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14 Nov 2002 : Column 171—continued

Dr. Julian Lewis (New Forest, East): Will the Secretary of State confirm that the Bill will not concentrate solely on the understandably controversial

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matter of people with untreatable personality disorders, but will also pay attention to an issue that has worried many of us—that people who have to have in-patient care for serious depression are put cheek by jowl with people who are seriously psychotic? In other words, there should be separate therapeutic environments for people with very different types of mental disorder.

Mr. Milburn: The hon. Gentleman makes an extremely good point. Inevitably, all the headlines will be about one aspect of the Bill; that is understandable. However, the Bill in its entirety is not about that issue. It is about how, from a system fundamentally based on 1950s legislation, to get a better balance between safeguarding individual patients' rights, and protecting the community as well as individual patients. It is absurd that, although most treatment takes place in the community rather than in hospital, because the current legislation does not allow compulsory treatment for the minority of patients who need it in the community, doctors must wait until they become so seriously ill that they are a threat to themselves or to others before they are admitted to hospital for compulsory treatment. That is palpable nonsense, and it is not good for the patient or for the community. That is what we must change. We will consider the responses extremely carefully. Make no mistake, reform must happen in mental health services, just as it must across the whole national health service.

National standards make a difference. Through the Commission for Health Improvement, the very real variations in performance that exist in the NHS are being tackled. Indeed, as the Queen's Speech made clear, we will now strengthen the system of national inspection so that there is more information, not just about health services in the public sector, but about health services in the private sector too. Wherever NHS patients are treated they have not just the right to a common ethos and a common system of inspection, but a right to know that standards are high. Our objective is to have good services not just in some places, but in all.

Laying down national standards does not by itself raise standards. That can happen only when staff feel involved and communities are more engaged. The top-down, centralised structure in the NHS has too often inhibited local innovation. Too often when I talk to front-line staff, they feel disempowered. Local communities feel disengaged. Individual patients have little say and precious little choice.

In today's consumer age that structure is no longer sustainable. Therefore, our reforms are designed to shift the balance of power in the NHS so that standards are national, but control is local.

Mr. Andrew Lansley (South Cambridgeshire) rose—

Dr. Evan Harris (Oxford, West and Abingdon) rose—

Mr. Milburn: I give way to the hon. Member for South Cambridgeshire (Mr. Lansley).

Mr. Lansley: While the Secretary of State is talking about national standards and access, will he tell the House to what extent the intention that there should be specialist stroke units in each district general hospital, which was the April 2002 target, has been met? In

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addition, will he reiterate the intention that all stroke patients should be treated in specialist stroke units by April 2004?

Mr. Milburn: The hon. Gentleman is referring to the national service framework for elderly care services. He is right that the intention is to have specialist stroke services by April 2004 in all parts of the country. We have made progress towards that, and I know that it is happening. We have two years to go, and we are making good progress. We have to learn from the stroke services that are being set up. I visited a specialist stroke service in the Freeman hospital in Newcastle, and I know what a difference it makes, not just to the care of the patients but to the morale of staff, who feel that they can use their specialist skills for the purpose for which they were designed—is to make sure that older people, in particular, get the quality of care that they need. We have made a start and I am confident that we will achieve our ambitions.

Dr. Harris: The Secretary of State talked about the importance of reform, and in these exchanges he has given the impression that only his party supports reform, and the Liberal Democrat and Conservative parties do not. I am happy to accept that the onus is on Opposition parties to recognise, as I do, that radical reform of the health service is necessary. Having started with insults, if he remains to hear my contribution, which he does not usually do—[Interruption.]—he will have an answer. The Secretary of State cannot start by insulting parties and then slope off before they are given a chance to respond. I accept his challenge that before criticising the reforms proposed by the Government, Opposition parties have to have their own proposals. That would be a test of effective opposition, and I hope that he will remain to hear what is offered on the menus today.

Mr. Milburn: As for my attendance at the hon. Gentleman's speeches, there are questions of decorum and good taste. I have heard him speak in this place and say different things almost in the same sentence to the same audience. I will stay and listen to him today. How is that? I must have nothing better to do.

