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8 Jan 2003 : Column 268—continued

Mr. Dobson: If the proposals are going to liberate people, why is there such a lack of enthusiasm for them among those who represent doctors, nurses, midwives and therapists?

Roger Casale: My right hon. Friend is a former Secretary of State for Health, and is in regular contact with his local hospitals. I am in very regular contact with my local hospitals and with the people who work in them. I take issue with him as to whether there is a lack of interest in the proposals. I believe that people are keen to take on more responsibility. We must recognise that there has been a great deal of change in the NHS, and the way in which we manage change is very important.

St. Helier hospital in my constituency got a no-star rating two years ago. It appointed a new chairman and new chief executive and was given the resources that it needed, with the result that this year it achieved a two-star rating. All the staff in the organisation were involved and believed in the need for change. We must win the hearts and minds of people in the NHS. We cannot work against them. They have to work with us. If we can get them to do that, we can really transform things, as I have seen happen with St. Helier hospital.

Angela Eagle: Will my hon. Friend admit that people who are worried about whether foundation trusts are the right answer to what is a very effective analysis of some of the difficulties in the NHS are also afraid that the proposals will lead to the unleashing of competition and fragmentation in the system, despite the assurances about co-operation? There is a danger that that will be the result of the reforms, to the detriment of the NHS as a whole.

Roger Casale: I agree that that danger exists, and it is a valid and fair apprehension for people to have. We

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must deal with it, but our priority must be to create levers to improve the quality and standard of the health service as a whole. No one says that that will be easy, or that other problems will not arise. My hon. Friend has highlighted the very important difficulties that will be encountered when we implement the policy, but I believe that, on balance, it is right to go down this route.

I believe that allowing hospitals to be foundation hospitals will accelerate the development of excellence in the provision of their services. The key is how that is linked into everything else and how the improvements are spread around. For example, the Sutton and Merton primary care trust in my constituency was one of the first to be set up. It is an example of best practice and I am in very regular contact with the staff there. The PCT has received extra resources and is doing very well. I always ask staff what they are doing to stimulate, support and help other trusts. As with beacon schools, for instance, it is no good for people to rest on their laurels and say, XWe are the best, everyone should come to us." Staff must recognise that they have a duty and responsibility to spread best practice around.

We have to start somewhere, and it is right to start with the three-star hospital trusts. They are the best, and will be the easiest to deal with. However, there is a special responsibility on those hospital trusts and on the Government to do everything possible to improve standards in the NHS. They are simply not high enough today.

Caroline Flint: My hon. Friend will be aware that the Government have recently passed legislation to allow the best performing schools to have greater freedoms. Local authorities were recently assessed by the Audit Commission, and those found to be of good standard will also be given greater freedoms. Why should we not be able to consider reforms to the NHS similar to those that have helped to improve education and local government?

Roger Casale: I agree with my hon. Friend—I think that we can learn from successful approaches in other parts of the public services. We cannot automatically transfer such approaches, but we can be encouraged by the success of beacon schools and spreading best practice around. We should do everything we can to ensure that if we go ahead with this proposal of foundation hospitals, we share best practice in the health service as well.

These are valid fears and apprehensions, but that is what they are—fears and apprehensions. With the money that is being invested, we have a historic opportunity to be much more bold, ambitious and imaginative. Of course we must avoid having a two-tier system. If the Conservative party were returned to Government, we would have not a two-tier system but a no-tier system.

We do not want a system that produces inequality; we want one in which there is both greater equality and quality. Three hospitals serve my constituency—Kingston is in the more prosperous, middle-class area, St. Helier is in a poorer area and St. George's in Tooting, to which my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) referred, is in more of a mixed area. When the star rating system was introduced,

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Kingston had two stars, St. George's had one and St. Helier had none. Many have asked me why there is a superior level of service in Kingston compared with St. Helier. As a result of our reform package, our investment and the changes in St. Helier that I have talked about, St. Helier, Kingston and St. George's all had two stars this year. I believe that we can uprate the service, improve quality and bring everybody up to the same level, but we have to start somewhere, and we need the levers to do it. I believe that that is what the foundation hospitals proposal will provide.

