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8 Jan 2003 : Column 276—continued
Mr. Burns: Before the Minister continues to perpetuate a myth, the 20 per cent. cut relates to cuts in administrators, bureaucrats, spin doctors, clerical staff and public relations managers so that the money is spent on health care.
Mr. Hutton: What a load of cobblers. The people the hon. Gentleman describes as managers are cooks, cleaners and porters. If he wants to sack those people from the NHS, it will be interesting to hear his proposition expounded.
Six years in opposition and all we get is the old Thatcherite agenda. No wonder there is talk among sensible Conservatives—there are still one or two of them—about getting rid of the Leader of the Opposition. Labour Members agree on the need for the Department of Health to continue to take action to deal with poor performance and poor management in NHS hospitals. We do that because we are absolutely committed to a universal and comprehensive health care system. We will not tolerate or make excuses, as others would, for poor performance anywhere in the NHS. By contrast, the Tories and the Liberals are opposed to that intervention. They have opposed the national standards that we have established, they have complained about the new inspectorate to monitor performance and the Tories opposed the establishment of the National Institute for Clinical Excellence, which has helped to tackle the postcode lottery that we inherited.
Dr. Fox: Will the Minister give way?
The Opposition are wrong on the great issue of principle that should govern the debate about health care in our country, and so they are wrong on the detail of the reforms that are needed to improve the NHS. That is the Tory record on health and it is how we should judge their performance today.
The Tories have nothing sensible to say about the future of the NHS. That should not come as a surprise to Labour Members. The truth is that under the Tories, the NHS does not have a future. That is clear from everything they said today and what the hon. Member for Woodspring spelt out last year. The Government, however, believe in the NHS. It can become the service
that we want it to be, offering more choice to patients over where and when they are treated, greater access to higher quality care and faster, more convenient treatment.
Mr. Andrew Turner: If the Minister is in favour of those things, will he explain why my constituents who need cardiac treatment were told a year ago that they could not go to King Edward VII hospital, Midhurst, which would treat them quickly? Instead, they were sent to Brighton, which delays their treatment and takes longer. Indeed, Brighton is now sending them back to Midhurst after a six-month wait. Is not that an absurdity?
Mr. Hutton: What is absurd is the fact that the hon. Gentleman complains about the shortage of capacity in the NHS, but will not vote for the means to redress those problems. Until he does, we are not interested in anything he has to say.
Three basic concerns have been raised about foundation trusts. Some hon. Members argued for no more change in the NHS. They thought that we should maintain uniformity across the NHS, in terms of both structures and performance and operation. That is very much the point that my right hon. Friend the Member for Holborn and St. Pancras made. Some hon. Members argued that unless there is such uniformity, there will be competition rather than co-operation across the NHS and ultimately a two-tier health care system. They drew attention in particular to staff recruitment, financial freedoms and the commissioning process. Others, however, put forward a different argument. They were not opposed to the principle of NHS foundation trusts and wanted the freedoms intended for them extended to all NHS trusts at the same time. Several Conservative Members made that point.
Finally, concerns have been expressed that the freedoms we are proposing for NHS foundation trusts are not extensive enough, and that the Government should be prepared to go even further than they have already proposed to do.
In relation to the first of those three main areas of concern, it is important that all my right hon. and hon. Friends bear it in mind that NHS foundation trusts will be an integral part of the NHS. They will be set up to provide NHS services according to NHS principles and NHS standards. They will work under a clear statutory duty of partnership with other NHS organisations. NHS care will remain free at the point of use. As for pay and the terms and conditions under which staff will work, all the candidates for NHS foundation trust status will be signed up to implement the new NHS pay system.
Borrowing can be fairly and properly managed through the new prudential borrowing code, which will be operated by the independent regulator. That will prevent any explosion in unsustainable borrowing, or any unfair redistribution of capital borrowing across the system. In addition, we will establish proper safeguards around the use of public assets to protect the public interest.
