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8 Jan 2003 : Column 250—continued
Mr. Simmonds : I am taking careful note of my hon. Friend's structured arguments. Has he considered the possibility of money following the patient? If that does not happen, a successful foundation hospital could suck in patients from elsewhere because it provides services
that are not offered by other hospitals. Will foundation hospitals have to use the same financial cake to provide more services to a greater number of patients?
Mr. Lansley: I am grateful to my hon. Friend. His point is exact: money ought to follow patients. That is how the system should work. But how much money should there be for each case? The Government's proposals for payments by results ought to work in that direction, but if they are allied to a national tariff that is, in effect, dictated from the centre, even with regional variations, that will remove any possibility that spare NHS capacity can take up the slack, because of pricing at the margin, or that hospitals, such as Addenbrooke's, which can provide additional quality, can meet the cost of providing additional capacity because of the premium they can attract. Such hospitals could demonstrate to the private sector—like a business—that their advantaged position in the general ecology of health care would allow them to secure demand for the foreseeable future. They would not base their case on the Secretary of State's guarantee, but on their own performance, quality and ability to attract patients.
The two essential problems are that if local accountability is not reflected in patient choice and if price cannot also reflect some of the changes in efficiency and quality advantage that foundation hospitals are able to make, the hospitals will not be able to exercise those freedoms to provide both additional capacity and innovative and improving services.
I am in favour of foundation hospitals and share with my colleagues the desire that they should not only start with hospitals with three-star status, such as Addenbrooke's, which received three stars in both the performance ratings that have been carried out, or Papworth. To jog back to the comments of the hon. Member for Oxford, West and Abingdon (Dr. Harris), I am not quite sure on what basis the Radcliffe did not receive its stars as it seems to be very similar to Addenbrooke's. Papworth has demonstrated a three-star performance, allied to a Commission for Health Improvement report that is as good as for any hospital in the country.
Those hospitals should lead the new system because they have the clinical and corporate governance that is more likely to deliver innovation and to influence policy in the right direction. However, their performance cannot influence the policy unless the basic structure of the policy is right. The structure needs to reflect patient choice and financial flexibility—including price—and it needs an independent regulator who not only focuses on high quality and standards but also has a duty to deliver increasing freedom to NHS institutions over time.
5.19 pm
Mrs. Janet Dean (Burton): I welcome the opportunity to take part in the debate, which gives the House the chance to discuss the concept of foundation trusts as well as the future of the health service.
Both the motion and the amendment welcome the principle of NHS foundation trusts and hospitals. That might seem to be rare agreement between the Government and the Opposition, yet we know that
there has never been a greater gap between the philosophies of the two main parties on the future of our universally available health service, free at the point of use.The Conservatives have made it clear that they would reduce public spending and encourage private treatment, paid for by the individual patient or by private medical insurance subsidised by the taxpayer—[Interruption.] I think that they have made that clear. That would lead to two-tier health provision, in which those who have the money or the insurance cover would have easy access to treatment. Those who are less well off would have to take their turn in what would soon be seen as a second-class service. The Tories' belief that private health insurance is the right way forward is both immoral and flawed. Insurance companies, by their nature, are mainly interested in covering low risks. If one is young and fit, it is easy to insure oneself. If one is elderly or has a chronic disease, the cost of insurance is likely to be prohibitive, or the main chronic condition will be excluded from cover.
I am proud that the Labour party, which founded our national health service, is determined that the principles of a health service free at the point of use should continue. I welcome the changes that have been made over the past five years. The setting up of primary care trusts has brought decision making to a local level. At the same time, the establishment of the National Institute for Clinical Excellence has begun to address the problems of postcode prescribing. The Commission for Health Improvement is helping to raise standards within our health service, and the Labour Government have shown their commitment to the health service by making available an unprecedented level of extra investment, bringing in extra doctors, nurses and other health care staff.
For our health service to have public confidence, we need to be able to offer rapid treatment when it is needed. We need to look at innovative ways to reduce waiting lists and times, and I am pleased that the Queen's hospital in Burton was successful in being chosen as the site for a new #20 million diagnosis and treatment centre. That DTC will be developed alongside the new cancer and endoscopy unit, which is being funded both by Government and by local people through the Queen's hospital cancer appeal. I would like to pay tribute to everyone who has supported that appeal, which has raised nearly #1.5 million. There is already much good will for our local hospitals and for the NHS in general, not only from the general public who are always happy to support such appeals but in terms of the amount of volunteering activity that enhances the well-being of patients. Dozens of my constituents are involved in helping to make the stay of patients in the Queen's hospital more bearable. Nor must we forget the paid staff of the health service: doctors, nurses and all hospital staff work under tremendous pressure, and we should always make sure that they know that they are greatly valued.
