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8 Jan 2003 : Column 201continued
Dr. Harris: If the hon. Lady looks at the history of the trust, she will see that it was subject to several ratingsthe Government's flawed star rating system, which means very little, and, more worth while, a Commission for Health Improvement report which identified significant failures. Unfortunately, the Secretary of State is like a man with three watches. The Dr. Foster performance tables say one thing, the Commission for Health Improvement will say another, while the star rating systems will give an entirely different view. In the midlands and the London area, different ratings have been provided by each mechanism. The correct one,
Dr. Harris: I would choose the Commission for Health Improvement's in-depth studies. [Interruption.] However, unfortunately, the Secretary of State has subverted the commission's studies by forcing it to inspect against his star rating system so even when he had a quality programme of inspection in which the health service could have confidence, he subverted it because of political priorities. The Commission for Health Improvement and the people who work in the health service recognise that as long as they are inspected against his political targets, standards are not being properly measured.
The Oxford Radcliffe NHS trust, which services my area, does not have worse doctors and nurses or poorer outcomes than anywhere else, but it did not achieve any stars. This was specifically because it was unable to admit patients as the local social services could not place people who were ready to leave and because some 120 beds were closed because of an inability to recruit nurses at the wages for which the Government are responsible. Simply to use the people working in the hospitals as a scapegoat misses the point.
Dr. Harris: In the latest Billand, I suspect in the new Billthe Commission for Health Improvement will be forced to inspect according to priorities and targets set by the Department of Health. The Secretary of State is not disagreeing with me. The targets will not be set according to public health indicators of general health outcomesthey will be ridiculous, such as the number of people waiting for procedures. That is a measure of activity and of the number of people using the service. It is not a measure of the amount of time that people wait, which is critical.
Furthermore, it is clear that foundation hospitals will not be free from Whitehall control. They will still be subject to Commission for Health Improvement inspections based on the targets and the star ratings. They should be inspected by the commission but should design their own rational, evidence-based and patient-centered outcomes rather than having to use the Government's politically centred and target-based outcomes.
Foundation hospitals will also be subject to performance management by commissioners. That is right and proper, but the commissioners are forced to measure the trust's performance against the Government's star rating targets.
The Secretary of State will have the power to remove foundation hospital status. That Damoclean sword hanging over the trusts gives the Secretary of State yet more power , so even when the right hon. Gentleman talks about freedom, he is not talking about genuine
Is it right that foundation hospitals should be free to sell landland that they have not bought but happen to have through serendipity, which really belongs to the entire NHS and therefore the public purse? Why should those foundation hospitals be given specific advantages to sell off land to use in their area?
The other inconsistency surrounds local pay. The Government said that there will be local pay flexibility but that there can and will be no poaching. How will that work? The Secretary of State has never given a satisfactory answer to me, Conservative Front Benchers or his own Back Benchers. Will people have to sign an affidavit when they change jobs for the perks that are available through local pay flexibility that they have not left another NHS employer or that if they have, they are not doing it for the purpose of benefiting from local pay flexibility?
I turn now to the good things about the Government's proposalwell, the good thing about the Government's proposal. [Interruption.] There is only one good thing about this proposalthe restriction on pay beds in these hospitals. The problem with pay beds in the NHS when NHS capacity is limited is that part of the capacity is thereby restricted solely to those who can afford to pay. There may be an argument when there is spare capacity for allowing people with resources to choose to have their private treatment in the NHS. It also helps to keep consultants in the NHS, if the Government are unable to get them to stick to their job plans. However, pay beds simply allow people to buy their way in ahead of the queue at the expense of those whose need is more urgent but who cannot afford to pay. Pay beds do not even bring in the extra resources that the Government claim they do.
Mr. Mark Simmonds (Boston and Skegness): Does the hon. Gentleman accept that the ability of foundation or other hospitals to treat private patients would generate revenue that could then be transferred to the treatment of additional national health service patients?
Dr. Harris: I have just said that that is not the case. When I asked a hospital in my area what proportion of its operations were given over to paying patients in its private wing, the answer was 20 per cent. I asked what the net income to the hospital was. It is very difficult to
In the Barber memo, the Government state that a productivity improvement of about 15 per cent. is needed. Will the Secretary of State explain the difference between the 15 per cent. efficiency gain per pound spent, currently being demanded by Labour masters, and the efficiency gains that he decried when he was in opposition?
On democratic accountability, the Government are choosing weird electorates, based on an opt-in process, instead of using existing democratically accountable local authorities or regional bodies. The Government claim to be devolving, but they are not offering true freedomthey are simply devolving the blame. They are giving new status to the provider side, but they are not decentralising decision making or giving freedom to the commissioning side. On flexibility, they say that, yes, there will be local pay, yet there will be no poaching.
