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8 Jan 2003 : Column 206—continued

Mr. Jon Owen Jones: Will my right hon. Friend give way?

Mr. Dobson: No, not for a moment—partly because Wales is not yet threatened with foundation hospitals and my hon. Friend would be talking about theory while we are talking about something that may in practice damage our constituents.

Mr. Jones: In that case, may I again ask my right hon. Friend to give way?

Mr. Dobson: No, I shall not give way.

Most of my case against foundation hospitals is not ideological but strictly practical. That is why that case is shared by most people working in the NHS and opposed by the Tories.

The starting point for any discussion of the future of the NHS must be the recognition that two decades of Tory failure to train enough doctors, nurses, midwives and therapists means that those skilled professionals will be in short supply for many years to come. That is unavoidable. For as long as that shortage exists, to give financial and other advantages to some hospitals can only be at the expense of neighbouring hospitals, because there is no surplus. For example, the chief executive of University College hospital in my constituency is desperate that it should become a foundation trust. If that comes about and the hospital can consequently offer better pay and working conditions, it will inevitably attract scarce staff from neighbouring hospitals that also serve my constituency—perhaps from the Royal Free, the Whittington, Barts or Great Ormond Street. The same will apply in every part of the country in which a

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foundation hospital is established. The best may get better as a result, but that can only be at the expense of the rest.

Ms Drown: One of the unanswered questions put in the debate in Westminster Hall yesterday related to extra pay being given to foundation trust staff. Does my right hon. Friend think that it would be appropriate for all the neighbouring trusts to have to sign off any differences from the national pay structure to ensure that staff were not pinched by other trusts?

Mr. Dobson: I must admit that that had not occurred to me, but it seems that that is very difficult territory. Let us suppose that University College hospital had a vacancy. I cannot see how, in employment law, someone who wanted to apply for that vacancy could be stopped from doing so, irrespective of whom they were working for. As to the effect of the pay deal, I will need to think about that.

There is a danger that the foundation hospitals will reintroduce competition into the national health service and set hospital against hospital. That is what we promised to get rid of, which we have done. It would not even be fair competition, however, as it would be a handicap race in which the least favoured horses carried the heaviest handicaps, which would be contrary to Jockey Club rules. That cannot be right, which is why I cannot support it.

Besides getting extra funding, the Secretary of State says rightly that foundation hospitals should be free from central direction and control, with fewer Government targets, less interference and less earmarking of extra funds. I agree with that, and I must plead guilty that some of that interference started when I was Secretary of State for Health. I was becoming a little dubious about some of that by the time I resigned, although I must say, from observation, that there has been rather more of it since. My point to my right hon. Friend the Secretary of State—he is my friend—is that interference and central direction is not just a burden for the best hospitals; it is a burden for all of them. The argument must therefore be to ease up on all of them, except for perhaps one or two desperate cases. Above all, we should try to let them get on with their job, give them a chance to settle down with the changes that have been made so far, and allow them to concentrate on dealing with patients.

The NHS needs change, but it does not need more structural change; it is sick to death of that. We need local, practical changes to help the clinical staff to do their job that include new and better ways of running clinics and dealing with out-patients; help in reducing cross-infections; relieving clinical staff of necessary clerical work, which the Tories forced on to them when they got rid of legions of clerks in the health service; reducing assaults on staff; and providing what the Tories singularly failed to provide—a modern IT system that serves the needs of patients and staff. Those are vital, local, long-term improvements. Greatly to his credit, my right hon. Friend is getting on with many of those things, and he and all his officials should be concentrating on that. He should ignore the anonymous

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advisers who have an obsession with continuous change. They are like a collection of Maoists driven by the concept of continuous revolution.

Mr. Milburn: Trotskyists.

Mr. Dobson: I thought that, too. Perhaps the Secretary of State knows more about Trotsky than I do, but I was told that it was Mao who devised that theory. Whoever is the source of that influence, it is out of place among Downing street advisers.

One of the problems with the constant effort towards change is that we are seeing doubts growing about the Government's overall intentions. Foundation hospitals are being linked in the minds of sensible people with the franchising-out of national health service hospitals that are in trouble, or the franchising-out of new diagnostic and treatment centres. That is beginning to look like ending the commitment to a national service and a move towards a mixed economy in health care, blurring what has up to now been a clear distinction between the Labour party and the Tories.

