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8 Jan 2003 : Column 217—continued

Mr. John Redwood (Wokingham): I have declared my interests in the register.

The test I apply to a health policy is this: will it be good for my constituents? I am a strong supporter of the NHS and its principles. I want all my constituents who need health care to get access to it in a timely way. I want them to receive high-quality care that is free at the point of need and use. I regret the way in which such debates are characterised by Labour Members, who make futile and inaccurate attacks on the Conservatives. Many of us are children of the NHS. We have received our care and attention from the NHS when we have needed it. The Conservatives have a long record in government of increasing money to the NHS year after year. We never privatised it or attacked it in the way that Labour Members claim, yet they are still peddling the same old nonsense.

Nor is it the case that Conservative Front-Bench spokesmen are wedded to 20 per cent. cuts across the board. I have seen a comment by the shadow Chief Secretary to the Treasury, who would not be doing his job if he were not looking for ways to improve and reduce spending, that he would like to find examples of wasteful spending that he could cut by 20 per cent. I am happy to recommend one to him from my area. I should like him to get rid of more than 20 per cent. of the regional government that is being foisted upon us. It is totally unnecessary and completely wasteful. I would rather have more nurses and doctors than more bureaucrats in Guildford misrepresenting our views and getting in our way.

I am delighted that the Royal Berkshire hospital, which serves my constituency and adjacent ones, received substantially larger sums in successive years under Conservative Administrations and has received more money under the Labour Administration. I am confident that when a Conservative Government are elected, they will not cut the amount of money going to that hospital, but that they will accept the budgets they inherit and see the need to continue to increase them, as they always did in the past. I wish that that were common ground between the parties.

Caroline Flint (Don Valley): The right hon. Gentleman says that the 20 per cent. cut in public services proposed by his party over Christmas would not affect the health service. What does he say to the member of the shadow Cabinet quoted in The Sunday Telegraph—

Mr. Burns: It says here.

Caroline Flint: Yes, it does say here, in The Sunday Telegraph of 29 December:


Does not that suggest that some of the 20 per cent. cut will attack public services, including the health service?

Mr. Redwood: No, it does not suggest that at all. I repeat my firm promise and expectation that the policy, when announced in the run-up to the election, will not include a single cut to a hospital such as the Royal

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Berkshire hospital, and that our pledge to increase the number of nurses, doctors and other important medical staff in hospitals will need to be renewed. I am sure that we will want to employ all those whom we inherit, and I am equally sure that we will discover that there are not enough. That is because almost six years into a Labour Government—a Government who came to power pledged to save the NHS—we discover that the Royal Berkshire hospital is still chronically short of beds, consultants and nurses, waiting times are unacceptably long, and sometimes even the quality of care suffers because of the pressures the medical staff are under. I would dearly love the Government to sort that problem out. I thought that the one thing that a Labour Government might do for my local area was get enough money into the hospital to enable it to hire the staff needed, but, unfortunately, they have not done so.

When evaluating foundation hospitals, I ask myself whether they might be the answer. I find that difficult to judge yet, because of the paucity of information and the complexity of and imperfections in the details that have so far come before us. Sometimes, I wake up thinking, yes, foundation hospitals could be the answer—they could be real reform, providing the freedom we need to manage our hospital locally and the opportunity to raise money from private sources if we cannot get enough from public sources. On other occasions, when I hear Labour Ministers and spokesmen and read the conflicting details that emerge, I think that foundation hospitals will be merely an expensive charade.

What is needed to make the policy work? First, I would like my hospital and others like it to be eligible, regardless of star ratings. If it makes sense to free good hospitals, would it not make sense to free hospitals that are not doing well within the current structure, to see whether local management would be better than highly centralised management? I would like foundation status to be available to any group that wanted to improve the hospital and to exercise freedoms, whatever their current star rating.

Secondly, I would like genuine freedom to be given to those that gain foundation hospital status to borrow against their assets as well as against their revenue stream. An artificial distinction has been drawn. Today, we heard the Secretary of State say that it would be quite wrong to allow foundation hospitals to borrow against their assets, because the wicked capitalists might, in certain circumstances, then take the assets away, but it is perfectly reasonable to let them borrow against their revenue stream. I cannot see how that type of technical nitpicking will work in practice.

Dr. Stoate: The right hon. Gentleman believes that all hospitals should be given the opportunity to become foundation hospitals. Is he suggesting that even hospitals that are manifestly failing to deliver a reasonable service should be given those freedoms, without any sorts of checks and balances to prevent their failing their local communities even more than some are doing currently?

Mr. Redwood: I do not think that they would fail their communities more. I think that they would fail them less if they had more freedom. Much of the failure derives from central control, direction, intervention and bureaucracy, which is well above the heads of local

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management. That must be the Secretary of State's view, because he now wishes to trust local management more.

Next, I want real democracy to surround the idea of members of a foundation hospital. Some Labour Members are on to that real difficulty in the Government's position, and I am sure that they will not be satisfied by the Secretary of State's argument, which is that people should have to volunteer to be members of the hospital. That would mean that small groups of people who are motivated in a certain way—not necessarily by the public interest or the interests of everyone else—could take over a foundation hospital and, through the lethargy and inertia of everyone else, gain control over extremely important assets.

