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8 Jan 2003 : Column 195—continued

Mr. Dawson: In concentrating on his speech, my right hon. Friend has obviously not noticed the eloquent facial expressions of the hon. Member for Woodspring (Dr. Fox). Every time the values and principles of the NHS are mentioned by my right hon. Friend, the hon. Gentleman pulls a face. That shows the difference—the Opposition do not understand the values and principles of the national health service.

Mr. Milburn: My hon. Friend is absolutely right. I was about to say that perhaps I am not sorry to hear of the hon. Gentleman's pain, but as it is early in the new year I shall be generous and say that I am very sorry to hear that he is in some pain.

So I say to my hon. Friends: do not be fooled by the hon. Gentleman's argument that NHS foundation trusts further the Tories' agenda—

Helen Jones (Warrington, North): If my right hon. Friend's aim in setting up foundation trusts is to give more power back to the local community, why are we not creating a system in which everyone on the electoral register in the locality is automatically a member of the foundation trust? Why is there an opt-in provision? Who will the electorate be for a regional hospital like Christie hospital, or Walton hospital's neurosurgery unit?

Mr. Milburn: My hon. Friend makes two very important points. First, automatic entitlement on the basis of the electoral register is an option in terms of becoming a member of an NHS foundation trust. Since people need to demonstrate positive involvement with their national health service, my own preference is that they apply for membership. However, there are two different, although not necessarily competing, ways of doing that, and to tell the truth I have a relatively open mind on the issue.

On the second point about membership that my hon. Friend raises, as we tried to explain in the guide published on 11 December, different hospitals are in different positions. Some serve one town or even approximately one constituency, and others such as the neurosurgery centre at Walton hospital and the Christie

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hospital serve a broader span of patients. I can think of hospitals in this city, such as the Royal Marsden hospital, which are not really local hospitals at all, but national tertiary centres. In those cases we need a slightly different form of governance, and perhaps people from the local community can apply if they want to become members of an NHS foundation trust. However, in most situations it must be right for the patients who have used those hospitals—they often have a very deep attachment to them, and a long-standing relationship with them—to formalise that relationship through membership. The important point is that principles will underpin our assessment of governance proposals from NHS foundation trusts, but there must also be some flexibility, given the very differing positions that NHS hospitals are in.

Dr. Andrew Murrison (Westbury): I wonder whether the Secretary of State can help me. I am struggling with his concept of an opt-in electorate for foundation hospital boards. His party is always railing against the sharp elbow of the middle classes. How on earth does he expect an opt-in electorate to work? Surely that will increase the power of a small part of the electorate, rather than giving a broad spread of influence to the people whom I think he is trying to help.

Mr. Milburn: Frankly, that is absolute and patronising nonsense of the highest order, and it speaks volumes about the perspective of the hon. Gentleman and his party. Some people managed to join even the Conservative party, so I have heard, and people certainly managed to join the Labour party. If people are passionately committed to an organisation, they tend to want to join it. That is the tradition of mutualism and co-operation that underpins NHS foundation trusts, and it is a perfectly good principle.

So I say to those of my hon. Friends who are concerned about this issue: do not be fooled by the argument of the hon. Member for Woodspring that foundation trusts somehow advance the Tories' agenda, because the reverse is the case. Their agenda is self-evident: to make patients pay in a privatised system of care, and to pass NHS hospitals out of public ownership and into private ownership.

NHS foundation trusts would frustrate both of those Tory ambitions. Any future Conservative Government would not only have to pass an Act of Parliament to dismantle the NHS; they would have to legislate to take away direct ownership from the local communities in which it has been vested. NHS foundation trusts are a means not of weakening public ownership, but of strengthening it.

The hon. Gentleman now says that all hospitals should become foundation hospitals, and in time that may be a laudable enough ambition, but today, as he well knows, NHS trusts have very different starting points. Some would benefit from more freedom, and others from more support; frankly, a few need more central intervention.

As we set out in the NHS plan, the more performance improves among local health services, the more autonomy will be earned. That is why we plan that the first round of NHS foundation hospitals will be drawn from trusts that are rated Xthree star" next summer. As

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more NHS trusts improve, more will be eligible to gain foundation status. There will be no arbitrary cap on the number of NHS foundation trusts.

