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Mrs. Humble: I thank my right hon. Friend for giving way. Will he clarify the important statement he made a moment ago about reviewing the first waves of foundation hospitals before making progress? He used the plural "waves", so can he clarify how many hospitals will be involved and whether he will come back to the House with a report before making an announcement about more foundation hospitals in the future?

Dr. Reid: It is anticipated that the first waves will start in 2004 and will consist of two parts. One has already been publicly announced and includes 29 hospitals, falling to 25. The second part will include 30 hospitals or fewer, so the round figure is about 50. As for reporting to the House, I have always made it plain that we will review the situation as we go along, because it is the study of modern society that has led us to the conclusions we have reached about the need to give patients better information, quality, power and choice and, therefore, the need to decentralise. It would therefore be wholly contrary to our approach and intuition to say that we shall plough ahead irrespective of any obstacles or difficulties we encounter. We are prepared to review as we go along.

My hon. Friend is right, however. As I said, there is a period of approximately 12 months between autumn 2004 and autumn 2005 in which it would appropriate to carry out a specific review of what is happening. I shall ask CHAI to assist in that review. The commission, which is established under the Bill, is responsible and

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accountable not to me but to Parliament, so any report it produces will be presented to Parliament. I hope that that answers my hon. Friend's point.

Several hon. Members rose—

Dr. Reid: In fairness, I shall give way to my hon. Friend the Member for Warrington, North (Helen Jones), who has tried to intervene twice.

3.30 pm

Helen Jones (Warrington, North): I am grateful to my right hon. Friend. Will he clarify the remit of any such review? Will it include the effects of the change on the whole health community and not be only a review of foundation trusts?

Dr. Reid: My hon. Friend tempts me to hold a review of the workings of the whole system, which is neither what I said, nor what I intend. We are instigating one of the most radical transformations within the NHS, but that is only a part of a much wider agenda. One of our problems all along has been that foundation trust status has not been put in context. When it is seen in the context of the vast increase in capacity and of the reform of the system as a whole—in particular, reversing the NHS engine and navigation system away from central diktat and toward giving patients the sort of power that they have previously had only in the private sector—it is easier to understand why we have to decentralise.

This is a radical move, so we are duty bound to investigate and oversee the changes as we proceed. I have said that, to reassure colleagues, I shall, in the period between autumn 2004 and autumn 2005, call in assistance to examine the difficulties, challenges and experiences of the early foundation trusts, which will be to our benefit and enable us better to drive forward improvements in the NHS. To assist, I shall call in CHAI, which is responsible to Parliament, not to me. I think and hope that that will give a great deal of reassurance to many of our colleagues, who have continually asked us to reassure them that we will not proceed willy-nilly, regardless of experience.

Several hon. Members rose—

Dr. Reid: If my hon. Friends will forgive me, I really have to draw my remarks to a conclusion. The Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), and I will be more than happy to respond to points raised during the debate. For now, let me take a last few interventions, so that no one is offended.

Mr. Gordon Prentice (Pendle): I do not think it is right to experiment on so many NHS trusts. It does not satisfy me at all that a huge number of trusts are to be subject to audit. My question is this: given that this is such a radical transformation, why is it not possible to pilot the scheme in a small number of trusts across the country?

Dr. Reid: First, we would still need legislation to do that. Secondly—I say this with all due respect to my hon. Friend—when it was first suggested that we might carry out a limited number of pilots, we were

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immediately accused by my hon. Friend of creating a two-tier health system. I accept it as a consolation of my job that, in a sense, we cannot win. If we pilot in a small number of trusts, we are accused of privatisation or creating a two-tier system; if, for the sake of equity, we propose that the entire service be affected, we are told that that is far too radical a plan for a timid beast like the Labour party to contemplate. When we formed the NHS, it was a radical vision of amazing proportions and, of course, it involved risk. There is a degree of risk in everything—I do not deny that for a minute. That is precisely why we shall proceed with a degree of caution and in waves, and why I have reassured my hon. Friends that I shall genuinely examine the experience of the early trusts. However, I am not prepared to go back to the beginning and say we shall allow only 10 foundation trusts to be created, and have all the arguments about equity again.

Several hon. Members rose—

Dr. Reid: I will give way, first, to my hon. Friend the Member for Birmingham, Northfield (Richard Burden), then to my hon. Friend the Member for Halifax (Mrs. Mahon), who has been trying to intervene for a while. Then, I must conclude.

