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8 Jan 2003 : Column 238continued
The creation of the NHS was a joy in my family and a joy to the community in which we lived. I am absolutely committed to the NHS, but I am also keen to stress that we must be careful not to mistake a legacy for a monument. There is a crucial difference between them. A monument is a fixed and unchangeable moment in a country's life, important though it may be. A legacy offers us the opportunity to innovate, develop, refresh and reinvigorate. The NHS is a legacy that will always require a high level of reinvigoration and refreshing. It needs new ideas. I do not believe, as many hon. Members do, that there have been enough changes in the NHS. Like all other services that respond to an ever changing community and society, the NHS will always have to change so that it increases its capability of serving people. That is my starting point.
I believe strongly that that process of change will require substantial funding, but although I believe equally strongly that my Government have provided that funding, it is clear that many reforms remain to be achieved. There is a culture of management and control, of delivery of health or illness, and that culture is highly resistant to change. It is incumbent on all Members of Parliament on both sides of the House to persuade and encourage that change to take place.
In that context, I regard foundation hospitals as an important part of a changing approach to the ever-changing needs of our communities. Change must come in response to the problems. Many people say that our health service is good, but it could be better. My belief is that there is no one reform on which we can hang our coat, but many reforms. Foundation hospitals are one part of an enormously complex policy that will be discussed throughout this Parliament. The foundation hospitals policy is valuable, because it will achieve for local hospitals freedom from central direction in the management of their affairs.
Foundation hospitals will be subject to a considerable degree of local accountability. I was unhappyalbeit not surprisedto hear the Opposition health spokesman pour cynicism on the idea of local accountability. The hon. Gentleman misunderstands and underestimates the value of owning a problem. Invariably, those who have ownership of a problem are the ones who drive the solution. Ownership and management of illness, and being central to deciding what change is needed, is important in terms of educative capability and sharing of responsibility. I believe it also ensures good policy.
Mr. Lansley: The hon. Lady talks about local accountability. Does she not agree that, in reality, the issue is not simply governance arrangements that involve local people, but the degree of freedomthe power of which she speaksto change services, develop services and introduce flexible services according to local decisions? Can she tell me where those freedoms are? I have looked hard for them. Which freedoms does she think local people will have, independent of the regulator, the commission, and the Secretary of State and all his data requirements?
I have spoken with the chief executive of my local trust. I thought it was important to do so, because although many of us here would argue in favour of the proposals from a position of principle, I wanted to know how those who willor mightdeliver the policy felt. She told me that discussions had taken place between trust board members, staff and medics, but that no decision had been taken. I want to make that clear. I would not want anyone to believe that a decision has been taken in respect of the North Tees university hospital; it has not.
The chief executive told me that a number of concerns had been raised, but that, to date, a number of opportunities had been outlined and identified as well. Medicsdoctors and other members of staffsaid that they would value a formal structure of involvement with local people. They believe that that would persuasively change the environment for the management of illness, and establish an open relationship in which difficult questions about new procedures and services could be discussed in a quiet and controlled environment, as opposed to being exposed in a newspaper, which makes people more likely take sides. They believe that there would be a balanced relationship between professionals and people in the community, and that once people understood and accepted the problems, their dynamism and involvement would support achievement.
The chief executive said to me that she had a space problema buildings problemand that investment from capital would be valuable to her. She knows what the local needs are and how she can deliver the services, but she needs capital to do that.
One can be cynical about what that chief executive is saying, or one can choose not to be. I happen to want to believe what she, the trade unionists, the medics and the other staff are saying. They have achieved three-star status and, starting from a very difficult position in 1997, an excellent hospital has developed. The chief executive believes that the best could now lead the rest, and I support that statement. I hope that I have answered the question asked by the hon. Member for South Cambridgeshire (Mr. Lansley). I have used what the chief executive of North Tees university hospital said to try to persuade himalthough I rather doubt whether I have done so.
My concern is that the innovation of establishing a foundation hospital could be seen as a way of opening the door to privatisation. Again and again the concern has been expressed that more private operators will move in and the service will be less and less nationally owned and delivered. However, unless I am reading the information that has been given to us to date incorrectly, and am not hearing correctly what the Minister says, I am right in saying that according to the papers, new foundation trusts cannot be taken out of the public service. Indeed, there will be a legal lock on their assets to protect national health foundation trusts from the sort of demutualisation that has taken place in the building society sector. That reassures me, but I would still like to hear again from the Minister the assurance that foundation trusts will remain for all time within the public sector, owned by the local staff and local people who comprise the membership community.
The concept of a membership communitythe idea of local accountabilityis perfectly compatible with social democracy. The old state system was only ever one model of social democracy, and arguably it came to predominance in the Labour party only as a result of the experience of the first world war. Other models have always existed and have always been attractive. Municipalisation, co-operatives and foundations all bring accountability closer to people. That model, with its ability to shepherd, to change and to help a service evolve, should be embraced by all of us.
I recognise the dangers. We have all heard clearly what my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) has said. He was right to warn us that the middle classes have sharp elbows, and we know that the middle classes are more able to work systems, especially health and education systems, than those in the poorer socio-economic groups who often need the services more. I am looking for assurances from the Secretary of State that the elected bodies will not be socially self-selecting.
There is also a fear that the introduction of foundation hospitals will introduce a two-tier system. My local hospital, North Tees university hospital, was definitely a second-tier hospital in 1997, but our investment in it has made it a first-tier hospital. I would like every hospital in the country to adopt the same structure of control and service delivery. None of us wants to duck such concernsthe problem is not the status or names of hospitals, but the shortage of doctors and medical specialists, about whom which we have legitimate worries. Staff shortages are the problem, not changes in hospital structure, which could be positive, innovative and valuable to our communities.
There are also concerns that a two-tier system could be introduced because foundation hospitals have capital borrowing rights. I am seeking assurances that that will not be so. I have read statements by the Secretary of State and the Chancellor of the Exchequer that the funding of foundation and non-foundation hospitals will not become imbalanced. I want reassurance about that. We have all heard worries expressed in the Chamber, and none of us wants any hospital to receive less financial support.
The one critical question that we must answer is: XAre we delivering the best health service to all people all the time?" While we are delivering the best health service to many people much of the time, some people are left outside. While finance and investment are crucial, it is important to acknowledge that other reforms need to be made so that we can achieve the best for everyone at all times.
To conclude, involving staff and local people in the management of hospitals is appropriate, as is freeing up the delivery of service so that it can respond to local needs. We must encourage local innovation and regard doctors and medics as natural entrepreneurs, which many of them are, and give them the opportunity to explore and develop service in their own way. I believe that foundation hospitals will achieve various changes and reforms, and we will see a refreshed and reinvigorated legacy in the NHS which will command public support.