North Down and Ards Community Unit

Part of the debate – in the House of Commons at 10:17 pm on 11 June 1992.

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Photo of Mr Jeremy Hanley Mr Jeremy Hanley , Richmond and Barnes 10:17, 11 June 1992

I congratulate the hon. Member for North Down (Mr. Kilfedder) on being fortunate in the ballot for the Adjournment debate. The debate is on an important subject, but it also allows me to pay tribute to the hon. Gentleman personally. In the time during which I have served at the Northern Ireland. Office I have known of no hon. Member more assiduous in serving his constituents. He has often visited me both at Stormont and at Westminster, serving the interests of the people for whom he has a special responsibility. I can say that without being patronising, not only because people know it to be true but because I feel that it is right that the hon. Gentleman should bring such matters to the Floor of the House, even though weighty events are taking place at Stormont, where we are considering some of the issues that he has raised today.

The hon. Gentleman mentioned a possible Northern Ireland Select Committee. That is very much a matter for the House authorities, but I hope that progress in the constitutional talks in Northern Ireland can return greater authority to the people of Northern Ireland—on the issue of health as well as on many other issues. There is great talent in Northern Ireland, which should be bearing the responsibilities to which the hon. Gentleman rightly referred. For reasons well known to the hon. Gentleman—I find it difficult not to call him my hon. Friend—our duty as a Government is to govern fairly. He may not always agree about Government policies, but I hope that he agrees that we adminster those policies fairly.

The Eastern health and social services board today published a consultative document on the future of hospital services in its district. It sets out the board's views on the changes needed in acute hospital services if patients are to continue to receive the best services that the latest technology and techniques can provide. My noble Friend Lord Arran is the Minister responsible for health and social services in Northern Ireland, and I know that he is taking a keen interest in this debate. For almost 18 months I had the honour of holding that post, so I also take a personal interest in the matter.

The board's document could be regarded as—I know that my hon. Friend the Minister believes that it is—a valuable contribution that will stimulate public debate, out of which will emerge firm proposals for change. Neither the board nor the Department of Health and Social Services proposes specific changes to particular hospitals. Such action will come later, probably next November when the board begins to firm up its purchasing intentions.

It is clear that with the remarkable and—I am sure that the hon. Gentleman agrees—welcome advances taking place in equipment, and medical and surgical techniques, particularly with the less invasive forms of surgery, patients spend considerably less time in hospital and can even be treated on a daily basis, which is for their convenience and happiness. I was once told by a surgeon that the majority of time a patient spends in hospital when undergoing surgery is used to heal the operation wound. Therefore, if the wound is smaller, the time spent in hospital will be less. That means that one can treat more patients in fewer beds as more patients can be treated in the available time.

The document of the Eastern health and social services board estimated that possibly up to 750 fewer beds would be needed over the next five years in its area. That will not, as the hon. Gentleman might fear, ruin the services provided to patients and prospective patients, but the reverse— hospitals will be able to take advantage of new techniques, but not waste money when it is not needed. We are running not a furniture warehouse, but a health service. We need to spend the money efficiently and wisely when serving patients.

The board usefully sets out in its consultative document a list of the standards and criteria that it expects hospitals to meet if they are to secure contracts in future. The document comments on the extent to which existing hospitals meet the standards. The consultative document stated that Ards hospital fell short of the standards required to ensure clinical effectivenss. It stated that Bangor hospital had not operated as an acute hospital for some time and it did not envisage it doing so in future.

The board has set out its thinking in relation to those two hospitals, and it is now for the local management unit and local community to respond and engage in a debate with the board. I take this debate as the first salvo in the consultative process. I assure the hon. Gentleman that he will always be free to consult my noble Friend the Minister, but I do not believe — and I know that my noble Friend does not believe—that now is the time to do so. It would be better to wait until after the board has decided before petitioning the Minister, who will listen.

The hon. Gentleman spoke about prospective trust status for the community services in his area. Government reforms in the health and personal social services in Northern Ireland are working extremely well. The process, which includes the new arrangement for the provision of community care from April, is directed at ensuring the continued provision of high-quality cost-effective health and social care for the population of the Province. Health and social service trusts form a key element of the service and will ensure a clear separation between the purchasing of services by the four health and social services boards and, as from April, some GP fundholders. and the provision of those services by the provider units. The trusts will remain firmly part of the health and personal social services. There is no question of opting out of privatisation.

