Previous Section Back to Table of Contents Lords Hansard Home Page

Baroness Cumberlege: My Lords, I have already made it clear that the Government's commitment to improving health services for London is very great. The direction has been well set out. The strategy was clearly laid out in Making London Better, which also set out the framework for action: to develop better, more accessible primary and community health services; to provide a better balanced hospital service to meet the needs of London's resident working and visiting population in the most appropriate way; to develop and enhance specialist services that continue to provide a high quality service; and to take action that will benefit and enhance London's excellence in medical teaching and research.

24 Apr 1995 : Column 724

Progress on all these fronts was announced earlier this month with proposals for change in services in north, east and south east London.

The Government established the London Implementation Group to provide a short-term boost and extra support to existing health agencies in London in the considerable task before them.

As my noble friend Lady Miller mentioned in Committee—the noble Lord, Lord Rea, mentioned it again this afternoon—the work of the London Implementation Group is now complete. A great deal has been achieved and London's health authorities and trusts are now moving forward this great agenda for change. But, as I emphasised in Committee—and as the noble Lord, Lord Rea, has said this afternoon—London cannot be treated as a single entity. It is a large and diverse city, often characterised by extremes. Areas that receive huge influxes of people by day—for example, in the city and the West End—have much smaller resident populations. As the noble Lord said, the needs of the inner city are in contrast to those of its suburbs. Account must be taken of London's size and the character of its local populations. Collaboration must take place between a range of health and social care agencies if the needs of Londoners are to be met. I agree with the noble Lord, Lord Desai, on that point. The health service in London has made good progress in achieving major change to give Londoners access to a comprehensive range of services. Much of that work has been taken forward at a local level.

I do not agree with the noble Baroness, Lady Jay, about "projectitis" or with her philosophy in coining that phrase. It is at local level that the real difference will be made and where better services will be experienced by Londoners. There can be the most cerebral strategies, but they are worthless if they are not translated into real services of a higher quality experienced by Londoners; for instance, through better premises for GPs.

Nevertheless, I would not dismiss the fact that some strategic overview of the needs of the whole of London is still needed. A London focus has been retained at the highest level by the North and South Thames Regional Offices working with the NHS Executive, the Primary Health Care Forum and the Primary Care Support Force. That focus will ensure that a wider view is retained.

The London focus will mean that health authorities and trusts in London will be able to maintain a broader strategic vision across the capital. They will share experience and good practice in implementing and managing the pace of change in London's health care. This has already been demonstrated by the London Initiative Zone which focuses on improving primary care in those parts of London where need is greatest. Within the zone, health authorities have identified priorities for their local communities and have moved towards closer working partnerships, including local authorities and the voluntary sector, in tackling the problems of underdeveloped services in the community. These working partnerships have not required the establishment of a strategic, overarching, authority.

24 Apr 1995 : Column 725

They have emerged as part of the responsibilities of existing health authorities to work with other agencies. I urge your Lordships to reject this amendment.

Lord Rea: My Lords, I was slightly puzzled when my noble friend mentioned the word "projectitis". The way I heard it it was "project Titus"—which I thought might be a Roman monument built in anticipation of developments in the future Yugoslavia. I now understand that it is a form of disease.

All the words of the noble Baroness could easily have been taken as an argument for establishing a strategic body for London such as we suggest in the amendment. All the things that she said had been established by the London Implementation Group and were being done in the London implementation zone—how there was need for co-operation between the different health authorities and local authorities in London—seem to me to cry out for such an overall strategic body as we propose. However, it is perfectly clear that the Government are not taking our advice. I cannot count on mobilising support for the amendment today. It is possible that we may try yet again. For the moment, I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

4.30 p.m.

Lord Carter moved Amendment No. 4:

After Clause 2, insert the following new clause:

Annual report on activities of regional offices of NHS Executive

(" .—(1) It shall be the duty of the Secretary of State to lay before both Houses of Parliament an annual report on the activities of the regional offices of the National Health Service Management Executive in respect of the discharge of all duties and functions transferred to those offices upon the abolition of Regional Health Authorities.
(2) In this section, "regional office" means any office of the National Health Service for the time being designated by the Secretary of State to have responsibility for the oversight of the finances and activities of the National Health Service purchasing authorities and trusts on a regional basis.").

