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3.30 pm
If amendment No. 164 is not accepted, I urge Members to support my amendment. I hope that my colleagues will do so, as well as Liberal Democrats, in the light of the speech of the hon. Member for Oxford, West and Abingdon. I believe that the right hon. Member for Birkenhead (Mr. Field) and the hon. Member for Hornchurch (John Cryer) tabled amendments with a similar aim to mine. I hope that all hon. Members will regard amendment No. 96 and the linked amendments as a way of injecting such proposals into the legislation.
I answered the question of the hon. Member for Mitcham and Morden about the two hospitals in my constituency, but I wish to deal in more detail with the principle of NHS foundation trusts. Essentially, my objection to the Government's proposals is not about the principle of such trusts; as my hon. Friend the Member for Woodspring said, we support the principle of foundation trust status. We favour freedom for NHS providers to manage themselves and respond to local priorities, rather than being subject to central control. The problem is that the Bill simply does not offer that. We know that NHS trusts will be tied to the "Agenda for Change" on pay and conditions. Addenbrooke's is happy with that but, in principle, managers should be free to vary them. Trusts will be subject to a national tariff but, if they want to maximise the utilisation of capacity, they ought to be able to discount the cost of capacity so that they can use spare capacity.
Nobody has mentioned the NHS information technology strategy. Most providers, including hospitals, are clients of IT companies. NHS foundation trusts will be subject to the entire NHS IT strategy, but will not be direct clients of IT companies. Instead, regional bodies will be the clients of IT providers. Trusts will be subject to PFI. The Minister reminded us that Government amendment No. 356 reinforces the fact that PFI will operate in exactly the same way for foundation trusts as for NHS trusts. Foundation trusts will also be subject to the same overall departmental expenditure limit as other NHS trusts. The freedoms that I seek, including the freedom from bureaucracy, are simply not present in the Bill, so I cannot support the introduction of foundation trusts, because the rhetoric is simply not matched by the reality. I shall therefore press amendment No. 96 to a vote.
Mr. Adrian Bailey (West Bromwich, West): I shall speak in support of new clause 24 and amendments Nos. 233 and 234, which I tabled. First, however, I should like to declare the fact that I am vice-chairman of the Co-operative group in Parliament, and a lifelong supporter of the principles of mutuality and co-operation in the delivery of our public services.
Before I discuss the substance of the amendments, I should like to pick up a couple of points. First, many Members have spoken about the running costs of any form of democratic involvement in foundation hospitals. Various mutual and co-operative organisations have developed low-cost, effective means of communicating with their members, and I know that the movement would be happy to make its expertise available to any prospective foundation trust. Secondly, there is nothing intrinsically socialist about the present Whitehall-driven NHS. The debate about local control and mutuality in the health service went on for many years before the NHS was founded in the 1940s. The current model was not arrived at because it was intrinsically egalitarian or socialist—it was the result of horse-trading between the Labour Government and health professionals in the 1940s.
I have tabled these amendments because I recognise that legitimate concerns were expressed on Second Reading and in Standing Committee about the commitment of foundation hospital trusts to democratic participation, and because the provisions in the Bill appear a little vague. New clause 24 would place
a legal duty on foundation hospital trusts to take steps to secure a membership that is truly representative of the local community. Amendment No. 233 stipulates that, to obtain authorisation, a foundation hospital trust must be representative, and amendment No. 234 would place an obligation on trusts to report annually on the steps taken to achieve that.My prime objective with the amendments is to ensure that the full potential offered by this new form of governance is realised. I believe that the democratic responsibilities of the trusts must not be subordinated to the other freedoms that foundation status will bring. The amendments define more clearly the obligations of applicant trusts to democratic ownership and control. To achieve foundation status, an applicant trust must demonstrate that it is as committed to local accountability as it is to gaining freedom from Whitehall.
In the debates on Second Reading and in Standing Committee, concern was expressed that the proposed membership arrangements could be open to abuse. One fear was that a highly organised religious group might hijack a governing body to demand that the clinical priorities of the hospital be changed in accordance with its religious beliefs, irrespective of the views or needs of the local community.
