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NHS Trusts

Part of the debate – in the House of Commons at 3:30 pm on 16th October 1991.

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Photo of Mr William Waldegrave Mr William Waldegrave , Bristol West 3:30 pm, 16th October 1991

I will, with permission, make a statement about national health service trusts.

On 4 December 1990, I reported to the House that I had received 66 applications from hospitals and other units wishing to operate as NHS trusts from 1 April 1991, and that I was able to establish 57 of these as the first-wave trusts.

The decision to pursue trust status was one which the managers and the clinical staff in those units took for themselves. Hon. Members will recall that, in the great majority of the 57 first-wave trusts, most of the consultants expressly supported the applications.

The experience of the first-wave trusts confirms the confidence which was shown by the managers and professional staff, who recognised the benefits to be gained from putting management responsibility back where it ought to be, in the hospitals themselves. Many of my hon. Friends have constituencies, as I have, which are within the catchment areas of trusts. They will know, as I do, that it is easy to find examples of the new, devolved arrangements improving care for patients.

I will give just four kinds of examples out of the many which are available. On waiting lists, the Royal Liverpool university hospital trust now sees 90 per cent. of all its patients within 10 months—one of the best performances in the country. On activity levels, the Freeman hospital trust in Newcastle has treated 4,700 more patients in the first five months of this year compared with last. On front-line recruitment, the East Gloucestershire trust is to recruit an additional seven consultants to meet growing demand for its services, and the South Devon trust is recruiting an extra 55 nurses and midwives. On improved quality, the Norfolk ambulance trust has speeded up its training programme for paramedics and aims for a target of 24 paramedic teams for its ambulances each year.

Independent surveys—for example, by the consultants Newchurch—quoted warmly last year by the Opposition spokesman, the hon. Member for Livingston (Mr. Cook) and by The Sunday Times—point to the same conclusion, that the trusts are improving their performance, treating more patients and cutting waiting times. A British Medical Association survey published this week has also shown increasing consultant support for trusts. This has strengthened our commitment to the trust programme, through which more and more NHS patients can benefit from the clearer and simpler management structure which trust status gives to hospitals and other services. I was glad therefore to receive applications from 113 hospitals and other units—double the number of first-wave trusts—wanting to become trusts in the second wave from 1 April 1992.

I have considered all these applications very carefully and assessed them against the same criteria that I used last year. Each one has been the subject of a full public consultation. As a result, I have decided today to establish 99 hospitals and other units to operate as trusts from April 1992. The details are available in the Vote Office and have been placed in the Library.

In addition, I have agreed to approve applications from the four London teaching hospitals in the second wave. As the House will know, I have recently Commissioned Sir Bernard Tomlinson to act as my adviser on health services in London, supported by a high-powered team. It is obvious that he may have recommendations to make which would affect the shape of the London teaching hospitals. In order to allow the four new London teaching hospital trusts to develop their plans with the benefit of Sir Bernard's advice, I have therefore decided to delay the date on which they become operational until April 1993. However, I have asked the NHS Management Executive to establish devolved management in these hospitals at the same time as the other trust boards are established. In this way, these four great hospitals will get as early as possible the benefits of devolved management.

Seven other units have the potential to become successful NHS trusts, but I have not felt able to establish them in the second wave. I am sure that they will benefit from having longer to develop their applications and I hope that they will reapply next year. A further three units have withdrawn their applications from 1992. However, I can tell the House that I have today agreed that 153 expressions of interest from hospitals and other units may be pursued for the third wave, starting in 1993. I have also made this list available in the Vote Office and placed a copy in the Library.

All trusts are accountable to me through the NHS Management Executive. I have now asked the Management Executive to strengthen and expand its monitoring arm in order to ensure that the growing number of trusts remains fully accountable to the centre. This will be done without increasing overall NHS administrative numbers.

The campaign against trusts and against devolved management fostered by the Opposition has failed. Throughout the NHS, as the British Medical Association has confirmed, there is increasing recognition of the benefits which trust status brings. My statement today is good news for the national health service and good news for its patients. After next April, when the new trusts which I have announced today will begin operating, more that one third of all NHS hospital and community health services will be in the capable hands of trusts.

Despite a truly scurrilous campaign by the Opposition parties, no informed observer can now doubt that trusts represent a necessary modernisation and simplification of NHS management, which is already proving itself good for patients, good for staff, and good for the country. It is a tribute to their commitment to the NHS that so many doctors, nurses and managers have put so much work into preparing the applications that I have been able to approve today.