The noble Lord said: My Lords, this amendment places a duty on the Secretary of State to lay before both Houses of Parliament an annual report on the activities of the new regional offices of the National Health Service Executive and to report in respect of the discharge of all duties and functions transferred to those offices upon the abolition of the RHAs. The second subsection of the new clause defines "regional office".

The purpose of the new clause is clear. It will create a mechanism by which Parliament can be informed of the outcome of this legislation and can monitor its effects in practice as opposed to its claimed intent. The enthusiasm of the Government for open government and accountability has often been asserted. If their real intention is, as they claim, to remove unnecessary bureaucracy, increase efficiency and create savings, the new clause will raise no problems for them and will present an opportunity for the Government to report back and parade their achievements.

We know that in 1991, as part of the Government's so-called reforms, regional health authorities were given greater powers because it was judged that a strategic

24 Apr 1995 : Column 726

authority at regional level was required. As we went through the Bill and began to see how this legislation might work, two matters became very clear. First, the Bill will allow much greater secrecy, and indeed concealment, in hospitals and trusts. We have tabled some amendments to deal with that matter. Secondly, in line with everything else the Government have done in a number of fields of activity, this legislation will ensure that all roads lead back to the Secretary of State.

Perhaps I may repeat a point I raised in Committee. At present, regional directors of public health have a duty to produce an annual public report on health care in their region. Historically, the role of practitioners of public health medicine as potential whistle blowers for public safety is one of the glories of British medicine and British public service. But at regional level—this point was underlined in an exchange I had with the Minister in Committee—they will become civil servants, bound by the Official Secrets Act 1911. Their duty will not be to the public but to the Secretary of State.

So what will happen to the annual public health report on health care in their region? Who will make that report? Can it be done by civil servants at the regional level? As the Minister underlined in Committee, they will be bound as civil servants under all the normal rules. In fact, will that reporting just stop?

The only remotely independent voice in the new structure that the Bill creates is that of the community health councils. Their chief executives, full time salaried public servants, are presently employed by the regional health authorities. What will happen to them?

I turn to statistics and information. At present the RHA collects statistics at regional level in the service of the public and, if requested, much of that information is made public. We shall also deal with that point in a later amendment regarding the codes of practice on openness. The only information that anyone can currently obtain about matters such as hospital closures come from the RHAs. The Department of Health, for understandable reasons, does not want to know about that. It tells us that in future the regional offices will collect only the statistics that the department wants for its own purposes in administering the system. Will that include information about hospital closures, for example? Will it include the closure of accident and emergency departments, or other such decisions, which impinge directly on the pattern of available health care across the region and which are certainly of public interest whether or not the department wishes to know them.

It was confirmed again in Committee that if the decisions deal with policy, however defined, the Minister will answer questions in Parliament but operational matters will be referred to the executives. So apart from the information that the regional health authorities will no longer collect, any request for information from Members of Parliament on operational matters will in future be referred to individual authorities or trusts. So there will not be the same responsibility for the flow of information to the public or their representatives for the use of public money.

24 Apr 1995 : Column 727

The mechanism proposed in the new clause will allow Parliament to explore how those and other functions of existing RHAs are being carried out under the new structure; or, if they are not being carried out, to consider the effects of the change. We know that the vital responsibilities of the present RHAs are to stay at regional office level and be lifted into the power of the NHS Executive. On those grounds there remain severe doubts, including among health professionals, whether the new authorities that the Bill creates in place of the regions will have the expertise to plan and co-ordinate the existing activities of those regional health authorities. We have tabled a number of amendments to try to make sure that they do have the expertise that is required. The Government have resisted any attempt to put that on the face of the Bill.

All this shows is that whether at regional office level or away from that level there is a continuing and important role to be played by those who are charged with carrying out the duties which are currently the responsibility of the RHAs. We feel that Parliament must have the chance to scrutinise the effects of the legislation, not only by discussing the regulations when they are proposed but by exploring every year the cumulative practical changes to which the Bill will give affect. The new clause will do that. I beg to move.

Next Section Back to Table of Contents Lords Hansard Home Page