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Mr. Salmond : As the Secretary of State should be aware, there are huge implications for funding in Scotland if foundation hospitals, via the Barnett formula, go ahead in England; however, he has not answered the point made by my hon. Friend the Member for Angus (Mr. Weir). How can Scottish Labour Members be in favour of foundation hospitals in England, given that the Labour party policy in Scotland is against them? How can Labour Members in Scotland simultaneously hold the positions of being in favour of them south of the border and against them north of the border?

Dr. Reid: The answer is the same as the one that I gave earlier. What the hon. Gentleman is saying is not true—there is a thing called devolution. The Labour party is slightly bigger than the hon. Gentleman's own party. We draw our members from a much wider base, whereas his party is confined to one country—as, incidentally, is the Tory party. Indeed, if the Tories are not careful, they will be overtaken by the SNP. For those of us who belong to a party that is truly represented throughout Britain—

Mr. Mark Francois (Rayleigh): Will the right hon. Gentleman give way?

Dr. Reid: I am afraid that I genuinely cannot. I have already taken a long time, and I want to get to some of the meat. We believe in devolution. We believe that there is no one-size-fits-all solution for Britain, and nor is there a one-size-fits-all solution for the national health service. That is why we are decentralising power.

The second principle is that the value of the national health service is defined around patients, not around the needs of providers. Yes, I have the greatest respect for politicians—for those who provide the decisions, the policy and the money—for those who work in the national health service, for those who lay the bricks and build the buildings, for those who make the tea, and, indeed, for those who make the surgical incisions. But ultimately, this is not about the providers; it is about the patient, and the patient must be the arbiter of everything that we do and the benchmark of our success. Again,

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that leads to striking difficult balances and making difficult choices, but Labour Members have never been frightened to do that.

Mr. Allen : Will my right hon. Friend give way?

Dr. Reid: I shall give way one more time.

Mr. Allen: The whole foundation hospitals episode has been bruising for everybody on the Labour Benches, regardless of which side of the argument they are on. Many of us remember my right hon. Friend's pugnacity as Leader of the House and as chairman of the Labour party, but some of us also remember the skill that he brought to bear in Northern Ireland and in the former Department for the Environment, Transport and the Regions. Will he make every effort to ensure that those who have made honest representations on this issue are still part of the family of people whom he will consult and maintain very close links with as we rebuild the health service?

Dr. Reid: The answer to that is yes, yes and yes again, because I genuinely believe that the commitment on the Labour Benches to the values of the national health service is such that it overcomes, and should overcome, any differences in terms of exactly how we get that system operating and how we enshrine those values.

The third point is that the Bill enshrines true security and equity for our people. That was built in as one of the objectives of the early health system, but to be truthful, it has never been delivered in the light of the sheer uniformity of production of service. The truth is that choice, in terms of meeting the ambitions of our people through the decades, will remain theoretical rather than real unless sufficient capacity is injected into the NHS itself. I am not one of those who think that this is a question of choosing between increasing capacity and increasing choice; the truth is that both are necessary. If we do not increase capacity, we cannot give the patients themselves true choice; and if we do not give them true choice, we will not maximise the focus, direction and use of the extra capacity that we are putting into the health service—a point that also relates to the question of fairness.

As has been pointed out, we have listened to the various concerns that have been expressed about the Bill. For instance, we have introduced measures to cap the amount of private work that an NHS foundation trust can do, introduced local accountability and ensured common application of the terms and conditions agreed under "Agenda for Change". So in the teeth of opposition from the Conservatives, we have tried to listen, but above all we have tried to make real progress for the national health service. I believe that NHS foundation trusts will help us to take a further great stride forward for patients. And when we do so—when we make decisions about the systems, processes and structures through which we are trying to enshrine our values—Labour Members will never forget, I hope, that the choice is now clear.

The real dividing lines are opening up on this great issue of health care. After six decades of post-war consensus, there is now a breach in that consensus. The

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choice, which is enshrined in this Bill, is between reforming the NHS or breaking it up; between mending it or ending it; between massive investment or savage cuts; between modernisation or privatisation; and between increased spending or increased charging. It is a choice between our promise to provide the systems to run alongside the training of doctors and nurses, the building of skills in hospitals and the provision of teachers and skills, thereby building on the Bill itself; or the Tory pledge card, of which the hon. Member for Woodspring (Dr. Fox) is the architect and proud parent. That pledge card outlines their aims: to cut public spending, to sack nurses and doctors, to axe hospitals and to transfer money away from the NHS and into private care.

When I consider that choice—between a Labour party that believes in health care free at the point of need, and a Tory party that now apparently believes that when someone is ill, the health service should take their money before taking their temperature and feel their wallet before feeling their pulse—all I can say is, "Roll on the general election." Meanwhile, I commend the Bill to the House.

8.35 pm

Dr. Fox: To end with an utterly fatuous analysis of the difference between the parties and to create demons that do not exist, thereby frightening the sick and vulnerable, is unworthy even of a Secretary of State thrown into the job unwittingly in a botched reshuffle by a Prime Minister who had the poor sense to put in charge of health care in England someone who does not have to take responsibility for any of his actions in respect of his own constituents in Scotland. I am also saddened that the Secretary of State made his debut on this subject tonight by barely mentioning the Bill at any point in his speech. Instead, he gave us a lecture about some strange and bizarre version of history and his party philosophy. He preferred that to facing his Back-Bench colleagues head on in the difficult debate on foundation hospitals. If the Secretary of State does not have the courage to do so, the Opposition cannot be held to account for it, but it is a great pity.

We should remind the Secretary of State of a couple of things. When it comes to the post-war consensus on the national health service, which he says has been maintained up to this point by all Governments, it is worth pointing out that in the post-war period since the NHS was created, it has been maintained for 35 years by a Conservative Government and for only 17 by a Labour Government. I would have thought that that speaks for itself.

The Secretary of State spoke rather patronisingly—and the Minister of State insultingly earlier—to his own Back Benchers, accusing them of going into the Lobby with the Tories tonight. I had better point out that it was a Labour amendment, not one of our amendments, on which the Conservatives chose to go into the Lobby with his hon. Friends. The Secretary of State needs to learn not to insult his own side as often as he seems intent on doing.

One could not have gleaned it from listening to the Secretary of State, but there are three main elements in the Bill—foundation hospitals, the CHAI and its reform to provide a new system of inspection, and of course the

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GP contract, which is essential to changes in primary care, though it was not mentioned once in the Secretary of State's Third Reading speech on his own Bill. That speaks volumes about the Government's approach to primary care.

Dr. Reid: The hon. Gentleman said that there were three main elements, but he has just mentioned four.

Dr. Fox: No.

Dr. Reid: Does the hon. Gentleman want me to elaborate them?

Dr. Fox: The Secretary of State needs a little lesson, because the GP contract is primary care. I know that he is not au fait with the terminology of his new job yet, but most of us regard general practice as one of the essential parts of primary care. Perhaps the Secretary of State should ask the Minister of State for some advice on the language of the NHS in England.

Dr. Reid rose—

Mr. Deputy Speaker: Order. All I insist on is that we do not have two Front-Bench Members on their feet at the same time.

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