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8 Jan 2003 : Column 180—continued

Mr. Hilton Dawson (Lancaster and Wyre): Has the hon. Gentleman not missed the point about the most important issue in health? Surely, the biggest issue underlying acute health needs across the country is prevention, and the key matter in prevention is poverty. Do the Conservatives recognise poverty as a cause of ill health or, if we ever had the misfortune of them getting back into power, would they continue to ignore it?

Dr. Fox: There is no doubt that there is at least some truth in what the hon. Gentleman says. Poverty is a contributory factor to a number of disease processes, but in the western world we are also seeing for the first time the morbidity of affluence, such as the huge increase in obesity and type 2 diabetes in this country, which will force us to change our mindset on preventive health care. We must start to weigh those things up, but I am surprised that the hon. Gentleman chose preventive health and public health policy as a means of attempting to attack the Conservative party. Under the Government, there has been a virtual abandonment of public health policy—there has been no proper response

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to the huge growth of HIV, TB or the burgeoning cost on the system of type 2 diabetes. Public health has been systematically downgraded by the Government. A Conservative Government would put public health as well as mental health at the top of the agenda, but sadly they have been moved too far down by the present Government.

I like to be fair in these debates when talking about the Government's promises so I should say that it is not long since the Secretary of State told the House that Britain has a monopoly supplier in the NHS. As long as Labour is in power, he said, that is how it would stay. There has certainly been a change in his position, rhetoric and policy in recent months. The best analogy is the programme XBlockbusters". I am sure you know the one I mean, Mr. Speaker—we could, for example, take a Xt" and see what it stands for. Let us take a Xp". What Xp" would describe a Conservative policy to use the private finance initiative exclusively to fund private capital projects; sign a concordat for greater co-operation with the private sector; buy the exclusive use of a private BUPA hospital for patients; bring in private management to run NHS hospitals; give PCTs powers to buy private provision for their patients; and give NHS trusts the ability to borrow private money outside Government limits? What Xp" would the Labour party use to describe that Conservative policy? The answer is privatisation.

I do not object to any of the policies that I already have laid out, which are entirely in line with what the Conservative party would like. It is the hypocrisy of the Government's approach, pretending to do one thing, but in fact doing another, that I find offensive and which, I am sure, lies behind the 109 signatures to early-day motion 351, which was tabled recently.

Mr. Andrew Turner (Isle of Wight): On the subject of hypocrisy, a concordat for co-operation was signed with the private sector. However, at the same time King Edward VII hospital in Midhurst, which served many of my constituents who needed cardiac surgery, is in danger of closing because the health service no longer sends patients there. What does my hon. Friend say about that?

Dr. Fox: Double-thinking is part of new Labour: it has an Orwellian nature, and the fact that it says one thing and does exactly the opposite should come as no surprise to anyone after six years. However, any loss of capacity in the area of clinical care described by my hon. Friend is tragic when we still have huge waiting lists, notwithstanding the fact that the Government have been throwing money at the health service as if there were no tomorrow.

However, it is only fair that when we support a policy, we should say so. We can take some comfort in the Government's proposals on foundation hospitals. An incoming Conservative Government would feel comfortable with the direction that the Labour Government are taking, as they are moving towards the sort of policies that we want—a dramatic decentralisation of the NHS and a reduction in politicisation. If the proposals are implemented properly, people on the front line would get more freedom and patients would get more choice. However, there must be action, not just rhetoric.

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When the Secretary of State made a statement on the foundation proposals, I asked a number of questions. I took note of your comments, Mr. Speaker, to my hon. Friend the Member for Reigate (Mr. Blunt) about the delay in answering questions. Since the Secretary of State's statement, I have tabled more than 50 questions on foundation hospitals, to which I have had no reply, which is staggering. Foundation hospitals are one of the Government's flagship health policies, but Ministers are unable to answer some basic questions. I therefore thought that I might take advantage of our Opposition day debate, and use the rare opportunity of getting the Secretary of State to respond by putting some of my questions to him again.

My questions fall into a number of categories. What freedoms will foundation hospitals have? Will NHS foundation trusts be able to carry out work for private patients through the medium of subsidiary companies and public-private partnership arrangements? Will they have the freedom to vary pay and conditions for clinical conditions outside the Xagenda for change" arrangements announced by the Secretary of State? Will they be required to charge standard tariffs for each area of activity? Those are important questions about the running of foundation hospitals.

On finance, will borrowing by NHS foundation trusts from the private sector be guaranteed by the Secretary of State, strategic health authorities, PCTs or other NHS bodies? Such a basic question has not yet been answered. What assessment has the Secretary of State made of the willingness of the private sector to lend money for capital projects to NHS foundation trusts in the absence of security on related assets? Will NHS foundation trusts be able to transfer their existing assets as part of a private finance initiative transaction, and can they invest surplus financial assets as they wish? What consultation has the Secretary of State had with the Office for National Statistics about the classification of NHS foundation trusts in the national accounts, and what advice has he received? It is a crucial question whether NHS foundation trusts are truly part of the state sector or not, yet on that fundamental issue there is still radio silence from the Secretary of State.

On the board of governors and management, will the board of governors of an NHS foundation trust be able to remove members of a management board? Will local authorities be able to appoint members to the board of governors of an NHS foundation trust? What provision will there be for election to boards of governors of NHS foundation trusts? There is no answer.