Richard Burden (Birmingham, Northfield): May I take my right hon. Friend back to the issue of membership? I am one of those who have doubts about aspects of the proposal without necessarily endorsing some of the more cataclysmic opinions that have been expressed about foundation trusts generally. However, if foundation trusts are to achieve the objectives that he has stated, is it not vital that their membership base be as wide as possible? He says that there will be an amendment that will allow foundation trusts automatically to accept patients and staff as members, unless they opt out. I welcome that, but I am worried by the wording, which is that the trusts may do so. Will he make it clear that, unless people opt out, automatic membership will be expected, and that membership will not be something that they can opt in or out of, as they see fit?

Dr. Reid: I entirely agree with my hon. Friend that there is a problem. There is no doubt about that. That is one of the risks involved. Having listened to my hon. Friend and other colleagues, we have decided that for patients and staff it will be an opt-out procedure. In other words, there will automatically be a reasonably representative basis of staff and patients from the beginning to stop particular groups, political or otherwise, trying to gain control of an asset of the local community and of the nation for their own benefits.

On the question of extending the idea of opt-out to the whole constituency, I am sure that my hon. Friend will understand that there are some places where the local constituency may be huge. Therefore we have not compelled trusts so to do. However, we have said that we would expect them, unless there are very good

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reasons not to, to follow the same procedures of opt-out as would otherwise be the case. We shall examine carefully whether they have such reasons.

Mrs. Mahon: My right hon. Friend and I were in the House when an experiment was carried out in Scotland to decide whether to impose the poll tax, with disastrous results. He has tried to say today that the opposition is coming from a few Back Benchers and the Tories. However, is it not true that most of the unions, staff organisations, workers, the royal colleges, the Society of Radiographers, physiotherapists, the general public in the latest poll—61 per cent.—pensioners, including Halifax pensioners, and the King's Fund are opposed to the proposed experiment? Has my right hon. Friend ever heard of the expression, "Everybody is out of step except our Johnny"?

Dr. Reid: It is true, to name a few, that the British Medical Association, consultants, the House of Lords, the Tories, the Liberal and Democratic party and some of the royal colleges—[Interruption.] Yes, and some trade unions. It is true also that every group that opposed the formation of the NHS is opposed to the proposal. Incidentally, all of these groups, with the exception of the trade unions—I will come to them in a moment—were opposed to Nye Bevan when he introduced the NHS in the first place. The trade unions, through the Labour party conference and in other ways, have expressed their opposition. That does not necessarily reflect the experience of staff when we are speaking for staff throughout the country. As my right hon. Friend the Prime Minister said the other day, when the trade unions invited him to speak to their political committee, and when I have invited trade union leaders to come with me to talk to staff in hospitals, we have not found rampant opposition to letting staff get on with the job themselves.

When "foundation trust" is understood by the public and the staff—let us be honest, there is often a bemused audience listening to our debates on radio and television about the term "foundation trust"—and once the term is explained to them, the vast majority of them think that it is a good idea, provided that it is part of a bigger system of change, provided that the founding values of the NHS are retained, and provided that they understand that the NHS will embrace within it the foundation trust, which will remain an integral part of the NHS.

I do not accept what my hon. Friend is saying, but I accept that, despite the controversy, some Opposition Members have been so deeply interested in the NHS—incidentally, they can hardly muster two or three questions—that they will be present, every one of them, to vote against the Government this evening. I know that in practice they will be voting against what they say and what in theory they support. The Liberals will be voting against decentralisation. The Conservatives will be voting against choice—real, substantial choice for patients in the NHS. I believe that their position is marked by a degree of opportunism and a degree of hypocrisy. I do not blame the Conservatives for that. I would go so far as to say that it is exactly what I would expect of the Conservatives.

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If, however, any Member on the Labour Benches is looking for guidance or inspiration, or a swithering on the vote this evening, I merely ask them to look across the Chamber. Look at the Opposition. Remember what they did to the national health service when they were in power. Think what they will do if they ever get back into power. However sincere Labour Members might be, they should remember what is represented by those with whom they would walk into the Lobby tonight. Whatever position we take, I do not believe that there is any degree of coalescence with the Conservatives. If Labour Members vote against the Government tonight, they will be harming not only the NHS but our Government, by marching into the Lobby with the crowd opposite, who have no commitment to improving the health service. I ask the House to support the Bill and a Government who take pride in the past of our national health service and who have faith in its future.

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