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Mr. Milburn: The hon. Gentleman made five substantive points. As for being dragged to the House, I understand that the House will have an opportunity this afternoon and this evening to discuss NHS reform in copious detail. [Hon. Members: "No."] Tomorrow, on a Liberal-Democrat motion, hon Members will discuss health issues and, on Thursday in Government time, they will have the opportunity to discuss changes to structure and culture in the NHS, when we produce our response to the Kennedy report on the inquiry into events at the Bristol royal infirmary.
The hon. Gentleman says that he could not understand the speech that I made this morning. If he spent a little more time talking to NHS staff at home, rather than running down the NHS abroad, he might be able to keep up. As for the issues that the hon. Gentleman raises, yes, we have set out today proposals for greater independence for the highest performing hospitals. He asks how many. I said in my statement and, indeed, in my speech that that would be a matter of voluntary discretion. It would depend on the number of hospitals or primary care trusts that wanted to move in that direction.
The hon. Gentleman always urges on me less day-to-day management, less interference and less centralisation, but he does not seem to like it when it happens. As for the sort of powers, resources and responsibilities that the foundation hospitals and othersthe primary care trusts, toowill have, as I said in my statement, we will discuss those issues precisely with the primary care trusts and the hospitals. As for pay and conditions, I believe in a very simple principle: if NHS hospitals that have done really well and are performing the best in the NHS, providing high-quality care to NHS patients, want to give extra rewards and more pay to the staffwhether a porter or a cleaner, let alone a doctor or a nursewhom they employ, they should be free to do so.
The hon. Gentleman seemed to allude to the internal market. I shall tell him the difference between these proposals and the internal market. The internal market involved using one clubcompetitionto try to lever up standards. It did not induce competition, and it certainly did not lever up standards. The difference is that we now have in place a clear framework of national standards, national service frameworks, the National Institute for Clinical Excellence, which evaluates new treatments and new drugs as they come on to the market and into the NHS, and an independent means of inspecting them.
We want to see high standards everywhere, but we also recognise that the NHS cannot be subject to day-to-day running from Whitehall, as it has been for 50 years; it has to have power, resources and responsibilities located in the hands of doctors, nurses, porters, cooks, cleaners and mangersthe people who actually deliver NHS care to NHS patients. The big divide in British politics is between those of us who say that NHS values should be maintained, but its structures changed and the Conservative party, which says that NHS values must be abandoned and that the people must pay for their treatment.
Mr. Frank Dobson (Holborn and St. Pancras): I am reluctant to say what I am about to say or to ask the questions that I am about to ask, but will my right hon. Friend bear it in mind that the fact that some NHS hospitals are outstandingly successful demonstrates that NHS hospitals are capable of doing a first-rate job without their management being franchised to the private sector? Will he also bear in mind the fact that private sector health care managers are unlikely to have appropriate experience, as most private hospitals are small, low-tech and have few, if any, emergency admissions compared with a very large NHS teaching hospital, which probably has more emergency admissions, involving great complexity, than the private sector hospitals' total admissions, and perhaps 1,000 doctors on their staff? Will my right hon. Friend guarantee that absolutely none of those outside managers come from such private sector disasters as Railtrack, Equitable Life, Marconi, or the accountants, auditors or management consultants associated with those private sector disasters?
Finally, will my right hon. Friend at least give some thought to the fact that the public service ethic managed to maintain the national health service through all the Tory years of underinvestment and malignant policies? In those circumstances, would it not be right to give the public service ethic the opportunity to flourish with the extra resources that are now available?
Mr. Milburn: I am glad that the hon. Gentleman is alive and awake for once. [Interruption.] God, Conservative Members are in a tetchy mood todaythey really are. I understand why the hon. Member for Woodspring (Dr. Fox) is tetchy; he has been brought back from his inter-railing holiday in Europe. He is bound to be a bit uncomfortable. However, I do not know about the rest of them.
As far as my right hon. Friend's points are concerned, yes, the NHS has very many outstanding managers. There is absolutely no doubt about that. He has some of them in his area; thankfully, I have some of them in my area, too. It is right that NHS managers should be given opportunities, particularly when they are running high performing NHS organisations that have a track record of success. However, if we have poorly performing NHS organisations, it seems to me highly appropriate that we use the expertise of such managers and garner that for the benefit of other NHS patients.
On my right hon. Friend's point about Railtrack, he is right. What the Conservatives did when they sold off the rail network was catastrophic. [Interruption.] My right hon. Friend asked about Railtrack. [Interruption.]
Mr. Milburn: In relation to my right hon. Friend's question, the fundamental difference between what the Conservatives did with the railway network and what we are proposing is that they sold off lock, stock and barrel public sector assets and sold them to the highest private sector bidder. There is no question whatsoever, under any of these proposals, of selling off NHS assets. What we are doing is franchising the management of NHS organisations that are not performing as well as they should.
I could not agree more with my right hon. Friend when he says that the public service ethos should be maintained at all costs. I think that the best way of strengthening the public service ethos is to get the investment in, but to make some fundamental reforms too.
Dr. Evan Harris (Oxford, West and Abingdon): Is not the Secretary of State creating a two-tier system of hospitals? The first is for those hospitals that he judges to be performing well and to which this most centralising of Government claim to be giving independence. The Commission for Health Improvement is being charged with inspecting these hospitals based on performance criteria laid down by himpolitical hoops that hospitals will be asked to jump through. The commission will have to examine how well they are doing not whether it is worth their time doing that. In providing freedom to pay more to staff in better-off hospitals that are doing well, is not the danger that they will simply recruit staff at the expense of the poorer hospitals that have been even more under-resourced by the Government?
On the so-called failing hospitals, does the Secretary of State recognise that, by his criteria, hospitals could be judged as failing because they put patients and clinical priority before politics and political targets? They will be judged to be failing if they suffer from the Government- induced crisis of bed blocking due to underfunding of social care and the crisis in the care sector.
The Secretary of State used a comparison with schools. Does he not recognise that naming and shaming to shift the blame from him creates a crisis in confidence that will worsen staff retention in the health service? If it comes to bad managers being removed, he need look no further than himself as the worst manager of a centralising Government who try to micromanage the whole health service.
On paying staff the same, I do not know about the hon. Gentleman, but I spend part of my week in the north-east of England and more than half of it in the south-east, and I have noticed a big difference between the two. I do not know whether the hon. Gentleman has also noticed it, but house prices are different, the labour market is different and, by and large, there is full employment down here. To argue that somehow or other we should simply pay everyone the same regardless of the labour market conditions is absurd.
The hon. Gentleman knows that trusts in his area are rightly paying staff more in order to recruit doctors, nurses and other staff. He seems to be arguing for a uniformity that we have not seen for many years in the national health service, but all that would do is plunge NHS trusts in many parts of the country into growing, not diminishing, problems of recruiting and retaining staff.