The details will be set out in the forthcoming Bill, but our intention is crystal clear. NHS foundation trusts will be an addition to the NHS family, not a subtraction
from it. They will strengthen public ownership, not weaken it. They will help to encourage local delivery of high-quality services by giving greater power and responsibility to local staff and local people. In doing all those things, NHS foundation trusts will help to sustain public support for NHS values and NHS principles.As my right hon. Friend the Secretary of State for Health has repeatedly made clear, establishing NHS foundation trusts will not diminish our efforts to support poorly performing hospitals to improve their performance. On the contrary, we remain absolutely committed to improving the services provided in every NHS hospital at the fastest possible rate. Establishing NHS foundation trusts will not deflect us from that objective. No NHS hospital in any part of the country will simply be left to sink or swim—that is the Tory approach. Action will be taken to improve standards where that is necessary, but where standards are already high, Whitehall should be prepared to stand back and let local staff and management get on with the job at hand. That is the principle that underlies our approach.
That is the right approach, but it is equally right that we should look again at the historical model of public ownership in health. Why should public ownership be synonymous with state control? A model that was right for 1948 cannot, for that reason alone, continue to command unquestioning support today. It is right that we aim to design a new model that can genuinely enhance the concept of public ownership, the values of public service and the principle of democratic accountability. That is what NHS foundation trusts are designed to do.
That is precisely why we have made our proposals. We can carry them out in a way that will entrench and deepen the concept of public ownership in our society, not undermine it in the way that some have suggested. In my view, a model of public ownership in which the public feel they do not own anything at all, which is our present model, does more to undermine the concept of public property and public service than anything else, and makes it easier for the privatisers on the Conservative Benches, if they ever get into power again, to realise their aspiration to sell off the NHS. We can and should look to other models of public ownership, drawing on the experience of mutual and co-operative societies as a way forward. Those are good Labour traditions and I believe that we can apply them successfully to the NHS.
Let me make three brief comments on the second argument advanced today. First, we should begin the reforms in the right place and we should start them carefully. There is a judgment call to be made—I accept that—but I think it sensible to consider the best performing hospitals as the first possible candidates for NHS foundation trust status. They have an established track record of outstanding performance, so they are the logical and prudent starting point for the reforms—but others can follow. There will be no arbitrary limit on the number of trusts that can become an NHS foundation trust—the more, the better.
Secondly, to separate the proposed new ownership model from the freedoms that we propose should accompany it would create a formula for confusion.
With our proposed new model of ownership for NHS foundation trusts should come new responsibility. If poorly performing hospitals—
David Maclean (Penrith and The Border) rose in his place and claimed to move, That the Question be now put.
Mr. Speaker: Is the Minister finished?
Question, That the Question be now put, put and agreed to.
Question put accordingly, That the original words stand part of the Question:—
The House divided: Ayes 144, Noes 381.
