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8 Jan 2003 : Column 271—continued
Roger Casale: I said that there was a debate and that it is right that there should be such a debate, but that
there was no division about the fundamental values and principles of the NHS, by contrast with the clear divisions in the Tory party.
Mr. Burns: I am grateful to the hon. Gentleman; that intervention really has clarified the situation.
The hon. Member for Leigh (Andy Burnham) supports the Government, but if the narrow party political points are stripped from his speech, I give him credit for an extremely interesting and positive contribution on the whole subject of foundation hospitals. The House will have benefited from that, and I look forward to working with him on the Health Committee when we consider the whole issue of foundation hospitals.
The hon. Member for Cardiff, Central (Mr. Jones) gave what can best be described as grudging support for the proposal, but support it was. Finally, the right hon. Member for Holborn and St. Pancras (Mr. Dobson) made an excellent and classic speech of opposition to a policy. I did not agree with the points that he made, but I respected his clarity and his commitment to his point of view. What particularly interested me, given that, just over two years ago, he was a senior member of the Government, was that he had the courage to accuse this Government and No. 10 of being Maoist. He was wrong, because, immediately, the Secretary of State—I am surprised that he is so knowledgeable, or I was before the matter was researched further—claimed that the correct description was Trotskyist, not Maoist. I wondered why he had such an intimate knowledge of the matter, until I realised that, in the early 1980s, before he joined the Labour party in 1983, he shared a house with local members of the International Marxist Group—of which he was not a member, I hasten to add, so as not to slander him—and he was active in Newcastle in a left-wing bookshop called XDays of Hope". I am sure that he will be able to tell the House the pseudonym of that shop. We then heard the contribution of the hon. Member for Wakefield (Mr. Hinchliffe), who remained a trenchant critic of the Government's proposals.
Those Members are the tip of the iceberg of their more than 100 colleagues who are wedded to the idea that what is best for the improvement and enhancement of the national health service should not go ahead, because they are locked in a time warp of an ideology and philosophy and an archaic realisation of needs. Society has moved on, as have the demands of the national service. As my hon. Friend the Member for Woodspring (Dr. Fox) said at the beginning of the debate, we welcome the principle of foundation hospitals. That principle will provide freedom and diversity in the provision of health care, and will significantly advance patient care. While we favour the principle of foundation hospitals, we believe that freedoms for hospitals to borrow and set their own priorities should be given to all hospitals and not simply to a chosen few at the outset. That is the way forward, and that is the way in which the Government should move forward. The principle should be universal.
The Secretary of State and the Prime Minister should have the courage of their convictions:
- XAt our best when at our boldest."
- XFor patient choice to thrive it needs a different environment. One in which there is greater diversity and plurality in local services which have the freedom to innovate and respond to patients needs."
- Xchanging it from a monolithic, centrally run, monopoly provider of services to a values based system"
- Xdifferent health care providers in the public, private and voluntary sectors."
To take the Secretary of State's rhetoric to its logical conclusion, he should not pass up the opportunity to be bold, as the Prime Minister so proudly proclaimed. He should allow all hospitals to seek foundation status from the outset. The trouble is that his announcements so far smack of fudge surrounded by confusion. Sadly, the publication of XA Guide to NHS Foundation Trusts" has added little clarity.
We have found during this debate, starting with the points raised by my hon. Friend the Member for Woodspring and continuing with the remarks of almost every Conservative Member who has spoken, as well as some Labour Members, that there is confusion about exactly what the Government intend to do. The framework and guidelines that have been provided are full of glib expressions and do not give details about how free hospital trusts will be. What powers will they have? What will they be able to do with their money and with the funds that they borrow? We must have greater clarity and detail on those matters before we can be expected to sign up to a principle to which we are not opposed.
I urge the Secretary of State to make available as soon as possible, preferably before the Committee stage of any legislation that emanates from his Department, the details that have been requested during the debate, so that we know exactly what the Government are doing. We need to know whether the reality of what they are planning will live up to their rhetoric. For that reason, I urge my right hon. and hon. Friends to join me in the Lobby tonight in support of the motion tabled by my right hon. Friend the Leader of the Opposition and other colleagues.
6.42 pm
The Minister of State, Department of Health (Mr. John Hutton): I warmly congratulate all right hon. and hon. Members who have spoken in what the hon. Member for West Chelmsford (Mr. Burns) was right to describe as a very good debate. We have heard excellent speeches from hon. Members on both sides of the Chamber, all of them certainly delivered with passion and conviction.
There have been strong speeches from my hon. Friends the Members for Cardiff, Central (Mr. Jones), for Mitcham and Morden (Siobhain McDonagh), for
Putney (Mr. Colman), for Stockton, South (Ms Taylor), for Leigh (Andy Burnham), for Dartford (Dr. Stoate) and for Wimbledon (Roger Casale) in support of the Government's intention to create NHS foundation trusts, and I welcome that support. A number of perfectly fair and reasonable concerns have also been raised by some of my right hon. and hon. Friends. Those concerns are valid; I understand them, and I shall deal with them in a moment.Our debate started with the contribution from the hon. Member for Woodspring (Dr. Fox). It was his usual dismal diatribe of doom and gloom, which has become familiar to all of us in the House because we have come to know what his real objectives are. They are, first, to undermine the NHS rather than to support it and, secondly, to characterise the brilliant work done by staff, day in day out, as failure rather than success. It was clear to us all that the hon. Gentleman was too embarrassed to talk about his party's policies on the NHS because he knows just how unsavoury the British public will find them.
