National Health Service Trusts

– in the House of Commons at 3:30 pm on 4th December 1990.

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Photo of Robin Cook Robin Cook , Livingston 3:30 pm, 4th December 1990

(by private notice): To ask the Secretary of State for Health if he will make a statement on his decisions on the applications by hospitals and other units to become self-governing.

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

I am happy, Mr. Speaker, to make a statement about which national health service hospitals and units will become self-governing trusts in April 1991.

In answer to a parliamentary question from my hon. Friend the Member for Ryedale (Mr. Greenway), I am announcing today my decisions on the 66 trust applications that I have been considering for implementation in April next year. I am also announcing my decisions on a further 111 expressions of interest that hospitals and other units have submitted for becoming NHS trusts on 1 April 1992. A full list of all my decisions is in the Vote Office and the Library.

The House will appreciate from the number of applications that it is not practicable to read them all out, or to give detailed descriptions of the units included in each trust.—[HON. MEMBERS: "Why not?"] Because there are several hundred separate hospitals and units involved, affecting the constituencies of several hundred right hon. and hon. Members. I thought that it would be more helpful to give right hon. and hon. Members the information in written form initially.

Given the Opposition's request for a full statement, I am delighted to have this opportunity to restate the principles that underpinned my decisions. NHS trusts are a central element in our plans for reforming the NHS and improving the service that it provides for patients. No one should be in any doubt that trusts are, and will remain, within the NHS. They are not opting out of the NHS. They are opting into greater freedom to run their own affairs—freedom from much of the bureaucracy of district and regional health authorities, and indeed, Whitehall.

We have not been short of volunteers, and today's announcement is the result of a very vigorous selection process. In making my decisions, I have been concerned to satisfy myself on four key criteria. They are benefits to patients; leadership and management; involvement of key professional staff in management; and financial viability.

Against that background, I am delighted to say that, having considered all the applications and the comments made on them during the consultation process, I have decided to establish 56 NHS trusts to become operational on 1 April next year. I believe that those trusts will use the greater powers and freedoms that we are giving them to pioneer further improvements to the quality of care for patients that are at the heart of our reforms.

I received 10 other applications for trust status that had also been the subject of extensive consultation. The sponsors of two of those applications, from the proposed North Devon healthcare trust and the proposed Brighton hospitals trust, have asked me to defer their applications, and I have agreed. I am confident that those applicants have the potential to become successful trusts in the future.

I am confident also that the remaining eight applicants have the same potential to become successful. trusts. However, I believe that, given the very significant management tasks that they face, it would not be right to establish them as trusts now. I know that that decision will come as a disappointment, and I have written to each trust setting out my decisions.

I have also decided that a further 111 hospitals and other units that expressed an interest in trust status can proceed to work up applications to become operational in April 1992. I should make it clear that those expressions of interest in no way commit the hospitals or other units to making an application. I shall also be considering four further expressions of interest from colleges of nursing.

The response to the trust initiative shows that those working in the NHS understand, and are keen to take advantage of, the very real benefits of trust status. It is very likely that over time, trust status will be the natural model for units providing patient care. My decision to establish the first wave of trusts marks a further step in the implementation of our programme of reforms. It underlines the Government's commitment to the NHS and to improving the quality of care for patients.

Photo of Robin Cook Robin Cook , Livingston

Will the Secretary of State confirm that, until we tabled this private notice question, it was his intention to make his statement at a press conference at 3.30 pm? On reflection, does he not agree that a statement of such importance was better made in the House than to the press, and that his protestations of delight would be more convincing had he offered a statement to the House in the first place?

Does the right hon. Gentleman recognise that today's announcement makes a mockery of the consultation process? Is he aware that more than 70 ballots have been held in the communities served by the hospitals concerned? Does he know—does he care—that, on average, 83 per cent. of local general practitioners voted against the applications, and that an average of 88 per cent. of local staff voted against them? Has anyone dared to tell him that the people of Bristol voted six to one against the application by the hospitals that serve his constituency?

How can the right hon. Gentleman claim that today's decision gives local people local control, when he has flatly ignored local opinion? Why will not he publish the report that he himself commissioned to audit the business plans of the applicants? Has he seen the independent report produced by New Church and Co., which concludes that many of the applications are almost totally devoid of realistic financial objectives? How can he ask Parliament to accept the transfer of ownership of hospital assets worth over £3,000 million without serious financial figures?