AYES
Ainsworth, Peter (E Surrey)
Amess, David
Ancram, rh Michael
Arbuthnot, rh James
Atkinson, David (Bour'mth E)
Atkinson, Peter (Hexham)
Bacon, Richard
Baldry, Tony
Barker, Gregory
Baron, John (Billericay)
Beggs, Roy (E Antrim)
Bellingham, Henry
Bercow, John
Beresford, Sir Paul
Blunt, Crispin
Boswell, Tim
Bottomley, Peter (Worthing W)
Bottomley, rh Virginia (SW Surrey)
Brady, Graham
Browning, Mrs Angela
Burns, Simon
Burnside, David
Burt, Alistair
Butterfill, John
Cameron, David
Cash, William
Chapman, Sir Sydney (Chipping Barnet)
Chope, Christopher
Clappison, James
Clarke, rh Kenneth (Rushcliffe)
Clifton-Brown, Geoffrey
Collins, Tim
Conway, Derek
Curry, rh David
Davies, Quentin (Grantham & Stamford)
Davis, rh David (Haltemprice & Howden)
Djanogly, Jonathan
Dorrell, rh Stephen
Duncan, Peter (Galloway)
Duncan Smith, rh Iain
Evans, Nigel
Fabricant, Michael
Fallon, Michael
Field, Mark (Cities of London & Westminster)
Flight, Howard
Flook, Adrian
Fox, Dr. Liam
Gale, Roger (N Thanet)
Garnier, Edward
Gibb, Nick (Bognor Regis)
Gillan, Mrs Cheryl
Goodman, Paul
Gray, James (N Wilts)
Grayling, Chris
Greenway, John
Grieve, Dominic
Gummer, rh John
Hague, rh William
Hammond, Philip
Hawkins, Nick
Hayes, John (S Holland)
Heald, Oliver
Heathcoat-Amory, rh David
Hendry, Charles
Hoban, Mark (Fareham)
Hogg, rh Douglas
Horam, John (Orpington)
Howarth, Gerald (Aldershot)
Hunter, Andrew
Jack, rh Michael
Jenkin, Bernard
Key, Robert (Salisbury)
Kirkbride, Miss Julie
Knight, rh Greg (E Yorkshire)
Laing, Mrs Eleanor
Lait, Mrs Jacqui
Lansley, Andrew
Leigh, Edward
Letwin, rh Oliver
Lewis, Dr. Julian (New Forest E)
Liddell-Grainger, Ian
Lidington, David
Lilley, rh Peter
Luff, Peter (M-Worcs)
McIntosh, Miss Anne
Mackay, rh Andrew
Maclean, rh David
McLoughlin, Patrick
Maples, John
Mates, Michael
Maude, rh Francis
May, Mrs Theresa
Mitchell, Andrew (Sutton Coldfield)
Moss, Malcolm
Murrison, Dr. Andrew
Norman, Archie
O'Brien, Stephen (Eddisbury)
Ottaway, Richard
Page, Richard
Paice, James
Paterson, Owen
Pickles, Eric
Portillo, rh Michael
Prisk, Mark (Hertford)
Randall, John
Redwood, rh John
Robathan, Andrew
Robertson, Hugh (Faversham & M-Kent)
Robertson, Laurence (Tewk'b'ry)
Roe, Mrs Marion
Rosindell, Andrew
Ruffley, David
Sayeed, Jonathan
Selous, Andrew
Shephard, rh Mrs Gillian
Shepherd, Richard
Simmonds, Mark
Simpson, Keith (M-Norfolk)
Smyth, Rev. Martin (Belfast S)
Soames, Nicholas
Spelman, Mrs Caroline
Spicer, Sir Michael
Spink, Bob (Castle Point)
Spring, Richard
Stanley, rh Sir John
Streeter, Gary
Swayne, Desmond
Swire, Hugo (E Devon)
Syms, Robert
Tapsell, Sir Peter
Taylor, Sir Teddy
Tredinnick, David
Trend, Michael
Turner, Andrew (Isle of Wight)
Tyrie, Andrew
Viggers, Peter
Waterson, Nigel
Watkinson, Angela
Whittingdale, John
Widdecombe, rh Miss Ann
Wiggin, Bill
Willetts, David
Yeo, Tim (S Suffolk)
Young, rh Sir George
Tellers for the Ayes:
Mr. Mark Francois and
Mr. David Wilshire
NOES
Abbott, Ms Diane
Adams, Irene (Paisley N)
Ainger, Nick
Ainsworth, Bob (Cov'try NE)
Alexander, Douglas
Allan, Richard
Allen, Graham
Anderson, rh Donald (Swansea E)
Anderson, Janet (Rossendale & Darwen)
Armstrong, rh Ms Hilary
Atherton, Ms Candy
Austin, John
Bailey, Adrian
Baird, Vera
Barnes, Harry
Barrett, John
Barron, rh Kevin
Battle, John
Bayley, Hugh
Beard, Nigel
Beckett, rh Margaret
Begg, Miss Anne
Beith, rh A. J.
