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3.35 pm
Hywel Williams (Caernarfon): Last year, in a reply to me, the Secretary of State said that it is an abiding joy for him that he is
- "not responsible for all things Welsh".—[Official Report, 22 January 2002; Vol. 378, c. 739.]
Under the Bill, Wales will have no foundation hospitals—we have that on the authority of no less a personage than Mr. Rhodri Morgan, newly triumphant in the polls, who said that Wales will be a foundation hospital-free zone. Over the weekend, the Prime Minister, promising a "fairer and better Britain", defended the principle of foundation hospitals—presumably, he meant foundation hospitals in Britain. As we know, he wants all hospitals to be foundation hospitals within five years. I would therefore be grateful if, at the end of our debate, the Minister of State would say whether Mr. Morgan is right that Wales will not have foundation hospitals, or whether the Prime Minister is right that we must have them if we are to have a fairer and better Britain? They cannot both be right—or was the Prime Minister merely saying "Britain" while he lay back and thought of England?
Before the recent election in Wales, Mr. Morgan famously said that he would push for "clear red water" between Cardiff and London. The people of Wales deserve an explanation of the exact place of foundation hospitals in the new Labour push for independence for Wales.
Linda Gilroy (Plymouth, Sutton): Will the hon. Gentleman share with us his thoughts on foundation hospitals? Does he consider it surprising, given the lead that Wales has taken on the water utility and housing stock transfer by adopting mutual models, that there is not greater enthusiasm for them?
Hywel Williams: I shall refer to that later in my speech. Unfortunately, given the recent election results, my party is scarcely in a position to think in those terms. If the Prime Minister is right and we are to have foundation hospitals in Wales, I do not see how that can be achieved in the face of opposition from the Labour party in Wales and my party.
We might wonder what the red water of independence might mean for Mr. Morgan. No slouch at spin, he made much in Wales in the past few weeks of the value of political congruence between Cardiff and London. Only a Labour Administration in Cardiff, he said, could work properly with a London Labour Government. But with foundation hospitals, we have an apparent split—a parting of the ways, a downside.
If there is to be clear red water between Wales and England on health, let it be properly thought out. Hon. Members may be reminded of Macbeth's speech in the Scottish play when, after he has killed Duncan, he muses whether he should kill again. He says of the red water:
- "I am in blood
Stepped in so far that, should I wade no more,
Returning were as tedious as go o'er."
Establishing foundation hospitals in England, particularly in the western part of the country, will have a profound effect on the NHS in Wales. Foundation hospitals will be in a much better position to compete with Welsh hospitals. They will be able to offer better conditions and possibly more advanced clinical work. Given the shortage of medical staff, they will no doubt attract staff from Wales, where individual hospitals' freedom of action is constrained.
One obvious example is the Countess of Chester hospital—an excellent hospital which has three stars, and which will no doubt opt for foundation status soon. What effect will that have on the Wrecsam Maelor and ysbyty Glan Clwyd? The hon. Members for Wrexham (Ian Lucas) and for Clwyd, West (Gareth Thomas) may have something to say about that, although they are not present today. A similar process may take place in the south-east of my country.
We in Wales have a shortage of medical staff, and the National Assembly has responded by extending medical training to the north and to the west. Some newly qualified staff will stay in the locality, but others will move over the dyke. That has always happened. Young
people in Wales, newly qualified, will go where the work is. It is a process to be welcomed. Producing and training people such as teachers, doctors and nurses who go on to serve elsewhere has been our historical experience in Wales. That is one thing, but it is quite another deliberately to set up a system that will draw doctors and nurses away from Wales, where health is the worst in the UK. Our fear is that the development of foundation hospitals in England will undermine the policy and strategy of the National Assembly in Cardiff.What of the effect on patients? A critical mass of patients is required to justify new and expensive treatments. If part of the required critical mass is drawn away from Wales, how will hospitals such as ysbyty Gwynedd, ysbyty Bronglais and Withybush justify spending large sums of money on the latest treatments, when many of their potential patients are drawn over the border?
Some hon. Members will probably say, "So what?" People from north Wales have long been used to travelling for medical treatment to Liverpool, Manchester, Clatterbridge and Gobowen. A constituent of mine recently heroically undertook a £400 taxi drive to Scotland to have a pacemaker fixed. It is an historical fact that we have had to travel far to get anything like equality of treatment, but historical fact is no reason to establish a new system that will entrench that historical inequality—at least, not without a policy response from Cardiff, which is sadly lacking.