Change is not new to the NHS. In the past 20 years, we first saw the health authorities that directly ran the services in their area reduced in size. In my area, the Staffordshire health service was broken up into three health authorities in the early 1980s. As other hon. Members have mentioned, that was a time when local councillors were nominated to serve on those health
bodies, and I served on the south-east Staffordshire health authority at that time. In the early 1990s, health providers were separated from health authorities and trusts were formed, and the internal market was created with its associated divisiveness. I am pleased that the Labour Government dispensed with that internal market and looked to health trusts and providers to co-operate and to spread best practice. I do not wish that co-operation to be jeopardised by the creation of foundation trusts, although I would support greater democracy for all our NHS trusts.Although my right hon. Friend the Secretary of State provided some reassurances, I am concerned that foundation hospitals may prove to be divisive, creating a two-tier system in which some hospitals, able to pay higher salaries, could poach staff and, ultimately, patients from other hospitals. While we should not follow a pattern of rewarding failure in our NHS by bailing out inefficient trusts, neither should we abandon health providers, as they need the expertise to reform and improve. If the creation of foundation hospitals increases the divide between providers and causes hospitals to close, local people will lose out.
The proposal in the Conservative motion that all trusts should be allowed to bid for foundation status is not practical because it is clear that trusts that are struggling would not be able to go it alone. I am concerned that those trusts with a three-star rating, which will be eligible to become foundation hospitals, may not always remain of three-star quality. If their star rating falls, how will help be given to independent foundation trusts?
Foundation hospitals will not produce more trained staff; only the Government's investment will do that. We need to give that investment and the changes that we have introduced time to bring about the improvements that all Labour Members want. The Secretary of State talked of the progress that has already been made. The NHS should be allowed a period without the further change that foundation trusts would bring. I hope that Ministers will consider delaying the proposals so that there can be further consideration and consolidation.
5.26 pm
Mr. Adrian Flook (Taunton): As the debate has made clear, Conservative Members welcome the principle of foundation hospitals. I rise to support the motion in the names of my right hon. and hon. Friends. We support that principle because it would give control to individual hospitals, and I reject the remarks of the hon. Member for Stockton, South (Ms Taylor), who is no longer in her seat, who was attempting to say otherwise.
The Conservatives' philosophy is dramatically different from that of the Government. The Labour party appears to have borrowed our language, and it has not delivered the substance. It recognises what needs to be done but fails to implement a policy that will deliver on that aim. In his announcement on 11 December, which appears to have been rushed and poorly thought through, the Secretary of State said that he was giving hospitals independence, but is it true independence according to what he believes?
A non-executive member of a health authority told me that the 11 December announcement was nothing more than a political game. It reminded him of the
Government's response to the Conservatives' proposals for independence for local health care, which we made just before the last election. The Government rushed to implement strategic health authorities as a panacea. It was an attempt to counter the Conservative party's rather good idea of decentralising power from Richmond house and giving it to local areas, thereby getting rid of regional health authorities.No one denies that extra money is going into the NHS, and that is good. However, there are two sides to the way in which the Government are raising taxes and then spending. How much one spends is not an indicator of how much one cares. In every other area Labour has raised taxes to increase public spending and imposed national targets with ever increasing interference and centralisation.
I remember in the previous Parliament a senior non-executive member of a health authority telling me that one Monday the authority received a call from on high—from Richmond house—saying that the Minister was demanding a certain amount of information for a meeting on the Friday. The health authority had to approach the Taunton and Somerset NHS Hospital Trust and demand the information that the Minister wanted. That meant that all Tuesday and Wednesday, the hospital's central management staff were involved in trying to compile that information. They delivered it to the health authority on Wednesday evening, as they had promised.
On Thursday morning, the health authority discussed how it would present those figures to the Minister at the meeting on Friday. On Thursday afternoon, the Minister's secretary rang up to cancel the meeting. For four days, Somerset's health authority ground to a halt because central interference meant that figures were demanded that the Minister ultimately did not want. We have heard too much of such interference by central Government, and it has continued.
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