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8 Jan 2003 : Column 261—continued
5.52 pm
Mr. Mark Simmonds (Boston and Skegness): It is a great pleasure to follow the hon. Member for Dartford (Dr. Stoate), who always speaks with great enthusiasm and passion about health, although I am not sure that his remarks today were pertinent to the motion or the amendment.
I am delighted to be able to take part in this important debate. Foundation hospitals are an essential way forward for the provision of health care, particularly in England. It was slightly cheeky of the Secretary of State to try to persuade the House, even though he did so with a smirk, that the provision of foundation trusts and hospitals fitted comfortably with socialist ideals and the history of the NHS going back to Keir Hardie and others who formulated the ideals of the health service. That was duplicitous and disingenuous, to say the least.
I agree with the principle of setting up foundation trusts and hospitals. I shall come on to specific questions later, but any positive decentralising move that severs Whitehall control and creates greater local control, ownership and accountability must be encouraged. Any positive move to reduce the politicisation of the NHS and devolve decision-making power to people with knowledge of the requirements and priorities of a particular locality is to be encouraged, as is increasing democratisation and democratic control. In my constituency, where I have two hospitals—Pilgrim hospital in Boston and the Skegness and District hospital, of which the former is by far the more significant—there would be definite advantages in allowing much more local control and decision making to determine where money is spent and which services are given top priority.
Before I discuss the detail of the foundation hospital and foundation trust proposals, I want to put on record my admiration for the enormous amount of hard work done by all those who work in the health service, from the top clinicians, through the doctors, the nurses, to the ancillary staff—those who work in the kitchens, and cleaning staff—particularly those in my constituency. I have taken the trouble to spend quite a lot of time in the hospitals in my constituency, and have done a night shift at Pilgrim hospital in Boston, which gave me a far greater understanding of the pressures faced by many hospital staff.
There seems to be a considerable dichotomy between the Government's view of the state of the NHS and the view of most Members of Parliament, who receive in their postbag a great deal of correspondence about the health service. If Labour Members were more honest and were not simply supporting their Government, I expect that they would acknowledge that there are severe problems in the health service. The Secretary of State admitted as much in his comments earlier today.
To my mind, the problems are systemic. It is not possible to provide a successful and flexible service that is controlled from the centre. The Government are right to examine ways of improving the quantity and quality of health care provision, but that can be achieved only by removing central control, which creates a large, unwieldy bureaucracy that cannot cope or react to local priorities. For the sake of making the argument, I shall repeat the two stark statistics that have been quoted by other hon. Members: there are 24,000 to 25,000 more administrators than beds for patients. That is an extraordinary statistic. As was mentioned, I think, by my hon. Friend the Member for Woodspring (Dr. Fox) and my hon. Friend the Member for Taunton (Mr. Flook), despite the 20 to 22 per cent. increase in funding that has occurred over the past couple of years, hospital treatments are up by only 1.6 per cent. and admissions are down by 0.5 per cent. or 55,000. In Scotland, there has been a 28 per cent. increase in funding and a 25 per cent. increase in waiting lists.
Those statistics demonstrate clearly that money alone is not enough to improve the provision of health care. I do not represent a particularly affluent area of the country. It is rural Lincolnshire, and many people in my constituency are economically challenged. I know of people on benefit who are so desperate for treatment that they are going private by borrowing money from neighbours next door, which they can never hope to pay back. If the health service allows that to happen and does not look after the worst-off and most vulnerable people in our society, it is clear that there is something fundamentally wrong with the system that is currently in operation. It is right that we look at ways to improve it.
Despite the splits at the most senior level of Government between the Prime Minister and the Chancellor, through to the Back Benches, as we have seen in the debate today and through the early-day motion that has been signed by more than 100 Labour Members of Parliament, the main criticism seems to be that the creation of foundation trusts and foundation hospitals would produce a two-tier system. As other hon. Members have pointed out, we not only have a two-tier system already; we have a multi-tier system.
