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6.12 pm
Jim Dowd (Lewisham, West): As a member of the Select Committee on Heath, I am grateful to be able to say just a few things because I know how pressing time is. The Bill has six parts, as most people have pointed out, and although the last five are neither above criticism nor incapable of being improved, they generate nowhere near as much controversy and antagonism as part 1. I am pleased that my hon.—and usually good—Friend the Member for Wakefield (Mr. Hinchliffe), the Chairman of the Select Committee, has returned to the Chamber, because I shall refer to his amendment and the way in which the Select Committee conducted itself when it produced its report.
My hon. Friend said that he thought that he had to move the amendment because it was the only way to deal with his profound opposition to foundation trusts, despite the fact that much in the rest of the Bill met with his approval. He was either misinformed or being disingenuous, because he would have been perfectly able to wait until the Bill reached a later stage before moving an amendment to delete part 1. His attempt to derail the whole Bill now is not only irresponsible but disingenuous.
The Secretary of State certainly learned the truth of the maxim that one should never do anything for the first time when he outlined the proposals for foundation hospitals. The humorist H.H. Munro said that one should never be a pioneer because the earliest Christian gets the fattest lion. The Secretary of State got a fat lion today—and before the hon. Member for West Chelmsford (Mr. Burns) says anything, I do not mean
my hon. Friend the Member for Wakefield.The production of the report was the most difficult thing that the Select Committee had done in the couple of years since the general election. A great deal of time and effort went into it, including three evidence sittings and more than twice as many deliberative sittings. The report is an almost biblical work. I say that not because it is definitive but because it contains parts that may be drawn upon by those who support foundation hospitals and parts that may be drawn upon by those who are implacably opposed to them, such as my hon. Friend the Member for Wakefield. Sometimes our attempts to reach a consensus resembled a dialogue of the deaf. Although all Select Committee reports are theoretically unanimous, to paraphrase George Orwell, some parts of the report were more unanimous than others. It proved to me the truism of the old native American saying, "You cannot wake someone who is pretending to be asleep."None the less, we covered all the ground, and the clear mass of oral and written evidence that we received was broadly in favour of the proposal, although it was sceptical, questioning, contained reservations and wanted reassurance and clarification, which to some extent reflects my position. I am broadly in favour of the foundation trust principle, but a great deal more work needs to be done before it can become a usable model. If it is to be rolled out across the NHS, it certainly needs to be much more precise and durable.
Mr. Colin Challen (Morley and Rothwell): Does the Select Committee consider that there are benefits in having a greater sense of public ownership, which will derive from local ownership, of the NHS and that that is better than people thinking that it is a massive nationalised ship that we cannot turn around? For example, surely it would be possible to reduce the rate of missed operations if local people could convey to their communities the fact that not turning up creates longer waiting lists.
Jim Dowd: We did not consider that latter point, but we looked in detail—the evidence is in the report—at the submissions made by co-operative and mutual organisations on improved management and effectiveness.
As I said, the majority of evidence was in favour of the proposal. Unison has bombarded most of its members with its views over recent days, but it submitted its evidence late, long after the evidence sessions were closed. However, with my hon. Friend the Member for Wakefield in the Chair, its views did not go unrecorded.
There was no press conference to launch the report. I am not sure why, especially as it covers such a contentious and interesting issue, but the Chairman did issue a press notice when it was released this morning. The press notice encapsulates the difference between me and my hon. Friend. In it, he says:
- "If Foundation Trusts, through their increased access to resources, are able to develop their services in a way that lowers waiting times or improves quality, GPs and patients will choose to use their services rather than those of poorer performing local hospitals. As money follows patients, poorer performing hospitals will see their revenue streams dry up and will have even less to invest in improving services, locking them into a downward spiral of poor performance."
I agree that, ideally, we should have started with primary care trusts, and I made that clear in the Select Committee. That would make more sense, but I accept the Secretary of State's argument that they are new and need time to bed down in their current responsibilities before expanding them further. The PCT is no more than a unit of organisation within the health service. Most people—rightly or wrongly—have a much greater sense of identity, inclusion and involvement with their local hospital than they do with the PCT or any other apparatus of NHS bureaucracy. The hon. Member for Wyre Forest (Dr. Taylor) is a tribute to that. He said it himself: he would not be here today if the plan in Kidderminster had been merely to reorganise the PCT. The public are more likely to react to changes to acute hospital services. It is a good idea to try initially to tap into that enthusiasm and support, which my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) spoke about earlier. We do not need to go further into two-tierism. The report deals with it, and plenty of Members have already done so.
