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6.45 pm
The Minister of State, Department of Health (Mr. John Hutton): Some excellent speeches have been made today, but sadly I am not sure that that of the hon. Member for West Chelmsford (Mr. Burns) was one of them. It has been a debate of high quality in the best traditions of this House. I particularly want to congratulate my right hon. Friends the Members for Copeland (Dr. Cunningham), for Livingston (Mr. Cook), for Southampton, Itchen (Mr. Denham), for Tyneside, North (Mr. Byers), for Bishop Auckland (Mr. Foster) and for Birkenhead (Mr. Field). I can say the same of my hon. Friends the Members for Doncaster, North (Mr. Hughes), for Plymouth, Sutton (Linda Gilroy), for Bedford (Mr. Hall), for City of York (Hugh Bayley), for Cardiff, Central (Mr. Jones), for Cannock Chase (Tony Wright), for Milton Keynes, South-West (Dr. Starkey) for Lewisham, West (Jim Dowd)—who gave us a fascinating insight into the preparation of the latest report by the Select Committee on Health; I wish that I had been a fly on the wall—and for Wirral, West (Stephen Hesford).
We heard, too, from the Liberal Democrats. I am not sure that we were much the wiser for that, although the hon. Member for Oxford, West and Abingdon (Dr. Harris) served one unique purpose—I am sure that it was accidental—by managing to make the speech by the hon. Member for Woodspring (Dr. Fox) look clear and cogent. I do not think that that could have been his game plan.
We also heard another rendition of the depressingly familiar prospectus of the Conservative party. Some new soundbites, perhaps, but underlying it all were the same old prejudices. Conservative Members remain firmly stuck in the past. They propose subsidised private medical insurance, taking away resources that could be used to build up the NHS, and top-up vouchers for those who can afford to go private. That is what the Tories mean by greater patient choice—the freedom of the few, funded by the many, to opt out of the NHS altogether. That, not our proposals, is what my hon. Friends could fairly describe as a two-tier health care system.
We now know, too, that the Tories do not support our proposals on NHS foundation trusts. They do not support the cap on private patient income. They do not support our proposals on democratic government arrangements, which the hon. Member for Bognor Regis and Littlehampton (Mr. Gibb) thought were a management distraction. It is not: it is called democracy. The NHS is a public service, and it is going to remain so. Conservative Members want NHS foundation trusts to opt out of the NHS altogether. The biggest myth of all is that the Tories support the Bill. Behind that grim façade lurks something even more sinister—a 20 per cent. cut across the board in NHS spending. By starving the NHS of investment, they hope to persuade more people to opt out of it altogether.
Those are the Tory tactics that we have seen today. Their attitude to the Bill has been the classic combination of opportunism and cynicism that we have come to expect from them. They are devoid of any purpose save one—to undermine the NHS and the values that it stands for. None of my right hon. and hon. Friends should vote with the Tories when the future of the NHS is at stake.
The debate has been marked by a number of myths and misconceptions about the Bill, especially part 1. That was particularly evident in the speeches of my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) and my hon. Friends the Members for Wakefield (Mr. Hinchliffe), for Stoke-on-Trent, South (Mr. Stevenson), for Wallasey (Angela Eagle), for South Swindon (Ms Drown) and for Coventry, North-West (Mr. Robinson). It was true to different extents of the speeches of the hon. Member for South Cambridgeshire (Mr. Lansley), the right hon. Member for North-West Hampshire (Sir George Young) and the hon. Member for Wyre Forest (Dr. Taylor), who was elected on the basis of extending democratic control to the NHS but is now about to vote against that principle. We had the usual music hall turn from the hon. Member for Southend, West (Mr. Amess).
The Bill is based firmly on the traditional values of the national health service. It will safeguard what is good and decent about the NHS, and help it to fulfil the new challenges of today's society by giving new freedom to front-line staff and real ownership to local communities. Consequently, there will be less bureaucracy in the NHS, not more as some have wrongly alleged.
Kate Hoey: The Minister knows that I represent two of the largest three-star trusts in the country. The staff have asked me to ask him a question. Given the 17 reorganisations that have taken place and the fact that the staff would like more control over the way in which they handle matters and to have the Whitehall shackles removed, why cannot the Minister do that without going through reorganisation and spending huge amounts of money on foundation trusts?
Mr. Hutton: My hon. Friend is wrong about that. We need new front-line freedoms and responsibilities, but they must be matched by new forms of public accountability. Otherwise we would hand over control of the NHS to people who do not pay for it or own the service. Reforms must be matched by changes to principles of democratic accountability.
The Bill is based on the right principles: devolution, democracy and decentralisation. They will operate within a clear framework of national standards to guarantee equity and universality. It does not, as some of my hon. Friends have mistakenly claimed, herald a return to the old internal market of the Tories. The Government were right to get rid of that because it caused so much damage to the NHS. In those days, there were no national standards to ensure quality and consistency.
The internal market was based on a crude and clumsy bargain-basement competition throughout the NHS to ascertain who could provide the lowest price. Nothing in the Bill or any of the Government's actions will allow a return to those bad old days. The internal market is dead and buried; the Bill does not bring it back to life.
