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8 Jan 2003 : Column 241—continued

4.37 pm

Mrs. Patsy Calton (Cheadle): The Liberal Democrats have been engaged in a lengthy and detailed internal debate and consultation about the future of the public services since just after the 2001 general election. Our membership debated and voted on the policy paper, XQuality, Innovation, Choice" last September, and I was concerned to hear that the Secretary of State and others have not read it—they would find it a very good read indeed. Many recommendations made by Labour Back Benchers and Conservative Members today can be found within it, so I commend it to the House. It was overwhelmingly passed by our membership and starts:

It gives four main reasons—a lack of guaranteed long-term funding; lack of access and choice about services; Whitehall making decisions that can best be made locally; and politicians interfering for political purposes in decisions that should be made by trained professionals.

Liberal Democrats believe that the Government's proposals for foundation hospitals must be measured against those problems, which are at the core of frustrations shared by the public and professionals alike. Before anyone claims that I am anti-health service or the people who work for it, may I say that I am profoundly pro-NHS—I was one of the first babies born in the health service? I pay tribute to the part of the health service that my family needed over the Christmas holiday. On Christmas eve, my daughter mentioned that she could not see properly. Our local optician, Harry Cooke, saw her within minutes and spent more than an hour with her. He referred her to an eye clinic at

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Stepping Hill hospital in Stockport, where she was seen later that day. She was admitted to the Manchester royal eye hospital on Boxing day and had her retina repaired early the next morning. I cannot speak too highly of the excellence of the care at every stage, the quality of the explanations, the nursing staff and their care, the cleanliness of the hospital, and the aftercare, which is ongoing.

The Liberal Democrats are fully committed to the national health service. Sadly, the streamlined emergency approach that we experienced is not available for all serious conditions everywhere, as numbers of my constituents tell me regularly, as we heard from the hon. Member for South-West Hertfordshire (Mr. Page), and as the House will hear in the Adjournment debate this evening.

Will the Government's proposals for foundation hospitals make the difference and produce the sort of highly motivated care that we received? I think not, for they fail to address the issues that the Liberal Democrats believe are central to the problems faced by the NHS. As my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) said, we want a decentralised health service where decisions are made at local level, with a guaranteed income and local accountability. We would give all hospitals the opportunity to become public benefit organisations if they wished—a bottom-up approach, rather than the top-down approach of the Government's proposals. Sadly, the Government's proposals do not go far enough and continue the authoritarian Whitehall-knows-best attitude that we have come to expect, particularly from the Department of Health.

The Liberal Democrats will guarantee funding for the health service and hospitals for the long term and make it work. We will do that by earmarking national insurance for the national health service as the people's NHS contribution. We would improve choice, quality and access to health services. There should be greater accountability and transparency, and a diversity of options for provision to put maximum pressure on regional and local politicians and public service managers to deliver efficiently.

The hon. Member for Wakefield (Mr. Hinchliffe) mentioned that the health and social care services need to come together at local level, operating from the same budget. We would support that. We need local people to make decisions about local matters.

Mr. Lansley: Can the hon. Lady explain an apparent paradox in her remarks? She speaks of guaranteed funding for the NHS as a Liberal Democrat policy, yet she says that that would be hypothecated from national insurance revenues. However, national insurance revenues are not guaranteed for the next 20 or 25 years. They can vary according to economic circumstances. How does the hon. Lady reconcile those two things?

Mrs. Calton: I thank the hon. Gentleman for his intervention. National insurance contributions are less likely to be a roller-coaster than the roller-coaster produced by politically induced funding. I strongly recommend that he read our document, which sets out the full reasons. He should check the figures.

We want democratically accountable regions to take strategic decisions at regional level, and local authorities and local communities to be involved in the governance

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of hospitals and PCTs, as the hon. Member for Wakefield described. Whitehall's role should be limited to information gathering, dissemination and persuasion. There needs to be a simplified, comprehensive and authoritative system of inspection that puts the focus on meaningful information for users, voters and local policymakers. We would stop Government interference by limiting their role to functions including public health, regulation, medical research and medical, nursing and other professional training, and allow front-line doctors and nurses to take front-line responsibility. To ensure value for money, we need to make service providers and commissioners locally accountable.