Bell, Stuart
Benn, Hilary
Bennett, Andrew
Benton, Joe (Bootle)
Berry, Roger
Best, Harold
Betts, Clive
Blackman, Liz
Blears, Ms Hazel
Blizzard, Bob
Borrow, David
Bradley, Peter (The Wrekin)
Bradshaw, Ben
Brake, Tom (Carshalton)
Breed, Colin
Brennan, Kevin
Brown, rh Gordon (Dunfermline E)
Brown, Russell (Dumfries)
Browne, Desmond
Bruce, Malcolm
Bryant, Chris
Buck, Ms Karen
Burden, Richard
Burgon, Colin
Burnham, Andy
Burstow, Paul
Byers, rh Stephen
Cairns, David
Calton, Mrs Patsy
Campbell, Alan (Tynemouth)
Campbell, Mrs Anne (C'bridge)
Campbell, Ronnie (Blyth V)
Caplin, Ivor
Carmichael, Alistair
Casale, Roger
Caton, Martin
Cawsey, Ian (Brigg)
Challen, Colin
Chapman, Ben (Wirral S)
Chidgey, David
Clapham, Michael
Clark, Mrs Helen (Peterborough)
Clark, Dr. Lynda (Edinburgh Pentlands)
Clark, Paul (Gillingham)
Clarke, rh Charles (Norwich S)
Clarke, rh Tom (Coatbridge & Chryston)
Clelland, David
Clwyd, Ann (Cynon V)
Coaker, Vernon
Coffey, Ms Ann
Cohen, Harry
Colman, Tony
Connarty, Michael
Cook, rh Robin (Livingston)
Cooper, Yvette
Corbyn, Jeremy
Corston, Jean
Cotter, Brian
Cousins, Jim
Cox, Tom (Tooting)
Cranston, hon. Ross
Crausby, David
Cruddas, Jon
Cryer, John (Hornchurch)
Cummings, John
Cunningham, rh Dr. Jack (Copeland)
Cunningham, Jim (Coventry S)
Cunningham, Tony (Workington)
Curtis-Thomas, Mrs Claire
Darling, rh Alistair
Davey, Edward (Kingston)
Davey, Valerie (Bristol W)
David, Wayne
Davidson, Ian
Davies, Geraint (Croydon C)
Davis, rh Terry (B'ham Hodge H)
Dawson, Hilton
Dean, Mrs Janet
Denham, rh John
Dhanda, Parmjit
Dismore, Andrew
Dobbin, Jim (Heywood)
Dobson, rh Frank
Donohoe, Brian H.
Doran, Frank
Doughty, Sue
Dowd, Jim (Lewisham W)
Drown, Ms Julia
Dunwoody, Mrs Gwyneth
Eagle, Angela (Wallasey)
Edwards, Huw
Efford, Clive
Ellman, Mrs Louise
Field, rh Frank (Birkenhead)
Fisher, Mark
Fitzpatrick, Jim
Fitzsimons, Mrs Lorna
Flint, Caroline
Follett, Barbara
Foster, rh Derek
Foster, Don (Bath)
Foster, Michael (Worcester)
Foster, Michael Jabez (Hastings & Rye)
Francis, Dr. Hywel
Gapes, Mike (Ilford S)
Gardiner, Barry
George, Andrew (St. Ives)
George, rh Bruce (Walsall S)
Gerrard, Neil
Gibson, Dr. Ian
Gidley, Sandra
Gilroy, Linda
Godsiff, Roger
Goggins, Paul
Green, Matthew (Ludlow)
Griffiths, Jane (Reading E)
Griffiths, Nigel (Edinburgh S)
Griffiths, Win (Bridgend)
Grogan, John
Hain, rh Peter
Hall, Mike (Weaver Vale)
Hall, Patrick (Bedford)
Hamilton, David (Midlothian)
Hamilton, Fabian (Leeds NE)
Hancock, Mike
Hanson, David
Harman, rh Ms Harriet
Harris, Dr. Evan (Oxford W & Abingdon)
