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Madam Deputy Speaker: Order. The right hon. Gentleman's time is up.
2.47 pm
Mr. Stephen Dorrell (Charnwood): I have been attending health debates for quite a long time now and have spoken in debates before and after the right hon. Member for Holborn and St. Pancras (Mr. Dobson). I have seldom agreed with him, and I am afraid that I did not agree with him this afternoon.
I want to start from the point of view of someone who spoke in January this year in support of the Secretary of State's initiative for foundation hospitals. I have no doubt at all that the policy for greater freedom for NHS trusts that he described when he spoke last May is correct. It is worth reminding ourselves of the words that he used to describe that policy, because he made it clear that his policy was designed to take the freedoms ascribed to NHS trusts beyond what he described as the halfway house established by my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) when he was Secretary of State for Health in 1990.
Last May, the Secretary of State said:
- "NHS trusts were supposed to guarantee self-governing status. In fact they were at best a half way house and at worst a sham. Trust status promised independence but in practice didn't guarantee it. In reality their legal status—with direct accountability to Ministers—meant that Whitehall continued to hold on to the purse strings . . . The challenge now must be to genuinely free the very best NHS hospitals from direct Whitehall control."
I wholeheartedly agree with the Secretary of State that the lesson of the period between 1990 and 1997, for a large part of which I shared responsibility for the NHS, was that those reforms needed to be taken an order of magnitude beyond the position established by the National Health Service and Community Care Act 1990. The problem with the measures in the Bill is that they do not follow through the logic of what the Secretary of State said last May, nor do they learn the lessons of the history of the period between 1990 and 1997.
It is worth reminding ourselves of the two arguments, both of which I find wholly persuasive, for the words that the Secretary of State used last May. He made clear the first argument in that same speech, when he referred to a visit that he had paid to Spain. He had visited a hospital in Madrid and
- "was struck by the fact that the greater independence it enjoyed from the rest of the state run health system had given patients there faster waiting times and improved outcomes despite dealing with a more severe case mix than comparable state run hospitals."
Beyond that—and this is part of the reason that the forces of conservatism are so heavily arrayed on the Labour Benches today—is the fact that this policy is not just about the NHS; it is also, as the Prime Minister has made clear, about a model for reform for public services as a whole. The forces of conservatism have understood the message and are drawing what is, from their point of view, the right conclusion. The Prime Minister has put the Secretary of State for Health in the front line of what he hopes will be a major reform of public services, along the lines of the Secretary of State's speech last May.
I shall quote the words of the Prime Minister in an article published this year entitled "Where the Third Way Goes from Here". It has not gone far yet, but we are always hoping:
- "On public services, we need to explore the usefulness of choice and contestability".
- "the principles underlying Alan Milburn's espousal in the UK of community-owned Foundation hospitals need to be applied far more systematically across the public sector."
The simplest way to illustrate that problem in a short time is to invite the House to compare the status of a foundation hospital under the Bill with a British university in the time of Lady Thatcher. I know of almost no one who would argue that universities under Lady Thatcher enjoyed unrestrained freedom or that they suffered from too much freedom to get on with their own affairs without constraint from Whitehall. It is surely the case—I certainly believe it to be so—that the last Conservative Government imposed too tight a straitjacket on British universities to allow proper institutional development of higher education in this country. I am pleased to say that my party is learning the lesson of that history and is seeking to support a more liberal regime for universities.
If we compare the freedoms that the universities had in the 1980s with the freedoms that the Secretary of State promises foundation hospitals now, whether it is the freedom—or lack of it—to pay people to do the job that they want to do, the freedom to raise money to develop their institutions for the future, or the freedom to decide their own clinical or educational priorities, we realise that the truth is that universities had greater freedoms in the 1980s than the Secretary of State is promising hospitals now. If this were a first offence for this Government in terms of the gap between rhetoric and reality, I would give them the benefit of the doubt, but they are serial offenders and I do not want to be responsible—
Madam Deputy Speaker: Order. The right hon. Gentleman's time is up.
2.55 pm
Dr. Jack Cunningham (Copeland): I rise to support the Second Reading of the Bill and the speech of my right hon. Friend the Secretary of State. I do so based on my experience of the hospital in my constituency, which my right hon. Friend knows very well because he visited it recently, and more generally on the experience of North Cumbria Acute Hospitals NHS trust. Like my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), I want to begin by paying a warm tribute to the hospitals in my constituency, including the ancillary workers, the technicians, the paramedics, the nurses, the doctors and the managers, because every day of their lives those thousands of dedicated people do their very best for all the patients who come into their care.