If we are to take the democratic route—there is much to recommend doing so—it must be done as a democracy of all the people in the area served by the hospital. That surely means using the electoral roll and having elections to the board of those institutions. I suggest, for cost reasons, holding them at the same time and in parallel with elections to the local council, so that the normal democratic apparatus can be used without much being added to the cost burden.

It would be far more democratic to provide the chance to cast a vote when making important choices about people who will offer guidance in an important sector of public service, and thus influence the lives of those who need health care, to the electorate as a whole than to give it only to self-selecting and self-interested groups of people. I do not want my local hospital to become a foundation hospital based on a limited number of people who expressed an interest because they happened to be in the right place on the right day to see an advertisement in the newspaper. I want democratic involvement to be extended far more broadly, to all the electors in the area, who are, after all, the paymasters of the organisation because they pay the taxes.

Mr. Dawson: How would the right hon. Gentleman achieve the involvement of my constituents who live in the rural Over Wyre area, who have a great allegiance to and need to use the services of the excellent Blackpool Victoria hospital, but who do not live within its immediate area?

Mr. Redwood: That is an interesting complexity, but I would be democratically generous and give them a vote in the affairs of any foundation hospital that served their area. That might mean their having a vote in respect of more than one foundation hospital, which brings me neatly to my third important point.

In some of the Government's rhetoric I have noted words and phrases that I find a little surprising, but welcome—those attacking what they call Xthe monolith". When, before I became a Minister, I wrote a pamphlet setting out why I thought the NHS monolith had many defects and was rather old-fashioned, Labour was horrified. Now, we discover that that is language that both the Prime Minister and the Secretary of State for Health are happy to use, but they must think through what they are saying, which is that it is the monopoly elements of the NHS that are serving patients badly. I agree with that.

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One of my disappointments is that amalgamations, mergers and closures under Governments of both parties over the past 20 years have resulted in my area having, in effect, only one hospital offering services. I would prefer a variety of hospitals of different shapes, sizes and styles offering different choices. I deeply regret the closure of many of the smaller hospitals, maternity hospitals and accident and emergency centres. Under Governments of both parties, the argument ran that the health service needed to specialise, concentrate and create those large monopolies, but monopolies are not the normal mode of operation in other sectors of public service. I therefore want the Government to extend their dislike of monoliths and to understand that what we need are foundation hospitals of a variety of styles and sizes serving local communities—a plurality of foundation hospitals.

The Government have not gone that far, because doing so would get them into ideological dispute with many of their supporters. Labour Back Benchers believe that a command-and-control system, with monopoly hospitals guided from the centre and the Secretary of State being responsible for every bedpan, is the way to run the health service, and they are extremely unhappy about the freedoms that are now being offered to local hospitals through this potentially interesting scheme. The Government will not go the distance because they will find it difficult to persuade their supporters that offering real choice—having smaller hospitals as well as bigger ones, and having more than one hospital in an area and a contrast of styles—is a good idea.

I can understand the dilemma. The Labour party desperately wants to create common standards across the country so that everyone has access to treatment that is of the highest possible quality. So do I—if only. However, I happen to think that choice drives that system better than monolithic and central control. Labour Members who are most critical of the Government fear that foundation hospitals will introduce a two-tier health service, but do they not realise that we already have a multi-tier health service? We have a great deal of postcode rationing: certain treatments can be obtained in some places, but not in others, and in others still a long wait is required. Even the distribution of medicines, despite the intervention of the National Institute for Clinical Excellence, has an element of local differentiation.

The Labour party has to accept that if it chooses the route of localism there will be variations and diversity—but its document on foundation hospitals does not deal with that central dilemma. The Government say that they want both diversity and common high national standards, both strong central regulation and freedom for individuals to make local decisions. My point is that the Government have to choose; they must decide whether they really believe that a system of diversity and choice delivers the best average results—that is my view—or that a bit more money, or a bit more command and control, will deliver better results. If the latter, they should choose that route.

The danger is that the foundation hospital will fall between two stools, and be neither one thing nor the other. It could end up as an expensive charade. It could spend a lot of money on recruiting members and appointing the board and the new management team, only to discover that it does not have all the powers that

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it needs to pledge the assets and borrow the money to negotiate the right contracts and deals, to sell its assets and buy different ones that might be better for its purposes, or to hire the staff that it wants.

Other hon. Members have pointed out the awful contradiction between local terms and conditions of employment, which I strongly welcome and recommend in my local area, and the idea that there must not be any poaching or movement of staff around the former NHS system. Again the Government are demonstrating muddle, and they must make up their mind. I strongly recommend that they go for more choice and diversity and more local determination.

That means foundation hospitals based on a full democratic electorate, with full power to borrow and to pledge their assets. It means allowing foundation hospitals to sell and buy assets as they see fit, in pursuance of their duty to provide health care for their areas. It means allowing them to choose not only the staff they wish to employ but the way in which they remunerate them. Yes, that does mean allowing them the right to attract staff from other health institutions. Where else are health staff likely to come from? That will be good for the staff because it means new ideas and new people spread around—and of course, the better staff will be paid more under that system, which I also happen to think is a rather good idea, which will help innovation and drive higher quality.

My fear is that the Government will do few of those things, and we will end up with another expensive bureaucracy and there will be a multi-tier health service. Foundation hospitals will be given not only greater freedoms but more money to try to make them work, to create a favourable impression. That will leave other hospitals, such as my local hospital, struggling. I would like to see a system open for all and free for all the patients, with many more freedoms for the managers, based on proper local democratic mandates.


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