The hon. Member for Oxford, West and Abingdon (Dr. Harris) also made a familiar contribution. It was genuinely hard to see what reforms his party favours that would genuinely help to improve NHS performance. With the greatest respect to the hon. Gentleman, I have to say that I found his contribution utterly incoherent, and it was one of his better ones. He has come to propagate an excuse culture, not a problem-solving one. He has nothing to say of any relevance.
My right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) made a very effective speech. He will know that I have huge respect for him, and I enjoyed enormously the time that I spent working with him as one of his junior Ministers. However, I have to say to him and to the House that I think that he is fundamentally wrong in his view of foundation trusts and about our intention behind introducing these proposals. I shall return to his comments and to those of my hon. Friend the Member for Burton (Mrs. Dean) in a few moments.
The right hon. Member for Charnwood (Mr. Dorrell) is a distinguished former Secretary of State for Health and he made a skilful and careful speech. However, I would be interested to hear his views about his party's policies on health. As they have emerged over the past few weeks, I cannot bring myself to believe that he has any support whatever for the varied contributions that we have heard from those on the Opposition Front Bench recently. I assure him that foundation trusts will be a new type of institution and not another vehicle for state ownership.
I hope that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) will not mind my saying this, but I listened to his speech and I genuinely feel that he might be open to persuasion about the merits of foundation NHS trusts. I very much look forward to working on him—or rather with him—to convert that indication of implicit support into more concrete support in the future.
Although this point was made by a number of right hon. and hon. Members, I do not believe that the establishment of NHS foundation trusts will or should undermine primary care or the role of primary care
trusts as the commissioners of local health care services. Exactly the opposite can be the case. I shall refer to that again in a second.The right hon. Member for Wokingham (Mr. Redwood) believes heroically and against all the odds and evidence that the Tories would stick to this Government's health budgets if they ever returned to office. Of course, that is a pledge that none of his Front-Bench spokesmen has been able or willing to make. I suspect that we will wait long and hard before we hear such a commitment from anyone who speaks for the Tories on health.The right hon. Gentleman talked about his commitment to ensuring maximum democratic involvement in the local NHS, and I welcome that support. The only problem that we have with that comment is that I can never recall him doing anything about it when he had the opportunity to do so in all his long years in government. I suspect that we will therefore probably treat his support with a hefty pinch of salt.
My hon. Friend the Member for Cardiff, Central made local accountability the main theme of his speech. I welcome his comments on that. He graciously said in relation to the speech of the right hon. Member for Wokingham that he remembered the time that the right hon. Gentleman was Secretary of State for Wales. I remember it too. I hate to bring it up—the right hon. Gentleman probably cringes every time this is referred to—but I remember his singing the Welsh national anthem. I have to be honest and say that I have no idea what the words are, but it was probably not a pleasant experience for him or for the rest of us. Let us not dwell on that any longer.
The hon. Member for South-West Hertfordshire (Mr. Page) made an impassioned speech. By his own admission, it was a rare foray into our debates in the House on health. I will not say anything more about that, but his support for his local NHS would probably count for a lot more if he were prepared to support the extra investment that the Government are putting into it.
My hon. Friend the Member for Mitcham and Morden made an excellent speech, and I congratulate her on her ambition for the NHS. It is one that we share in government. My hon. Friend the Member for Putney also made a very useful contribution, emphasising the need for the Department to continue to deal with the performance of poorly performing hospitals. We will certainly continue to do that.
The hon. Member for Wyre Forest (Dr. Taylor) made a contribution that was essentially a long string of criticisms, so no change there. My hon. Friend the Member for Stockton, South made a powerful speech and I warmly congratulate her on her contribution. In a telling phrase about the NHS, she said that we should not mistake a legacy for a monument. She is absolutely right. If that is her own comment, I shall quickly grab the copyright because I want to use that phrase in some of my speeches.
The hon. Member for Cheadle (Mrs. Calton) talked at length about internal health policy documents that had been produced by the Liberal Democrats. She helpfully proceeded to read most of them out. In the process, she did not really have anyone listening to her.
Her contribution and those of the hon. Members for Taunton (Mr. Flook) and for Boston and Skegness (Mr. Simmonds) showed that none of them had actually read the Government's proposal to establish NHS foundation trusts. They raised a number of questions. I shall simply send them the document so that they can find the answers for themselves.Labour Members are agreed on the need for extra investment in the NHS so that we build up the capacity of our public health care system, putting right decades of neglect, as many of my hon. Friends said. As a result of the action that we are taking, the NHS is the fastest growing health care system in Europe. By contrast, the Opposition oppose the investment in the NHS. They prefer the route of subsidising private health insurance, of top-up vouchers for those who can afford to go private and, we now discover, of 20 per cent. across-the-board cuts in public expenditure.
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