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NHS Trusts

Part of the debate – in the House of Commons at 3:32 pm on 29th April 1991.

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Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West 3:32 pm, 29th April 1991

The prospectuses of the trusts were published last year. There were no "secret" business plans. The business plans, which are required to be returned to the national health service management executive in the early part of this year, are part of the arrangements for monitoring both NHS trusts and directly managed units by the national health service management executive. As management documents, they were never intended under the National Health Service and Community Care Act 1990 to be public documents. The annual report of each trust will of course be published.

That leads me to a wider point about accountability. For the first time, we now have a system in place where, through the contractual arrangements, hospitals will be fully accountable to the district health authorities for the quality and quantity of the services they provide for patients.

Within that reformed system my job is to ensure that patients have the access that they need to comprehensive, free, health care. I exercise this responsibility through a strengthened chain of accountability from districts through regions to the NHS management executive.

With this accountability for the provision of health care goes more delegated management freedom for the hospitals themselves, including directly managed units. It is not for Governments to tell hospitals how to organise their services and how many staff to employ. That must be a matter for the hospitals themselves. In a service that employs over 1 million people, it would be ludricous if Ministers or civil servants attempted to run the service from Whitehall.

What I sought last year, and will seek this year when examining trust applications, is a management team which will match in professionalism the professional standards of the doctors and nurses themselves. For far too long we have had outstanding clinical professionalism allied to second-rate management systems. One cause of that over the years has been the political intervention in what are properly management decisions, of which this bogus pre-local elections row, stirred up by the Opposition parties, is a classic example.

Referring to the situation in London, I have noted the comprehensive review of their hospital proposed by the new management at Guy's. I am pleased to note that they have given a number of undertakings: that patient care will not suffer; that compulsory redundancies will be used only as a last resort; that services in the local community will be protected; and that quality of service is an overriding objective.

I am also pleased to be able to reassure the House that Lewisham and North Southwark health authority, in whose district Guy's hospital is situated, believes that the contracts which it has let to Guy's, and to other hospitals, provide satisfactorily for the health needs of its resident population. Moreover, it recognises that prompt action is needed to tackle the financial situation at Guy's, and prefers that to unplanned action later in the year.

I am also pleased to record that, in Bradford, no reduction in services or activity is planned by the trust. It is the judgment of the public health authorities in the city that some increase in emphasis in primary and community services is right for local people. It is likely that, in terms of staff numbers, any reductions in hospital staff would be more than offset by further increases in community nursing and in the resources available to GPs.

The proposals by those two trusts illustrate a fundamental point. Neither district health authorities nor hospital managers are any longer prepared to accept that, simply because a hospital has always provided a certain service in a certain way, they should necessarily continue to do so. The needs of the patients they serve are constantly changing. Leading hospitals like Guy's and Bradford need to respond to those changes. Hospitals that can adapt successfully to change will flourish and expand. That is what I believe we are beginning to see happen in Bradford and south-east London; and, since any savings will go straight back into the health service, it will be the patient now, and in the future, who benefits.

Labour Members have nothing to say on health. Their leader yesterday finally let the cat out of the bag: under Labour there would be no more money for health. They have no proposals for dealing with the obvious managerial problems of the service. Their sole interest is in playing party politics with it. Their behaviour over the past few days is the final proof, if any was needed, that that is the truth.