When I asked my local representatives of various trade unions and the British Medical Association, they made the same point. With reference to the creation of foundation hospitals, the chairman of the BMA said:
- XThese freedoms ought to be available to all hospitals. Our prime concern must be to avoid creating a two-tier service in which patients who live near to Foundation Hospitals or are vocal and assertive in pressing to be referred to them, receive better services than those who are treated in other hospitals."
Mr. Lansley: Does my hon. Friend recall that during the debate, a number of Labour and Liberal Democrat Members referred disparagingly to the experience of GP fundholders? They said that that created two-tier status. Does not that suggest that there should be a larger number of hospitals with foundation status at an early stage, so that there are not some hospitals with that
status and some without? The greater freedom would be in the collective interest of the NHS, and everybody should aspire to that at an early stage.
Mr. Simmonds: I thank my hon. Friend for that pertinent intervention. He is absolutely right to highlight that issue. However, the question involves not only controls on the finances of foundation hospitals, of which there should be more, but democratic control, which does not exist as it perhaps should—a point that I shall deal with later.
It is not necessarily important who owns the hospitals, but we should consider every possible way of maximising the beneficial outputs and improving health care provision in totality. Diversity, by its very nature, leads to innovation, so why will so few hospitals benefit from the freedom of foundation status? Surely, if the motivation is to improve the quality of health care, foundation hospitals and trusts should be used as a route to improve hospitals that are already improving. They should be used as an extra incentive, without the best merely being selected in terms of those that have three stars. That would be a major way of improving the service that is already being provided on the ground. One of the main bodies that deals with health care is the King's Fund. Julia Neuberger says:
- Xfoundation status should not be limited to those trusts with three stars. Real power should be devolved to the local NHS and not just superficial autonomy from every central directive."
One of my greatest concerns—I hope that the Minister will deal with it—is that there will be a tremendous challenge, bearing in mind the volatility of the star system, in trying to maintain a three-star system year on year while also trying to bed down the complexities that will be involved in the transferral to foundation status. What will happen if a hospital loses its three stars because it is trying to move to foundation trust status? Will it lose the opportunity to become a foundation hospital? If that were the case, it would be an enormous waste of time and resources.
Are there problems with guaranteed service provision? There are great concerns that, when the funding is devolved, foundation hospitals will have the ability to decide which service provision to make a priority, so there may be opportunities for them to drop services that are not particularly popular or well used. That point was eloquently made by the hon. Member for Wyre Forest (Dr. Taylor) and I do not think that it has been sufficiently dealt with.
Will the argument about population shifts be built into the funding formula calculations? Lincolnshire, especially in my constituency, has an ever-expanding
population driven by the many people who are rightly retiring to the beauties of the county. Funding needs to be addressed to take account of that. Many of those who are retiring to Skegness come from the ex-coal-mining areas in the midlands and some of them have serious health problems that rightly need to be addressed. I want to ensure that the funding is available so that foundation-status trusts can cope with that.I want to deal with two main issues before my time is up. The first relates to the independent nature of foundation hospitals. How can a hospital be independent when it must still meet Government targets, even if there are fewer of them? What happens if there is a clash in which the foundation hospital does not think that it is a priority to meet the Government targets that are still set down? Will that be an excuse for the Secretary of State to withdraw foundation status?
I had a brief exchange earlier with the hon. Member for Oxford, West and Abingdon (Dr. Harris) about private patients. They represent a way in which a hospital can generate additional income and use up surplus capacity, thereby also generating income. They may, in extreme circumstances, stave off the closure of part of a hospital. Why are provisions for private patients limited? What would happen if a foundation trust or hospital decided to circumvent the Secretary of State's specifications on this point? Would that be another reason to withdraw the hospital's status?
Will primary care trusts be able to decide which foundation hospital to put their funds into, or will there be detailed contracts drawn up for a period of years? I have heard five or seven years being mentioned. Would that not limit the hospital's decision-making processes and service provision capabilities?
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