I beg to move
That leave be given to bring in a Bill to abolish regional health authorities.
In seeking leave to introduce the Bill, may I first welcome the comments made by my right hon. Friend the Prime Minister on "Panorama" last night. I am sure that they will bring great relief to the general public, because if the Government are as successful in reviewing the National Health Service as they have been in revising the education system and the economy, there is great hope for the Health Service in the next few years. I thank my right hon. Friend for her remarks.
I propose a modest measure for directing money in the Health Service away from administration and into patient care. I therefore seek leave to introduce a Bill to abolish the regional health authorities. My reasons for doing that are based, first, on the ground of cost. The money would be better spent on patients. Secondly, the functions of the regional health authorities are superfluous, as they could be carried out by district health authorities, by a central board of management, or by central Government. Thirdly, their structure is wrong, as too many disparate interests are grouped together, competing for scarce resources. Fourthly, there is too little accountability.
Theoretically, the regional health authorities are accountable to the Secretary of State, but their powers and budgets are devolved, and very often we hear it said that something must be a purely regional decision. Unlike the Secretary of State, regional health authorities do not have to answer to the public through the ballot box every five years for what they are doing. Furthermore, many of those who sit on regional health authorities have to pass judgment on local situations prevailing in areas with which they are not familiar and which they do not know, whereas district health authorities deal wholly and all the time with what is going on in their own patch, with which they are very familiar.
In 1986, across the country, regional health authorities cost £109 million on administration alone. That figure was given by my right hon. Friend the Minister for Health in answer to a parliamentary question from my hon. Friend the Member for Wokingham (Mr. Redwood). That was £109 million on top of the £317 million that we spend every year on administration costs per district. That represents thousands of nurses' salaries. That represents an opportunity lost for thousands of operations. The Government have always stated, and have more than proved, that they believe that money must be spent at the sharp end of our public services, so that money should be taken from that wholly superfluous tier of administration and put in at the sharp end.
The Bill would allow district authorities to control consultants' contracts. At the moment, the regions issue contracts to consultants and the financial liability for them is passed on to the districts. I know of no commercial analogy which allows one department to issue contracts and another to accept the financial liability.
The Bill would devolve the control of property and land to the districts. At the moment there are considerable numbers of surplus properties and pieces of land throughout the country. There is very little incentive for districts to put their backs into selling that property, because too often the proceeds go back to the regions because they are over certain limits. The districts could develop those properties and that land, or sell them to raise income to help patients, which is what the service should be about. I strongly believe, therefore, that they should have the control, which would mean that they would also have the incentive to make the best use of such assets.
The territorial overview of facilities that would have to be provided, not in every district, but simply between three or four districts, could, I believe, easily be carried out centrally by a fairly minimal and not particularly costly expansion of the existing regional liaison structure within the Department.
There is already provision for the central purchasing of supplies. I believe that this should continue, but that the districts should take over the control of distribution.
It has often been said that 219 districts is a rather large number for any Government Department to deal with, and I have some sympathy with that view. Nevertheless, the Department of the Environment has to deal with several hundred district councils, and the Department of Education and Science is contemplating dealing with a large number of individual schools, which will draw their grants centrally. I therefore think that this requirement could be accommodated by a slight expansion of the regional liaison department.
I do not regard this proposal as any sort of alternative to any other major reorganisation that may be proposed for our health services, nor that on its own it will solve the problems of the National Health Service, but I do believe that at the moment we are spending money that could be better spent, and this would, administratively speaking, be a fairly easy and straightforward way of getting the money for patient care, to pay nurses and to pay for operations.