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Hywel Williams (Caernarfon): My party's standpoint is abundantly clear, as is that of the Scottish National party: we do not want foundation hospitals in Wales or Scotland and we are worried about cross-border effects. As was said earlier, the standpoint of the newly democratically elected Labour Government in the National Assembly for Wales is clear: they are against foundation hospitals.
As the hon. Member for Cardiff, Central (Mr. Jones) said, clause 1 contains no reference to Wales, and he tabled amendment No. 60 to add such a reference. I take it from his remarks that he is in favour of establishing foundation hospitals throughout Wales, but that would be against the expressed wishes of my party and the Labour Government in Cardiff.
The hon. Gentleman says that adding a reference to Wales in clause 1 would address the problems of cross-border treatment. We are certainly worried about those problems. We are concerned that three tiers of treatment will be available in England: treatment available in foundation hospitals, treatment available in other hospitals and treatment available for Welsh patients. As my hon. Friend the Member for Angus (Mr. Weir) said, there are potential consequences for the Barnett formula if hospitals in England lever in large amounts of private money. Will the Minister explain the consequences that that would have on the proportion of money available for Scotland and Wales?
We accept the force of some of the arguments made by the hon. Member for Cardiff, Central about cross-border treatments, but we note the Government's
assurances that the issues are properly addressed. Presumably, the logical conclusion for the hon. Gentleman is that if his amendments are not adopted, the Bill is flawed. In that case, is he prepared to vote against it? I understand from his remarks that he will support it even if it is flawed. Should he undertake to vote against the Bill, Plaid Cymru will be prepared to consider our position on his amendments.4 pm
Mr. Frank Field (Birkenhead): I want to speak to amendment No. 321, the 25 associated amendments and new clause 34, which stand in my name and those of my hon. Friends.
I begin where my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) began, by reminding the House that we are debating the one institution about which this country cares. He was right to say that, but it was only a partial truth. If we look back over the past 20 years, the respect that the NHS has commanded among our voters has declined. Just because most of our constituents willingly vote for extra taxes to pay for improvements in the NHS, we cannot sit back and think that that state of affairs will continue. If any of my hon. Friends doubt me, they need only look at that other popular institution of 20 years ago—the monarchy—which was more popular than the NHS. The fact that something commands public favour at one point in time does not of itself mean that that favour will continue.
So the Government are right to take a twofold approach to NHS reform. The first approach is to commit record sums of taxpayers' money to improving services. The second is to consider institutional changes. I want to dwell on the size of the extra moneys that our constituents are willingly putting towards the NHS. We are approaching the mid-point of the Parliament. Even if our minds are not concentrated on the next election, our voters are increasingly thinking about it and the Government's record and performance. They will want improvement, over and above what they already expect, from the very large sums of money that they have willingly donated to improve the NHS. So my right hon. Friend was correct in saying that there are huge dangers in the Government playing around with the structure again at this time in the Parliament.
I am glad that my hon. Friend the Member for Wakefield (Mr. Hinchliffe) is in the Chamber. No one was more favourable to the Bill's principles when we discussed it on Second Reading than I was. The direction that the Government wish to take—the ownership of the NHS—is right. I just question whether they have had sufficient time to listen enough or think enough about the structure that they will not only impose on many people, but roll out before the next election.
Before hon. Members vote, I beg them to acquaint themselves with what is in the Bill on the register of electors. My right hon. Friend the Member for Holborn and St. Pancras was rather gentle with the Government. He talked about the additional cost each year for local authorities to keep their register of electors up to date—some £50 million. But we will not be asking foundation hospitals to use an existing body of electors. They have to start from scratch, so mega resources will go into
trying to understand the legislation which we may or may not pass today, and building up that body of electors.The amendments and new clause in my name and that of my hon. Friends recognise that the Government are right to consider ways of changing from a producer-run to a consumer-run organisation. I do not accept that, as my right hon. Friend the Member for Holborn and St. Pancras said, there was a choice only between a producer-run body and a laptop. If that were the only choice, we would be with him. The Government are trying to feel a new way as they in effect denationalise the last nationalised industry in this country and the only nationalised industry about which people care.