As many hon. Friends said, giving genuine power and responsibility to front-line staff will help to ensure that local services better fulfil the needs of local communities. That must be right for the NHS today, for patients as well as staff. The Bill hands out no favours to some hospitals for which others will have to pay. However, there will and should be more financial as well as operational freedoms for hospitals that have shown by their performance that they can make good use of them.
In the next few years, all NHS trusts will be able to benefit from the freedoms. That is consistent with the NHS plan and accords with the conclusions of the Wanless report, which my right hon. Friend the Chancellor commissioned. It is the sensible way in which to run any organisation. The freedoms and flexibilities will help to maximise the effective use of resources, facilitate innovation and, with the new governance arrangements, help improve local responsibility for delivery.
The reforms will help lay the foundations for better public services and improved local control over them, for industrial democracy in the NHS for the first time, for public sector enterprise and public sector values to thrive and prosper in the new century.
The new financial and operational freedoms for NHS foundation trusts will not be gained at the expense of other parts of the NHS because that would not be fair or equitable. The safeguards in clauses 1, 3, 12, 14, 15, 16, 23, 27, 28, 40, 41, 46 and 47 will ensure that that does not happen. There will therefore be no unfair advantages for some for which others pay. Peter will not be robbed to pay Paul.
There will be no unfair poaching of staff between foundation trusts and other NHS bodies. I know that many of my hon. Friends are worried about that, but let me make it clear that all NHS foundation trusts will operate in the same pay system as the rest of the NHS. It will be a national pay system. The independent regulator will hold NHS foundation trusts to account under their statutory duty of co-operation. He can intervene under clause 23 when that does not happen.
The new national tariff means that NHS foundation trusts cannot pass on to primary care trusts the cost of paying high wages. The new freedoms will be matched by new safeguards. Moreover, for the first time the Secretary of State will be allowed to set national standards for all NHS hospitals. That will help to ensure that NHS foundation trusts remain an integral part of the NHS, providing care in accordance with NHS values and NHS principles, helping the NHS to raise standards, and guaranteeing equity.
The changes are not a distraction, as has been claimed by some—particularly my right hon. Friend the Member for Holborn and St. Pancras and my hon. Friend the Member for Wakefield. The reforms are necessary because society itself has changed beyond recognition since the NHS was established 50 years ago. Because we on this side of the House are committed to the NHS and all that it stands for, the choice facing us relates not to whether there should be further reforms, but to what reforms we decide to make.
Some, including my hon. Friend the Member for Wakefield, have said today that we need no reform, but then listed a series of existing problems with the NHS. Those whose counsel is no reform must realise that that will lead to a single consequence: the abandoning of the field to those who have already given up on the NHS, and who, as my right hon. Friend the Member for Southampton, Itchen pointed out, claim that it is bound to fail, and should be broken up and sold off. That would be a huge mistake, and we should not make it.
The choice today, as always, is between Labour values of co-operation and public ownership, which the Bill enshrines, and Tory values of competition and privatisation, which it eschews. Our public services need to be better tailored to the individual needs of patients. A service as complex as the national health service cannot be run from the centre and at the same time provide the necessary degree of localism if it is to be truly responsive to the needs of communities and patients in the way described by my right hon. Friend the Member for Copeland. That is why the new freedoms and flexibilities are so essential.
There is nothing wrong with the NHS that cannot be put right by those who work in it and care passionately about its future; but NHS staff have not always had the tools with which to do the job properly—a point made very effectively by my right hon. Friend the Member for Livingston. We all know that to be true, and it is what the Bill will begin to put right. It will help the NHS to become the service that we want it to be. Just as important, it will bring our concept of public ownership for the new century up to date, while holding true and fast to the values and principles that it has always represented.
These reforms will not promote a "pay as you go" health care market. That is the policy of the official Opposition, a policy to which this Labour Government are completely opposed. The reforms that we are making in the Bill—the introduction of new national standards, stronger NHS inspection and new powers for primary care trusts to commission NHS dental services—are based on equity and fairness. They rest on the fundamental assumption that the NHS should provide a consistently high-quality service everywhere, not just for some in our society but for everyone. That is the equity guarantee sought by my hon. Friend the Member for Stoke-on-Trent, South, and it is contained in clauses 1 and 3.
The way in which we cast our votes tonight will give us an opportunity to set the direction of travel for the national health service in years to come, and the direction we are setting in the Bill is fundamentally right. When we last debated NHS reform in January, my hon. Friend the Member for Stockton, South (Ms Taylor) said that we should not mistake a legacy for a monument. She was absolutely right: we must not view the NHS as a monument. If we do we will not give it a chance to adapt, to reinvigorate itself, and to develop in
new ways to meet the needs of our country and its people. I agreed with her then, and I hold that view even more strongly tonight.Along with the investment and reforms that we have already made, the Bill will help to improve the health service in the constituency of every right hon. and hon. Member. That is why we should give it a Second Reading.
Question put, That the amendment be made:—
The House divided: Ayes 117, Noes 297.
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