Harris, Tom (Glasgow Cathcart)
Harvey, Nick
Havard, Dai (Merthyr Tydfil & Rhymney)
Healey, John
Heath, David
Hendrick, Mark
Hepburn, Stephen
Heppell, John
Hermon, Lady
Heyes, David
Hill, Keith (Streatham)
Hinchliffe, David
Hodge, Margaret
Hoey, Kate (Vauxhall)
Holmes, Paul
Hopkins, Kelvin
Howarth, George (Knowsley N & Sefton E)
Hoyle, Lindsay
Hughes, Beverley (Stretford & Urmston)
Hughes, Kevin (Doncaster N)
Hughes, Simon (Southwark N)
Humble, Mrs Joan
Hurst, Alan (Braintree)
Hutton, rh John
Iddon, Dr. Brian
Illsley, Eric
Irranca-Davies, Huw
Jackson, Glenda (Hampstead & Highgate)
Jackson, Helen (Hillsborough)
Jamieson, David
Jenkins, Brian
Johnson, Alan (Hull W)
Johnson, Miss Melanie (Welwyn Hatfield)
Jones, Helen (Warrington N)
Jones, Jon Owen (Cardiff C)
Jones, Kevan (N Durham)
Jones, Lynne (Selly Oak)
Jones, Martyn (Clwyd S)
Joyce, Eric (Falkirk W)
Keeble, Ms Sally
Keen, Alan (Feltham)
Keen, Ann (Brentford)
Kelly, Ruth (Bolton W)
Kemp, Fraser
Kennedy, rh Charles (Ross Skye & Inverness)
Kennedy, Jane (Wavertree)
Khabra, Piara S.
Kidney, David
King, Andy (Rugby)
Kirkwood, Sir Archy
Knight, Jim (S Dorset)
Kumar, Dr. Ashok
Ladyman, Dr. Stephen
Lamb, Norman
Lammy, David
Lawrence, Mrs Jackie
Laws, David (Yeovil)
Laxton, Bob (Derby N)
Lazarowicz, Mark
Lepper, David
Leslie, Christopher
Levitt, Tom (High Peak)
Lewis, Ivan (Bury S)
Liddell, rh Mrs Helen
Linton, Martin
Lloyd, Tony (Manchester C)
Llwyd, Elfyn
Love, Andrew
Lucas, Ian (Wrexham)
Lyons, John (Strathkelvin)
McAvoy, Thomas
McCabe, Stephen
McCafferty, Chris
McCartney, rh Ian
McDonagh, Siobhain
McDonnell, John
MacDougall, John
McFall, John
McGuire, Mrs Anne
McIsaac, Shona
McKechin, Ann
Mackinlay, Andrew
McNulty, Tony
MacShane, Denis
Mactaggart, Fiona
McWilliam, John
Mahmood, Khalid
Mallaber, Judy
Mandelson, rh Peter
Mann, John (Bassetlaw)
Marris, Rob (Wolverh'ton SW)
Marsden, Gordon (Blackpool S)
Marsden, Paul (Shrewsbury & Atcham)
Marshall, David (Glasgow Shettleston)
Marshall, Jim (Leicester S)
Martlew, Eric
Michael, rh Alun
Milburn, rh Alan
Miliband, David
Miller, Andrew
Mitchell, Austin (Gt Grimsby)
Moffatt, Laura
Mole, Chris
Moonie, Dr. Lewis
Moore, Michael
Morgan, Julie
Morley, Elliot
Morris, rh Estelle
Mountford, Kali
Mudie, George
Mullin, Chris
Munn, Ms Meg
Murphy, Denis (Wansbeck)
Murphy, rh Paul (Torfaen)
Naysmith, Dr. Doug
Norris, Dan (Wansdyke)
Oaten, Mark (Winchester)
O'Brien, Bill (Normanton)
O'Brien, Mike (N Warks)
Olner, Bill
O'Neill, Martin
Osborne, Sandra (Ayr)
Owen, Albert
Palmer, Dr. Nick
Picking, Anne
Pickthall, Colin
Pike, Peter (Burnley)
