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3.50 pm
Dr. Andrew Murrison (Westbury): It is a great pleasure to follow the hon. Member for Doncaster, North (Mr. Hughes) and to have witnessed his conversion to consumerism. I am sure that most hon. Members who have the interests of their constituents at heart will welcome many aspects of the Bill in its drive to improve standards. It is often important to realise that the NHS is not an ideological tool, but is there for one purpose and one purpose only—to deliver services for constituents. I hope very much that aspects of the Bill will move us in that direction. None the less, this is an atherosclerotic sort of Bill. It appeared to start well, but somewhere between No. 10 and No. 11, it managed to become furred up. I hope that we will be able in Committee to unclog a great deal of the Bill and turn it into something vaguely useful.
Last week, I had personal experience of the national health service as a patient. I attended for a minor procedure at the district general hospital serving my constituency and was faced with a monumental form. It was a consent form that had been dreamt up by some bright spark in Richmond house, it ran into two sides of A4 and it brought home to me what we must do as we try to work towards a 21st-century national health service—unclog the NHS of much of the bureaucracy that has acted as a dead hand, a great deal of which comes from the centre. The form was presented to me by the consultant concerned, who also gave me a copy of the previous consent form that he had drawn up in his department. It was considerably shorter, and he told me rather sadly that as a result of the new form that had been presented to him from the centre and Richmond house, he had had to cut the number of patients whom he was seeing. The form was so bureaucratic that he had had to reduce from 10 to nine the number of patients whom he saw every morning. Given that the sessions cost £700,000 a year, that form alone had cost £70,000. That is a salutary example of what we need to do in the national health service to drive up standards—reduce bureaucracy. If the Bill goes some way towards achieving that, I for one will be very pleased.
The intentions of the Secretary of State, however, have been shown to be in stark contrast to his actions in the Health Act 1999 and the Health and Social Care Act 2001, in which he increased the number of directions and his direction-giving powers for NHS trusts. Here is a Secretary of State who says he has at heart the reduction of central control of the national health service, but is inherently inclining towards an increase in the number of directions that he issues from the centre.
I have a parochial concern—the Royal United hospital, Bath. The Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), has described the RUH Bath as his No. 1 headache. It has certainly caused politicians locally and nationally much headache in recent months and I fear that it lurches from crisis to crisis. Despite that, it continues to give a first-rate clinical service to my constituents, which I welcome both as a patient and as a local representative.
It is very difficult to see how the Bill will act in the interests of my constituents, given that foundation hospitals will borrow against departmental expenditure limits. It is difficult to see how the capacity of hospitals such as the RUH and others to dig themselves out of the financial morass in which they currently find themselves will be improved, bearing in mind the increased powers that hospitals selected as foundation hospitals will be given to borrow against that departmental expenditure limit. I have to say, therefore, that the message from my constituents is that the Bill is unlikely to serve them particularly well.
Although I welcome the £200 million that the Secretary of State announced to encourage no-star and low-star hospitals to work towards foundation status, it is woefully inadequate and has to be set against historic debt—in the case of the RUH, a debt of some £20 million. Without addressing that, I am afraid that the RUH will not move on at all.
I welcome the Secretary of State's proposal to roll out "Agenda for Change" across the national health service, but I have a concern—again, perhaps parochial—that the piecemeal roll-out of foundation hospitals will lead to the migration of staff from low-star and no-star hospitals to those that are three-star and have an expectation of becoming foundation hospitals. The NHS is nothing if it is not the staff who work within it. Members such as me who represent areas served by low-star and no-star hospitals fear that hospitals that are rated fairly low on the criteria set by the Secretary of State may start to do even worse. We live in a funny old world in which Ministers focus first and foremost on hospitals that are apparently doing extremely well, anointing them as foundation hospitals, without first concentrating on hospitals that are flagging. It is a great pity that they do not focus more heavily—first and foremost—on hospitals that have been identified as performing less well. In my area, I would particularly identify the Royal United hospital, Bath.
The Local Government Association has sent right hon. and hon. Members some information that I hope Ministers will take into account. The LGA has huge experience in the running of elections, and it is extremely concerned about the hotch-potch of elections that could be created under the Bill and what might happen subsequently. At the moment, we have a robust set-up for electing district councils—many of us have been through that procedure recently—and it is a great pity that we cannot work on that to create constituencies around primary care trusts. I firmly believe that we need to build on the good work that the Government have done in promoting primary care by focusing heavily on
primary care trusts and being less exercised by acute trusts. That would ease some of the difficulties that I am sure will emerge in Committee about the democratic accountability of the new structures, and rescue the Government from the mess that they will get themselves into by trying to elect bodies to run acute hospitals. I urge Ministers—
Mr. Deputy Speaker (Sir Michael Lord): Order. The hon. Gentleman has had his time.