Labour's health service has become a bit of a dog's breakfast of pilots, trials, centrally driven targets, discredited star-rating systems, staff driven to distraction by bureaucracy and patchy provision. I fear that the proposals that the Government are making for foundation hospitals will fail to deliver the service improvements that we need everywhere. Only the Liberal Democrat proposals will set clinicians free everywhere to drive the change forward and place a proper emphasis on prevention in public health measures.

Yesterday, the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), in winding up the Westminster Hall debate on foundation hospitals, asked the rhetorical question of whether the reform was coming at the right time. I do not think that any hon. Member is saying that reform is not necessary. The question should have been whether it is the right reform. Before I saw the detail of XA Guide to NHS Foundation Trusts", I thought that the Secretary of State had at last seen the light, was interested and wanted devolution. However, the proposals do not go nearly as far as they should.

The Government's proposals are distinctly unclear, as several hon. Members have pointed out, in a number of areas. What will the freedoms be? How could tariff setting and payment by results work? Will they not produce a distortion of clinical practice in which high value-added, fast-throughput operations and so on are likely to be carried out at the expense of rather slower results, patient time and money? Why should there be only a few foundation hospitals? Hon. Members in all parts of the House have said that they do not understand why foundation hospitals cannot be made available to everybody if they are such a good thing.

The Liberal Democrats are very concerned about the concept of the electorate and who they will be. We believe that it is perfectly possible that the electorate will end up as a very small self-selected group. I echo what the right hon. Member for Wokingham (Mr. Redwood) said in his eloquent remarks about the need for a broad electorate and not allowing a takeover by a small, self-selected group. The hon. Member for Wyre Forest (Dr. Taylor) said that the only good thing about the proposals was devolution. That is certainly the case, but as I said, it has not gone far enough.

The ability of some hospitals to pay staff more on the basis that they are foundation hospitals will lead to poaching and inequalities, and will definitely lead to a two-tier system.

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4.45 pm

Andy Burnham (Leigh): It is a pleasure to follow a fellow Greater Manchester MP. I often agree with a lot of what the hon. Member for Cheadle (Mrs. Calton) says, but if she does not mind, I shall pass on the Liberal Democrat health paper.

David Taylor: My hon. Friend said that he endorsed much of what the hon. Lady has said in the past, but does he agree with her comment just now that foundation hospitals would be freer to pay at local rates? Does he agree that trusts have had that power to negotiate local pay for more than a decade, but only a handful have done so, and that some of those have backed off because of the difficulties? Was that not a flaw in her otherwise quite good speech?

Andy Burnham: My hon. Friend is right that trusts have that flexibility and that few have used it.

Mrs. Calton: The point about the ability to pay more is that it was not there in the past. It will be there in foundation hospitals, as the money will be available.

Andy Burnham: I thank the hon. Lady, but I shall now get on with my speech.

An altogether more important document than the Liberal Democrat health paper is XA Guide to NHS Foundation Trusts", which was published shortly before Christmas. Having read that document, I find the Conservative party's motion more than a little surprising. Do the Conservatives really now support the creation of a community ownership mechanism in the NHS that will rule out future privatisation and the selling off of assets, unless the members of that new society vote for it? Is that what Conservative Members are saying? Do they also really support local communities owning and controlling their health services? Finally, do they also support NHS staff—porters, cleaners, nurses, the entire hospital staff—being voting members of the organisation in which they work, and being able to influence its policy and leadership? That is precisely what that document proposes.

If the Conservatives do support those things, I suggest that we are witnessing something of a Damascene conversion on the Conservative Front Bench to some of the oldest principles of the Labour movement, namely community and mutual ownership. I do not know whether there is an ulterior motive here—there often is with the Conservative party. Perhaps the hon. Member for West Chelmsford (Mr. Burns), who is shaking his head, is seeking sponsorship from the Co-operative party. Perhaps he is not doing that, however, and perhaps the Conservatives' support for these measures is misplaced, because I do not think that they truly understand the full impact of what is being proposed by the Secretary of State.

