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8.50 pm

Kate Hoey (Vauxhall): I am pleased to have caught your eye, Mr. Deputy Speaker. I spent eight hours in the Chamber on Second Reading and all of today without being able to express my views, despite having two trusts with three stars in my constituency. I would like to put on record my reasons for opposing the setting-up of foundation trusts and not backing Third Reading, despite the fact that I support certain aspects of the Bill.

I am disappointed that the Secretary of State did not choose to answer some of the many serious criticisms made by many hon. Members about foundation hospitals. I would like to remind the House that, according to the Secretary of State, the fundamental reason for establishing foundation hospitals is to improve the care of patients. Since Second Reading, I have spent a lot of time talking to my hospitals, local people and the PCT, and have yet to meet anyone who can come up with a single reason as to why a foundation hospital trust will achieve concrete improvements to patient services. It is important that we look at all the proposals in the Bill that could have been carried out simply by amending existing measures. We talk about democratisation of governance, and want local authorities to get involved, but that could have been done by amendment.

Trying to achieve a supposed democracy by involving local people will be a nightmare, and will cost far too much. I cannot justify the spending of thousands of pounds by hospitals in my constituency. Kings College hospital and Guy's and St. Thomas's hospitals will all compete for the same membership, with the exception of people who go for treatment at national centres at St. Thomas's and Guy's, not to mention the huge numbers of MPs who are always popping over to St. Thomas's. Presumably they will all be able to pay their money and become members of trusts. I cannot justify the spending of that money to establish an electoral process that will stand up to legal scrutiny—it is just nonsense.

No one in my constituency accepts the need for that kind of artificial democracy, as the hospitals already offer patients forums. St. Thomas's, in particular, reaches out to people in the area with pensioners forums—pensioners go to the hospital to discuss their needs, such as home helps and many other things. There is no need for this supposed democracy, which will not make the slightest difference, because the money is held by the PCTs, which are undemocratic. The whole thing is therefore nonsense.

Hospitals will supposedly be able to borrow more than they can at the moment, but they will have to pay it back. I am worried about what will happen if they run into difficulties. At the moment, if they decide to sell an asset, they have to offer it first to other hospitals and keep it within the NHS but, under the new arrangements, as soon as they get into trouble there will be asset stripping. I shall be brief, as other hon. Members wish to speak. I am all in favour of taking power away from Whitehall and giving it to local hospitals, but we do not need to create foundation hospitals to do so. All the problems that hospitals experience with bureaucracy and paper-chasing could be solved, as my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) said, by the Secretary of State simply saying that things are not going be done that way. This is a complete distraction

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and diversion, and it comes just as hospitals are beginning to see the benefits of the money that the Government have put in. It takes a long time for the benefits to come through but that is beginning to happen. However, we are completely diverting everyone in the trusts and setting them to work on establishing foundation hospitals.

Officials from the Department of Health are on the telephone and sending e-mails almost every day to the trusts, asking what people there think that they should do about foundation hospitals. The Department cannot answer a single question about the practicalities of how the system will work. Resources will be taken away from those in our health service and hospitals who should be working to improve matters for patients. The proposal is a diversion and a distraction. It was not in the manifesto, and I feel no compunction whatsoever about opposing my Government today.

8.55 pm

Dr. Evan Harris: Second Reading was held some time ago and was kicked off by the right hon. Member for Darlington (Mr. Milburn). It is appropriate to pay tribute to his work on the Bill, flawed though the proposals are. There is no doubt that he was a very able Minister and Secretary of State. It is unfortunate that personal circumstances should have prevented him from seeing the Bill through to this stage.

I wish the new Secretary of State well. I recognise that, despite the qualifications held by me and the hon. Member for Woodspring (Dr. Fox), he is the only proper doctor among the three of us. I tell that to my constituents on a regular basis. However, when questions are raised on specific policies, I hope that he will resist the temptation that his predecessor could not always resist—that is, to impugn the motives of others and to launch half-hearted and supposedly humorous personal attacks on those who do not agree with him.