The poaching of staff has been mentioned, and various assurances have been given. Poaching already occurs. There is a problem in my part of south London, where a trust grades its midwives two or three grades higher than the surrounding trusts. Even within current confines it is able to cream off staff in that sense.
There are plenty of other things that I would like to say, but in view of the time I shall draw my remarks to a conclusion by saying that those of us who support the principles and the values of the NHS must have the courage to reform it, to adapt it and to modernise it. If we do not do those things, we shall leave one of the nation's most valued and valuable institutions prey to Conservative Members, who yet again have expressed their intention to dismantle it.
6.21 pm
Stephen Hesford (Wirral, West): I am honoured to speak in this important debate. However, I am saddened that I am, in a sense, sandwiched between two of my colleagues from the Wirral. One of the great benefits of living on the Wirral is that there is so much partnership, which works well.
Some Members have talked about patient pathways, not altogether in glowing terms. To illustrate my support for the Government, I shall talk about the hospital journey that my local hospital trust has made since the early 1990s, to show where we have come from and where we are going.
The Wirral hospital trust was a second-wave trust in 1993-94. It worked in relative isolation. There was an element of competition with the hospital down the road, the Countess of Chester. The local health economy was distorted by the closed nature of that reform. At the same time, the trust was starved of funds. That was reform without benefit. That is precisely the opposite of the reform that we are debating. I ask my right hon. and
hon. Friends who are worried about this reform to understand that it is precisely different from the one that took place in the early 1990s.The hospital in my areas was defensive and rather inward looking. It was less than positive. It was financially sound but waiting lists were growing. Managerially, it was going in the wrong direction. More crucially, because of the system under which it operated as a second-wave trust under the previous reforms, staff felt frustrated. At the same time, they felt a deep sense of unease at their inability to co-operate with their colleagues in the health service.
What has happened since 1997? The budget of the hospital trust has increased by 50 per cent. Nurse numbers are up, and can be measured in hundreds. There are two new orthopaedic operating theatres and five new orthopaedic surgeons. Waiting lists have been slashed. That is a benefit. That is a step in the right direction.
In 2001, the hospital trust had two stars, and was going in the right direction. I am delighted to say that in 2002 it was awarded three stars. I put on record my respect and admiration for the management and staff at the hospital for having brought about that change since the early 1990s.
The hospital board was faced with the choice of how to respond to foundation hospitals, which is the key debate today. Should it apply for foundation hospital status or should it not? It decided not to apply for foundation status on this occasion, and there is some logic in that decision. The same chief executive who was in post in the early 90s, when he took charge of a second-wave hospital trust, is in post now. It remains to be seen what happens next year, but having spoken to him, I learned that the board decided to adopt a cautious approach, as it wanted to be sure on behalf of its patients that the local health economy, which is good, co-operative and collaborative on the Wirral, would not be distorted by a precipitate move—it did not want to rock the boat. It was therefore decided, subject to decisions to be made in due course, not to apply in the first wave of foundation trusts. How can it judge what will happen in the next 12 months to the 12 new foundation trusts? That is the question that I wish to put to the House while supporting the principle behind the Bill.
My local chief executive and his board could apply five "health interest tests"—my words, not theirs. There should be no diminution in A and E activity for a foundation trust. That is a worry, but I do not believe that there would be. There should be no diminution in the quality of services overall—again, I do not believe that there would be. There should be no backsliding from three-star status. There should be, as the British Association of Medical Managers believes there will be, a demonstrable managerial gain from achieving foundation status. There should be no diminution in terms and conditions for any staff employed by the trust—that should not be the implicit or explicit result of achieving foundation status. There should be no distortion of priorities in the local health economy—a key area of debate, as we have heard from many hon. Members. Key players in the local health economy on the Wirral as elsewhere are our PCTs, both of which have rightly had 75 per cent. of the budget devolved
down to them. The breathing space that my hospital trust has effectively bought for itself will, I believe, be used positively and imaginatively as it and the PCT watch the development of foundation status.In summary, foundation status will add value. My right hon. Friend the Member for Livingston (Mr. Cook) said that services should be located more locally, which is precisely what will happen if foundation status is granted to my local hospitals. In due course, subject to the performance of my local hospital trust, which I do not expect to diminish—I expect it to continue to improve—they will, I hope, apply in the second wave.
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