On the regulator—one of the stipulations that the Chancellor made to ensure that there was not profligacy—we have asked in what ways the independent regulator will be independent of the Secretary of State; what freedom the independent regulator will have to interpret the terms XNHS standards" and XNHS values" when deciding to issue and monitor foundation trust licences; and whether the Secretary of State will have the power of direction over the independent regulator for foundation trusts.

On the application, what policy will primary care trusts need to have towards a foundation trust application to allow such an application to go forward? Which PCTs will be entitled to have their views considered? As I pointed out in our last exchange, in my constituency, we have no acute hospital. Will our PCT

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therefore have a right to be consulted, and will my constituents, who are not patients in a constituency where there happens to be an acute hospital, have the right to be consulted? What evidence will be required to demonstrate that local people support an application for foundation status?

As he did in his statement, the Secretary of State will no doubt wrap all that up in public ownership terms and speak of the great progress for the co-operative movement, but ownership implies a financial stake and independence. There will be no financial stake, and the Secretary of State will be able to take back foundation status at will. That is not ownership, in my book.

Mr. John Redwood (Wokingham): Does my hon. Friend agree that if those hospitals are to have true freedom, they must have the freedom to buy and sell assets as they see fit in pursuance of their medical and clinical aims, and they need to be free to borrow on the private markets with or without a Government guarantee?

Dr. Fox: There are a number of basic freedoms that have to be defined to make foundation hospitals genuinely independent. We need to hear clearly from the Secretary of State how far the Government are willing to extend such freedoms or, as my right hon. Friend correctly pointed out, the whole exercise will be a complete sham. There is danger in the Government deciding what the prescription ought to be, but being unable to deliver it, for a number of primarily political reasons.

As well as the unanswered questions, there are several enormous contradictions in the prospectus that the Government have issued on foundation hospitals. They have sent a huge number of confused messages. The prospectus claims that the foundation trusts will be free. It states that


However, as the prospectus also makes clear, the trusts will be restricted in a number of ways—for example, in relation to which patients they can treat. Under paragraph 1.30, the licence will restrict the number of private patients that foundation trusts can treat. Paragraph 1.34 will restrict the services that they can provide. Long-term legally binding service agreements with primary care trusts will restrict the types of services that foundation trusts can provide. That is not freedom.

Whom will foundation trusts be able to employ? The prospectus claims in paragraph 1.37 that an NHS foundation trust will be free to recruit and employ its own staff. However, it also states that


In the real world, does that mean that NHS foundation trusts are free to recruit the staff that they want, or that they are not free to do so? The Secretary of State said in his last statement that they would not be able to poach staff from other NHS bodies. Who will define that? Who

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on earth will make that legally binding? Either they have the freedom to employ the staff that they want, or they have not.

How competitive will foundation trusts be? The national pricing structure will guarantee that NHS foundation trusts will be unable to undercut other NHS providers, according to paragraph 1.34. What is the point of giving them freedom to become more efficient if they are not able to lower their costs and thereby undercut other providers? What is the point of the entire exercise if we restrict what they can do, whom they can treat and the cost at which they can do that? The whole thing smacks of being made up as it goes along. It smacks of a panic response by the Government, who think that they must produce reform because the No. 10 policy unit is extremely unhappy with what the Department of Health is doing.

Sadly for the Secretary of State, it is the Chancellor who is slowing down the process. He is the one who put the restrictions on the regulator. He is the one who wanted long-term binding agreements to make sure that foundation trusts cannot operate in a way that is fundamentally different from the way in which the NHS currently operates. It reflects a fundamental split within the Government between those who believe that they must deliver at any cost and those who believe that the means of delivery is still one of the most important things in the Labour party's creed. That is the debate that will no doubt take place on the Government Benches today.

As I have said on many occasions—although the Secretary of State thinks that he and the Daily Mirror have an exclusive on this—the NHS as it is currently constructed and run is not working and will not work, irrespective of how much money is thrown at the system. The one question that needs to be answered is this: if the present NHS model is such a great model, why has it not been adopted by any other country in the world? The Government have at least been clear in laying out their prescription. Whether they can deliver it is another matter.

The Liberal Democrats have four hon. Members on their Benches and have not yet intervened in the debate. The House will be interested to know that in the Register of Members' Interests, the hon. Member for Winchester (Mr. Oaten) tells us that the Liberal party literature in his constituency is sponsored by Denplan. That might explain why the Liberals have such an odd view of private medicine. However, the House would all agree that there is a logical link between the Liberals being sponsored by Denplan and the content of their literature. Most of that is designed for them to lie through their teeth, so I suppose it is only logical that they would want to look after them.

We in the House need to look at what has happened in other countries and where success has come from. I suggest that where there is a genuine mix of public and private provision and public and private finance, the record of health care is better than it is in this country. The Government may be moving towards more mixed provision in their current proposals, but as long as health care is provided irrespective of the ability to pay and free at the point of use, both of which the Conservative party supports, we need have no fear of diversity. Diversity provides innovation, and innovation provides excellence.

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Foundation hospitals begin that process of diversity, the break-up of the monolith and the beginning of the end of a centralised national health service. No doubt the Secretary of State will dip liberally into the lexicon of the left when describing his policy today. That is no less than we would expect from a Minister in his position when facing the opposition of his own Back Benchers. However, his real test is not today. If he can keep his nerve and see his policy through without dilution, he just might begin to make a difference in the process of providing better health care in this country, and he would have the support of the Conservative party. It is a direction with which we are comfortable. If he knows what needs to be done, but he does not have the power within the Government or the courage to do so, the patients and the voters of this country will not be forgiving.


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