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Mr. Gordon Prentice: In what respect are foundation trusts mutual organisations? Having asked the Minister about that, I was told in a parliamentary answer yesterday that he would write to me as soon as possible.
Dr. Harris: It is in the context of staff representation on governing boards that we consider the Government's proposals vaguely similar to our proposals for mutuals. I think there is merit in those proposals, regardless of what happens on the commissioning side. If that were all that the Government were proposing, without some of the other problems, we would be minded to support it—and in Committee we did not oppose such measures. When the Government announced amendments to extend the franchise of the staff side to people in ancillary roles, often low-paid, who have worked for a hospital all their lives but whose service has been contracted out, we tabled our own amendment in Committee and the Government accepted it. We have
worked to make these hospitals more like the mutuals that we want to see, but unfortunately we are still not satisfied.
Andy King (Rugby and Kenilworth): Surely it is possible to put staff representatives on the hospital boards without creating a huge two-tier economy.
Dr. Harris: I agree. That would have been an alternative approach for the Government and for us. We still think that providers should be allowed to seek mutual status, but we do not think that it should be imposed or awarded, or that there should be electoral nonsenses.
I hope that the Secretary of State or the Minister will tell us why, despite our many attempts to establish the facts, the Government have still not provided a shred of proper evidence that the high-level targets or performance indicators—such as the numbers on waiting lists, or the two-week wait—on which they base their award, or reward, of three-star status have any basis in clinical outcomes. I ask the Minister to provide that answer, because he has never done so before. The "Panorama" programme that focused on my local hospital in Oxford identified exactly how patients are put at risk by the imposition on managers of the need to meet these targets. The trauma surgeon Keith Willett, who works at the John Radcliffe hospital, showed how the need to treat the least urgent patients within a maximum time limit often means that treatment of patients whose needs are more urgent is postponed, to their detriment. The Government have not responded to that point; indeed, they refused to address the questions raised in the "Panorama" programme. Until they ditch such politically based performance indicators, their approach will have no support from health care professionals or, even more important, from patients and those who represent them.
The Government propose a sham democracy for foundation hospital trusts, in which local members will elect a few people to the board of governors. This is clearly a far less effective method of ensuring proper democratic accountability than our proposal properly to democratise, through the electoral roll franchise, the commissioning side of the NHS. Although there is certainly merit in the public's having a stake in major local providers, this should not be seen as an alternative to, or rival to, proper, democratically accountable commissioning. A pseudo-democracy like that proposed in this measure creates the real problem of a parallel franchise, rivalling local, democratically elected councillors. The resulting confusion would actually damage accountability.
We would prefer—we proposed amendments in Committee to this effect—a stakeholder-type board for mutual hospitals, representing staff and the community. The interests of patients and the public are more powerfully represented by elected commissioners and by patients forums. The Government proposed to set up patients forums as a replacement for community health councils, but they now propose to ditch them in respect
of foundation hospitals, and, in due course, in respect of all hospitals, because all hospitals will be foundation hospitals.
Mr. Patrick Hall (Bedford): Will the hon. Gentleman give way?
Dr. Harris: Yes, I will give way to the hon. Gentleman, who chairs the all-party group on community health councils and may well be keen to catch your eye, Mr. Deputy Speaker.
Mr. Hall: I thank the hon. Gentleman for giving way. Does he not agree that not having a patients forum on a foundation hospital trust would remove that element of independence that is crucial to the new system of patient and public involvement in the NHS?
Dr. Harris: The hon. Gentleman is right, and given his experience of talking to the people involved in patient and public representation, the Government would do well to listen. I invite him and others to look at new clause 9, on page 2,489 of the amendment paper, which is tabled in my name. When this issue was debated in Committee, there was support for the proposal from both sides of the House, and the hon. Gentleman makes a very good point. It is impossible to secure the interests of patients simply through the efforts of those who run hospitals. That creates a conflict of interest, and with the best will in the world, those who try to exercise the dual roles of defending and supporting hospital management and representing the views of patients would find it impossible to juggle them.
