House of Commons Hansard Debates for 16 Jan 1998 (pt 24)

2.51 pm

The Minister of State, Department of Health (Mr. Alan Milburn): I am delighted to have the opportunity to respond to my hon. Friend the Member for North-West Norfolk (Dr. Turner). I congratulate him on securing time for a debate on a subject that concerns him and is important to his constituents.

Health services in Norfolk have already featured large in the Department of Health's business this year, which is the 50th anniversary year of the NHS. As my hon. Friend knows, only last week I was pleased to announce the go-ahead of the largest private finance initiative scheme so far in the history of the NHS--the £200 million development of the Norfolk and Norwich hospital.

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This is one of the first debates of the new year, and the issue that my hon. Friend raises touches on much that is at the heart of the White Paper that we published last month. As he rightly said, the White Paper sets out a 10-year programme of modernisation for the NHS. The proposals in it provide an important context for the debate on the boundaries of the health authorities covering Norfolk.

First, the White Paper ends the internal market in the health service. The internal market was divisive and costly, setting hospital against hospital and doctor against doctor. That system led to the creation of North West Anglia health authority. Part of the rationale for setting up the health authority in 1992, when Peterborough and King's Lynn were merged, was to ensure that it had two district general hospitals that could compete with each other. That is no longer a reason for determining health authority boundaries. With this Government, the needs of patients, not of institutions, come first.

Secondly, in the White Paper there is an emphasis on partnership. We need to break down the Berlin walls between health authorities and local authorities because whether those are Berlin walls, Hadrian's walls or Offa's dykes, they can hinder patient care. The White Paper sets out a range of measures to promote closer working between health and social care.

New local health improvement programmes will be drawn up by the health authority in conjunction with local authorities and other partners. Those will identify the most important health needs of the local population and how services should be developed to meet them, either directed by the NHS or, where appropriate, jointly with other organisations. We propose to strengthen the duty of partnership between all parts of the NHS and local authorities. All those steps should go some way to addressing the issues of partnership between health authorities and local authorities, regardless of where the boundaries lie.

Thirdly, the White Paper sets out a new role for health authorities. They will give strategic leadership on the ground to help overcome the fragmentation that characterised the internal market. One key task will be to support the development of primary care groups so that family doctors and community nurses can help shape services. We obviously want to work with health authorities to streamline their administrative functions so as to release time, effort and, perhaps most importantly, resources for higher priorities.

As my hon. Friend pointed out, that may provide scope for making economies of scale at the health authority level. We are certainly committed to cutting out unnecessary bureaucracy. That is why we are reducing the number of commissioners in the health service from something approaching 4,000 to more like 500. That will help free £1 billion within the health service for investment in the front line.

While there is an appetite for change in the NHS, there is no appetite for upheaval--and certainly not for upheaval imposed from the centre. We want to change the NHS for the better rather than introducing change for change's sake. We certainly envisage that there may be fewer, leaner health authorities in the future and that the type of merger proposed by my hon. Friend may be

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the shape of the NHS in the next century. However, I should emphasise that there is no question of any change being imposed from here. We are clear that local decisions rather than national edicts should determine the shape of health authority boundaries.

That brings me to the specific question raised by my hon. Friend. North West Anglia health authority was created in 1992 and, as my hon. Friend said, serves the western part of Norfolk and the northern part of Cambridgeshire. This eastern end of the Anglia and Oxford health region is the only part of the region where the health authority boundaries are not coterminous with the county boundaries. Therefore, it is right and proper to raise the issue of its boundaries as the NHS begins to implement the White Paper.