Consultation on National Health Service Trusts

Part of Orders of the Day — National Health Service and Community Care Bill – in the House of Commons at 5:15 am on 13 March 1990.

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Photo of Robin Cook Robin Cook , Livingston 5:15, 13 March 1990

Indeed, we had, Mr. Deputy Speaker. However, first I require your guidance. My hon. Friend the Member for Bradford, South (Mr. Cryer) has been good enough to point out that you have not intervened at any point to draw me to order. If, when responding to the Secretary of State, who has tempted me to discuss the general financial environment of hospitals and to respond to some of the statements that he made, I stray out of order, could you guide me, Mr. Deputy Speaker?

Since the Secretary of State has raised this point, let me respond to it. The right hon. and learned Gentleman said that cash limits were introduced by the last Labour Government, to which I can make two responses. First, I pray in aid my hon. Friend the Member for Makerfield (Mr. McCartney) and invite him—[Interruption.] I am terribly sorry if I have misplaced my hon. Friend, who is unusual among Scotsmen for having a detailed knowledge of Lancashire geography which is denied to many of his compatriots. I pray in aid my hon. Friend who has a knowledge of his area that stretches back to the days of the last Labour Government. Can he recall a like case that arose during the period of the Labour Government?

My second response to the Secretary of State is that although the last Labour Government introduced cash limits, they were subject to supplementary estimates. Throughout the period of office of that last Labour Government, the cash limits were automatically raised to reflect every staff and pay increase. It is the loss of that automatic uprating in line with the award to staff which has created the squeeze of the hospital sector under this Government.

I put it to the Secretary of State, since he asked the question, that I and my right hon. Friend the Leader of the Opposition have stated our commitments clearly. The next Labour Government will do two things in the hospital sector. First, they will restore to the hospital sector that sum by which the health authorities estimate that they have been shortchanged by this Government since 1984. Secondly, we shall fully fund pay awards that are made thereafter. I notice you shifting uneasily, Mr. Deputy Speaker. I am conscious that it is perhaps time that we returned to the new clause.

6.15 am

I wish to respond to one point in the Secretary of State's lengthy intervention—which I believe was in order. He made a comment about computer systems. I was not objecting to computer systems. It would be a good thing if more computer systems were developed within the Health Service. The point that I queried and which has been queried by Computer Weekly and by most reputable computer companies is whether it can possibly be done in the time scale on which the Secretary of State insists. He is shoving hospitals and health authorities down a path at a pace that is likely to guarantee chaos.

Just as the staff who work in hospitals should have a vote and patients should have the right to a ballot, the district health authority should have the right to record its views before the House. I have dealt with each of those three groups separately. But it is worth recording that they all have reasons in common to worry about the self-governing proposals. Each has a right to wish to express its view before self-governing status is acquired

I stress to the House that if it does not accept new clause 4, it will leave each of the three groups with no statutory right to express a view on the proposal for self-governing status. That is because the Bill makes little provision for any consultation before, during or after the creation of self-governing trusts.

If new clause 4 is not accepted, there will he no consultation before self-governing trusts are set up. There is no proposal in the Bill for consultation. Ironically and rather eccentrically, it proposes that there should be consultation before a self-governing trust is wound up, but not before it is created. It is one of the rare flashes in the Bill that suggest that the Secretary of State may have a sense of humour.

Staff, patients and health authorities will be excluded from the choice of directors. Just as the Secretary of State will decide whether to set up the self-governing trust, he will appoint the directors. There are only two constraints on his choice. First, in appointing the non-executive directors, he must consult the chairman. Who appoints the chairman? The Secretary of State. Secondly, the two non-executive directors drawn from the local community will be appointed by the regional authority. Who appoints the regional health authority? The Secretary of State. There is a seamless web stretching back to Richmond terrace.

Staff will have no right to nomination, community health councils will have no right to consultation, and patients will have no right to representation. Most breathtaking of all, the district health authority will have no right to nomination. The Secretary of State's choice of the regional health authority as the body which nominates the local community representatives is particularly eccentric.

As the College of Health has observed, A board of 10 directors with a Chairman appointed by the Secretary of State and including at least two community directors appointed by the regional health authority does not sound like local people running their own hospitals. I may be wrong. Perhaps the non-executive directors will be excellent people who are so much in touch with the local community and staff that there is no need for the new clause. Possibly, the need for new clause 4 will vanish at the announcement of their names. The simplest way to put that thesis to the test is to name them. It appears that the non-executive directors have already been appointed.

I have with me the minutes of the conferences of project managers held in December, January and February, all in large central London hotels. There is something perverse about decisions on local hospitals being taken in central London hotels behind closed doors.