I have had more meetings about the hospital service in my constituency since the general election of 2001 than about any other two issues put together, because, in spite of much excellent work, the huge and considerable improvement, and the massive increases in investment since 1997—initiated courageously, first of all, by my right hon. Friend the Member for Holborn and St. Pancras and carried on by my right hon. Friend the present Secretary of State—we know that all is not well in the hospital service. That is an inescapable conclusion.
We all understand now, if we did not before, that securing better, more consistent high standards of performance in the hospital service requires much more
than simply providing enormous increases in cash. Such increases have been provided and will continue to be provided, as the Government have made clear, but that will not be sufficient in itself to get the health service that we are all striving to achieve. Thanks to Government initiatives, we now have a much clearer picture of performance in our hospital service. We know that the present management systems are not delivering consistently within hospital trusts, let alone between trusts. A point that is often missing from these discussions is that the systems' failures not only affect the level of care for patients but inherently prevent hospital staff from giving patients the level of care that they want to provide.That is why we cannot preside over an inadequate status quo, and this is where I depart from the argument advanced by my right hon. Friend the Member for Holborn and St. Pancras. We know that the best-performing hospitals in our system are excellent; they are outstanding by any international comparison. We also know, however, that there are too few of them, that others struggle, and that some fail to meet the standards that the public, rightly, increasingly demand.
I did not expect in 1997, or again in 2001, that we would be hearing people defend the status quo in a debate about the health service. I am not in the Labour party to defend the status quo, and I am certainly not content with the level of service on offer to many of my constituents at present. It is true that the health service has changed and is changing. I believe that it must continue to change, and those working in it, more so than we in this House, know that, too. They know that, in many cases, they are simply unable to provide the levels of care that they are so dedicated to providing.
There are other reasons for change. We have more knowledge of illness and medicine than ever before, and better medical science, technology and diagnostic systems than ever before. We have increasing numbers of key people in the service, thanks to the policies of this Government. We have the largest hospital building programme in living memory—again, thanks to this Government. All those things are producing sweeping changes in the health service, and the argument that, in the fact of that, management systems can stay exactly as they have been is untenable.
Patients and staff together are rightly demanding better performance and choice. I am afraid that I must tell my hon. Friend the Member for Wakefield (Mr. Hinchliffe), who has long dedicated himself to health policy issues—I commend him for that—that if patients are able to identify a better-performing hospital and choose to go there, who can blame them and say that that is wrong? I would not condemn someone for doing that. That does not undermine the health service: it makes other hospitals perform better and drives up standards. General practitioners and patients should choose the better provision because they are entitled to do so. We need to drive up the performance of hospitals that do not meet the standards, and we are not here to defend them if they do not do so.
There has been much talk of a two-tier system, which would represent a big step forward. I think that we have a four or five-tier system at present. We have some of the best hospitals in the world, but there are some
dysfunctional hospital trusts at the other end of the scale, which is simply unacceptable. Staff make the same point. If Labour Members have a fundamental ideological point, it is surely that we demand the best possible care, on the basis of clinical need, that is free for all at the time of use. That is the basic ideological difference between Labour and Conservative Members. The Conservative case descended into confusion and disarray within five minutes of the start of the speech made by the hon. Member for Woodspring (Dr. Fox), although that was not because of anything that we said but because of what his colleagues said about the Tory Opposition's untenable position.The public do not care how the service is organised and managed. That issue is not fundamental for them, and nor is any ideology. People care passionately about better access, better care and better performance by the hospitals that they rightly admire and love. They rightly believe that all public services should be delivered for the benefit, support and convenience of users, not providers. Some of our managers and trade unions understand that, but, sadly, others do not.
We are told that foundation hospitals will undermine the NHS, but my right hon. Friend the Secretary of State demolished that myth during his speech and I support what he said. Several Governments and numerous Secretaries of State for Health have tried to undermine or diminish the national health service in one way or another. It survives and has seen them off and it is still here long after they have gone. It is a robust, popular and much-loved Labour creation that is vigorous, durable and more necessary for people today than ever before. We must work to drive up performance for all patients, as many others, including the King's Fund, have made clear. If I have one reservation about the Bill, it is whether the proposals are too modest. My worry is that people in the health service and trade unions will try to frustrate the proposals—
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