I urge the Government, even at this late stage, to say that they will support new clause 9. After all, when they abolished CHCs—in itself a highly controversial measure—their defence was that patients forums would roam further than CHCs, not only examining the commissioning side but being active on the provider side. Now, the Government propose that there be no patients forums in any hospital. The hon. Member for Wakefield (Mr. Hinchliffe) strove hard with many of us to secure amendments to initial Government proposals during the previous Parliament, and to secure amendments to an earlier Bill in this Parliament under which the Government proposed to abolish CHCs. He must share my disappointment that the Government intend that if foundation hospital measures are adopted—I accept that he hopes they are not—there will no longer be patients forums in hospitals. That raises questions about the Government's good faith in making the concessions that they claim to make in abolishing CHCs.
Dr. Fox: Are the hon. Gentleman's anxieties about the lack of patients forums diminished or heightened by the fact that the Government, through one of their own amendments, are moving away from the concept of postal votes and potentially towards electronic voting, which might further disfranchise patients?
Dr. Harris: That may well be a problem. The electoral arrangements are likely to be not only a parallel franchise, as I said, but a dog's breakfast. The Government's saying that they are simply going to leave
the matter to the constitution of foundation trusts gives no comfort to those of us who think that it will be impossible to find a clear way out of this mess.In terms of foundation trust status, it seems that the Government's motto is: "To those who have, more shall be given, and from those who have not, it shall be taken." In Committee, the Government effectively admitted that because any borrowing by foundation trusts, using their greater licence to do so from the private sector, would be set against the total amount of capital available to the NHS, any extra ability to borrow—and any extra borrowing achieved from the private sector for foundation trusts—will by definition reduce the pot of money available for non-foundation trusts. If the Minister looks at the record, he will see that the Government simply did not address that point, either in answer to me or to the hon. Member for Birmingham, Hall Green (Mr. McCabe), who is no longer in his place.
I invite the Minister to explain this at the Dispatch Box today: if the total amount of NHS capital is limited and any borrowing by foundation trusts through their increased licence to do so will be taken from that total, how will that not by definition reduce the amount of capital available for the second wave of borrowers—those with less power than non-foundation NHS trusts? [Interruption.] The Dispatch Box remains empty, and as happened in Committee, no answer is given, for the reason that there is no answer to that problem. It is the inevitable consequence of the decision to ensure that such borrowing is against the pot available.
There was an alternative, which was not to go down this path at all, or even to allow such borrowing to be set against expenditure limits. Unfortunately, the Government chose not to do so, and the result is a policy that robs Peter to pay Paul. Our proposals for mutuals would have allowed additional private borrowing without its counting against Treasury limits for borrowing in the health service. In addition, we would not have proposed that the sale of assets by foundation trusts—those that are allowed because they are not necessary for core service—be available only to foundation trusts, rather than to the NHS as a whole. I suspect that other Members will make that point in more detail.
We are not opposed to foundation trusts because we think that everything has to be the same; there can be a mixed market in provision. In the Liberal Democrats' opinion, the NHS should be free at the point of delivery, as comprehensive and universal as possible, and based on need rather than the ability to pay. In that respect, who owns or runs hospitals is not important, so long as they guarantee equity, quality and other essential factors. We are not opposed to foundation trusts because we think that they amount to quasi-privatisation of the NHS. Such privatisation is far more likely to happen through a version of the patient passport policy proposed by the Conservatives. Although we do not consider foundation trusts to be a direct route to privatisation, private care issues do arise, particularly in relation to pay-beds.
As has been pointed out, in Committee the Government weakened the provision relating to the cap on private income. The Minister may say that it was not his intention to do that in changing "must" to "may" and "duty" to "power", but on an issue as important as
this the phrasing should have put the matter beyond doubt. I invite him to do so, and if he is unable to give such reassurance, those of us who are concerned that that cap guarantee is not worth the paper that it is written on will not be reassured by his approach.Amendments Nos. 397 and 398 seek to reverse the changes made in Committee, and amendment No. 400 makes it clear that there should not be arbitrary limits on pay-beds. People should not occupy pay-beds in the NHS if there are NHS patients with greater clinical need. We know that NHS waiting lists are far longer than private waiting lists, and that beds and precious capacity in the health service are given over to private patients. I urge hon. Members to consider amendment No. 400, which would ensure that, regardless of any arbitrary limit on private income, NHS patients are not badly treated.
New clause 39, also tabled by the Liberal Democrats, urges the Government to accept a proposal whereby overview and scrutiny committees and patients forums have to be consulted before approval is given.
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