There is no logic in the Tories' position. They say that the present system is fundamentally wrong, but if the best hospitals are doing really well under the existing system, that shows that it is not fundamentally wrong, as it can produce first-rate performances. The Government apparently accept that, but they are saying that they will give new status to the successful while expecting the unsuccessful to catch up using the existing system. It seems to me, therefore, that the Government are placing even more faith in the existing system than anybody else has done hitherto. If they have faith in the existing system, surely we should stick to it.

Many of the problems that we face spring from the adherence to the concept of choice and diversity. There can only be a real choice for everybody if there is a surplus, but there is no surplus of staff or beds. Most patients are not looking for choice. As I have said before, someone who lives in Leicester wants one of the hospitals in Leicester to provide first-rate care; they do not want the choice of going to a foundation hospital in Nottingham.

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

Mr. Dobson: No. I do not have much time, and I want to make progress.

In addition, the establishment of foundation hospitals will cause great trouble for general practitioners, who will be faced with patients who say, XI do not want to go to the local hospital, I want to go to the foundation hospital down the road." That will not be of overall benefit. I come back to the point that we ought to let people in the NHS get on with their jobs, and ignore the anonymous, Maoist—or Trotskyist—advisers at No. 10. They have not even learned the lessons of the waste of time and money when the Tories were in charge, and of constant, repeated reorganisation on top of reorganisation. They should learn lessons from the Tories, not repeat their mistakes.

I urge my right hon. Friend to carry on with the practical measures that he is introducing, which go right across the board in an effort to improve our health system, and to ignore the option of individualised,

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specialised treatment for a limited number of privileged hospitals. Whether he intends it or not, the latter option is bound to bring about a two-tier service, which will damage the national health service and blur the distinction between our party and its wonderful record on the health service and the Tories and their abominable record.

2.17 pm

Mr. Stephen Dorrell (Charnwood): I hope that the right hon. Member for Holborn and St. Pancras (Mr. Dobson) will not misunderstand me if I say that his speech had an air of familiarity about it. It is fair to say that he and I have exchanged arguments on similar subjects across the Floor of the House of Commons for more than decade; in truth, we have argued about exactly this policy for more than a decade. What has changed this afternoon is that the Secretary of State has swapped sides in the argument.

The right hon. Member for Holborn and St. Pancras has been as consistent as I have been; he has argued against the establishment of, first, NHS trusts and, now, foundation hospitals. I have argued, first, for the establishment of NHS trusts, and I shall go on to argue in support of the principle of foundation hospitals today. In doing so, I shall take the opportunity to welcome the Secretary of State as a turncoat from the arguments that have just been advanced by the former Secretary of State, the right hon. Member for Holborn and St. Pancras, to the arguments that were first advanced by my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) when he was Secretary of State in 1989.

The reality is that the analysis that has led the Secretary of State to advance the policy of foundation hospitals is exactly the same as that which led my right hon. and learned Friend to advance essentially the same policy through the NHS reforms of 1990. The right hon. Member for Holborn and St. Pancras understands that, as does the hon. Member for Wakefield (Mr. Hinchliffe), the Chairman of the Select Committee, who has made clear his opposition to the Secretary of State's policy. What is also clear, although the Secretary of State was less explicit about it this afternoon, is that he understands it.

When the right hon. Gentleman was speaking to a meeting of health service representatives on 22 May last year, he described the NHS trust policy of my right hon. and learned Friend the Member for Rushcliffe as Xa halfway house". If that is the case, the obvious question is what it is halfway between. The truth is that the Secretary of State is being more ambitious in espousing the arguments that led to the establishment of NHS trusts than were the Government of whom I was a member, and I plead guilty to that charge.

The Secretary of State's critique of NHS trusts is that they are not sufficiently free from external centralised control. The system that we set up, which was freer from those controls than the system that went before, is now dismissed as a halfway house. I offer him the thought that the challenge that he should embrace is to show, when he has completed the delivery and implementation of his policy, not that trusts were a halfway house but that they were short of being a halfway house. Let him be more bold. Let him try to get more than double the distance away from the policy as it was before trusts were established.

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In short, I agree with the Secretary of State's analysis, and I congratulate him on it, of one of the key problems on what we used to call the provider side of the NHS. It is that one of the major failings of the health service, pre-and post-trusts, is that the degree of central control stifles innovation and the efficient use of resources. I hope that the right hon. Gentleman will agree with me that that is true not only of big acute hospital trusts but of the whole delivery of health care within the NHS, including community trusts, mental health care and care for those with learning disabilities. We must not be seduced by the big-budget acute hospitals.

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