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8 Jan 2003 : Column 235—continued
Mr. Eric Martlew (Carlisle): Going back to the 1970s, can my hon. Friend remember a time when councils had the right to nominate an elected councillor to sit on such boards? Would not that be a better way forward?
Mr. Colman: I would certainly like more nomination rights in relation to all hospitals for local authority representatives. Currently, a basis exists on which it is presumed that the cabinet member for social services for the area in which a primary care trust operates should serve on that primary care trust. I would certainly like more representatives of local councils on an interim basis. What attracts me to the proposal, however, is that the majority of the governors for a foundation hospital would be locally elected. That would be the first time in the NHS that power has gone to the people and the patients and moved away from the clinicians, the bureaucrats and everyone else working within the NHS. That is an important initial move.
I support the amendment, but I want to quickly set out my four points. First, management should be freed up within foundation hospitals that have improved themselves, with the key caveat that extra support should go to those that have not. Secondly, there must be more money for the worst performers, but for foundation hospitals there must be less restraint and speedier access to finance. However, that should not drain the pool of resources so that other hospitals lose out. Thirdly, the NHS must work with the unions, as Queen Mary's hospital has done. All good companies and successful organisations work with the unions, and it is important that Health Ministers adopt that practice. Lastly, we must establish a local election process with local accountability within national standards and regulatory frameworks.
I return to the comment with which I started. I warn the people of Putney that the shadow Chief Secretary to the Treasury is putting under threat the 30 per cent. increase in funding announced last December. If he had his way, there would be a 20 per cent. cut in funding for public services.
4.10 pm
Dr. Richard Taylor (Wyre Forest): You are being very generous, Mr. Deputy Speaker, in allowing us a certain amount of freedom, and I would like first to make one comment to the hon. Member for Bosworth (Mr. Tredinnick). He must know that many conventionally trained NHS anaesthetists are already undertaking acupuncture in NHS pain relief clinics.
Turning to the main subject, I welcome very much the Secretary of State's admission that there are still problems in the NHS and that they will take some years to solve. There are still major weaknesses and health inequalities in the service, but I pay tribute to the improvements in cancer care and cardiac care. It is a shame that a meeting of the parliamentary health forum just before Christmas was so badly attended—I think that only four or five MPs were present—because the tsar of cardiac services told us how waiting lists for cardiac surgery are improving.
The hon. Member for Oxford, West and Abingdon (Dr. Harris) said that there is one good point about foundation hospitals, and I agree. That one extremely good point is devolution. Most hon. Members want much more power to be given to local people. I was interested in a recent intervention in the debate because my memory goes back to the 1970s and 1980s and to the old local district health authorities, which in some cases were extremely efficient. They had elected members in that a proportion of their members were councillors. I welcome devolution and the Secretary of State's suggestion that the number of foundation hospitals could increase dramatically in the future. However, the one good point about the policy does not disarm my criticisms.
My first and biggest criticism is the one that has been so ably expressed by the right hon. Member for Holborn and St. Pancras (Mr. Dobson) and which was addressed yesterday by the hon. Member for Crewe and Nantwich (Mrs. Dunwoody). I am referring to the two-tier system. My memory of the NHS does not go back to 1948 but it does go back to 1956, when I was training in London, half a mile from here, and we still had many patients coming to London from far afield. There was then a gradual change as medical schools throughout the rest of the country improved tremendously, and the quality of district general hospitals improved.
That happened because the basic tenet of the NHS is that all staff should be on the same pay scale. That means that it is attractive for a high-powered senior registrar from a teaching hospital to apply to a district general hospital if that is where he wants to work. Parity of staff through parity of pay is crucial to fighting for, and maintaining, equality throughout the health service. That point also applies to managers and more and more to nurses, particularly given the proposed extension of their role. That is my first and biggest criticism.
I find it hard to understand one section in the Government's document. Paragraph 1.13 refers to
- Xinspection to guard against two-tier health care."
My next criticism relates to the method of selection. If the policy is implemented and if, as one hopes, the range of foundation hospitals increases over time, their method of selection will be less important. However, as other hon. Members have pointed out, basing selection on the star-rating system would have serious flaws. The star-rating system depends on just a number of key targets, and, as far as I can see, patient opinion points have been disregarded. There are six such points in the ratings, and the no-star trusts scored from seven out of 30 at the lowest to 24 out of 30 at the highest. That covers a wide range. The three lowest of the three-star trusts on the crucial points of patient understanding and perception scored nine out of 30, 10 out of 30 and 11 out of 30. That sums up why I do not have much confidence in the current star-rating system. I hope that the Commission for Health Improvement, under its new name, will be able to improve the value of the ratings considerably.
My next criticism is that the proposal risks a tremendously damaging split between primary and secondary care, which one would like to come together much more. I note that a representative of the primary care trust will be on the board of governors, and I
welcome that. It is a small improvement on the current position in which there does not appear to be any cross-representation between primary care trusts and acute trust boards. I hope that such representation can be increased, because certain conditions, which are not mentioned in the document, depend on better management across the whole system. In particular, I refer to chronic care and to palliative care, which involve a partnership between secondary and primary care.My next criticism refers to the services to be provided. Paragraph 1.30 on page 11 of the document is obviously fairly vague about that. It states:
- XThe licence for an NHS Foundation Trust will detail . . . the clinical services which it must provide to the local community".
- Xthe clinical services that it must provide to the local community".
The hon. Member for Woodspring (Dr. Fox) said that the NHS will not work if it continues to be constructed and run in the same way. I have a severe criticism of the Tory party. The way in which the NHS runs stems from the internal market and the purchaser-provider split that it introduced. That was one of the big disasters for the health service. However, I support the Tories in one way. As an independent Member without party allegiance, I am getting fed up with Labour Members' continual attacks on the Tory party purely and simply on the matter of money for public services. Labour Members hide behind the criticism rather than answering questions. There was an example of that in Prime Minister's questions today. An hon. Member asked a legitimate question about the disastrous services in parts of Worcestershire, but the concerns were not addressed.
I finish with an appeal. I agree that freedom for local people to run their services is crucial. I want the integration of primary and secondary care. Most of all, however, I appeal for the retention of common pay scales because otherwise we will have a two-tier system.
4.22 pm
Ms Dari Taylor (Stockton, South): For Labour Members, the NHS is especially important as an ideal. It is an expression of our values and an enduring legacy of the reforming and modernising Attlee Government.
We are very proud of that period and will always state that in the House. The idea that something as vital as health provision should be available equally to all fellow citizens on the basis of need, not on the basis of wealth or power, is central to social democracy. For my generation, the operation of the national health service represented social democracy in action. I was four when the NHS was created. [Hon. Members: XSurely not!"] Hon. Members are right: I agree that I do not look that old.
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