On the one hand, the Government say that these new beasts will be free from Whitehall control while, on the other, they will still be subject to targets and star ratings through the CHI and commissioning performance management. The more that the Secretary of State describes his policy on foundation hospitals, the more muddled and inconsistent it becomes. In trying to please the right-wing free marketeers in 10 Downing street while appeasing Labour rebels loyal to 11 Downing street, the right hon. Gentleman is trying to have it both ways and will end up satisfying no one but himselfand he looks very satisfied.
The fundamental problem is that foundation hospitals are neither truly free nor locally accountable and that, to the extent that they have flexibility, they are divisive. In the light of the memo from Michael Barber expressing concern about the potential failure to deliver on health targets, we can see what a failure the policy on foundation hospitals is: flawed proposals, inadequately defended by a rattled and increasingly desperate Secretary of State.
Mr. Frank Dobson (Holborn and St. Pancras): As we debate this Tory motion, it is worth reminding the House that the national health service is by a long distance the most popular institution in the country. It is certainly at least twice as popular as the Tory party. Indeed, it is more popular at present than the Tory party ever waseven at the height of its popularity. That is why the Tories have two problems when they are talking
For a start, the Tories opposed the establishment of the NHS. Then, because it proved so successful and popular, they could never dare make a frontal attack on it and resorted, over decades, to a policy of malign interference. The Tories left the national health service short of money, short of staff, short of beds and short of modern equipment. Almost the only thing the NHS was not short of under the Tories was reorganisation, reform and modernisation. The Tories delivered reorganisation to the health service by the bucketload: endless rounds of structural change that achieved little or nothing while consuming resources and distracting staff from the priority of treating patients.
That placed a huge burden on the staff. They becameand remainsick to death of structural change for the sake of it. The whole country owes NHS staff a huge debt of gratitude, because the health service was kept alive during the Tory years only by the commitment of its staff, their dedication to the public service ethic and their resistance to the Tory introduction of competition.
Now, the Tories are at it again. Not content with a double whammyas invented by a former chair of the Tory partythey have come up with a triple whammy. They want to cut NHS funding by 20 per cent. They want to go over to a funding system that is more expensive and less cost-effective than the present one and to break up the NHS in preparation for privatisation.
Where do the Tories' ideas come from? They say that we should imitate Europe. That really takes the biscuit. The most anti-European party of modern times, the knee-jerk Eurosceptics, are saying that we must imitate Europe. Apparently, they claim to have been on a European study tour. It is clear that rather more touring than studying went on, because they appear to have missed the fact that while they were in government investment in health care in Europe was far higher than it was in this country.
The Tories have also missed the fact that the level of tax in Britain is lower than it is in most European countries. Never mind that, they say. Spend less on the NHS, they say. British people pay too much tax, they say. Let us force the British people to pay tax and also take out private medical insurance, they sayand they say it as though private medical insurance came free. However, private medical insurance does not come free; it costs money. What people do not pay on the taxation swings, they have to pay on the private insurance roundabout.
The Tories have come up with a real gem of a popular policy for the British people: pay tax and top it up by paying for private health carein other words, top-up fees for the NHS. What the Tories are talking about means more money being spent on the bureaucracy of insurance cover; an extra burden on business as firms feel obliged to pay insurance cover for their employees, thus eliminating one of our advantages as a centre of attraction for inward investment; and people's health cover being dependent on private insurerspresumably such as Equitable Life or Britannic Assurance.
On top of that, the Tories have seized on the idea for foundation hospitals because they see it as leading to the introduction of competition in the health service and the break-up of the NHS. They see the establishment of foundation hospitals as a big step down their road of privatisation.
That is no surprise, of course, because the Tories want to privatise the NHS. They stand for competition, elitism and privilege. They always have and they always will. However, what surprises and, indeed, saddens me is that it is our Labour Government who are proposing foundation hospitalsa system in which some hospitals will deliberately be given advantages over neighbouring ones, inevitably leading to a two-tier service.
Some of the articles and speeches in favour of foundation hospitals state that they represent traditional socialist values in a modern settingnot just new Labour but new socialism. Some of those articles note that the Tories will not oppose foundation hospitals, which has certainly been confirmed today. The House may call me old-fashioned, but it has never occurred to me that Tory support for an idea was a touchstone of its socialist nature.
I freely admit that part of my objection to foundation hospitals is ideological. That is one reason that my views are shared by most people in the Labour party and, of course, why they are not shared by the Tory party. However, most of my case against foundation hospitals