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 6:45 am on 13 March 1990.

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Photo of Tom Clarke Tom Clarke Shadow Minister (Disability) 6:45, 13 March 1990

If there is not much to choose from on quality that might happen. The first judgment that the authority makes will be based on quality, as I have said. However, in using all the resources, it will have to do what it does now—to make decisions about how to get a comprehensive service so that everything, not just orthopaedics, is financed. It will want to get the best quality across the spectrum, using the resources that it has.

It may be that in some areas the de luxe quality is so expensive that the authority will decide that it cannot spend that much on orthopaedics and has to go for a cheaper option, either because it has to get the volume to get its waiting lists down or because it wants to invest more money in its mental illness or mental handicap sectors.

Those sound difficult choices, and they are. But they are exactly those that the Health Service has always made. The odd-sounding events described by the hon. Member for Makerfield (Mr. McCartney) related to a specific example, about which I know nothing. However, we all know the sort of difficulties that health authorities currently get into when they have to make just such judgments.

The trouble is that, at present, authorities do not know exactly how much they are spending on their orthopaedics or their community services. Nobody measures the quality. We are introducing quality control through clinical audit. The authorities do not know whether the services that they are receiving are better than those at the place down the road. When a district discovers that it is spending spectacularly more on a part of the service than is the next-door district health authority, it is often a revelation to those in the district. When they look to see what they are getting for the extra money, they may find that it is nothing, in which case the contract system will enable them to rationalise.