Another concern was that the governing body would be dominated by representatives of the so-called sharp-elbowed middle classes. It was feared that the professional, better educated and more self-confident members of the local community would be more skilled at using the democratic machinery, and that the views and principles that they expressed would take precedence over the interests of the less educated and more inarticulate members of the community.
The amendments are designed to stop that. However, they are not just defensive: they are also designed to promote social inclusion. My constituency is fairly representative of a large number of inner-city areas. It has a high percentage of elderly people on low incomes who do not have cars. They spent their lives in local industry and suffer from a range of conditions related to a hard working life. We also have a substantial ethnic minority population. Many of them are first-generation immigrants, with limited language skills but considerable health needs.
Such people could be excluded from participation by hidden barriers that are not directly or deliberately erected by a hospital trust. Those barriers could exist because the trust's governors are not sufficiently representative, or because their understanding of the measures that need to be taken to ensure full participation is incomplete. Ironically, it is the elderly and disabled—the ones with the most pressing health care needs—who could be the ones least able to play a part in a service on which their quality of life might crucially depend.
My amendments would ensure that the elderly, the disabled and the disadvantaged are heard. As a condition of the granting of foundation hospital status, credible steps must be taken to ensure that all views are incorporated into hospital governance.
The Bill's provisions represent a dramatic change from the centralised, Whitehall-driven control of local hospitals that has developed since the formation of the NHS. I accept that they pose an enormous challenge for management and represent a change in working culture.
The current management trusts appointed from local applicants are a recognition of the need for local input into hospital management. Many of the trusts are staffed by able and dedicated people, but they are not directly accountable to the local public. They amount to little more than a genuflection in the direction of local participation.
Currently, hospital management has no track record of democratic involvement. That lack of experience means that there is a danger that the mechanism of member involvement will not achieve its full potential. The last thing that we want is an incomplete and rudimentary form of member participation that enables a coalition of the great and the good in the local community to perpetuate its control of the trust by a form of mutated democracy. That would be no more than a sort of quango with votes on.
Siobhain McDonagh: Is my hon. Friend aware that my constituency is not represented on the board of either St. George's hospital or St. Helier hospital, both of which serve my community? It is not represented on the primary care trust and, so far, it has been excluded from all centres of power and the limited democracy in the health service. Does he agree that foundation hospitals will give some of my constituents a chance to be represented on those boards?
Mr. Bailey: My hon. Friend raises a valuable point. Local membership would give the opportunity to elect people to the governing board, which would effectively represent their interests.
I believe that Ministers share with me the intention that foundation hospitals should be genuinely mutual. The amendments detail the obligations of the trust, and provide a mechanism by which the means and level of membership recruitment can be measured to ensure that the boards are truly democratic.
The amendments are positive; they are designed to extend and promote the principles already incorporated in the Bill. They will provide a record of best practice and achievement that can be shared by everyone and passed on to subsequent generations of applicants. Furthermore, as democracy develops and becomes more successful, the model could be transplanted to other NHS services.
I take the point that has been made about PCTs. However, if we are to pioneer a new form of democratic participation in the health service, it makes sense to do so where the local community has the strongest identity and interest, which is undoubtedly at the local hospital.
The proposals offer the opportunity for a whole new constituency to engage in the running of our most valued public service. Few institutions arouse more justifiable loyalty and regard than the local hospital. By giving local residents, patients and employees a say in the running of their hospital we are both pioneering new forms of public participation and providing a means of educating people about the structures, policies and priorities of the service. We shall also be educating
administrators on the wishes and aspirations of the local communities, and making them accountable in a way that might lead to a refinement of established practices better to meet the needs of their constituents.Developing the bond between the public and their local hospital opens new possibilities for voluntary support and recruitment to add value to the hospital's existing work. In his Second Reading speech, my right hon. Friend the Member for Birkenhead (Mr. Field) talked of the potential that could be unlocked. Once people feel that they own and control their local hospital, who knows what extra efforts they will make to support it? Above all—
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