Over time, NHS foundation trust status will become the norm for many—perhaps most—hospitals in the national health service. These are radical reforms and it is right they be taken step by step.

Mr. Dawson: Will my right hon. Friend give way?

Mr. Milburn: No, I want to make progress and wind up, because I know that other hon. Members want to get in. It would be folly to believe that reforms can be delivered without resources, and it is self-evident that the NHS needs both. No party can claim with credibility as a reformer of public services if it is not also an investor in public services. The problem for the Liberal Democrat party is that it wants the investment but does not want the reform. The problem for the Conservative party is that it says that it wants reform, but it will not commit to investment. In fact, it is becoming increasingly clear that today's Conservative party appears hellbent not on reform of the health service, but on its wholesale abandonment. What other interpretation can be placed on its twists and turns on tax and spending during the Christmas period?

On the first day of this Tory turmoil—the morning of 22 December—the Leader of the Opposition was reported in The Sunday Times as saying that the Tories were going to talk more in 2003 about cutting spending. On the afternoon of the same day, the shadow Chancellor contradicted the Leader of the Opposition in an interview on the BBC. Six days later, the shadow Chief Secretary contradicted the shadow Chancellor with a proposal of a 20 per cent. cut in public services. On 31 December, the Leader of the Opposition contradicted the shadow Chancellor by supporting the position on spending cuts taken by the shadow Chief Secretary, who had himself contradicted the shadow Chancellor only a week before. Simultaneously, the Leader of the Opposition contradicted the shadow Chief Secretary by saying that the Conservatives are

including, therefore, in health and education.

The hon. Member for Woodspring has the nerve to stand at the Disptach Box and talk about policy debates within the Government. There were more episodes of this Tory soap opera over the Christmas holidays than there were of XEastEnders". So where exactly does the hon. Gentleman stand? Does he back the 20 per cent. cuts or not? He is prepared to welcome Labour policy on foundation hospitals, but is he prepared to welcome the Conservative policy of 20 per cent. cuts in all NHS hospitals?

The Conservatives must be the only people in the country who believe that the best way to get more out of the health service is to put less into it. So this Xchanged" and Xmodernised" Conservative party—the self-proclaimed caring, sharing party of the vulnerable—offers us nothing but the oldest Tory policy in the book: cut back on public services, force more people to pay privately, provide tax perks for those who need them least, and offer poorer public services for those that need them most. The way forward for the NHS is a programme of investment and reform: high and

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sustained investment, and bold and radical reform. The Conservatives' programme is cutback and closure, Labour's is investment plus reform. It is our programme that will deliver improvement in the NHS.

1.49 pm

Dr. Evan Harris (Oxford, West and Abingdon): The internal Government memo leaked to the Financial Times said that there was an Ximmense risk" that the Government's NHS investment might be squandered. It said that the Department had to do more, that there has not been enough forethought and planning, that there is weakness in the primary care trusts and strategic health authorities set up by the Secretary of State, that the Department needs to get the right people into the right jobs faster—perhaps chilling words for the right hon. Gentleman—and that the Department was understaffed. Downing street has apparently responded saying that that was a sign of the Department's strength. That is a bizarre interpretation of the Department's criticism of itself.

There is no doubt that the NHS needs reform. The Secretary of State has an endearing way of saying that everyone with whom he disagrees is stupid and also that he is the way and the light, so that the only path to reform is through him. He is probably wrong on the former count, and certainly wrong on the latter. The Liberal Democrats have a specific programme of reform. The last time we debated these matters I invited the right hon. Gentleman to read up on the policy. I know that he is a busy man, and he may not be very interested, but he should not say that my party has no reform proposals until he has made the effort to read about them. No doubt he will want to criticise them, but ours is the only party with a clear and rational approach to delivering an accountable and efficient NHS. We want national targets to be abolished and funding, purchasing and strategic decision making to be radically decentralised to the regions and to local NHS bodies that are democratically accountable to people on normal local electoral rolls.

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