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Hugh Bayley (City of York): My right hon. Friend the Secretary of State mentioned the cancer specialist Professor David Kerr. He told me last week that, despite the progress made with the NHS cancer plan, it can still take between four and six months in some hospitals for a patient with a cancer who has been referred by a GP to get to the point of treatment. A similar patient in an American hospital could go through the patient journey, to use the modern jargon, in four to six days. Professor Kerr told me that he needs the changes in this Bill to allow hospitals to reorganise their cancer services to meet the better standards. Why are the Opposition standing in the way of consultants such as David Kerr, who want to drive up standards?
Dr. Fox: I suggest that, for every consultant in favour of foundation hospitals, the hon. Gentleman will find many who oppose them, but he makes an interesting point. If he is suggesting that foundation hospitals move in the direction of the American health care system and the benefits that it brings, that is an interesting point of view. I think that he will find that his views are in stark contrast to some of the remarks made by the Chancellor of the Exchequer.
Sadly, the Chancellor of the Exchequer cannot be with us today. Cocooned in his time warp, he opposes what he considers to be dangerous ideological ideas, and the Prime Minister has neither the courage to remove him nor the strength to face him down. The Chancellor, either directly or indirectly, has sought to rubbish any reforming ideology before systematically emasculating any specific policy proposals.
The gap between the Prime Minister and the Chancellor is very clear. I shall give the House the best example of that. In his speech to the Social Market Foundation in February, the Chancellor said that, in health,
Dr. Fox: Our view on competition and markets is, of course, much closer to that of the Prime Minister. That is because his view is far closer to ours than it is to that of his own Chancellor of the Exchequer. The Opposition have always been supportive of the concept of foundation hospitals as developed in Spain and Sweden, for example. We have visited those countries to look at the foundation hospitals. An incoming Conservative Government would be comfortable with the models developed there, but we do not see them as an end in themselves. Such hospitals would be among the building blocks that we would use to create a more diverse provision of health care that was increasingly independent of state control.
Mr. John Redwood (Wokingham): Will my hon. Friend tell the House which extra freedoms he thinks that foundation hospitals should enjoy, compared with the garbled model presented by the Government? That may calm Labour Members' impatience, as I think that they have not yet grasped his argument.
Dr. Fox: The emasculated version of what has been established in other countries that is contained in the Bill is not the programme of a bold and reforming Prime Minister. It is a timid and pale imitation of what works elsewhere.
Dr. Fox: Of course, the radical rhetoric will remain, but the sad reality will change insufficiently. As ever, the proposal has been spun wonderfully, but it will not be sufficient to turn the NHS around. It may well produce the worst of both worlds for the Government, whose overblown rhetoric maximises anxiety about change but whose lack of delivery still further frustrates voters whose taxes have risen but who have seen no clear benefits.
In answer to the question posed by my right hon. Friend the Member for Wokingham (Mr. Redwood), I shall look at the details of the proposed foundation trusts. The first area for concern is borrowing. In May 2002, the Secretary of State said that the intention was that foundation trusts would
An annual limit is just laughable. What about the longer-term security and planning that we were promised? What happens if the foundation trust comes up with a good idea to expand services during the year? Before it can proceed, a hospital wanting a new MRImagnetic resonance imagingscanner, for instance, will have to tell patients that it must wait until the following year to find out what borrowing the regulator will allow. What kind of freedom is that?
When a foundation trust gets its borrowing limitdetermined by the regulatorwhere can it go for money? It can borrow money, but it has little real freedom as to where and how it borrows. How does that compare with the freedoms in the voluntary and private sectors? The private sector can create floating charges over its assets. Foundation trusts will be debarred from that. The private sector can enter into asset financing deals, but foundation trusts will have to ask permission from the regulator if the assets are protected property. Will scanners, for example, be protected property? Will foundation trusts have to get the regulator's agreement every time they want to improve medical equipment through the year?
Given those restrictions, it would be very surprising if foundation trusts could borrow from the private sector, as the Secretary of State has suggested, unless the Secretary of State was willing to underwrite their liabilities. That may have been what he wanted originally, but the Chancellor of the Exchequer denied him that.
The real damage produced by the borrowing restrictions will be found in the effect that the system will have on non-foundation trusts. The Chancellor's emphatic ruling that foundation hospitals will be able to borrow only within the total NHS budget has confirmed the fears on all sides as to what the Bill would mean in practice. The Chancellor has made it perfectly clear that, if any foundation hospital wants to borrow more, other hospitals inevitably will get less. The Bill will create a dog-eat-dog culture, in which financial growth in foundation hospitals will mean cuts in the budgets of hospitals elsewhere. Progress in foundation hospitals will inevitably be at the expense of patients elsewhere.