrow NHS resources from other areas that underspent on their budgets in a particular year, so it cannot be right simply to wipe the slate clean, thereby penalising those areas that have managed their budgets properly. We need the right incentives in place to ensure that, in all parts of the country, financial management is always given the priority that it deserves. Equally, as the hon. Gentleman is aware, we are making extra resources available, through the NHS bank, to areas such as Avon, Surrey, Sussex, Bedfordshire and Hertfordshire, in which particular financial difficulties have arisen.

Fiona Mactaggart (Slough): Has the Secretary of State had a chance to read the letter from Dr. Neil Coleman of the Avenue Medical Centre, in Slough, a copy of which I sent to him? Dr. Coleman says that it would be possible to state that if the new contract can work in his practice, with high disease prevalence, it can work in any practice throughout the country. He also volunteers the Avenue as a pilot programme for the new contract. Could the Secretary of State spread this enthusiasm to other areas, in order to develop the contract?

Mr. Milburn: I will do my best. Although there has been controversy about the new contract, when GPs see the detail they will understand how they will benefit. Of course, their surgeries will benefit and there will be additional financial investment, but like most people working in the national health service, family doctors are after an improvement in services to patients. Crucially, that is precisely what this contract offers.

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