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Finally, the Government did not deal with Government amendment No. 356. As far as I know, the Minister did not mention it as he rattled through the list. That amendment proposes that the Government underwrite external loans taken on by foundation trusts. Will that not give even more power to foundation trusts to loan against the limit that is shared by non-foundation trusts? I invite the Minister to tackle that issue now.
Mr. Hutton: I do not wish to detain the House, but the hon. Gentleman is barking up the wrong tree. [Hon. Members: "Barking?"] In line 1, page 1, before "up the wrong tree" leave out "barking". The amendment to which the hon. Gentleman refers deals with the private finance initiative. We need to find an appropriate mechanism to support PFI deals in NHS foundation trusts. That is all that the amendment does, and that PFI borrowing does not score against the prudential borrowing limit.
Dr. Harris: This is the amendment that dare not speak its name—[Interruption.] The Minister conveniently forgot to mention an amendment that approves the ability of foundation trusts to close PFI deals.
In summary, for the reasons that I have given, we oppose the Government's proposals for foundation trusts. I hope that they fail today and I urge hon. Members to join me and my colleagues in opposing them. I also urge them to consider the need, if foundation trusts are approved, to secure adequate means of patient representation through patients forums. If I have the opportunity to move new clause 9, I hope to preserve patients forums on the provision side of the health service.
Mr. Frank Dobson (Holborn and St. Pancras): Out of courtesy to anyone who wants to intervene on my speech, may I use a clinical expression that I picked up as Secretary of State for Health? I have done my back in, so if I give way and sit down, I may not be able to stand up again.
The Government's various concessions do not deal with most people's fundamental objections to the concept of foundation hospitals. Those hospitals will impose an unwelcome and unnecessary reorganisation of the NHS, which will consume much money and a great deal of senior management time. Advantages will be given to one group of hospitals at the expense of another. Foundation hospitals will be allowed to set their own strategy and priority, taking that role away from local primary care trusts. Competition and the spirit of competition will be reintroduced to the NHS. All that is being done, we are told, in the name of less Government interference.
We do not need to reorganise the NHS or change the law in order to reduce the amount of ministerial interference. All my right hon. Friends need do is stop interfering—[Hon. Members: "Hear, hear"]—and they should stop interfering in all hospitals, not just a limited number of them. I confess that I did some interfering myself as Secretary of State, but by the time I resigned, I believed that there was too much interference and too much earmarking of funds. I am afraid, however, that that development has continued rather than being reduced, and we need to reverse that.
It is also said that the proposals will give local people a sense of ownership of their local hospital because they will be able to vote for the governors. We have to recognise, first, that the NHS is the most popular institution in this country. If we ask people about their local hospital, local town hall or local MP, I know which is most popular with my electorate—let alone anyone else's. They have a higher opinion of the hospitals that serve them than they do of my excellent council, or even of me. The fact of election will not necessarily give local people a sense of ownership or increase the popularity of the health care that they receive.
I know that the Government would never be swayed by anything to do with opinion polls, but they may be aware of the work carried out for the Audit Commission, which asked people whether they would like a bigger say in the running of their local hospital. In that survey, 22 per cent. said yes, and more than 50 per cent. said no, so it is not even popular with the people who are going to be enfranchised.
We are told that hospitals will receive more money, more beds and more staff. That is right, but all hospitals are getting more money, most will increase the number of beds and most will increase the number of staff. That is the crucial change that the health service needs, because for decades we have expected the service to go on with too few doctors, nurses, midwives, therapists and everyone else. That is the fundamental problem. The Government's 40 per cent. increase in the intake of students to medical schools is a huge step in the right direction, but it will be a long time before it produces great benefits.
In the absence of sufficient staff, the NHS has been exposed to reorganisation after reorganisation until the people working in it are sick to death of reorganisation. They know that every process of reorganisation distracts the people working in the health service from their proper and chosen job of looking after patients. It takes up money and, above all, it takes up time. It is safe
to say that as we debate this proposal, the 32 applicant foundation trusts will be having one of their innumerable and endless meetings about how to progress their application for foundation status. We know that every hour they spend on that aspect of reorganisation is one less hour spent on helping clinicians to help patients.As my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, we have had 18 reorganisations in the last 20 years. Some people are now saying that extra money, extra staff and extra beds are not delivering the improvements that we want. Well, I can tell them this: the 18 reorganisations certainly did not deliver the improvements that were wanted. Given some time and the opportunity to let the changes bed down and to make good use of the additional resources, the NHS will improve, as it is already improving.