Mr. Kevin Hughes (Doncaster, North): Now that my right hon. Friend is coming to the part of his speech about reform, will he take time to explain to the House how the introduction of foundation hospitals will not lead to a two-tier service? In addition, if foundation hospitals are going to improve services, will he say why they are to be introduced only in those areas where existing hospitals already give their communities good service?

Mr. Milburn: I will answer my hon. Friend's question, but I hope that he will let me get to the relevant section of my speech. If he wants to intervene then, I shall be happy to allow him to do so.

As I have said, we want to have national standards and local control. Next year, local PCTs will control three quarters of the NHS budget. They will have three-year budgets so that they can plan and deliver a better

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balance between prevention and treatment, and between services in the community and services in hospital. They will also be free to commission services from the most appropriate provider, regardless of whether that provider is in the public, private or voluntary sector. That will permit a greater diversity of provision and greater choice for patients.

In our country, of course, there has always been choice in health care, but it has been the exclusive preserve of those who can afford to pay. Equity demands that that choice is available to all, not just to some. People should not have to opt out of the NHS to get high quality treatment. They should be able to get choice on the NHS.

We have made a start, with heart patients now choosing where they should be treated. Our plan is to extend choice to all NHS patients. The more that hospitals do and the more patients they treat, the more resources they will get. Those local services that are doing less well will get more help, more support—including financial support—and, where necessary, more intervention. They will not be left to sink or swim. Conversely, those doing better will get more freedom.

Mr. Hilton Dawson (Lancaster and Wyre): Will my right hon. Friend assure me that everything that he has said about improving the quality of health services can be read across to the social care services? Will the important measures that he is introducing to extend devolution and local decision making refer to both health and social care, and to crucial partnerships at local level?

Mr. Milburn: My hon. Friend makes an extremely important point, and perhaps I have been remiss in not making it clear that a common set of principles should apply to all our public services. We want to raise standards everywhere, not just in some places. That is why we instituted national standards and systems of inspection, and why we made available the help and support that we now give. When the Government came to office, we had no way of generalising good practice. There was no mechanism by which we could tell the best clinicians and managers to take the lessons that they had learned from their working environments to other organisations that needed help, so that those organisations could learn the same lessons. However, that is what we do now.

My hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) will also be aware that the response should always be the same where there is consistent management failure, be it in the private or the public sector. In such cases, we should change the management and bring new people in. The purpose of the new franchising proposals is to bring in new management. In those places where we have adopted it, that approach is beginning to produce results.

The same disciplines must apply in the social services as much as in the health service. That means that help, support and, where necessary, intervention are available in those areas that are not doing very well. Conversely, there are also incentives to improve, which brings me to the issue of NHS foundation hospitals.

NHS foundation hospitals will be part of the national health service. They will treat NHS patients according to NHS principles and to NHS standards, but they will

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be controlled and run locally, not nationally. Indeed, they will draw on traditions that many Labour Members will recognise—the traditions of the co-operative movement and of friendly societies and mutual organisations in this country and abroad. NHS foundation hospitals will be owned and controlled by local communities, replacing central state ownership with a modern form of local public ownership.

How will that work? People living in communities served by a hospital will be its members and, therefore, its owners. Staff will also be members. Local people will elect representatives to serve as hospital governors. Those directly elected hospital governors will make up an absolute majority on the trust stakeholder council. The council in turn will hold the management board that is responsible for the day-to-day work of the hospital to account, elect the chair and non-executive members of the board and approve the appointment of the chief executive.

For the first time since 1948, the public will be genuinely at the heart of our key public service—the national health service. This reform will help bridge the democratic deficit that has for too long kept the public out when they should have been brought in. I will shortly publish a prospectus setting out more details on NHS foundation hospitals, but I can tell the House one more thing today.

Some people have concerns that foundation hospitals are about privatisation. That is simply not true. NHS foundation hospitals will be there to serve NHS patients, not to make profits or to distribute dividends. To prevent any future Government pursuing a privatisation agenda in the NHS, there will be a legal lock on the assets of NHS foundation trusts to protect them from the demutualisation that we have seen in the building society sector in recent years or any future threat of privatisation. Our reforms are about giving life to the Labour ideal of common ownership, not resurrecting the corpse of Tory privatisation. Our aim is to bind NHS hospitals ever closer to the communities that they serve. In that way, NHS foundation hospitals will be part of the NHS and will always remain part of the NHS.

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