---

Glenda Jackson (Hampstead and Highgate): Will my hon. Friend give way?

Mr. Bailey: I am about to conclude my speech; I am conscious that other Members want to speak.

Above all, that bond will make it much more difficult for enemies of the NHS to privatise our hospitals in the future.

The only alternative to the proposals is to continue to invest more money in a structure run by local quangos and regulated by Whitehall. Giving local people a say in how the vast sums of money invested in their local services should be used is infinitely preferable.

We should be radical. It is time that we matched our financial investment to our commitment to local democracy. My amendments are designed to do just that.

Dr. Richard Taylor (Wyre Forest): May I pay very sincere tribute to the right hon. Member for Holborn and St. Pancras (Mr. Dobson), who put the case in favour of his amendments so intensely clearly and has spoken up so strongly for all NHS staff, who do not want more interference?

I shall be very brief because time is short, but I want to ask the Minister to clarify new clauses 36 and 37, which, to my amazement, were welcomed by the hon. Member for South Cambridgeshire (Mr. Lansley). As hon. Members will know I am extremely sensitive to mergers and closures, and those new clauses seem to provide draconian powers.

3.45 pm

The trusts interested in merger have to apply to the regulator, who at least, I am relieved to hear, will be accountable to the House, but new clause 36(3) says:

"applicants may modify the application with the agreement of the regulator at any time before authorisation is given".

The only mention of public consultation is in subsection (6):

"If regulations require the applicants to consult prescribed persons about the application, the regulator"

has to be satisfied that the applicants have complied. Which regulations may be relevant? Who are the prescribed persons who might be consulted? Are they just the management boards, the PCT patient forums, or the overview and scrutiny committees?

Without its own patient forum, a foundation trust has no one to refer matters to overview and scrutiny committees and, in turn, no one to refer to the

8 Jul 2003 : Column 968

independent reconfiguration panel, unless I have got that wrong, and I should be delighted to hear from the Minister about that. Mergers will inevitably become more likely because of the European working time directive. If those new clauses are accepted, proper open consultation will be bypassed and people will be unable to stop closures because of the unlimited powers in the Bill. I fear that MPs may find their seats at risk.

Mr. Jon Owen Jones (Cardiff, Central): I am pleased to be called to take part in the debate. Before I speak to amendment No. 60, which is in my name and the names of several of my hon. Friends, and a number of consequential amendments, I should like briefly to mention the right of Welsh MPs to speak in the debate, because my hon. Friend the Member for Wakefield (Mr. Hinchliffe) has indicated that other hon. Members and I should keep our noses out. He may not have noticed, but this is an England and Wales Bill—that will become clear when I speak to amendment No. 60, which is about foundation hospitals. Moreover, other parts of the Bill will be voted on by hon. Members from England in overwhelming numbers compared with the number of Members from Wales.

I am not sure whether my hon. Friend is interested in those constitutional matters, but if he is, he will have noticed that on every England and Wales Bill in the past I have expressed my frustration that the time available to debate matters of extreme importance to Wales—primary legislation for Wales still rests with the House—is completely inadequate when we are also debating English matters, and I have suggested other routes so that we could have those debates. If we had other routes—if Welsh matters could be referred to a Grand Committee—I would be sympathetic to the argument that I should not participate in English affairs, but we do not, so I shall take part in the debate and I hope that my voice will be respected.

The problem emerges from the first sentence in the Bill:

"An NHS foundation trust is a public benefit corporation which is authorised under this Part to provide goods and services for the purposes of the health service in England."

Hon. Members may not know it, but there is a great deal of cross-border movement for treatment in Welsh hospitals and English hospitals. Overwhelmingly, however, it is for the treatment of Welsh patients in English hospitals. Last year, 43,000 Welsh patients were treated in English hospitals. Some of those hospitals—particularly the one that treats the greatest number of Welsh patients, Countess of Chester hospital—are in the first wave of applications for foundation hospital status. Therefore, whether they have foundation status and whether it works properly is clearly an issue of importance to Welsh Members.