It is suggested that those who are opposed to the structural reorganisation are opposed to change and improvement in the health service. I do not use the word reform. Reform is a word that gets up the nose of virtually everyone who works in the health service and it does not impress the public. People working in the health service want to improve it. They want to improve what is happening in their clinics, their operating theatres and their surgeries—and they are getting on with it. However, if we introduce foundation hospitals, some of them will find it easier to get on with it than others, because those hospitals will be given advantages over the others. That fact cannot be denied.
I think of my own constituency. University College hospital, a wonderful hospital in my constituency, is going for foundation status. If it gets that status, it will get more money. If it has more money, what is it going to spend its money on except improving the pay and working conditions of its staff? There is nothing else for it to spend the money on. If it improves the pay and working conditions—by working conditions, I include acquiring new equipment that does not go on the blink as the existing equipment does—it is bound to attract staff from the Royal Free, the Whittington, St. Bartholomew's or Great Ormond Street: other hospitals that also serve my constituency. They will be put at a disadvantage, so University College hospital will get better at the expense of the rest.
Nothing that Ministers have said will prevent that happening. They tell us that "Agenda for Change" will apply to all hospitals, but that needs money, and those with more money will be able to implement the agenda quicker. If they feel like it, they will be able to upgrade a post—they have the money to do it—and then attract someone to fill it. That is made clear—unless the Government were being misleading originally—in the Green Paper, which says that the extra funds would allow hospitals to offer new rewards and incentives to staff. That means more money and better working conditions.
I am also concerned about the registers of electors to the boards. Some of the big teaching hospitals will have more than 2.5 million people on their register of electors—if they can put one together. Who will qualify? We are told that it will be people living in the locality, and anyone else who has made use of the hospital. However, we know that the hospitals will get it wrong. Compiling a register is a very complex process and it is a safe bet that within a few months the hospitals will
have 20 old ladies who regularly visit a clinic saying that they have been left off, and someone from Doncaster who went into A and E on a once-in-a-lifetime visit will be entitled to vote. We know that that is bound to happen.In addition, compiling the register will be astonishingly expensive. Local authorities annually spend £50 million making the minor incremental changes to their existing registers, even though they employ staff who are familiar with the problem and know how to do it. It costs another £20 million to organise local elections. Do most people think that that is the best use of the next lot of money for the NHS? Or would it be better spent on patients?
Patient confidentiality is another issue. Most hospitals do not put their name on the envelope when they send people letters, because many people do not want anybody to know that they are going to hospital. They do not like their employer knowing and often do not even like another member of their family knowing. However, if someone is on the register, everyone will know. The British National party will have access to the register and know who has gone to hospital. How will Asian people—for example—fancy the idea of the BNP trying to exploit their hospital attendance in some racist way, such as claiming disproportionate use of hospital services?
What will happen to the primary care trusts? They were established, with the full agreement of the professions, to involve the GPs, community services, local nurses and social services in laying down the priorities and strategies for health care in their area, based on an analysis of their day-to-day experience. That would assist in placing proper demands on the local hospitals. However, that role will now be taken back by the foundation hospitals. All the documents say that the foundation hospital governors will establish the strategy and priorities for their hospital. So foundation hospitals will be the cuckoo in the nest, and that is why the Royal College of General Practitioners joins the BMA and virtually every other health service organisation—including the main health service unions—to oppose the proposition.
I cannot agree with my right hon. Friend the Minister of State, Department of Health—and he is my good friend—that this proposal does not reintroduce competition and will not set hospital against hospital. It will. Its whole philosophy is to get hospitals competing with other hospitals down the road. That was a disaster when the Tories introduced it, because co-operation came to an end. I remember going with my hon. Friends the Members for Hampstead and Highgate (Glenda Jackson) and for Islington, North (Jeremy Corbyn) and my right hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) to talk to the chief executives in our area when the internal market was at its height. We pleaded with them to co-operate on something—I cannot remember exactly what—but one of the chief executives said, "Oh, we can't co-operate now, Mr. Dobson. It's dog eat dog in the health service now." We do not want that atmosphere back.
We know that competition increased bureaucratic costs and that waiting lists went above 1 million for the first time. The only serious academic study of the impact of competition of the quality of care was done by Bristol university, which looked at figures from all over the
country for recovery rates for people who had gone into hospital following a heart attack. The summary of their findings stated:
- "Our central finding is that competition is associated with high death rates: in other words competition is associated with lower quality."
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