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 8:15 am on 13th March 1990.

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Photo of Mr Keith Bradley Mr Keith Bradley , Manchester, Withington 8:15 am, 13th March 1990

I am grateful to be called after 16 hours of detailed debate of the Bill to look at new clause 4 in the light of a hospital in my constituency, Christie hospital, a famous national centre of excellence. I wish to show by this case study the process that has been going on over the past 12 months and why the clause is so important. I shall concentrate on subsection (2)(a) of the new clause, which refers to a ballot of staff at a hospital. I specify that part of the new clause because, although I fully support and commend the Opposition calls for wider consultation and ballots among the local community, I accept that, in the case of Christie, patients come from all over the country to use its facilities and there could be an argument—I say no more than that—why the electorate would have to be narrowed down in this ballot.

The people of south Manchester are proud of Christie hospital. They do a lot of work to raise money to ensure that it continues to operate. Without that support from local people many of the services that still exist at Christie hospital certainly would not have continued. With that reservation, I shall limit my remarks to a ballot of the staff.

I shall first make a general comment about the context of Christie hospital. It is in South Manchester health authority. In Committee, the Secretary of State for Health, on one of his rare appearances in the Committee, said that he was fed up hearing about the problems of South Manchester health authority. He is going to hear a bit more about them today.

The chaos of financial crisis in south Manchester continues. It has come to such a point that not only has the chair of the health authority resigned and will not be reappointed from 1 April, but the general manager leaves tomorrow. Three months of consultations have just been completed on a document containing plain supposedly to rationalise services between Withington and Wythenshawe hospitals, has been rewritten and a new document was to be presented to a health authority meeting this Thursday. At 11.30 pm yesterday I learned that that meeting has been cancelled and no meeting to discuss the consultation document will be held before the chairman of the health authority and the general manager leave. Therefore, the financial crisis and chaos in south Manchester continue. We must consider the proposals for Christie to opt out in that overall context.

It has been clear from the start that any expression of interest by the consultants and staff at Christie hospital to opt out of South Manchester health authority control has been based exclusively on the lack of resources within South Manchester to provide the amount of care that the hospital wants to give. There was an Adjournment debate on that very subject in 1986. If those resources had been made available to Christie hospital, recognising it from that point as a centre of excellence, there would have been no expression of interest in opting out. It is the last resort to gain some extra resources; a cynical attempt to grab what money may be available to prop up a failing service.

Even that expression of interest was not unanimous. A ballot was held among the consultants and, by only a narrow majority, they decided to express an interest. However, it was made quite clear that that was only so that they could receive more information about opting out. There was a clear understanding that no decision had been taken about opting out, that the information from the Department would be studied, and a decision then made.

However, based on that expression of interest, the whole bandwagon got under way at the hospital. The general manager, Mr. Fry, wanted to push ahead as fast as possible and to retain the hospital's position on the short list for being one of the first to opt out. He was egged on by a few consultants, and the whole process moved on.

Hon. Members have already mentioned the amount of work done in hospitals even before the Bill has completed its stages. Already a draft document is ready to be presented to the Secretary of State. A great deal of management time and expenditure went into that which should have been spent on health care for South Manchester. It is a scandal and the Secretary of State should be here to try to defend that.

What is the process of consultation to discover whether that vague expression of interest has any validity among the staff of the hospital? The Labour party has been accused of trying to influence public opinion on opting out by putting out misleading information. What did the management of south Manchester do? It regularly produces a good-news newspaper for the health authority called "Health Call". That is distributed to all the people in South Manchester. Throughout the financial crisis in South Manchester, when wards and even whole units have been closed and waiting lists have grown, with consultants saying that people are dying because they cannot be admitted to hospital, did the newspaper mention those facts? Not a word—it is all good news. It contains articles such as Why Christie's may opt for self-government with a nice picture of a smiling general manager exploding the so-called myths of what is happening.

Follow-up propaganda—a nice, glossy magazine—was also produced at the health authority's expense to explain why the hospital should opt out. It is probably only a coincidence that it is on blue-headed paper. It gives the management's position and then devotes a whole page to Some myths associated with self-governing status. The general manager, in his unbiased presentation of information for the staff on how to reach a decision, quotes the supposed myth: When health authorities or GP budget holders run low on funds, patients will be denied treatment. He then asserts: Not true. The Department of Health has stated many times that … no patient will be denied treatment solely on the grounds of lack of cash. However, when we tabled an amendment in Committee to ensure that no patient would be denied treatment because of lack of funds, the Government refused to support it and voted it down. Therefore, the "not true" assertion of the general manager of Christie hospital has exploded in his face. It is party-political propaganda to try to kid the staff that it will be in their best interests to opt for self-governing status. That flies in the face of the Government trying to accuse the Labour party of undertaking such propaganda exercises.

9.45 am

What is the process that Christie will undertake? The whole basis of the expression of interest has been on that one vote among the consultants. They have continued down the path. Now there is to be a series of consultative meetings with staff in the hospital. When the general manager was asked to have another ballot to see whether the expression of interest had been firmed up, he said that it was not possible to have a ballot because he could not identify which population should be balloted. When it was accepted that the ballot should take place only for staff in the hospital, he wondered whether all the staff should take part, or whether part-time staff should be allowed only half a vote. He refused a ballot and said that he would arrive at a consensus which would emerge from the consultative meetings. When he was asked how it would emerge, he replied that he would gauge the mood of the staff meetings.

The position is reflected in a copy of a letter that I received from a consultant who is happy to be named. Mr. Martin Harris wrote to the general manager: I have read the Draft Application for Self-Governing status for the Christie Hospital, and I do not believe that it sets out a convincing case that the Hospital is likely to be financially viable as a Trust. Furthermore, I feel that the application is misleading in a number of ways". He identifies why it is misleading. In the light of the new clause I shall read just the first one: I object to the implication made at several points that the Application has the support of staff in the hospital. Perhaps it does, but this has not been ascertained by a ballot. He wanted a ballot and he thought that the votes cast for and against should be identified in the application. The general manager has said that a consensus of support is emerging. Mr. Harris carried out a ballot of his staff and the consultants in pathology and medical oncology. Every consultant was against the proposal, as well as 15 out of 27 staff; 60 per cent. were against the proposal.

Here we have a general manager expressing a view based on no new information from the Department of Health. He has refused a ballot and said that he can gauge the consensus. Yet the evidence is clear that if there were a ballot, the majority would vote against the proposal.

As my hon. Friend the Member for Livingston (Mr. Cook) said, we will not allow the management of hospitals to opt out without a ballot. We will ensure that the staff in Christie hospital have the right to ballot. We will ensure that that is included in any further document and that the people of South Manchester, who care passionately about the future of the hospital, understand that the Government are ignoring the wishes of the staff and of the general public, and are ploughing ahead. That is democracy to the Tory party. We will ensure that democracy is seen to be done.