Will the right hon. Gentleman confirm that the boards of directors of the trusts, which he tells us will not leave the NHS, will own the hospitals and be able to sell parts of them; that they will hire the staff, and will be able to fire the staff; that they can decide on patient services and close patient services; and that, in every regard, their powers will be identical to those of the directors of any hospital now in the private sector? Given those powers, will the right hon. Gentleman tell us who will be appointed as directors? Will they be the same business men—the same friends of the Conservative party—with whom the Government have already peopled health authorities?

Does the Secretary of State understand that forcing those hospitals to go it alone as trading enterprises will break up the NHS—that, after today, those 56 units will no longer co-operate with other hospitals in serving the public, but will compete against them for business? Is not the game given away by the many applications that. The right hon. Gentleman has approved today from those who make it only too plain that they intend to use NHS facilities to treat more private patients?

Finally, will the Secretary of State be generous enough to acknowledge the authorship of the policy that he has confirmed today? May I tempt him to pay tribute to the right hon. Member for Finchley (Mrs. Thatcher), who chaired the NHS review body that came up with the policies that she put into practice? Does he appreciate that his announcement demonstrated that, while the faces may change, the health policies of the present Government stay the same, and will convince many who use the hospitals on his list of the case for a Labour Government who will bring those hospitals smartly back into the local NHS?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

Over the years, I have noticed that, when the Opposition do not have much of a case, they try to make a synthetic row about the manner of an announcement. So keen was I to hide this important announcement that I wrote to every hon. Member involved and provided all the material in the Vote Office. I am delighted to have the opportunity to reaffirm this policy.

The hon. Member for Livingston (Mr. Cook) made a point about ballots and asked whether anybody had dared to tell me things. I wonder whether anyone in his action groups up and down the land dared to tell him that many of the ballots that he quoted have been reversed. I happen to know of one near my constituency in Weston-super-Mare, where the ballot that he quoted, which went one way, was subsequently reversed by 80 to 20. The hon. Gentleman quoted Bristol. I know a little more about Bristol than he does. There was a subsequent ballot there, too. Did anybody dare to tell him that? I think not.

The point of trusts, surely, is to meet the objective that all of us have heard from our constituents up and down the land for many years: "Can't we get the management of hospitals back to hospitals, where it belongs?" How many times have we heard that in our constituencies?

The hon. Gentleman said that assets can be sold off. What nonsense. The instruments to set up the trusts, which we shall lay today and tomorrow, will reserve powers to the Secretary of State—powers similar to those to prevent district authorities from doing the same thing.

Photo of Mr Martin Flannery Mr Martin Flannery , Sheffield, Hillsborough

On a point of order, Mr. Speaker. Is it correct for the Minister to speak knowing that he is not telling us the truth?

Photo of Mr Bernard Weatherill Mr Bernard Weatherill , Croydon North East

Order. The hon. Gentleman must withdraw that allegation.

Photo of Mr Martin Flannery Mr Martin Flannery , Sheffield, Hillsborough

I shall reword it in case you, Mr. Speaker, throw me out, as you have before. I withdraw—[Interruption.]

Photo of Mr Bernard Weatherill Mr Bernard Weatherill , Croydon North East

Order. Please leave this to me.

Photo of Mr Martin Flannery Mr Martin Flannery , Sheffield, Hillsborough

Is it right for the Secretary of State to be so economical with the truth?

Photo of Mr Bernard Weatherill Mr Bernard Weatherill , Croydon North East

Unhappily, that phrase has come into the language.

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

The hon. Member for Sheffield, Hillsborough (Mr. Flannery), who may have become over-excited, will find nothing untrue or economical with the truth in what I have said. On the contrary, up and down the land, campaigns have been somewhat economical with the truth. I have one here that was issued in the name of the hon. Member for Peckham (Ms. Harman), which refers to Opting out of the NHS and concerns over opting out of the NHS. There is no question whatever of any of these hospitals opting out of the NHS.

The hon. Member for Livingston asked me to confirm whether we stand by the policies that we passed. Of course we do. They will bring benefits to patients and will achieve devolved management of the kind that both sides of the House, if they think about it quietly, should be in favour of.

Photo of John Battle John Battle , Leeds West

On a point of order, Mr. Speaker.

