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8 Jan 2003 : Column 192—continued
Mr. Lindsay Hoyle (Chorley): I welcome what the Government have done on NHS funding, but there is still a problem as between primary care trusts and the hospice movement. For example, Derian House children's hospice works very broadly—way beyond the north-west—yet there is no contribution from primary care trusts, so the hospice is the poor relation when it comes to funding. What help and support can my right hon. Friend give to ensure that the hospice movement gets its fair share of money and that we in Chorley do not suffer?
Mr. Milburn: My hon. Friend makes an important point, not just for his local hospice, which I know he is passionately committed to, but for hospices in many constituencies up and down the country that are in a similar position. As he knows, a hospice often serves not just one constituency or area, but a broader region, and it may also specialise nationally in particular conditions.
My hon. Friend is right to say that there is a fault line in the system whereby a hospice runs the risk of losing out if decisions are left to local PCTs. That is why one of the proposals that we are taking forward through the Under-Secretary, my hon. Friend the Member for Salford, who has responsibility for public health, aims to ensure that there is a national partnership group involving the national hospice associations precisely to address such problems. I hope that that benefits not just the constituents of my hon. Friend the Member for Chorley (Mr. Hoyle), but the hospice movement nationally.
I want to set out the facts on NHS foundation trusts. I also want to deal with some specific issues raised today by the hon. Member for Woodspring, as well as issues that he raised in response to my statement to the House on 11 December. First, those NHS foundation trusts will be part and parcel of the NHS. They will provide NHS services to NHS patients according to NHS principles. They will be subject to NHS standards, NHS star ratings and NHS systems of inspection. It is that which the hon. Gentleman completely fails to understand. [Interruption.] I am not surprised that the hon. Member for Oxford, West and Abingdon, who speaks for the Liberals, fails to understand, because he fails to understand most things.
Mr. Milburn: No, the hon. Gentleman will get a chance in a moment or two.
Indeed, the comments made on 11 December by the hon. Member for Woodspring at column 274 of Hansard not only suggest that he is mystified that we
could have foundation hospitals within the NHS, but signal a completely different vision for the future of health care in our country. He says that he wants foundation hospitals, but he will not say that he wants them in the NHS. Indeed, the Conservative motion is striking for the very absence of the words Xnational health service".As the hon. Gentleman seemed to indicate on 11 December, he wants hospitals to become free-standing privately run shareholder-led organisations, presumably because he regards the precedent of organisations such as Railtrack as an unmitigated success story, when everyone else in the country knows what an unmitigated disaster that failed Tory privatisation really was.
The hon. Gentleman may want NHS hospitals to be privatised. We want them to remain in public ownership. Indeed, part of the purpose of our NHS foundation trust policy is to usher in a new era of public ownership in which local communities control and own their local hospitals. The legal owners, who will elect the hospital governors of those NHS foundation trusts, will be local people, local members of staff and those representing key local organisations such as the PCTs. So in place of central state ownership there will be genuine local public ownership. That is no more a Tory policy for the health service than the minimum wage is a Tory policy on low pay; nor, indeed, is the Tory party the party of the vulnerable. To paraphrase the hon. Member for Buckingham on the Tories' electoral prospects, that is as believable as finding Eskimos in the desert.
Mr. John Bercow (Buckingham): I am grateful to the Secretary of State for giving way, although his badinage is a little more downmarket than I had confidently anticipated. It might add to the gaiety of the nation, but it does not improve the quality of his argument. May I put a simple proposition to him? Given that there has been a 28 per cent. real-terms increase in health expenditure in Scotland since 1997, but that that increase has been accompanied by a 25 per cent. rise in average waiting times, does he not recognise that it is grossly complacent of him to delay for two years the introduction of the new audit and inspection arrangements following the announcement of the money for which we need to know we are getting decent value?
Mr. Milburn: I always listen extremely carefully to what the hon. Gentleman says, and I am sure that the Leader of the Opposition does too. I know that they have a warm and meaningful relationship, or at least they used to until very recently.
To answer the hon. Gentleman's points, we shall introduce legislation as soon as we are able to establish the new health care audit and inspection commission. I hope that he feels able to support the establishment of that new Commission for Health Improvement, because it will be an important safeguard to enable members of the public and members of staff working in the NHS to know how well local health services are performing.
On the hon. Gentleman's point about investment, he frequently hears from me and from the Prime Minister that investment must be accompanied by reforms. If we
are to get the best value from the money, we have to have both. The problem for him and his party is that he wants only one of those. He talks about reform, but he is not terribly interested in investment.
Mr. Milburn: The hon. Gentleman may be, but the problem for him is Opposition Front Benchers and, in particular, the Opposition leadership. This is a Labour policy steeped in Labour traditions of mutualism, community empowerment and the history—[Interruption.] As far as I am aware as a former student of history, those were never closely associated with the Conservative party, either in the last century or in this. The policy is steeped in the history of co-operation that gave birth first to the Labour party and then to our proudest creation, the national health service.
Mr. Mark Francois (Rayleigh): Will the Secretary of State give way?
Mr. Milburn: No. Putting staff and public in charge of those NHS hospitals will give them the freedom to innovate and develop services better suited to the needs of different local communities. NHS foundation trusts will be free from Whitehall direction and control so that we can genuinely unleash the spirit of public service enterprise, which so many NHS staff share. [Interruption.] The hon. Member for Woodspring asked a series of specific questions, which I am going to answer. Those hospitals will be free to borrow, either from the public sector or from the private.
On those hospitals borrowing against their assets and our discussions with private sector lending organisations, we do not believe that it would be right to allow borrowing against assets, as they are needed to continue to provide NHS services to the local community and to local patients in all circumstances. Indeed, an important point is made by the private sector: it is not sure, either, that they would necessarily want to borrow against those assets. The borrowing will be against the revenue streams that NHS foundation trusts earn if they successfully negotiate agreements with local PCTs.
On classification, I have not had a discussion with the Office for National Statistics, nor would it be appropriate for me to do so. I do not make decisions on public or private sector classification, nor does any Cabinet Minister or any other Minister. The ONS is properly independent; the decision is for the ONS to take.
Mr. Milburn: I am running through the questions that the hon. Gentleman raised. He asked the questions; I am giving him the answers. [Interruption.] I may not be giving the hon. Gentleman the answers that he wants, but I am giving the answers that I want to give.
These hospitals will be free to retain any surpluses and any proceeds from the more efficient use of their assets where that is for the benefit of NHS patients. They will have freedom to recruit and employ their own staff. However, as I told the House on 11 December,
safeguards will rightly balance those freedoms to ensure that NHS foundation trusts always act in the public interest for the benefit of NHS patients. They will operate according to a licence issued and monitored by an independent regulator, accountable to Parliament. [Interruption.] No. They will be subject to no direction from me or from any other Minister. That will guarantee NHS standards and NHS values.Those hospitals will be bound by a statutory duty of partnership to work in concert with other local NHS organisations. The proportion of private patient work undertaken by any NHS foundation trust will be strictly capped to its existing level. They will not be able to compete for patients by undercutting other NHS hospitals. Also, to prevent any demutualisation or any future Government's seeking privatisation, there will be a legal lock on the assets of NHS foundation trusts and on the purpose for which they can be used.
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