Mr. Geoffrey Robinson (Coventry, North-West): The amendments in my right hon. Friend's name, mine and that of several other hon. Members, all make the simple point that there is no use in planning for a roll-out of a major reorganisation that has not been pilot-tested first. The proposals embody some good and bold aspirations. Is not the answer to try them first, involve the new foundation hospitals together with primary care trusts on a limited geographical scale, and let them iron out the difficulties without another massive disruptive reorganisation?
Mr. Field: My speech can now be even briefer. That was the next point that I wanted to make, and I agree with every word my hon. Friend said. Our large group of amendments is intended to say to the Government, "Well done. We think you are moving in the right direction, but we are worried about any possible disruption in the delivery of services between now and the next election." The amendments therefore propose the establishment of six foundation hospitals and six primary care trusts. New clause 34 lists who would carry out the evaluation and how they would report back to the Secretary of State and to us before there was any further roll-out.
The simplest form of election would be to use the roll of electors who elect us. That would entail no extra administrative cost, and the people who act as returning officers in parliamentary elections would return the board members in the 12 pilots that the amendments propose. [Interruption.] My hon. Friend the Member for Pendle (Mr. Prentice) asks whether it would be a mutual organisation. No, of course not. I do not understand why the term "mutual" is being used. Most of my constituents think they own the health service. When one considers the difficulties that we place on our hospitals now, the idea of asking them to collect the quids or parts of quids and to deal with more administrative detail is a nightmare. My constituents are willingly paying to try and own the health services that they have. The Bill should be designed to give that effective form.
The amendments set out the procedure for nominations. When we want to stand for Parliament, we have to get, say, 50 members of our local electorate to support us, and the same should apply to the election of board members. The returning officer would be the same as for parliamentary elections, as I said, and the Comptroller and Auditor General would carefully examine the key pilot experiments.
We were told by the Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), that we must not go into the Lobby with the Tories on any of the amendments today. Our fear is that if we rush headlong into reforms that are almost open-ended, we will deliver the NHS up to their reforms. What we want to do more than anything is to make sure that the extra resources being put through the NHS are shown to be effective, and that our constituents are allowed to experiment. The NHS has survived for 60 years because everybody in the country knew that it had a cast-iron guarantee, a security, a fall-back position. We could all say to our electorates, "Don't worry, the NHS would perform better if only it had more money," but the Government have bravely stripped away that defence. We cannot go into the next election saying, "The service would be better if only you were prepared to cough up more taxes," as our constituents are already doing that. I beg the Government to draw back a little in their proposed pace of reform, to concede that we need an array of pilots to deal with PCTs and foundation hospitals and to ensure that the vast majority of hospitals do what they are meant to do—deliver improved services—particularly before we have to meet our paymasters, the electorate, at the next election.
Mrs. Calton : Time is short, so I shall be brief and confine my remarks to two areas about which I am especially concerned. They have been raised by other hon. Members and, to that extent, I shall seek to labour them, as I think they are important.
Amendments Nos. 397 and 398 seek to reverse the Government amendments made in Committee that changed the sense of clause 15 and, in particular, the severity of the cap on private treatment. My hon. Friends and I regard it as imperative that the clause should be made clearer. Unfortunately, the Government have tabled yet another amendment, Government amendment No. 248, which makes it even less clear. It has become a dog's breakfast of a clause and, as a provision that deals with privatisation and the supposed cap on privatisation, it needs to be reconsidered to ensure that there is a cap on the amount of private treatment that can be given in a foundation hospital.
The second area about which I am very concerned again relates to a Government proposal—Government new clause 36, relating to mergers. The hon. Member for Wyre Forest (Dr. Taylor) mentioned that issue, which goes beyond an attempt by the Government simply to ensure that there is not another hon. Member for Wyre Forest waiting out there. What is really important is that there should be transparency and honesty about the situation into which we are moving. If a foundation hospital can effectively become merged or closed and if its authorisation can be changed so that it can involve itself with more private treatment, and if all that can happen right up to the point at which authorisation is given, there will be no time whatever for public consultation. People will see their local hospital whipped away from them with no chance for them, their local politicians or anyone else to make any difference whatever.
I ask the Government to reconsider new clause 36 and especially proposed subsection (3), which allows changes to be made to the application right up to the point at which authorisation is given. That is not right. The public need to know whether their hospital can be changed, closed, merged or privatised. There has been a reduction in transparency as the Bill has passed through the House.
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