Photo of Mr Bernard Weatherill Mr Bernard Weatherill , Croydon North East

Before the hon. Gentleman makes his point of order, may I say that it will take up time? This is a private notice question and time is limited. What is the point of order?

Photo of John Battle John Battle , Leeds West

The point of order is that it is difficult when the Conservative party plays games with the language. The phrase "opt out" was clearly used in the White Paper, but now we are being told that that is not the language that is being used. How can we oppose the policy?

Photo of Mr Bernard Weatherill Mr Bernard Weatherill , Croydon North East

This is a private notice question. As Front-Bench spokesmen have said, the House is being informed rather than the press. We shall no doubt return to it on numerous occasions.

Photo of John Greenway John Greenway , Ryedale

Does my right hon. Friend agree that self-government is the natural progression and development of the purchaser-provider concept, which now has widespread support, and will afford not only local control but local decision making to our hospitals? He announced that 56 hospitals have been successful in applying for trust status. Will he confirm that their plans include, far from a standstill in services, more consultants, a reduction in waiting times, renovation of wards, closer co-operation with general practitioners and speedier development of the community care programme? Does not that show that, under this Government, the best resources will be matched with the best management?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

My hon. Friend is entirely right. In every organisation of which I know, the management is better when it is brought nearer to where the real work is done. The instinctive reaction of the Labour party is always to go for an administrative, top-down and bureaucratic solution; that is not the best solution in each application—and I have studied them all closely—there are interesting and attractive proposals for how the hospitals will be improved.

Photo of Charles Kennedy Charles Kennedy Shadow Spokesperson (Health)

Is the Secretary of State aware that this confirmation of a Thatcherite approach to the health service today represents 56 nails in the coffin of a nationally funded and nationally delivered system of health care? If the consultation between self-governing trusts and the health authorities is as much a mockery as the consultation carried out by the Department of Health in assessing the applications, what hope can there be at local level that there will be a proper spread of service delivery in the health service? Did the right hon. Gentleman agree with his right hon. Friend the Foreign Secretary, whom he supported in the recent election for the leadership of his party, when he said that he considered that a review of the health service reforms would be one of the top items on his agenda if he became Prime Minister? Finally——

Photo of Mr Bernard Weatherill Mr Bernard Weatherill , Croydon North East

Order. It would be unfair to the House during a private notice question for the hon. Gentleman to continue. He has asked his questions.

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

I advise the hon. Gentleman not to talk such clichés. The hospitals will prove him wrong by providing better services to patients and people who have mouthed such clichés will look extremely foolish. I drafted that part of my right hon. Friend's speech, so I am thoroughly in favour of it. We shall be looking for further improvements, but the basic principles of the reform will go ahead.

Photo of Mr Roger Sims Mr Roger Sims , Chislehurst

My right hon. Friend will appreciate that Bromley health authority will be disappointed that its applications have been refused. Will my right hon. Friend tell the authorities whose applications have been refused the grounds on which he felt unable to grant them? Will he also confirm that any subsequent applications, either in similar or in amended form, by those authorities will not be prejudiced by the fact that they have been refused in the first wave?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

I am delighted to give my hon. Friend those assurances. I have written today to the unit managers concerned to set out the problems that I thought needed to be further addressed before the trusts could go forward. I very much hope that that applications will come forward again next year and that they will win approval.

Photo of Dawn Primarolo Dawn Primarolo , Bristol South

Under the public consultation, of the eight opt-outs that have been announced in the South West region, six voted overwhelmingly against the proposal. The Secretary of State clearly needs reminding that at the Bristol United hospitals—all the services in Bristol that cover his and my constituencies—the public consultation exercise conducted by the region produced a result of 83:1 against. The staff ballot conducted by the district health authority produced a result of 2,943 against and 255 in favour, although the Minister will not know that. He did not bother to take part in the consultation although he was a consultee. What right does he now have to override public opinion in Bristol? How can he call himself a democrat?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

The trouble with that argument is that the pre-printed forms and postcards were, in many cases, wholly misleading. An organisation called Labour Health watch—to which the hon. Lady may subscribe put roundstuff that said: We the undersigned totally object to … hospital or any of it's … outlying clinics or wards 'opting out' of the NHS. One of the trust managers told me that he would sign a petition against his hospital opting out of the NHS and he would be quite right.