Chris Grayling (Epsom and Ewell): The hon. Gentleman is making extremely important points, and I hope that Ministers will listen. Is he aware that not only is there a cross-border flow of patients but, in the Welsh border areas, the hospital in Chester is the prime referral point for the majority of local GPs?

Mr. Jones: Yes. The issue is even more important for people from mid-Wales, where the only acute services available are on the other side of the border in

8 Jul 2003 : Column 969

Shrewsbury, Hereford and other hospitals. For many Welsh patients, therefore, English hospitals provide the only available acute services. How they are run is therefore extremely important.

This Bill provides a legal duty and responsibility to treat English patients, but does not provide such a duty and responsibility to treat Welsh patients.

Ian Lucas (Wrexham): Has my hon. Friend, like me, received a letter from the Secretary of State for Health, which talks about the fact that health care should be provided equally to those who need it, free at the point of need? Does he agree that this Bill runs directly contrary to that principle, in that it provides preferential treatment to patients from England over and above those from Wales?

Mr. Jones: It certainly does. A pattern already exists, even prior to foundation hospitals being established, of Welsh patients finding it difficult to get access to the hospitals to which they would traditionally be sent from their catchment. An article in the Shropshire Star only yesterday stated:

"A patient from Mid Wales has been refused a vital hip operation at a specialist orthopaedic hospital in Shropshire—because he is from Wales, a letter revealed . . . GP Dr Hywel Lloyd in Llanidloes received the . . . letter from a consultant orthopaedic surgeon at the Robert Jones and Agnes Hunt orthopaedic and district hospital in Gobowen."

I could cite a number of examples of Welsh patients who are already having difficulty getting into English hospitals, even though those English hospitals do not have the additional power that they would have under foundation trust status to restrict the growing demand for their services from Welsh patients.

I raised these matters at the Committee's first sitting and the answers given by the Minister, which were repeated by the Secretary of State for Wales, other Ministers and the Health Minister in the Welsh Assembly, were all to the effect that, to paraphrase, nothing in the Bill precluded or prevented Welsh patients from getting treatment. But that was never the question that I had asked. I asked why it was necessary to give Welsh and English patients a different legal status and to put Welsh patients in a disadvantageous position?

The Government claim that they have amended the Bill to answer that point. They amended clause 14(1) in Committee, and at first glance it appears that the amendment meets the purpose. The original Bill said:

"An authorisation must authorise the NHS foundation trust to provide goods and services for the purposes of the health service in England."

The amended Bill now says:

"An authorisation must authorise the NHS foundation trust to provide goods and services for purposes related to the provision of health care. "

All well and good—it appears to answer the problem. However, the very next subsection says:

"But the authorisation must secure that the principle purpose of the trust is the provision of goods and services for the purposes of the health service in England."

8 Jul 2003 : Column 970

How can one read that and not conclude that the Bill and the establishment of foundation hospitals will put Welsh patients in an inferior position?

On Second Reading, I spoke in support of foundation hospitals, much to the annoyance of several of my hon. Friends, because I am in favour of reform in the health service. However, I must tell my hon. Friends on the Front Bench that the Government amendments tabled so far do not address the central point that I am making. I do not believe that they do not want to respond to the argument that I have made. Indeed, I am fairly convinced that privately they would like to agree to my amendments. They must stand up and make that point, because other hon. Members who support my proposals might think that if the Government cannot guarantee equal provision of services for people in Wales after the establishment of foundation hospitals, perhaps they should vote against establishing foundation hospitals. I do not hold that view because I support the principle of modernisation, but others might be less convinced.

Several hon. Members, especially Liberal Democrat and Plaid Cymru Members, have made a point about devolution. They are reluctant to support my amendments because they would empower the Welsh Assembly to create foundation hospitals if it wished. Provisions giving the Assembly the choice to do something exist in many other Bills. I do not understand—I have received no explanation—why the Welsh Assembly would want to put Welsh patients at a disadvantage in the way in which I described simply in order to make a gesture by saying that it would not create foundation hospitals or take up the power to introduce them at a later date. That puts ideology in front of any practical benefit and protection for Welsh patients.

---