The Labour party set up the national health service—that is our proudest achievement. We are rebuilding it today because we want it to be there tomorrow. We are determined to succeed and I believe that radical proposals such as foundation hospitals will allow us to do so.

6.27 pm

Mr. Simon Burns (West Chelmsford): I am not sure whether it is the third way or the new way forward in a new year, but it will not have escaped the notice of the House that the Opposition have chosen a debate in which we welcome the principle of the Government's policy of introducing foundation hospitals. I shall elaborate on that welcome in greater detail later in my remarks.

We have had an extremely good debate, to which eight of my right hon. and hon. Friends contributed. My right hon. Friend the Member for Charnwood (Mr. Dorrell), with his experience as a former Secretary of State for Health, gave an extremely lucid and interesting speech on the concept of foundation hospitals and how they can improve and enhance patient care. I strongly recommend any hon. Member who was not in the Chamber to read his speech at their leisure.

My right hon. Friend the Member for Wokingham (Mr. Redwood) also gave an extremely good and thought-provoking speech. He reiterated an abiding principle, which I wholeheartedly agree with, of a national health service free at the point of use for all.

My hon. Friends the Members for South-West Hertfordshire (Mr. Page) and for Bosworth (Mr. Tredinnick) highlighted, in their different ways, problems in their constituencies in Hertfordshire and Leicestershire. My hon. Friend the Member for Bosworth asked why hospitals in his county could not seek foundation status from the outset and also gave us the benefit of his knowledge of complementary medicine.

My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) spoke eloquently about local accountability and patient choice. My hon. Friends the Members for Taunton (Mr. Flook) and for Boston and Skegness (Mr. Simmonds) both raised valid points with regard to their constituencies and spoke about the benefits of improving and enhancing the national health service through the independence of foundation hospitals.

My right hon. and hon. Friends had the pleasure—I suppose that it could be described as such—of listening to classic Liberal speeches. At one point, the hon. Member for Oxford, West and Abingdon (Dr. Harris) had the audacity to complain that the Government were

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trying to have things both ways. For a party that wants first one thing and then something else, I found his gall and nerve staggering.

We now turn to the Labour party. In his Fabian Society speech last year, the Secretary of State said:

What would Nye Bevan have thought of the contributions from the Government Benches? Throughout the whole debate, notwithstanding the keenness of the Parliamentary Private Secretary in the Foreign Office, the hon. Member for Wimbledon (Roger Casale), the spectre of old Labour has been lurking with menace on the Labour Back Benches.

The Secretary of State already had an inkling of what he could expect as he has no doubt seen early-day motion 351, which was signed by more than 100 of his right hon. and hon. Friends. That early-day motion includes some interesting names; not only the usual suspects—to use Whips' parlance—but 13 former Ministers, including two former Secretaries of State, one of whom was Secretary of State for Health and the boss of the current Secretary of State. Amazingly, the list includes the name of a former Deputy Chief Whip, which suggests that the gamekeeper has finally turned poacher.

What is the cause of so many problems to a quarter of the parliamentary Labour party? The early-day motion notes

That is a significant accusation, especially as the Secretary of State himself—in his speech to the Fabian Society—stated:

Sadly, the Government's proposals set the framework for a two-tier system, although not for the reasons given by those who signed the early-day motion, but because they would allow only a small group of 34 three-star hospitals to apply for foundation status, rather than all hospitals. By that act, the Secretary of State will indeed set hospital against hospital and will create the two-tier system that so many of his hon. Friends do not want.

The contributions of Labour Members were interesting. I give credit to the Government Whips Office. There were speeches in support of the Government. I was interested, albeit slightly perplexed, when I heard the contribution made by the hon. Member for Mitcham and Morden (Siobhain McDonagh). She spoke from her brief—adequately. I was not convinced that she fully understood what she was saying but she did the business.

Rather like Nelson turning his blind eye to the telescope, the hon. Member for Wimbledon—a loyal PPS—had the audacity to reassure the House that there was no validity in the claims that the Labour party was divided on the issue. The hon. Gentleman cannot have been reading the newspapers or early-day motions, or listening to the remarks made by some of his right hon. and hon. Friends during the past month.

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