Call for debate over NHS as trust fears grow: The Commons health select committee says that fragmentation of the reformed NHS could hit strategic planning. Ian MacKinnon reports

THE Conservative-controlled health select committee yesterday called for a public debate on the future of the National Health Service as it issued a report expressing deep concern over the progress of trust hospitals.

The interim report warns of the dangers of losing strategic planning through the fragmentation of the reformed NHS which could be exacerbated by the 'lack of clarity' in the Government's policy towards investment in the service.

Yet, despite the criticisms and caveats in the document, Labour committee members maintained that it concealed wider fears and should have gone much further.

One Labour member, Audrey Wise, said that with 95 per cent of hospitals expected to attain trust status by 1994, the Government was proceeding at 'breakneck pace' even though many doubts and uncertainties had been highlighted. But Marion Roe, the chairman, pleaded that the split within the committee should not be allowed to overshadow the main thrust of the document.

The report, which includes evidence taken by a previous committee before the last general election, identifies three key areas of concern about the impact of trusts.

The loss of strategic planning as trusts grow rapidly is high on the agenda. The study says: 'The former committee was not presented with a persuasive statement as to how the growth of trust status will be reconciled with the retention of the ability of an agency to retain a strategic oversight.'

Fear is also expressed over the effects on lower-paid staff of the dismantling of national bargaining framework for pay and conditions, and the danger of the break-up of professional structures. The report says: 'In addition, there is the related issue surrounding the fear of speaking out about trust policies to the health and welfare of patients and others.'

Finally, there is the contentious issue of the public accountability of trusts - they are obliged to hold only one public meeting each year - and their relationship with community health councils. The committee is urging the Department of Health to review the statutory basis of CHCs under the reorganised NHS.

Alice Mahon, another Labour member, tried unsuccessfully to amend various sections of the report. In particular, she demanded that the Government bring forward legislation requiring openness from trusts and to protect 'whistleblowers' who speak out in the public interest. She had also pressed the committee to adopt a passage calling on the Government to 'immediately halt the trust programme until there has been a full independent inquiry on the existing trusts . . . '

Yesterday, at the report's launch, Mrs Mahon said: 'Clearly there is a huge division. We agreed to a report which certainly does not make the case for trusts. But even the conclusions (of the report) do not agree with the evidence. We are being reduced to mere spectators while the NHS is being turned into a marketplace. I do not find that acceptable.'

David Blunkett, Labour's health spokesman, said the report contained important criticisms of the impact trusts were having on health care. 'Virginia Bottomley (Secretary of State for Health) ought to make clear what action she intends to take to allay the real fears that now exist of the total fragmentation of the NHS with the massive growth in trusts and GP fund-holding.'

NHS Trusts: Interim Conclusions and Proposals for Future Inquiries; HMSO; pounds 9.50.