Health Service and Community Care

Part of Opposition Day – in the House of Commons at 3:36 pm on 14 May 1991.

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Photo of Robin Cook Robin Cook , Livingston 3:36, 14 May 1991

I beg to move, That this House records its concern at the damage to the National Health Service from the implementation of the National Health Service and Community Care Act; condemns the pressure created by the new system for a two-tier health service in which waiting time is determined not by clinical need but by commercial priorities; is disturbed that the introduction of block contracts had reduced patient choice of hospital and restricted general practitioners' freedom of referral; regrets the shortage of people representative of their local community among the businessmen appointed by Her Majesty's Government to decide local health priorities; notes with alarm the financial instability that has already become evident among hospitals that have formed self-governing trusts; deplores the decision of the Secretary of State to approve 57 health units for trust status despite advice that there were financial problems with 45 of them; and calls upon Her Majesty's Government to abandon its plans for a second wave of health units to form such trusts. It is just under four weeks since the House last debated health, yet so much has happened in those four weeks that it is almost unkind to remind Ministers of what they said in that debate.

The Secretary of State for Health took pleasure in the fact that the changes had been introduced with, as he said, "no significant problems." The Minister of State, eight days before the cuts were announced at Guy's hospital, announced to the House: It will not be long before the noise about trusts…abates."—[Official Report, 17 April 1991; Vol. 189, c. 512.] I took the precaution of checking Hansard last night in the Library in case a member of the Prime Minister's private office had been down with an errata slip.

My favourite passage was from the Secretary of State's speech in which he complimented the British Medical Association on—in his words—moving on and "becoming sensible." The Secretary of State will have followed with interest the views expressed by the new, sensible BMA over the past couple of weeks, culminating last Thursday after his meeting with it when it reported: the Secretary of State was not open to reason. That is from the very medical people who, 20 minutes ago, the Prime Minister said should take the decisions on whether a hospital should seek self-governing trust. Try telling that to the BMA.

There have been two developments since our last debate, which have given Ministers' speeches a near-comic irony which they lacked on first hearing. First, events have exposed the gulf between what Ministers promised as a result of the changes and the real effect of the changes. Last autumn, staff at Guy's were promised that the hospital would make a surplus of £1·5 million in its first year of trading. A month after the new system was introduced, the same staff at Guy's were told that the hospital was predicting a deficit of almost £7 million. At the beginning of April, the staff at Guy's received a circular from Mr. Peter Griffiths in which, under the heading "We are friendly and we are fun", he assured the staff: The management cares, really cares, about people, about their staff. At the end of April, 600 of the staff who had received that letter discovered that they might be made redundant over the next two years.

Whenever I refer to trusts as opting out, Conservative Members shout me down. I am bound to say that nothing has more convinced the public that a hospital that has formed a trust has opted out than the speed with which Ministers let it be known, when the cuts at Guy's became evident, that Guy's was on its own, that it was no responsibility of theirs, that what the board of directors did to staff jobs or patient care had nothing to do with them.

The Secretary of State cannot have it both ways. He cannot on the one hand assure us that trusts have not opted out and, on the other hand, wash his hands whenever they hit trouble. He cannot have it both ways, because his own reputation is on the line. He approved the very business plan that is now in such trouble. The Secretary of State has not been allowed by the media to ignore the crisis at Guy's.