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Madam Deputy Speaker: I remind right hon. and hon. Members that Mr. Speaker has imposed a time limit of eight minutes on all Back-Bench speeches.
2.10 pm
Mr. David Hinchliffe (Wakefield): I beg to move,
- That this House declines to give a Second Reading to a Bill which, by establishing Foundation Trusts and introducing other layers of bureaucracy, would increase disparities between hospitals and detract from the Government's commitment to a primary care led NHS, free from excessive bureaucracy, and believes that alternative ways of encouraging accountability in the NHS should be considered and a consensus established before legislation is introduced.
If I receive, as Chairman of the Health Committee, one clear message from national health service staff, it is that the Government have delivered record, massive levels of funding, to their great credit. The message to me is: now let us get on with the job; the last thing that we need is more restructuring. If Members have limited time today and cannot read the whole of the Health Committee report, they should just look at pages 9 and 10, which set out the major restructurings in the health service over the last 20 years—there have been 18 different significant restructurings. That is one of the reasons why the results do not reflect what the Government deserve from the investment and the efforts being made currently. Permanent revolution is impacting on performance at a local level. One witness to the Health Committee described the NHS as "an organisational shanty town", with structures and systems cobbled together hastily in the knowledge that they will be torn down again straight away.
The pace of change is so fast that new structures are being abolished even before being introduced: for example, patient forums. When community health councils were abolished, we had a long discussion about patient forums, which have been abolished before they have been introduced. That concerns me, because I was given certain clear assurances at the time of the abolition of community health councils.
The Government's central policy objective in health is for a primary care-led national health service, and I congratulate the Government on their success in going in a direction that should have been taken 50 years ago when the health service was introduced. It is the right direction, and one of the problems that the health service has had, over many years, is that we have never taken that direction. My right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) started those reforms and the current Secretary of State for Health followed on. That is to their great credit. We are seeing the results, slowly but surely, of that direction of policy.
Suddenly, however, we have a U-turn: the headline at the weekend was, "Superhospitals for all". To me, increased empowerment of hospitals undermines, or will undermine, that central plank of policy, and it entrenches divisions that we need to address rather than make worse.A little while ago, the Health Committee produced a report on delayed discharges. We came up with the solution that the answers to pressures on the hospital sector lay within primary and community care, not within reforms in the hospital sector. Last summer, I went to my local hospital, Pinderfields general hospital in Wakefield, and I found that, according to the consultants, a third of the people occupying beds did not need to be there. They were not all delayed discharges, although some were; the majority were people who could have been treated, and should have been treated, within primary care. That is the direction that we should take. My personal view is that we are suddenly doing a U-turn and going in completely the opposite direction. I agree with the central point of my hon. Friend the Member for Vauxhall (Kate Hoey), who intervened on the Secretary of State: primary care is surely the natural starting point for new models of social ownership by local people.
Dr. Phyllis Starkey (Milton Keynes, South-West): Will my hon. Friend give way?
Mr. Hinchliffe: No, not when I have only eight minutes. I apologise.
I support the idea of local governance. I imagine that none of my colleagues has spent more time in this Chamber arguing for local governance than I have. I have argued for that solidly, in every speech that I have made, for the past 16 years. I find the current proposals superficially attractive, but when I look at the detail as the Health Committee looks at it, the proposals are unclear and unspecific. The constituency is unknown; we spoke about Bristol earlier, and as has been mentioned, Chepstow people—Welsh people—could end up controlling a Bristol hospital. We do not know how the system will work. It worries me that on Second Reading we lack the detail to which we are entitled from the Government on such important issues. The Health Committee's criticism in respect of this area of governance was about channelling patient involvement and enthusiasm into acute hospitals, as we believe that that will undermine the step change towards primary and community care—a step change that the Government are to be commended on making.
To go to the heart of my concerns, I am a member of the Labour party because I believe in the Labour position on the national health service. I am proud that my party introduced the national health service. I am proud that the core of our thinking is the fundamental equity principle. I worry that the proposals under discussion today will increase disparities between hospitals rather than reduce them. The Secretary of State has offered a number of concessions. For example, we have a five-year roll-out. My view is that that will add to many of the problems. Over that five-year period, in the middle of which we will have a general election, we shall see those disparities occur. Resourcing will be affected. Foundation trusts will have privileged access to capital, and will have the right to retain operating
surpluses. The Health Committee asked whether borrowing by foundation trusts would count against departmental spending limits and therefore restrict capital resources available to non-foundation trusts. Last Wednesday, the Chancellor gave the answer loud and clear to the Treasury Committee: yes, it would do so. Just like the internal market, we will have winners and losers. That worries me, and it is not the direction that I expected from my Labour Government.On staffing, it is not just a matter of rewards. If more rewards are offered, we will see more disparities. Poaching will not just be on the basis of terms and conditions; staff will be attracted to other advantages to be given to foundation trusts. As the Health Committee said:
- "Areas of high mobility and workforce shortages will face problems."
In the limited time that I have been afforded, I shall conclude with the Health Committee's conclusion that the proposals are
- "not . . . fair, consistent and need to be rethought."
2.18 pm
Dr. Evan Harris (Oxford, West and Abingdon): The Secretary of State for Health is fond of saying that only he is in favour of reform. He concedes that other parties are in agreement with the extra resourcing that he is putting in, but he must accept that some on his side are not in favour of reform. The Conservative party may sometimes say that it is in favour of reform, but its proposals dare not speak their name, and certainly dare not speak their price. I therefore hope that the Secretary of State will concede that, in setting out our opposition to his plans, we have at least put forward an alternative, not only in our reasoned amendment but in the policy that we published last year. I have invited the Secretary of State to debate those proposals with us previously, and we started that debate today when we discussed what we will do about democratising and decentralising primary care.
Our proposals are essentially fivefold. We set the Government the following tests in relation to the Bill. Will the reforms concentrate sufficiently on the three Ps: primary care, prevention and health promotion? There is no evidence that this Bill will do that. Will the Government put in place measures to increase capacity in the NHS? Capacity constrains the ability of the health service to provide patients with what they need. At the top of patients' agenda is not more structural change but functional improvement in capacity.
Will there be adequate decentralisation and democratisation of the commissioning side of the health service? That is where the key decisions are made on what to buy, where it is bought and how much to buy in the internal market that still exists in our health service.
Will we see the end of targets, and of the distortions of resource allocation and clinical priority that go with them? Will we see true freedom for all parts of the health economy, with tax-varying powers locally? There is no sign of that in the Government's measure. Yes, we want to see a mixed market in providers, but without either the false elitism or the beggar-thy-neighbour approach that is inherent in the Government's foundation hospital proposals.
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