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14 Nov 2002 : Column 198continued
Dr. Harris: I am delighted that the hon. Gentleman asked me that, because we have made it clear that we want council tax to be abolished and replaced by a fair tax. Even if there is a fair tax, such as a local income tax, it is wrong for the Government to transfer responsibility[Interruption.] The hon. Member for East Worthing and Shoreham (Tim Loughton) asks why local income tax is fairer than council tax. I do not think that the idea of progressivity in taxation, which should be understood by a party purporting to support the vulnerable, has filtered down to him on the Conservative Front Bench. He would find it hard to argue in front of any audience for a property tax in which the highest band is barely twice the level of the lowest, even though the disparities in ability to paya foreign concept to him, perhapsmay be much greater.
The hon. Member for Westbury (Dr. Murrison) was right to imply that it is wrong for the Government stealthily to transfer central funding responsibilities to local tax payers. That would be so even if there was a fair tax, but it is even worse when there is a regressive tax. Council tax rises, which have been above inflation, have the greatest impact on people on fixed incomes, such as elderly widows and widowers who have been left in larger houses that attract a higher council tax. Council tax rises are already increasing as a result of the reallocation of taxation from central to local government. Central Government take the praise for cutting tax or holding it down, while blaming local authoritieseven their own party'sfor raising it.
Dr. Tonge: I am not clear how much the fines are going to be. If the fine is less than the local authority would normally pay for a person in a residential home, there is no point in its trying harder to find a place. Would not it be better to charge the same as the cost of a residential home, levying it in the same way, with the patient having to sell their home if necessaryalthough that might mean the local authority leaving them there indefinitelyand would it
Dr. Harris: The level of the fines is a concern, although not the major concern, and the Government have produced different figures and have not been clear. In a parliamentary answer to my hon. Friend the Member for Sutton and Cheam (Mr. Burstow), the Minister of State, the hon. Member for Redditch (Jacqui Smith), said that the reimbursementthe finefor delayed discharge should be #120 a day in London and the south-east, and #100 throughout the rest of England. That is hundreds of pounds a week.
The problem is not only the level of the fine but the fact that people will be fined for something that is not in their control. The fines will create resource allocation distortions and we will end up with game playing between hospitals seeking to discharge or get the fine, and local authorities, and indeed carers, concerned about whether patients are fit for discharge. Indeed, we are already beginning to see premature discharge from hospital departments. Between April 2001 and March
In Scotland, a different approach is takentrying to identify and share good practice. The Government in Scotland, who have a Labour influence, have rejected the approach proposed by the Westminster Government, and I hope that, even at this late stage, the Government will reconsider their approach.
Although there are some aspects of this legislation that we will support, there are plenty of others on which we will oppose the Government. If they are serious about reform, I hope that they will listen to the concerns raised and alternatives put, recognise the need for true independence for the health care inspectorate, for example, and recognise that, if we are to go down the path of public benefit organisations, equity must be protected. There must be no cherry-picking of staff, and no bribes or incentives. The Government must be consistent. They cannot say, as they did in 1997, that they oppose two-tierism in general practice, and then say that they support it in hospitals. They cannot say that they oppose GP fundholding, and then introduce hospital fundholding. More than anything else, after this Queen's Speech the Government have more questions to answer than they have answered so far.
Mr. Forth: On a point of order, Madam Deputy Speaker. Earlier today, I raised with the Leader of the House the question of the new procedure for written ministerial statements. I was particularly worried about the fact that they might trickle out during the day, and that Members might not therefore have proper access to them. There are 10 such statements listed on today's Order Paper. I have just checked with the Library, and one of them was in the Library at 9.30 this morningdemonstrating that that can indeed be doneanother arrived at 11.30 am, and six arrived between 12 noon and 1 pm. However, one statement has yet to reach the Library.
I hope that you agree, Madam Deputy Speaker, that it is unacceptable for the Government to handle the new procedure in this shoddy way. Members must have a reasonable expectation of when written ministerial statements will arrive in the House and be available for them to deal with as they wish. I hope that at this very early stage, the House authorities will make it clear to the Government and to Departments that we expect written ministerial statements of which notice is given
Madam Deputy Speaker: I thank the right hon. Gentleman for raising that point of order. There is no rule of the House that says what time such statements should appear. Perhaps it would be appropriate for him to take up this matter through the usual channels.
Mr. Frank Dobson (Holborn and St. Pancras): I am sorry that the Secretary of State has had to leave. As he knows, I go around supporting the Government and their health policies behind his back. As I am going to criticise them today, I thought that I should do so to his faceor rather, because of the layout of this place, to the back of his headbut unfortunately that is not possible.
When I first heard of the proposal for foundation hospitals, they sounded to me like a bad idea, and the more I have thought about them, the more I have concluded that they are. I believe that, as currently proposed, they would inevitably lead to a two-tier health service, with some hospitals getting better and better at the expense of others that were getting worse and worse. The proposal does not address the most serious problem faced by patients; indeed, it makes matters worse.