Photo of Nicholas Winterton Nicholas Winterton , Macclesfield

With reference to the 1992 applications for NHS trust status, does my right hon. Friend accept that my constituents are strongly opposed to the acute services and the community services in Macclesfield asking separately for trust status? Will he take it from me that there is strong support in my area for the concept of the health authority as a whole opting for self-governing status? Will he instruct Sir Donald Wilson, the regional chairman, to stop interfering in my area? Those who serve on the health authority, the staff, the nurses, the patients and the people in my area want the whole health authority to opt for self-governing status. Will my right hon. Friend bring that about?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

There are arguments on both sides. [HON. MEMBERS: "Oh."] Opposition Members would be unwise to claim my hon. Friend as an ally, as he is arguing powerfully for an NHS trust, albeit a whole district trust. I shall have to consider the arguments carefully. There is an argument as to whether it is better for the mental health institutions to form part of a separate trust or of a whole district trust. We shall consider those matters carefully in the months ahead.

Photo of Gwyneth Dunwoody Gwyneth Dunwoody , Crewe and Nantwich

Is the Minister aware that it would be helpful if he published the assessments of the financial viability of those exceedingly doubtful business plans? With the exception of one small group of consultants, everyone in my constituency totally opposes the application, and the cavalier manner in which the Minister is ignoring local people's views will be justly interpreted as typical of the Conservatives' desire to wreck the national health service.

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

What the hon. Lady says will be disproved by events. I advise her not to put herself out on a limb. The hospitals will be better run and they will be available to NHS patients as they have always been. The hon. Lady will have a lot of words to eat.

Photo of Mr Paul Channon Mr Paul Channon , Southend West

Does my right hon. Friend accept that, far from what the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) claims, there will be a widespread welcome—certainly in my constituency—for the formation of self-governing trusts and that many people in my constituency realise that the arrangements are likely to lead to a better service? How will the system work for the approval of capital development schemes in the future? I am sure that it will work to the benefit of Southend.

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

I think that there will be very successful developments at the hospitals in Southend when they are part of a trust. The capital allocations will come forward in due course. The new trusts will have a new system of external financing limits and those will be announced in due course.

Photo of Jim Cousins Jim Cousins , Newcastle upon Tyne Central

The Freeman hospital had its application for self-governing trust status approved today. Can the Secretary of State assure us that its ambitions to create a monopoly on certain key regional services and to acquire certain key services from neighbouring hospitals will not be agreed until he and the regional health authority have intervened to judge whether that is in the wider interests of the people of Newcastle and the rest of the northern region?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

I am not sure that people understand that the district retains its duty to ensure proper coverage of all the health aspects. If proper coverage is not given, it is for the district to ensure that one of the providers in its area provides it. The region also remains involved. The hon. Gentleman need not heed the scare stories that people have been putting about.

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow

Does my right hon. Friend agree that the Opposition's continuous use of the words "opt out" is nothing more than the cynical manipulation of the fears of the elderly and frail? The national health service hospitals will not be opting out of the health service; they will be delivering better quality and more efficient patient care. In view of that fact, is my right hon. Friend at all surprised that the Opposition want to abolish trust status hospitals?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

My hon. Friend is absolutely right. The nearest thing that the Opposition have to a policy—it has been leaked extensively over the past few days—is simply to abolish everything. They are going as far as they can. They have the idea that we must have what they call competition—I do not think that it is competition—but their model is completely chaotic and I think that when it is published it will be a laughing stock.

Photo of Mr Paul Boateng Mr Paul Boateng Shadow Spokesperson (Business, Innovation and Skills), Shadow Spokesperson (Treasury)

In assessing the financial viability of the application by Central Middlesex hospital, which is opposed by staff and patients alike, has the Secretary of State considered whether the Central Middlesex hospital trust will be able to retain 100 per cent. of the proceeds of the sale of land that is currently occupied by that hospital?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

It will be able to retain the proceeds from land vested in the trust.

Photo of Mr Giles Shaw Mr Giles Shaw , Pudsey

I congratulate my right hon. Friend on deciding to adopt the proposals for Leeds St. James's and Leeds general infirmary. I welcome the fact that the two district health authorities in Leeds are to be merged into one under the chairmanship of my constituent, Mrs. Pamela Smith. What will be the situation in regard to the massive capital project for Leeds general infirmary, which, as my right hon. Friend knows, is essential for that hospital to discharge its present duties?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

The allocation of capital, which I shall have to make in due course and which the regions in turn will make, will, in the first years, ensure those capital investments that a trust could have expected from a region. I hope that capital investments will be able to develop a little further. They will be subject to capital controls, as in all other hospitals.