A reasonable solution might be found to these problems that would allow policy in England and Wales to differ, while sustaining the less advantaged hospitals in Wales. However, I fear that such solutions are going by default. Hon. Members will know that in establishing the NHS, Aneurin Bevan's great slogan was "Freedom from fear"—freedom from fear that the doctor would not call, freedom from fear that the medicine would be too dear, freedom from fear that proper hospital treatment was not for the likes of us. Our NHS has given us freedom from those fears. We now have access to medical treatment.
Establishing foundation hospitals in England, with no policy response from Wales other than saying no, will not destroy the NHS in Wales, but it will endanger a principle that is close to my heart and the heart of our people—the principle of equity of access. That is reason enough for my party to reject the Bill.
3.43 pm
Mr. Kevin Hughes (Doncaster, North): Although the debate has so far focused on the establishment of foundation trust hospitals and will no doubt continue to do so, there are other issues in the Bill that will greatly improve health and social care for my constituents. I shall say something about foundation trusts, but first it is worth mentioning a couple of the other aspects of the Bill, which I hope are overwhelmingly welcomed by hon. Members.
Part 2 deals with the important matter of quality standards and sets up new health care and social care inspectorates. Lifting standards and the quality of care, inspecting and auditing will be the main function of the Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection. This Government have done more than any other to drive up standards and improve the quality of care, and these measures will continue those improvements.
We all know about the problems with NHS dentistry. The Bill seeks to address those problems by making it the duty of primary care trusts to provide primary dentistry services and promote oral health. The welfare food scheme is somewhat out of date and does not meet the nutritional needs of its beneficiaries. The Bill will broaden the nutritional basis of the scheme to include fruit, vegetables and cereal-based foods in addition to liquid milk, thus ensuring that children from less well-off backgrounds have access to a healthy diet.
The main question in the debate—at least, it is the main question among Labour Members—is about the proposals for foundation hospitals. I was convinced by the arguments that the proposals would create a two-tier health service, pit hospital against hospital and nurse against nurse, and result in some hospitals poaching staff. I believed that patients would have to travel out of area for less lucrative health care, and that the proposals would be the thin end of the wedge leading to privatisation. Before my right hon. Friend the Secretary of State faints on the Front Bench, however, let me add that I had been convinced by those arguments over a decade ago when we were advancing them against the trust status that the Tories introduced.
I want to tell the House what has happened to health services in Doncaster since those changes were introduced more than a decade ago. They have improved out of all recognition. The Doncaster royal infirmary has changed from what was not a very good hospital to one of the best in the country, achieving three-star status and continuing to improve. I pay tribute to its doctors and nurses—and yes, to the management, too—for taking forward those improvements and delivering a better health service for the people of Doncaster.
The arguments were wrong more than a decade ago, and they are out of date, tired and wrong now. This time I shall not campaign against the changes; I shall support a bid from the Doncaster royal infirmary to become a foundation trust hospital. Having seen the improvements in Doncaster over the past decade, I want to ensure that my constituents continue to enjoy the best health care possible, and foundation status should lift the standard and quality of care to yet new heights.
Set within the national framework of standards, but responding to local needs, foundation trust status will help to tackle the inequalities in South Yorkshire. Freedom from Whitehall control should mean freedom to deliver and develop services in the way that best suits patient needs in Doncaster. I have every confidence that the three primary care trusts in Doncaster, in partnership with the Doncaster royal infirmary as a foundation trust, will drive the local agenda forward and respond to local needs more directly and positively.
Social ownership of local hospitals, with direct elections involving local people, will ensure that local decisions are more responsive to community and individual patients' needs. Doncaster's doctors and nurses will be able to use their talents to innovate and develop new locally based health care services—the services that they know local people require.
I can sit down in my local travel agent and book, months in advance, not only a hotel in just about any country in the world and a flight to get me there, but a taxi to take me from the airport to the hotel. Why, then,
can I not sit in my GP's surgery and book an appointment at my local hospital for elective surgery at a time that suits both the health care team at the hospital and me?The freedom given by foundation status should be able to drive us towards that goal and release our NHS staff down an ever more innovative road. Foundation status is not a recipe for a two-tier service, nor will it lead to privatisation. It is a plan that should take our health care system to a higher level—a level that our constituents demand, and surely deserve. My right hon. Friend the Secretary of State can look forward to my presence in the Lobby supporting him tonight.
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