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8 Jan 2003 : Column 264—continued
Mr Flook: Does my hon. Friend agree that if such contracts were seven years long, they might arch over the four or five year period of office of the elected membership of the trust, and therefore tie those people in without giving them any flexibility to change any management practices?
Mr. Simmonds: That point had not occurred to me, but it is an extremely good one. I would be interested to know whether the ministerial team has thought through those issues.
How will the issue of not poaching staff be enforced? The right hon. Member for Holborn and St. Pancras (Mr. Dobson) made a good point about this; it was the only point he made with which I agreed. He said that we cannot stop people applying for jobs in different hospitals. There do not seem to have been many thought processes devoted to that point.
I totally and wholeheartedly agree that there should be more local accountability and democratic control of foundation hospital trusts, and I believe that that should be extended beyond the levels proposed in the forthcoming Bill. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) made a very eloquent speech on this matter. So many facets have not been explained yet. In my constituency, the Pilgrim hospital in Boston covers an enormous area, not only in my constituency but beyond: north towards Louth, over towards Grantham and south towards Peterborough. There are crossovers: some people go to Peterborough
hospital, some go to the Pilgrim hospital in Boston, some go to Lincoln or Nottingham. What will happen in those circumstances? Who will get a vote? Who will be elected on to the boards? Will people who live in Boston be able to sit on boards in Nottingham or Leicester, if they use facilities there? I would like the ministerial team to explain that.The foundation hospitals will get into enormous difficulties unless a detailed policy is introduced on how the funding will be allocated when the hospitals gather more and more patients as the services improve over time. Will they all be sharing the same cake? How will the contracts operate, not only with the primary care trusts but with the other primary organisations within a particular geographical location that feed into the hospital? Will they be long-term contracts? Will they be flexible? Will the trusts be able to break them if they prefer to use facilities at another hospital, if indeed there is another foundation hospital that they can transfer to?
While I agree with foundation hospitals, I do not think that the Labour Government are in a position to change the national health service sufficiently. They have too much baggage, both philosophical and ideological, and too many interests in the trade union movement—their friends and paymasters there have an entrenched and self-centred belief that things should stay the same—and, ultimately, there are too many left-wing Members of Parliament who do not want to see even the first foundation hospital come to fruition, never mind seeing the scheme rolled out across the whole United Kingdom.
6.9 pm
Roger Casale (Wimbledon): I welcome the debate and the opportunity to contribute, but I must say that when I saw it listed on the Order Paper I was a little surprised that the Conservative party had picked the national health service as its chosen topic for an Opposition day. I am sure that a lot of my constituents in Wimbledon, if they have been listening or tuning in, will share my curiosity at some of the things that have been said.
I understand that the Opposition are keen to depoliticise the issue of the NHS and to pick individual topics such as foundation hospitals, on which they feel that they may be in some agreement with us, but if they are in agreement with us, it is for the wrong reasons. I shall return to that point.
Most people in my constituency and, I am sure, around the country would recognise that the NHS is probably one of the issues, if not the leading issue, of the day that separates the two parties, as the differences are so stark.
Although the debate has at times had the tone and feeling of a Second Reading due to the development of a cosy consensus around a proposal that everybody favours, we should remember that the Opposition introduced the subject. They should be challenging the Government, and Parliament would not do its job properly if it did not use Opposition day debates to emphasise the differences between us, of which there are many.
My constituents will be surprised that the Conservatives have picked the NHS as the subject for the debate, because, like me, they know that, with few exceptions, Conservative Members no longer believe in
its founding values and principles. Those who do are a dwindling number and ever more at the margins of today's Conservative party.
Mr. Lansley: Will the hon. Gentleman give way?
Roger Casale: Not at the moment. The hon. Gentleman has had an opportunity to put his thoughts about the NHS on the record.
I do not say that there are no Conservative Members who see a future for the NHS, but let us not forget that the Conservatives opposed its establishment 50 years ago. We know that many leading Conservatives—perhaps the hon. Gentleman numbers himself among them—including the shadow Secretary of State, the hon. Member for Woodspring (Dr. Fox), want to dismantle the NHS. There is a big debate to be had on the future of the NHS, but, in terms of where the public stand, I believe that the Conservatives are on the wrong side of that debate.