The hon. Gentleman spoke about profits. There are no profits to be made by a health service trust. There may be surpluses or returns on capital, but those are merely extra funds for patient care. There are no dividends and no tax to be paid. It is purely a case of a business being run efficiently and being able to provide extra funds for the people for whom it exists. The trusts have freedom to manage. That will make separation from the purchaser more clear cut, but the timetable for the implementation of "Working for Patients", the document describing the Northern Ireland reforms, was a year behind the rest of the United Kingdom. That has provided a good opportunity for Northern Ireland to see some of the benefits already accruing from the separation of the purchaser and provider functions and especially from the establishment of GP fundholders and trusts in Great Britain.

Initially there were 59 trusts and in the second wave there were more than 100 applications. In Northern Ireland, there was only one application for trust status in the first wave. There have since been 10 more. I assure the hon. Gentleman that people do not apply for trust status merely because they think it is smart, a craze, the new thing to do. People who work in the health service are dedicated and do not always earn the salaries that they could earn in other milieux. Applications for trust status should not be considered with despair, disdain or suspicion. People apply for trust status because they believe that it is a better way to provide services for patients.

As I have said, Lord Arran is responsible for this matter and he wants to continue the long reputation of the Province for high calibre health services. I mentioned earlier that the Department of Health and Social Services has received 10 more applications for trust status. They were from the eight units of management in the Eastern board, the Eastern ambulance service and the Craigavon area hospitals group, which is in the Southern health and social services board area. My noble Friend announced last week that those applications are to be the subject of a three-month public consultation exercise, during which everyone can express an opinion. Those taking part may include hon. Members, MEPs, councillors, trade unions, the hon. Gentleman and his constituents and statutory and voluntary health and personal social services organisations. I know from the Royal group of hospitals that such opinions are carefully considered. By 8 September my noble Friend will have a considerable body of opinion and after that decisions will be taken.

When we make decisions about applications for trust status—particularly that made by the North Down and Ards community unit, to which the hon. Gentleman referred—a number of elements will be considered. First, there will need to be a sound business plan. Business is not a dirty word. A potential health and social services trust must demonstrate that it will be financially viable, it has a clear understanding of how it intends to develop into the future, and how it intends to use the freedoms conferred by trust status. Secondly, management must be able to demonstrate the necessary skills and capacity to run the unit. In this connection, the Minister would want to see the involvement and commitment of senior professional staff. Thirdly and perhaps most significantly, I shall expect a potential candidate to be able to demonstrate that the establishment of a trust will result in tangible benefits for patients, clients and the community. It is important to remember that trust status is not an end in itself but, as I stressed earlier, the means of providing a better service to those who need our care.

At the very heart of our proposals is the conviction that health and social services units are best run locally by the professionals and managers who have first-hand knowledge of the service. This is another way of saying that those actually involved in caring for patients and clients usually know best what patients and clients need and are in the best position to meet those needs.

Our aim is to give those working in the service the freedom and support to use the skills which professional training and experience bring. The key, therefore, is greater delegation and our proposals for the health and personal social services as a whole should lead to greater freedom, flexibility and responsibility for all hospitals and units. The trusts will be both the ultimate expression of this greater delegation and, I hope, the spur to its achievement.

Units that are approved for trust status will have the maximum freedom possible to run their own affairs. Each will be run by its own board of directors, which will allow it to develop its own sense of identity and those associated with it will be able to share in the pride in the trust and in its achievements, as we have seen throughout Great Britain.

I say again to the hon. Gentleman, and I beg him to accept it, that the trusts are not opting out of the national health service, or the health and personal social services of Northern Ireland. They are opting for their future to be within those bodies, providing for the patients who want to continue to receive services free at the point of delivery. The unit will take pride in its identity and its belonging both to the health service and the people of Northern Ireland.

I hope that the hon. Gentleman does not believe that there is any ulterior motive in creating the trusts. I hope that he will see, as countless thousands have seen here in England, the benefits that trust status can bring. I hope that he will take note of the votes that we have had, and the polls that have been taken among those who work in hospital trusts in Great Britain—the nurses who would not go back and the doctors who would not now surrender the freedom to deliver their service better than they could in the past. I hope that he will not believe that we are there to protect beds when we should be there to protect patients, or that we are saving money because of cuts in Government expenditure. In fact, we do so in order to use the money better to serve the people for whom he and we have a special responsibility.