Liberal Democrat Members, and even sometimes Conservative Members, ask reasonable questions that deserve to be answered, on Second or Third Reading. It is unfortunate when every question about the Government's policy draws as a response an attack on the policies of Opposition parties. That may be tempting but, if there is a time and place for such a response, it must come after questions about Government policy have been addressed.

The Secretary of State said several times that he is committed to an NHS that is universal and comprehensive, free at the point of delivery and in which treatment is based on clinical need, not the ability to pay. I do not doubt his sincerity about wanting to support an NHS like that, as that is the NHS that I support. However, I recognise that the NHS that we have at the moment—even before it is subject to the policies of any other party—is not universal or comprehensive.

We have to accept that rationing exists in the NHS, and recognise that the best thing that we can do is hope to limit rationing by putting in the necessary resources. I voted for the Government to do that. They have done it—belatedly, but they have done it. In addition, we must make sure that what rationing there is is made explicit. In that way, people will know the consequences of voting for tax cuts and for cutting resources for the NHS.

I do not doubt that the Secretary of State wants the NHS to be free at the point of delivery. However, he must recognise that it is not always free at the point of delivery.

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In dental care, for example, 84 per cent. of people, even including those of pensionable age, are not exempt from contributing to NHS dental charges, which can amount to as much as 80 per cent. of a maximum of £366. Also, hundreds of thousands of people, even those with chronic diseases, are prevented from getting their prescriptions because of prescription charging. For them, the NHS is not free at the point of delivery. The Government should have greater aspirations even than those contained in the Bill, as they would see it, to establish an NHS that is truly free at the point of delivery.

The Secretary of State would also argue that treatment should be based on clinical need and not the ability to pay. I hope that he recognises that the amount of NHS capacity reserved for paying patients means that, at a time when capacity is limited, there are thousands of people whose clinical need is greater than that of those in the pay beds. However, those NHS beds are occupied by people who have jumped the queue because they can pay. As the Select Committee said, the Government should do something about pay beds.

The Bill has five parts. One part, which has received less attention than it deserves, contains the proposals for the quality inspection regime—the Commission for Healthcare Audit and Inspection, and its sister body covering social care inspection. The Bill is a disaster for the independence of both bodies, which will become the Government's creatures, charged by the Government to implement Government policy. The Bill even contains a clause that states that the commission "shall have regard" to Government policy. The target regime and the so-called standards regime will clearly be seen to be political. The Commission for Healthcare Audit and Inspection will be far less independent even than the Commission for Health Improvement. I do not think that the NHS will have confidence in it.

Another part of the Bill deals with the recovery of charges from employers where they are liable. Even that has had to be postponed because the Department for Work and Pensions requires a review of its impact on small businesses.

The GP contract may be good for GPs; I do not blame them for voting for it. At best, however, it will mean no change for patients and, at worst, it will be worse for them. The contract provides neither more GPs nor more GP time; it merely allows GPs to opt out of providing holistic care on a one-stop-shop basis.

My hon. Friend the Member for Cheadle (Mrs. Calton), to whom I pay tribute, has drawn attention to the great deficiencies in the welfare food scheme. Many of the provisions should not and will not survive the Bill's passage through the House of Lords.

The Government majority of only 35 on the foundation hospitals proposals shows that their policy is wounded as the Bill limps to the Lords. The policy is unloved by staff; the unions and professional staff oppose it. It is unloved by patient groups; they know that the priority should not be to set hospital against hospital. We oppose it. Many of the Government's Back Benchers oppose it, including at least six former Ministers. The policy is loved only by the Tories, but not so much that they could not vote against it. The House of Lords should put the policy out of its misery so that

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the NHS can concentrate on providing the freedoms required to empower commissioners and to put patients' needs first. We should have an inspectorate free from political control.

For all those reasons, we shall oppose Third Reading and we urge hon. Members on both sides of the House to join us in so doing.

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