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Angela Eagle: I am listening to the hon. Gentleman's comments with interest. Could he tell the House which way his party will vote on the amendment?

Dr. Fox: Unless we hear something quite unexpected from the Minister, we will almost certainly vote with the hon. Member for Wakefield in support of the amendment. As I said, there are strong reservations about this part of the Bill.

We have concerns about governance. Where is the logic in applying any democratic leverage in the system not to the commissioners of health care, but to the providers? If there is a place for local democracy to be involved in the determination of the spending of health funds, it would have been far more logical to bring in election at the level of primary care trusts, where decisions about the commissioning of services, and therefore the spending of funds, will be taken. What is the point of introducing a democratic element into the providers—the hospitals? At that point, they cannot determine what the balance of the provision of services will be, because those decisions will already have been taken by the PCTs in charge of the funding. I find the proposal utterly illogical. It seems to invert the Government's intention.

John Mann (Bassetlaw): In my area, local people want a say about the future of accident and emergency services. The one hospital in Bassetlaw is part of a larger trust, Doncaster and Bassetlaw. When the decision was made to downgrade Bassetlaw hospital under the current rules, not only were people not allowed to have a formal say, but they were not even allowed to find out about it until decisions were being made. I called a ballot

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on that and 35,000 people voted—a 60 per cent. turnout. That was not within primary care. What is wrong with that principle?

Dr. Fox: That makes the point. The provision and maintenance of services is dependent on the funding of the services. It is the primary care trust that is responsible for the funding of accident and emergency services. There seems to be a dislocation between what the Government said they intended to do, and what they are doing through the Bill. There is no logic in the Government's approach.

I have a huge problem with the way in which the Government propose to take governance forward. Members of the foundation hospital board will be drawn from the public and the staff. The public members may be those who have attended an NHS foundation hospital as a patient or a carer. On the last two occasions on which we have had Health questions, the right hon. Member for Manchester, Withington (Mr. Bradley) asked about the Christie hospital. At a large hospital with regional and national status, where patients may come from all parts of the country, what will be the constituency if such a hospital became a foundation hospital? Twice Ministers failed to come up with an answer to one of the most fundamental questions about the practical application of the Bill.

Are we to have a foundation hospital which, because it can draw patients from anywhere in the country, can have hundreds of thousands, and possibly millions, of potential members, and what will the legal requirements be for the hospital trust to ask each of those members whether they want to be elected to the board? The system is supposed to reduce bureaucracy and red tape, according to the Government. It will create a nightmare of bureaucracy and red tape, without even considering the cost.

Let us consider a simple example—a foundation hospital with a patient catchment of 500,000 patients. Let us assume that one in 10 of the patients in the catchment area might want to be a member of the foundation hospital board at a servicing of between £4 and £5 a year, which is the cost estimated by trusts that have indicated that they might want foundation hospital status. If we add to that the cost of advertising and running the elections, we are speaking of a cost of £240,000 per year per trust simply to maintain and run the electoral arrangements and the foundation hospital board.

That cannot be what Ministers meant when they said that the public were willing to pay higher taxes to get better quality health care. The public will pay higher taxes, only to see the money diverted on a huge scale into an unnecessary bureaucracy that does not even exist yet. The hon. Member for Wakefield mentioned one of the trust chairmen, who also said that far too much of the time of his management would be taken up preparing and running the consultation process, rather than managing the hospital. All hon. Members must surely have deep reservations about the practical implications, if not the principle, of the proposal.

Mr. Gary Streeter (South-West Devon): My hon. Friend has spent a great deal of time in the past couple of years speaking to people who run hospitals. How many

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NHS trust chief executives, consultants, doctors and nurses have said that the real problem with the health service and with our acute hospitals is some kind of democratic deficit? Are not the Government introducing measures that will not improve the health service, and should they not think again?

Dr. Fox: Without going into the concept of the democratic deficit, I can say that as a doctor I have never had a patient and as an MP I have never had a constituent coming to complain that they had a real problem with the democratic deficit in the NHS. They usually complain about access to health care. There are arguments to be made about how a system of publicly financed health care is to be made accountable to those who use and pay for the system through their taxes, but the Government's proposals are not a reasonable solution, for the reasons that I have set out.

I want to mention just one or two other practical implications, as I know that many hon. Members wish to speak. The hon. Member for Wakefield referred to the problem in respect of private income. We believe that what Ministers are proposing has an enormous unintended consequence, as trusts will effectively be limited to the private income that they currently have and will not be allowed to increase it. I have raised the issue with the Minister before and we have still not received a proper answer. The provision will mean that when the new opportunities fund or a charity provides an MRI scanner for a national health service hospital, the foundation trust is prevented from selling to the private sector any spare time when that equipment is not being used to raise greater income. However, the private sector will be able to sell extra time on an MRI scanner to the NHS. Surely, that cannot be what the Government intended. Only a very badly thought out set of provisions would allow that to happen.

I have one other major reservation. Foundation hospitals are supposed to be set free from central regulation, yet they will be subjected to one of the forms of regulation that I find most ineffective and which is most resented in the health service—the star-rating system. In my constituency in north Somerset, we have five hospitals around us: the Weston hospital, the Royal United hospital in Bath and the three main Bristol hospitals. All those hospitals are officially no-star hospitals. In itself, that is deeply insulting and demoralising to staff, who would like to think that at least some of the services that they offer are high-class services and who resent hugely being rated across the board as having no stars. If there were one thing that might have attracted hospitals out of the current set-up and into the foundation hospital arrangement, it is that they would be freed from that deeply demoralising way of labelling our hospitals. Yet, that one opportunity is going to be denied. In almost every respect, the opportunities that the Government could have taken have been missed. Instead, they have misunderstood what could have been offered and introduced a new series of complexities, bureaucracies and costs that do not exist in the current system.

Dr. Evan Harris (Oxford, West and Abingdon): I was interested in what the hon. Gentleman said about

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private income. I think that he has a good point. Does he agree that one approach in tackling the issue is not to set an artificial maximum, but to ensure that the only restriction is that no NHS patient with greater clinical need should wait for a slot that might be given to private, paying patients? Amendment No. 400 deals with that point.

Dr. Fox: There are a number of ways of dealing with the practical problem; indeed, some were mentioned in Committee and raised in amendments. I was simply pointing out that there is a perverse consequence in what the Government propose. It cannot be what Ministers intended and such provision will be unworkable.

Finally, the Office for National Statistics has said:

It seems that the Government have managed to get the worst of both worlds. What we are going to get is the triumph of Network Rail, augmented by central Whitehall control. And this is progress.

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