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6.28 pm

Mr. Simon Burns (West Chelmsford): I begin more in sorrow than in anger for the simple reason that I believe that the Secretary of State and the Government have missed a golden opportunity genuinely to free up the health service to enhance patient care and allow a proper decision-making process, with decisions taken from the bottom up rather than imposed from the top down. We have seen, as I shall explain in the course of my speech, the putting together of a higgledy-piggledy collection of ideas that are not properly thought out.

During the debate, which has been extremely interesting if somewhat diverse, perhaps the most telling comment was from the hon. Member for Coventry, North-West (Mr. Robinson), who called the Bill an uncontrolled experiment, and said that all we had was a pretty vague idea of foundation hospitals and no proposals to improve non-foundation hospitals. He rightly said, as time will prove, that the cart was being put before the horse. That complaint has been expressed in various ways throughout the debate.

In an excellent speech, my right hon. Friend the Member for Charnwood (Mr. Dorrell) pointed out that our right hon. and hon. Friends support the idea of freeing up the national health service within the framework of the national health service as we know it. Unfortunately, for a variety of reasons, as my right hon. Friend the Member for Horsham (Mr. Maude) also said, the Bill fails to flesh out the details. We are being asked to buy a pig in a poke and take the Government's word that everything will be all right on the night. Far too many of us have a memory far too long to take the Government on trust.

What we needed was for the Secretary of State, as he travelled round Spain, Sweden and elsewhere studying alternative views, to have fully understood the concept in Spain in particular, and translated it to the British context, but he did not.

Mr. Drew: Will the hon. Gentleman give way?

Mr. Burns: I shall make a little progress.

My right hon. Friend the Member for North-West Hampshire (Sir George Young) highlighted the anomalies in the Bill and the way in which the Government have watered down the original intentions of the Secretary of State, as evidenced by the right hon. Gentleman's writings and speeches last year before he published his Bill. Similarly, my hon. Friend the Member for Westbury (Dr. Murrison) emphasised the dilution of the Secretary of State's proposals.

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In a typically welcome and robust speech, my hon. Friend the Member for Southend, West (Mr. Amess) demonstrated from his experience on the Select Committee on Health some of the pitfalls that the Government are failing to address. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley), with his experience of his hospital, Addenbrooke's, showed that all we are getting from the Government is possibly an excuse for Addenbrooke's to change its hospital notice board, but nothing else.

Of course, we know why the Bill is in many ways so diluted and so vague. That is because the Government have had considerable problems with many of their own Back Benchers over their proposals. Since the publication of the Bill, there has been a constant barrage of criticism and the highlighting of problems by individual hon. Members who, as trade unionists, are for various reasons concerned about the Bill's provisions. As my right hon. Friend the Member for Charnwood said in what I thought was probably a flattering reference, although the hon. Member for Wakefield (Mr. Hinchliffe) may not consider it so, it was ironically the forces of conservatism on the Labour Benches that were seeking to thwart the Government's bold and imaginative programmes.

Since their inception, the proposals of the Secretary of State have been interfered with, altered, revised, adjusted, messed around and changed more than Michael Jackson's face.

During the debate we heard 21 contributions from the governing party, of which five were distinctly anti. There was an impassioned speech by the Chairman of the Select Committee on Health, the hon. Member for Wakefield, who was clear in his view that the programme that had been put before him and his right hon. and hon. Friends was unspecific about aspects of what the Government wanted to do. He said that it was ill thought out and ill prepared in certain areas, especially governance, and the fiasco, which was also highlighted by my hon. Friend the Member for Woodspring (Dr. Fox), of how we will work out exactly who has a vote on the governance issues.

Mr. Drew : Will the hon. Gentleman tell me whether those on the Opposition Front Bench support the concept of mutuality in health? [Hon. Members: "Answer."] He does not seem to know.

Mr. Burns: The hon. Gentleman is mistaken. I was consulting my hon. Friends because I did not hear his last words, and I was checking what he had said.

My answer is that I strongly and passionately believe in a health service free at the point of use for all—a service that provides the greatest improvement in health care for all the people in this country who are eligible, so that they have access to NHS care locally with the minimum of waiting either to see a consultant or for their treatment. [Hon. Members: "Answer."] I also want to ensure that where there is investment in health care, we see significant improvement in outputs and in the treatment of patients.

As I was saying, during the debate we have had several contributions, not least from the hon. Member for Wakefield. Interestingly, yet again there was a contribution by the former Health Secretary, the right

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hon. Member for Holborn and St. Pancras (Mr. Dobson), who candidly said that in his view the proposals were the last thing the national health service needed, that they would set hospital against hospital, and that foundation hospitals would be a cuckoo in the local health nest.