3.58 pm
Linda Gilroy (Plymouth, Sutton): I speak as the chair of the parliamentary group of Co-operative MPs, but I want to preface my remarks with some points from my constituency. People are three times more likely to die from circulatory diseases before the age of 75 in the inner-city wards of Plymouth than in its leafy suburbs, and twice as likely to die from cancer. For me, therefore, any change in the health system must add real value.
I enthusiastically supported the Government's programme to get more money and capacity into the health service. That is certainly delivering in Plymouth, where we have 700 more nurses in the former South and West Devon health authority area than in 1997. We have several new cardiac theatres, which are treating more than 2,000 patients a year, compared with some 500 patients in 1997. The buildings for the new Peninsula medical school are going up as we speak, and more than 200 of the 1,000-plus extra doctors in training nationally will be there by this September.
In addition to more money, people, buildings, beds and equipment, we have for the first time the means to compare our local hospitals' performance. We also have sure start, healthy living centres and the new deal for communities, which help to tackle inequalities. They are underpinned by the significant shift that the new primary care trust framework provides. It will be patient and doctor led, but with other stakeholder involvement, and PCTs will soon spend 75 per cent. of the health care budget on our behalf. Such measures give us the means to identify and close the gap in what is not a two-tier but, as other hon. Members pointed out, a multi-tiered health service. Step by step, they are changing what many of us believed was an ill health service into a genuine health service.
The atmosphere in our acute hospitals, however, continues to feel like that of a pressure cooker. Sometimes it appears as though the pressure has been turned up rather than down—ironically, as a result of some of the changes that I mentioned. Most staff work their socks off and give of their best—often more than can reasonably be asked—to the hospitals. As other hon. Friends have said, up to a point targets have their place in achieving that, but their shelf life is limited.
Top-down plans and targets can dampen the enthusiasm, energy and experience of staff. We emphasised the targets in the early years of our determination to rescue our health service from the Tory legacy of underfunding and lack of ambition and commitment. The freedoms and flexibilities for foundation hospitals have the potential to build up the spirit of public enterprise to harness what existing structures do not fully realise in new and, more important, sustainable ways.
Those who claim that the plans will lead to privatisation are simply wrong. Public interest companies, which are run along mutual lines, have nothing to do with the private sector. They are the natural territory of the centre left, as some hon. Friends have said. They empower people rather than deflate them with top-down, state-knows-best, one-size-fits-all approaches.
Local public interest companies are the essence of the way in which we can achieve more through the strength of common endeavour than alone. Lively debate has already improved the Bill and I hope that my hon. Friends will continue to talk to the Co-operative movement and draw on its experience of good governance for co-operative and mutual frameworks that work rather than fail, although some co-operatives fail. It would be good to place a legal duty on every trust to promote the recruitment of members from all sections of the local communities and communicate with its members and the wider community to specified standards.
I should like a choice of the most appropriate mutual and co-operative model. Such models include public benefit corporations, industrial and provident societies and community interest companies. I look forward to that debate in Committee. I should like the hallmark of successful co-operative ventures—education—to be properly resourced to empower stakeholders in the health community to seek election to the new boards and be accountable in robustly democratic ways. Again, a commitment to that in the primary legislation or attendant regulations would be good.
The foundation hospital proposal is a vital piece of the NHS reform jigsaw. It is a piece that, once identified and put in the right place, enables the rest of the picture to form a whole. However, it is a piece that is difficult to place. If it is viewed in the wrong way and put in the wrong place, it will make the puzzle look and feel wrong.
I ask hon. Friends who are uncertain about the overall picture to give the Bill a Second Reading. It would be short-sighted to strangle or delay a measure that could unlock the public service dividend of our national health service in new ways. Achieving hospitals need the means to advance further now. They need to be free to pioneer ways of releasing an even greater public service dividend for those who are working hard to emulate them.
The commitment to a timetable that allows all to use such a framework is welcome. It would be lacking in vision to deny debate about the way in which the proposal could get traditional NHS values to survive and thrive in the challenging modern setting of the 21st century. It would be to forgo the opportunity of forging a unique British model that might just have greater relevance to others, including underdeveloped countries trying to grapple with ways of organising their health care in the future. Denying the chance of debating that model could rob them and us of a robust 21st-century alternative to the harsh privatised reality of the American-style system under which millions of people lose out.
Labour Members tempted to discard or delay the placing of this piece of the 21st-century NHS jigsaw put our constituents at a greater, not a lesser, risk: the risk
that a future Tory Government—were there to be such a thing—intent on privatisation, with all its horrible consequences, might succeed.In an article on foundation hospitals that appeared in The Guardian earlier this year, my right hon. Friend the Member for Makerfield (Mr. McCartney) said, with his usual panache and enthusiasm,
- "Keep your nerve: this is the rebirth of popular socialism".
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