As a member of the Co-operative party and a strong believer in the virtues of community ownership, I genuinely believe that these reforms have the potential to be among the most revitalising ever introduced in the NHS. Members of our party are proud that we founded the NHS, a point made by my hon. Friend the Member for Wakefield (Mr. Hinchliffe). Many members of our party have long complained about the democratic deficit

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in the NHS, although they love almost everything else about it. They are absolutely right to complain about that. The NHS's lack of accountability and responsiveness to public and patients has always been its Achilles' heel. Because of the way in which the NHS is structured, NHS bodies have always looked up to Whitehall for accountability, rather than downwards to patients and the wider public. The result is that, even today, there persists in parts of the NHS a like-it-or-lump-it culture in the services that are provided to people.

At the creation of the NHS, Bevan trumpeted as one of its chief benefits Whitehall's ability to monitor dropped bedpans. That has now become one of its main weaknesses. It was right in its day, because of the chaotic nature of pre-war health care. That control was necessary in those days, but today it is more and more of a problem. All of us hear that health professionals are finding things more and more difficult, and that they want more local flexibility. As a party, we have to respond to that.

People who can remember pre-NHS health care put up with the like-it-or-lump-it aspect of the national health service, because it is infinitely better than what they had before. My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) mentioned people in their early 30s. I am happy to confirm that I turned 33 yesterday, so I can probably scrape into that group. People of my generation will certainly not have the same forbearance towards the NHS as the generations before them. For the NHS to survive and thrive in a consumer society, it needs to get better at customer care.

The NHS also needs to get better at listening to local opinion. Ever since it was established, there have been countless examples in all parts of the country—dare I say it, in every constituency represented in the House—of proposed changes in service provision being fiercely resisted by local communities. My colleague, the hon. Member for Wyre Forest (Dr. Taylor)—a fellow member of the Select Committee on Health—is perhaps a living embodiment and constant reminder of the NHS's failure to listen and to involve the community in the way in which health services are delivered. Dare I say that the NHS has not always got it right when it has proposed service change, and that, on occasion, perhaps the community has been right instead?

These reforms are radical for the simple reason that they invert the traditional power relationship that has hitherto existed in the NHS. If the proposals in the document finally become legislation, and if assets are genuinely transferred to democratic mutual organisations, the members of those organisations will overnight become more important to trust managers than Ministers are now. That has to be a good thing. To me, that is the key argument for the Government's proposals. It is vital that that ownership and that democratic control be not token but genuine mechanisms that the local community can use.

That key test was rightly highlighted by the right hon. Member for Charnwood (Mr. Dorrell). He was wrong, however, about the recreation of the NHS internal market and the proposals being an attempt to recreate the Conservatives' NHS trusts policy. The issue needs to be carefully considered, and we must think about how

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the introduction of foundation trusts will affect health care provision and whether it will lead to a two-tier service.

The difference between these proposals and those described by the right hon. Gentleman is the question of GP fundholding. The reforms introduced by the Conservative party were pernicious, because how quickly people received treatment was decided on an entirely arbitrary basis. That point was extremely well made by my hon. Friend the Member for Wakefield. What counted when people were admitted to hospital was whether they were patients of fundholding or non-fundholding GPs. Access to treatment was determined not by clinical need, but by the negotiating power of the purchaser. That was entirely wrong, and I see no evidence to suggest that any of it is being recreated by the proposals before us.

People claim that the proposals will create a two-tier NHS, but they fail properly to realise that, even today, the NHS is multi-tiered. The quality of service offered by different NHS providers varies widely from trust to trust, but under the current system there is little that patients can do if they live in an area where the trust is underperforming.

As well as offering local, democratic control, the reforms are about creating a much needed improvement mechanism and a culture of improvement in the NHS. I do not see why our party should be opposed to allowing the good to get better or why we should have any ideological problem with that. What really counts is that we help those who need to improve most to reach a level that we would consider acceptable. That is the explicit aim of the policy—allow the good ones to get on with the job that they are doing and give more targeted help to the ones who need it.

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