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Siobhain McDonagh: I thank my hon. Friend for giving way. He castigates the Government for a system of hospital democracy that includes one fiftieth of people in an area. What would he say to me about the fact that nobody in my constituency is on the boards of St. Helier hospital, St. George's hospital or any other hospital or primary care trust that represents them?
Mr. Hinchliffe: I would say what I have said on many occasions, which is that every patient[Interruption.] My hon. Friend has asked a question and she is going to listen to me. Every patient ought to have a right to a vote in their local health service. What the Bill proposes is tokenistic; it is not thought through.
I have spent much of the last few days in my local hospital. I spent Saturday night and Sunday morning in the local casualty department with a member of my family. We are talking about spending £100,000 per trust just to start going in the direction of foundation trusts but, having spent several days this week in the NHS, I must say that there are a lot of other things that I would be spending that money on before that. There will be £100,000 for each foundation trust£2.5 million for the first 25and £2.3 million will be the cost of the regulator for one year, so £5 million of scarce NHS money that should have been spent on more doctors and nurses, and on treating people and hip operationson the kinds of things that are raised in our constituency surgeries week after weekis being wasted on a half-baked idea.
I hope that Labour Members will listen to the Labour party conferencethe decision was clearto their constituents, to their PCTs, and to the voice of local people, and that they will vote against the Government this evening.
Mr. Paul Burstow (Sutton and Cheam): While listening to the Secretary of State's opening speech, it occurred to me that he was having to rely on some of the more basic tactics to try to ensure that Labour Members stick with him tonight. Pressing the class button and suggesting that the House of Lords not agreeing with this House should be a sufficient argument for this House to overturn the House of Lords does not provide a sufficient case that we should not listen to what the Lords have had to say. It is important to bear it in mind that in the debates in the other place it was not just Liberal Democrat, Conservative or Cross-Bench peers who expressed concern about this legislation; it was Labour peers as well. It is important for those who have concerns to keep that in mind when they pass through the Lobby.
The Liberal Democrats do not have an argument with the Government about their underlying analysis and the case for devolution in the NHS. Central control, targets and tick boxes stifle innovation and initiative in the NHS, and one size certainly does not fit the needs of every community and every individual who uses the NHS. However, we do not believe that the foundation trust proposals go anywhere near lifting the dead hand of control from the NHS.
The freedoms that come with this Billthey are not many, and some of them are illusory when the Bill is studied closelyare earned at a price. It is a high price: it is about hitting Whitehall targets, achieving the star rating, and going through the hoops that Ministers set. There is still control, but it is slightly less clear where that control exists. In truth, freedom is granted at the pleasure of the Secretary of State. That theme runs throughout this Bill, because it applies to both the Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection. In each and every case, there are powers of direction and control that the Secretary of State may use to make clear what he wants to happen.
Indeed, the Secretary of State looms large in part 1, standing behind the regulator, armed with powers of direction, the final arbiter when deciding whether a trust may proceed to foundation status. We already know that not all trusts will be able to progress at the same rate. The best that the Secretary of State can offer is that it will be four years before all trusts have that status.
The Bill says little about the role of the regulator and how he will exercise his duties, yet decisions taken by foundation trusts will have profound effects on the balance of the local health economy. They will have real effects on the services that people need. In an intervention on the Secretary of State, the hon. Member for Norwich, North (Dr. Gibson) referred to cancer networks. I hope that he was not satisfied with the response that he received, as it gave us no confidence that foundation trusts will do anything but call into question the effective operation of such networks in future.
Will foundation trusts really see themselves as team players in the local health system? Will they be on the side of patients to ensure that cancer services are properly delivered? That is why my noble Friends want to amend the Bill so that it includes a requirement for the regulator to act in a way that is consistent with the National Health Service Act 1977. Lords amendment No. 4 would ensure that there is no ambiguity: the regulator would have to act in a way that ensures equity and safeguards universality of provision in health care services.
It is not good enough for Ministers in the other place and in the Chamber today simply to assert that foundation trusts will use their freedom in conformity with the key NHS principles and that they will not undermine the ability of other NHS providers in the local health economy to meet their obligations. Just putting something on the record in this place is not sufficient assurance. When legislation affecting patient-public involvement was being discussed in the House, Ministers gave numerous assurances that were not honoured subsequently.
It is important that Ministers confirm today that foundation trusts will never undermine other NHS hospitals and that they will never make predatory plans that would take business from another trust and cause it to lose activity. It is important to determine whether we are talking about competition or co-operation in the NHS. If foundation trusts secure freedom to act, it is hard to see how that freedom will not disadvantage the hospitals that are left behind.
Let us consider, for example, the borrowing rulesleaving to one side the question whether private finance initiative projects should count, although I think they should be included in the equation. Foundation trusts will have easier access to capital, but we have heard today that the Treasury has put a cap on the total amount available. The trusts will have to bid for the money in the pot that the Treasury makes available to the NHS. If they are allowed greater flexibility and freedom to dip into that pot, they will disadvantage everyone else. What will be the gains for those involved in the early part of the process compared with those who come later? As we reach the final wave of foundation trustsalthough I hope that we do notwhen everyone has that freedom, there will be no difference in terms of access to capital funds but there certainly will be a difference during the early phases.
There are questions about staffing. The Secretary of State says that foundation trusts will adhere to "Agenda for Change", but for how long? Nothing in the Bill would prevent foundation trusts from varying their pay and conditions over time so that they can expand their activities.
Tom Levitt (High Peak): Like me, the hon. Member for Cheadle (Mrs. Calton), who is sitting with the hon. Gentleman on the Liberal Democrat Front Bench, supports the application of Stepping Hill hospital in Stockport for foundation status. Does the hon. Gentleman support his hon. Friend's campaign, which I share, for that hospital better to serve the citizens of Stockport and High Peak?
At this point, there is a Bill before the House. My position and that of my party is opposition to the principle of foundation trusts. The measure has not yet completed all its stages; until it does, I certainly do not support applications for foundation status. That is my position and the position of my party.
Mr. Stevenson: While the hon. Gentleman is trying to find a way out of the question, will he confront the issue that concerns everyone I have talked to in my constituency in north Staffordshire? They are asking, if the Stockport application goes ahead, and the other
Mr. Burstow: The hon. Gentleman makes a fair point, which is that as we have a series of waves of foundation trust applications, those that get left behind can be washed up and really lose out as a result of the process, particularly when it comes to the ability to bid for capital resources. Those that have the freedom early on will be able to get money out of the pot. Once everyone has the freedom, there is really no difference in terms of the access to that money. The Government tell us, "We have a bigger pot of capital funds available, so don't worry about it." The reality is that this system will allow two tiers to emerge. Whether it is only for a few years or not, that will damage equity within the national health service, which is why we are raising our concerns and will vote against the Government's proposals tonight.