Plaskitt, James
Pond, Chris (Gravesham)
Pope, Greg (Hyndburn)
Prentice, Ms Bridget (Lewisham E)
Prentice, Gordon (Pendle)
Prescott, rh John
Price, Adam (E Carmarthen & Dinefwr)
Prosser, Gwyn
Pugh, Dr. John
Purchase, Ken
Purnell, James
Quin, rh Joyce
Quinn, Lawrie
Rammell, Bill
Rapson, Syd (Portsmouth N)
Raynsford, rh Nick
Reed, Andy (Loughborough)
Reid, Alan (Argyll & Bute)
Reid, rh Dr. John (Hamilton N & Bellshill)
Rendel, David
Robertson, John (Glasgow Anniesland)
Robinson, Geoffrey (Coventry NW)
Roche, Mrs Barbara
Ross, Ernie (Dundee W)
Roy, Frank (Motherwell)
Ruddock, Joan
Russell, Bob (Colchester)
Russell, Ms Christine (City of Chester)
Ryan, Joan (Enfield N)
Salter, Martin
Sanders, Adrian
Sarwar, Mohammad
Savidge, Malcolm
Sedgemore, Brian
Shaw, Jonathan
Sheerman, Barry
Sheridan, Jim
Shipley, Ms Debra
Simon, Siôn (B'ham Erdington)
Simpson, Alan (Nottingham S)
Skinner, Dennis
Smith, rh Andrew (Oxford E)
Smith, rh Chris (Islington S & Finsbury)
Smith, Geraldine (Morecambe & Lunesdale)
Smith, Jacqui (Redditch)
Smith, John (Glamorgan)
Smith, Llew (Blaenau Gwent)
Smith, Sir Robert (W Ab'd'ns & Kincardine)
Soley, Clive
Southworth, Helen
Spellar, rh John
Squire, Rachel
Starkey, Dr. Phyllis
Stewart, David (Inverness E & Lochaber)
Stewart, Ian (Eccles)
Stinchcombe, Paul
Stoate, Dr. Howard
Strang, rh Dr. Gavin
Stunell, Andrew
Sutcliffe, Gerry
Tami, Mark (Alyn)
Taylor, rh Ann (Dewsbury)
Taylor, Dari (Stockton S)
Taylor, David (NW Leics)
Taylor, Matthew (Truro)
Taylor, Dr. Richard (Wyre F)
Thomas, Simon (Ceredigion)
Timms, Stephen
Todd, Mark (S Derbyshire)
Tonge, Dr. Jenny
Touhig, Don (Islwyn)
Trickett, Jon
Truswell, Paul
Turner, Dennis (Wolverh'ton SE)
Turner, Neil (Wigan)
Twigg, Derek (Halton)
Twigg, Stephen (Enfield)
Tyler, Paul (N Cornwall)
Tynan, Bill (Hamilton S)
Vaz, Keith (Leicester E)
Vis, Dr. Rudi
Walley, Ms Joan
Wareing, Robert N.
Watts, David
Webb, Steve (Northavon)
White, Brian
Whitehead, Dr. Alan
Wicks, Malcolm
Williams, rh Alan (Swansea W)
Williams, Mrs Betty (Conwy)
Williams, Hywel (Caernarfon)
Williams, Roger (Brecon)
Willis, Phil
Wills, Michael
Winnick, David
Winterton, Ms Rosie (Doncaster C)
Woodward, Shaun
Woolas, Phil
Worthington, Tony
Wray, James (Glasgow Baillieston)
Wright, David (Telford)
Wright, Tony (Cannock)
Younger-Ross, Richard
Tellers for the Noes:
Mr. Jim Murphy and
Charlotte Atkins
Question accordingly negatived.
Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments):—
The House divided: Ayes 282, Noes 150.
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