Photo of Margaret Ewing Margaret Ewing , Moray

The Secretary of State clearly said that details of the proposed trusts and the various applications will be made available in the Vote Office and in the House of Commons Library. Will similar information be available about proposed trusts in Scotland, or will the Minister with responsibility for health in Scotland also be dragged screaming and kicking to the Dispatch Box?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

The hon. Lady may have missed the fact that I was not screaming or kicking. I am delighted that certain Opposition Members are getting themselves out on a branch, which will fall off and that we have yet another opportunity to publicise our policy, which is getting wider and wider support in the country and will deliver the goods. I am the Secretary of State for Health in England and my hon. Friend the Minister of State, Scottish Office, who has responsibility for health in Scotland, will doubtless make his own statement in his own time.

Photo of Mr David Nicholson Mr David Nicholson , Taunton

Is my right hon. Friend aware that I welcome the commitment that he and our right hon. Friend the Prime Minister have given to the future of the National Health Service particularly because I, or rather my wife, as an NHS patient, had a son born in Musgrove Park hospital, Taunton, two months ago? Is my right hon. Friend aware also that, for that trust to achieve its full potential, more informing and persuading needs to be done before next April? In particular, is my right hon. Friend aware of the importance that we in Taunton attach to the beginning of the second phase of the development of Musgrove Park hospital as soon as possible?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

I am sure that the whole House will join me in congratulating my hon. Friend. Hon. Members will also join him in congratulating Musgrove Park hospital on the much more secure future that it will have. The announcement of the trusts will not end arguments about capital allocations in future. There will never be unlimited capital, but we shall try to allocate the capital that we have in a way that supports the kind of development to which my hon. Friend refers.

Photo of Bruce George Bruce George , Walsall South

I very much regret that the hospital in my constituency is added to the list. In the interests of fairness, will the Minister of State instruct the chairmen of the regional health authorities to publish the fullest possible results of the consultative process? Will the Secretary of State himself publish in the fullest possible detail his reasons for deciding that the hospitals will opt out? In the interests of fairness and in the interests of determining whether hon. Members' views are right, that information should be fully disclosed.

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

It is up to the regions to disclose or not to disclose what they wish. The hon. Gentleman made a gesture that meant "opting out". That at least is progress compared with his hon. Friends. He understands that hospitals are not opting out of the national health service. The sooner that message gets across—a fair-minded man such as the hon. Gentleman will doubtless help us to get it across—the fewer unnecessary scare stories we shall have from the Opposition.

Photo of Mr Anthony Grant Mr Anthony Grant , Cambridge South West

Further to the point raised by my hon. Friend the Member for Macclesfield (Mr. Winterton), when considering future applications direct from hospitals, will my right hon. Friend ensure that excessive weight is not given to the views of the regional health authorities, which are often excessively bureaucratic and which are not necessarily always in touch with local opinion? My right hon. Friend will realise that I have a particular and very famous hospital in mind.

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

We are steadily streamlining and improving the standard of regional management. There is general consent now in the national health service that the standard of management is steadily improving, and it needs to. I note what my hon. Friend says, but I must advise him that I pay considerable attention to the advice of regional chairmen and their regional general managers.

Mr. Eddie Leyden:

Is the Secretary of State aware that there is widespread opposition to the opt-out measures being initiated by the regional health authorities? Does he realise that this will be a black day for the national health service, in view of his answers today? The national health service does not belong to the right hon. Gentleman or to the Government; it belongs to the people. This is probably the most regressive step that has been taken this century in social policy. The right hon. Gentleman has left no doubt in my mind that his intention is to dismantle the national health service.

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

I am well aware that there is widespread opposition to the policy of nonsense that the hon. Gentleman has just described. Luckily, nobody in this country has such a policy, which is why his anxieties can be laid to rest at once. The national health service belongs to all the people of this country, and the management of it should be in the hands of those who have most commitment to it, which is not the hon. Gentleman or me—it is those who work in the hospitals.