Mr. Lansley: The hon. Gentleman perpetuates a myth that the hon. Member for Stockton, South (Ms Taylor) also sought to perpetuate, which is that we in the Conservative party do not believe in the NHS. The day before the NHS was founded, my father worked for London county council. He then worked for the NHS for 34 years, including the day it was born, and ran a laboratory at East Ham memorial hospital. I was brought up by someone who worked in the NHS. I have always used it and I shall continue to do so. Why is the hon. Gentleman trying to distort and misrepresent the motives of Conservative Members?
Roger Casale: I said that a few Conservative Members believe in the NHS—perhaps the hon. Gentleman numbers himself among them—but I also said that they are a dwindling number and ever more marginal in terms of influence. I do not want to embarrass him, but perhaps he numbers himself in that group as well.
Roger Casale: If I may, Madam Deputy Speaker, I shall finish dealing with one intervention before giving way to take another. I would like to make a little progress, although I am glad to see that I have excited some reaction from the Opposition and nudged them out of their complacent consensus.
If there is to be a future for the NHS, there needs to be an ambitious, imaginative and radical reform programme as outlined in the NHS plan. That comes at a price, which is sustained investment in the NHS—the investment that the Government are putting in, not the 20 per cent. cuts that the shadow Chief Secretary has on offer.
I can only assume that the Conservatives have chosen to debate foundation hospitals because they want to engage in point scoring. They know that a debate is going on in the Labour party, and rightly so, about whether foundation hospitals and the other reforms that we are putting forward are a good thing or a bad thing.
However, so far as I can tell there is no division within the Labour party about the fundamental principles and values of the national health service, about the need to
invest in it, or about the need to reform it if we are to safeguard it for future generations. Nor is there division within the party about the need to rebuild the NHS as part of the political mission that people, including my constituents, elected Labour Members of Parliament to undertake.By focusing on an important measure that they actually agree with—although important, it is just part of an overall strategy and package of reforms—perhaps the Conservatives hope that people will think that we agree on everything else as well. However, nothing could be further from the truth. We certainly do not agree with Conservative plans for the national health service, and this proposal is not the first step down the road that they would like to take us down. There are two very different approaches at stake here. The fact that both Labour and Conservative Members think that the current proposal for foundation hospitals may be a good thing does not mean that we both approach it from the same direction. A foundation hospital is not some kind of shareholder-led, privately owned, market-driven hospital. Foundation hospitals are a new experiment in community-led, but still very much public, ownership. The proposal to establish foundation hospitals must be set in a much wider context than our overall strategy to reform and rebuild the national health service, important though that is. It must be set in the context of the changing balance between public and private that we need in today's world to secure and safeguard the public good.
These debates can sometimes seem rather sterile, in part because of the temptation to engage in inaccurate stereotyping, which we have had plenty of today from the Opposition. Apparently, we are all Stalinists because we believe in some form of central monitoring and standards for the national health service. However, let us not forget that it was this Government who introduced national standards for the NHS in 1997, and that in 18 years of Conservative Government we had no national standards of any kind. Is introducing such standards Stalinist? There has to be some form of central monitoring and control.
We should not engage in such sterile and inaccurate stereotyping of each other's positions, and I am not going to give hon. Members the chance to do so again.
However, the idea that state ownership and state control always equates with the public good, and that individual input into health and other public services is always bad—or indeed, vice versa—is no longer the most valid way to think about these issues, and we need to recognise that. The potential importance of this innovative proposal for foundation hospitals is that there may be ways of better balancing local accountability with national standards, innovation and public enterprise to serve the public good. We must think afresh about how we define the public good in relation to public services. There must be ways of safeguarding the public good, and some of the strongest proposals relating to foundation hospitals are those for an independent regulator, for important local and democratic input, and for regular inspections. The
national framework and national standards will remain, along with—I hope—a great deal of national and local democratic control.If the Conservatives think that foundation hospitals are a good thing because they will be completely free from any mechanism or framework of national control and inspection, or if they think that this is a step towards privatisation, they are going to be disappointed. I also hope that my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson)—he is indeed my friend—will take on board those remarks, and that they will help to cheer him up. He made some important points, and we would be wise to listen to what he says. He articulated fears and apprehensions felt by many people in the party and outside it about the new proposals.
One can oppose the proposals for ideological reasons, but I am not sure that that is why my right hon. Friend the Member for Holborn and St. Pancras opposes them. He raised many practical objections to the proposals, and that is where the core of the debate now lies. However, how can it be contrary to the public interest and good to allow a system to develop that is more flexible in terms of delivery, that can give more choice to the user—although I take his point that there needs to be a surplus capacity—and that helps to liberate the talent, energy and innovative potential of the people who work for the public good in the NHS?
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