Some NHS hospitals are doing a very good job, some need lesser or greater amounts of improvement, and others are doing really badly. Surely the priority must be to bring the worst up to the standard of the best, and until now that is what the Government have tried to do. They have introduced national standards of treatment for cancer, heart disease, diabetes, the mentally ill and the elderly, they have set up the Commission for Health Improvement to check on standards and give advice on improvements, and they have established the National Institute for Clinical Excellence to try to tackle the problem of postcode prescribing. All those measures were introduced with the opposition of the Conservatives, but with the support of the professionals involved, across the board.
However, foundation hospitals as currently proposed will not be introduced across the board. The 12 best performing hospitals will be singled out for privileged treatment. They will be allowed to borrow money, both from the City and from the Exchequer, and also to keep the total takings from land sales. They are also promised relief from Government interference through the earmarking of funds. Consequently, they will have more money and be better off. They will be able to attract scarce professional staff from neighbouring hospitals by offering better pay, better working conditions and newer equipmentso they will be doing better at the expense of the rest.
The question is: why should the best hospitals be singled out for special and advantageous treatment? If Government interference hinders improvement, why not stop interfering with all hospitals? The argument appears to be that the best hospitals should be rewarded for their performance, but that betrays an obsession with institutions rather than patients. We have only to ask one question to expose the irrationality of the proposal for foundation hospitals: which patients are getting the worst deal, and how do we get them a better one? We know that those who are getting the worst deal are those who have to rely on the worst run hospitals. We also know that they will benefit only if we can narrow the gap between the performance of their hospitals and that of the best hospitals, by levelling up performance. Foundation hospitals will achieve the reverse.
My right hon. Friend the Member for Tyneside, North (Mr. Byers)I am glad to see him heretalked about consensus. Until now, we have had a consensus on the national health servicejust aboutand it has been a Labour consensus. However, we are now in danger of setting out to establish a consensus that is basically Tory.
I cannot see how the current proposals will lead to anything other than a two-tier national health service, with one group of hospitals permanently doing better than the other. Moreover, hospitals will have to start competing again. We said that we would abolish competition between hospitals, and we didbut apparently, we are bringing it back: we are re-introducing the internal market. Indeed, we may be introducing something a bit beyond that. If such hospitals borrow, and their income from the trusts that commission their services is not enough to meet their outgoings on borrowingall borrowing involves paying interest and, eventually, repaying the principalthey will be increasingly tempted to look for private patients. Instead of advertising for doctors from abroad, perhaps some will end up advertising for patients from abroad, to make up any shortfall in funds.
This whole idea springs from certain Government advisers' obsession with the concepts of choice and diversity. People like them may want such choice, but I doubt whether most people do. I doubt whether people in Bristol want to choose to go to Gloucester to benefit from a foundation hospital, or whether people in Leicester want to choose to go to Nottingham for the same benefit. What such people want is prompt first-class treatment and care close to home, at their local hospitalbut their local hospitals might lose talented staff to foundation hospitals in Gloucester and Nottingham.
The proposals are likely to widen inequalities between hospitals, and inequalities in health. For example, land values in London and the south-east are much higher than in the rest of the country. If a foundation hospital in the south-east decides to sell off some of its property, it will be able to keep all that money, which will prove a great advantage. That money will no longer be spread across the country. Since 1997, #1.6 billion has gone into the NHS from the sale of property, but it has been shared out throughout the country. Members who
Very recently we have heard the proposal that there should be elected boards. Apparently they are not to be elected by the whole registered electorate of an area, but by a self-selected group of people. I am not sure whether those people will be residents or patientsbut patients of which hospital? I was talking to my wife about that this morning. We worked out that during the years when our children were still at home, we had made use of University College hospital, the Elizabeth Garrett Anderson hospital for women, Great Ormond Street hospital for children, Barts hospital, Moorfields eye hospital, St. Mary's hospital and the Royal Free hospital. Will we have a vote in all of them? There is no answer to that. The proposal has not been thought out.
If that electorate is to choose itself, it could be subject to manipulation, or something that some of us in the Labour party have a long history of resistinginfiltration. As my right hon. Friend the Secretary of State pointed out in another context, there is always the problem of what Tawney described as the Xsharp elbows" of the middle classes. It seems to me that their sharp elbows will get the middle classes on to those electoral rolls, and other people will not be there. If there are to be elected boards, they should cover everyone in every part of the country.
Finally, there seems to be a complete lack of logic in the Government's proposition. If the present arrangements are fundamentally unsound, how did the best hospitals get to be as good as they are, and why are the Government saying that non-foundation hospitals will have to continue to operate under those unsound and flawed arrangements in order to improve themselves? If it is true that the structure is fundamentally unsound, as the Government say, there would be no possibility of improvement under that system for the hospitals that need it.
I do not believe that the Government really have faith in the foundation hospital idea. If they did, they would choose 12 places at random to see whether the proposal would work not only in hospitals that have been well run, but in those that have been moderately run and those that have been badly run. I do not think that the proposal will work. It will be divisive, and I shall do my level best to oppose it at every stage.