Several Hon. Members:

rose——

Photo of Mr Bernard Weatherill Mr Bernard Weatherill , Croydon North East

Order. I remind the House that this is a private notice question. We have already exceeded the time that I should normally allow, but as this is a very important matter, I shall therefore call three more hon. Members from each side, but then we must move on. I shall certainly bear in mind those hon. Members who are not called today on future occasions—and I am sure that there will be future occasions on this important matter.

Photo of Mr Michael Shersby Mr Michael Shersby , Uxbridge

Why has my right hon. Friend decided not to establish Harefield hospital as an NHS trust, in view of the support of the medical staff and its pre-eminance as one of the hospitals engaged in heart transplant surgery?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

It was, indeed, a difficult decision because, in many ways, Harefield is an ideal hospital for trust status. I was also aware of the strong support in that hospital, and in very many others, for trust status. However, I had regrettably to conclude that it had not completed its plans in such a way that I could, with confidence, agree them. I very much hope that it will be ready for trust status next year.

Photo of Mr Nigel Spearing Mr Nigel Spearing , Newham South

Does the Secretary of State realise that this sad statement shows that we have a new salesman, but the same policy? In that context, does he agree that the succour of the sick within the principles of the national health service means that commercial criteria have no place? Because of the drop in land sales and the decrease in the value of land, £40 million has been cut from the money available for Newham general hospitals' much needed extension. Since we cannot trust the Government even to provide facilities that are wholly within what the right hon. Gentleman calls the health service, does not that show that we cannot trust the trusts either?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

I am not quite sure what point the hon. Gentleman was making. It is true that the price of land has fallen this year so, sadly, less money is available to the national health service from land sales. That is true, and we have taken account of that in our expenditure plans and in the public expenditure survey settlement for next year. I agree entirely with the hon. Gentleman that what drives the health service is not commercial criteria at all, but that does not mean that we cannot learn useful things from the organisation of other businesses, including those in the private sector.

Photo of Quentin Davies Quentin Davies , Stamford and Spalding

Does my right hon. Friend agree that it would be wise in this matter to be aware of a possible distinction between the interests of producer groups, including the unions, on the one hand, and the interests of consumers and patients on the other? Does he agree that this afternoon's proceedings make it clear that even the possibility of making that distinction has passed the Labour party by entirely?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

That is true; no real arguments have been made, except against a policy that does not exist—taking hospitals away from the national health service. We have established that both sides of the House would be against that, but luckily that is not our policy. My hon. Friend the Member for Stamford and Spalding (Mr. Davies) made the far more interesting point that it will be far easier for people to do proper jobs in the national health service when the distinction is made between those responsible for providing services and those responsible for ensuring that those services are provided, which is a real distinction.

Photo of Mr John Garrett Mr John Garrett , Norwich South

What benefits does the Minister expect from the Norfolk ambulance trust when its weighty application document gave no undertakings about future quality of service?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

That application, like others, argued that local, devolved management would provide a better service to patients, which I believe it will do.

Photo of Mr Roger Knapman Mr Roger Knapman , Stroud

Does my right hon. Friend agree that the importance of the announcement is that decisions can be taken locally wherever possible? Is not the Labour party's fear that we might clip the wings of groups with vested interests, particularly the National Union of Public Employees and the Confederation of Health Service Employees, in which case we can, for once, agree?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

One of the proposals which the Labour party has at the heart of its commitment to the future and which would be catastrophic for the national health service, as for the rest of national life, is to unleash secondary picketing again, which would take us back to the winter of 1978–79.

Photo of Mr Michael Welsh Mr Michael Welsh , Doncaster North

Does the Minister accept that the correct term is "opting out", because if the hospitals go bankrupt, they will opt back into the national health service. I have that on authority from the Severn-Trent authority. I totally condemned the proposals for Doncaster royal infirmary and Montagu hospital because the Government have not consulted the consumers. To my knowledge, no doctors agree with the proposal. If they send their patients to other infirmaries and hospitals still under the national health service, will the necessary finance be provided?

Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West

There is widespread medical support for the changes. I have to judge in each case whether there is proper clinical involvement in the proposals, and I have so discovered. The hon. Member for Doncaster, North (Mr. Welsh) knows that, at the heart of our policy is the principle—which I believe is accepted by the hon. Member for Livingston—that the money should follow the patients.