From the hon. Member for Stoke-on-Trent, South (Mr. Stevenson), we heard the accusation that what the Government were proposing was a dangerous distraction that could fragment the NHS and increase the inequalities within health care. Rather interestingly, the hon. Member for Wallasey (Angela Eagle) evoked the spirit of Nye Bevan. I have read the speech that the Secretary of State made last year, in which he managed to invoke the image of Nye Bevan, as if to give respectability to what he sought to do, no less than 17 times in 35 minutes, and I have often mused about what Nye Bevan—[Interruption.] I do know how to pronounce his name.

I have often mused about what Nye Bevan might be thinking if he could look down on proceedings over the past few months, and what is happening to the health service. In fairness to the Secretary of State, I must say that I suspect that he would not be as opposed to the proposals as the right hon. Member for Holborn and St. Pancras and the hon. Member for Wakefield might think. He was a realist, who wanted to see the health service, within the concept that he designed and brought to fruition, make progress and improve, rather than stagnate and thereby fail.

I shall also comment in passing on two other speeches by Labour Members. One was by the right hon. Member for Birkenhead (Mr. Field), to whom the House is used to listening with rapt attention because of the common sense, intelligence and interest of the points that he makes. His contribution today was no different. Similarly, the hon. Member for Cannock Chase (Tony Wright) made an interesting and sensible contribution to the debate.

The problem that has blighted what the Secretary of State is seeking to do is the opposition that he has received within his party. He has had to seek to buy off that opposition to a point at which we have ended up with contradictions and ill-thought-out policies. We have seen him constantly having to change. He originally announced that he wanted to free up the national health service and devolve its powers—an aim from which we do not dissent. Indeed, he has rightly commented:

"you can't run the national health service as if it's the Chinese Red Army from an office in Whitehall."

Sadly, the detail of the Bill contradicts his claims. The so-called independent regulator holds office on terms directed by the Secretary of State, who appoints him, states how long he can be in office, determines his salary and can also sack him.

The independence of the Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection is also under threat. The Secretary of State is to appoint the chairman and members of both bodies, which will exist only to advise him on changes that they consider necessary. He will have no duty whatever to act on that advice. Furthermore, he is to decide the number of members of those two bodies, their tenure of office and their remuneration. So the Secretary

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of State might not be directing the Chinese red army from his Whitehall office, but he is certainly commanding the troops in his army of independent regulators and inspectorates.

What is more, the Secretary of State claimed that foundation hospitals would be free from Whitehall control, but they can still be subject to the control of the regulator, whom he will appoint and in effect control, and of the star-rating system and Government-imposed targets, including the clinically distorting waiting list targets. Originally, he proposed that only the best hospitals—the three-star ones—would be able to apply for foundation status, thereby guaranteeing a two-tier health system. In the face of opposition, including from Conservative Members, he abandoned that position and said that all hospitals would be able to apply within five years. It now seems—I should be grateful if the Minister will confirm this—that he is climbing down and may be abandoning the three-star rule all together.

On borrowing, the Chancellor, that brooding colossus that casts its shadow throughout the Government, has well and truly left the Secretary of State out to dry. The Secretary of State has constantly claimed that foundation trusts will have significant powers to borrow privately, but on 30 April, in the Select Committee on the Treasury, the Chancellor clearly explained that

"borrowing by Foundation Hospitals would come off the NHS budget".

The full implications of that statement immediately became apparent, as I suspect the Chancellor desired. The implication is that whatever money the foundation trusts borrow, less will be available to non-foundation hospitals. As my hon. Friend the Member for Woodspring said, this is indeed the culture of dog eat dog. It is not so much survival of the fittest as of the most advantaged—a two-tier system in which hospitals fortunate enough to have foundation status will deprive other NHS hospitals without such status.

Yesterday, the Prime Minister categorically stated that "Reform is fundamental to" the public services' future, and said:

"To turn our backs on it would be a collective mistake of historic proportions."

In recent years, the Prime Minister has seen everything in historic proportions. I think that I am right in saying that he has felt the hand of history on his shoulder. Given the problems that the Government have had, he must feel that this evening's debate is weighing heavily on his whole body. Sadly, that is due to his machinations and those of the Secretary of State. In seeking to prevent a haemorrhaging of support, they have ended up with a Bill that is the very worst of all worlds. Far from freeing up the NHS to improve the provision of health care, it is more a pastiche that has been cobbled together in an attempt to ensure that the Secretary of State and the Prime Minister save face.

We know from past examples how Labour rebellions fizzle out, and we are fully aware that tonight's will be no exception, as Labour Members who signed motions and opposed the Government's proposals melt like snow in summer. We have no interest in playing party politics with the issue, but because the proposals are so

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cobbled together and ill thought out, I shall recommend to my hon. Friends that we vote against the Second Reading of a badly drafted Bill that will not achieve what the Government seek to achieve.

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