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Mr. Burstow: If the hon. Gentleman will let me develop this point, I will give way to him.
The Government have said that they will stick to "Agenda for Change", but the point is that in a health care system where trained staff are, and are likely to remain, a scarce resource, the ability to compete on pay and conditions will be a boon to foundation trusts at the expense of patients treated anywhere else in the national health service, and it is not possible for the Government to argue that the other freedoms that will enable them to generate additional activity and additional resources will not be used to enable them to compete more effectively in the labour market locally, to attract staff from other trusts that are not foundation trusts. How can that not be the case? That is not just my view; in the other place Lord Warner, the Under-Secretary of State, said that NHS foundation trusts
- "will be able to invest more easily in the delivery of new services, manage more flexibly, reward their staff in a way that is more appropriate to local circumstances and have access to a wider range of options for capital funding.—[Official Report, House of Lords, 6 November 2003; Vol. 654, c. 936.]
Kate Hoey: I very much agree with what the hon. Gentleman said in his last few sentences. Does he agree that a more dangerous issue is the fact that chief executives have already been discussing in national health trusts how they would be able to increase their own salary to some very large figure? They will now have the freedom to do that as well.
Mr. Burstow: That is true, but what is really an insult to the House and to the House of Lords is the fact that
the Government are driving through their first wave of foundation applications before the ink is even dry on the Royal Assent to the Bill. It seems to me that we should have waited for this matter to be concluded before thousands of pounds and hundreds of hours were invested in taking these proposals to the stage that they have already reached for many applications. That is why, in response to the intervention by the hon. Member for High Peak (Tom Levitt), I do not support this at this stage, and I think it is right for many hon. Members to take that view.It does not end there. The Secretary of State has said that the Government will reinstate the cap on the ability of NHS foundation trusts to pay more. The Bill as drafted leaves it up to the regulator to decide whether he will place any limitation on the amount of private work a foundation trust can do. It is a power, not a duty, a question of may rather than must, and Labour Members must look at the Bill and be certain what it says. This is a discretion for the regulator. It is not guaranteed that NHS foundation trusts might not do substantially more private work than they are doing now, because the regulator does not have to impose any such limitation.
The Minister of State, Department of Health (Mr. John Hutton): I am very reluctant to intervene on the hon. Gentleman, because I am following closely what he is saying, but I want to make it absolutely clear to the House that he is wrong in the point that he just made. There is no doubt whatever that the Bill requires the regulator to impose a patient cap.
Mr. Burstow: The Bills says "may", not "must". The wording is very clear, and I am sure that, if the Minister gets the chance later, he will take the House through the text and we will see how clear it is. I urge other hon. Members to take a view for themselves and to read the Bill.
At the very least, I hope that the Government will concede that foundation trusts should clearly state in their accounts the costs and income attributable to private activity, because that will also not be covered. That is what Lords amendment No. 29 is all about, and I hope that Labour Members will vote in favour of that as well.
The Government's proposed arrangements offer the prospect of costly sham democracy, which could have unintended consequences. Some of the most powerful speeches on foundation trusts in the other House were made by Labour peers. For example, Lord Lipsey warned that the governance arrangements would embed politics in the management of our hospitals. We should take that point into account.
I started by saying that Liberal Democrats agree with the need to free the NHS from the dead hand of ministerial interference, but the proposals will not achieve that. We need much more local control over the NHS, but we need to focus on PCTs and the commissioning side. Those who commission health care must be responsive to local needs. The commissioners should be democratically accountable. That is why we believe that the argument should be about democratic
health care commissioning. I refer, in particular, to the remarks of the Labour peer Lord Harris, who said:
- "I believe that a fundamental question must be answered first: why is the emphasis on membership and boards of governors applied to provider trusts—in particular hospitals—rather than to the bodies charged with commissioning, in particular the PCTs? Is there not a serious danger that the new governance arrangements will reinforce, if not fossilise, the traditional provider domination of the NHS, when what we should be encouraging in a modern health service is a more flexible approach to how services are delivered, led by local needs determined by commissioning bodies devoted to improving public health and reducing inequalities in outcomes?"—[Official Report, House of Lords, 8 September 2003; Vol. 652, c. 84.]
Hugh Bayley: Earlier in the hon. Gentleman's speech, he made the important point about the need to achieve equity in the NHS, but does he not recognise that there is gross inequity at the moment, with some hospitals operating on four times as many patients per doctor as others? If he rejects market forces, rejects national standards and regulation, and rejects patient and public empowerment as ways to get the poorer performing trusts to perform better, what method would the Liberal Democrats use to drive up standards in the poorer performing hospitals?
Mr. Burstow: The hon. Gentleman seems to have made a speech, and I commend him for taking that opportunity. [Interruption.] I want to finish my speech, as I should have thought that one or two other hon. Members want the opportunity to make theirs.
I just want to end with this: it has been made very clear, time and again, in the other place, that there is a strong case for saying no to the foundation trusts proposals. I urge hon. Members to go through the Lobby against the Government tonight. The proposals are the bathtub musings of a former Secretary of State, and they now appear in the form of half-baked legislation. This is the wrong way to try to decentralise and devolve in the NHS, and I hope that hon. Members on both sides of the House who still have doubts about the Bill and foundation trusts will take the opportunity tonight to send a message to the Government. That message is very simple: think again.
Mr. Stephen McCabe (Birmingham, Hall Green): I will endeavour to be brief, because I understand that many other hon. Members would like to speak.
I want to make it clear that I am a passionate supporter of the NHS. I have no private health insurance, and I receive no money from private health organisations. I came here quite simply in 1997 to defend the NHS and to see it rebuilt, but I have reached the conclusion that it has to be modernised; it cannot creak along on the 1948 model. I want it to reflect the needs of the people who use it. That is what is really important. Over a period, a tendency has developed whereby the health service has begun to reflect too much the needs of those who work in it. Important though
those needs are, it cannot merely serve those interests—it must serve the interests of the people who need to use it. That is the first thing that I want to happen.I understand that many of my colleagues have legitimate concerns and anxieties, and I respect the views that they hold. There is a tendency, however, to exaggerate some of those concerns. I had the benefit of serving on the Committee that scrutinised the Bill, and my slight concern is that if we overplay those anxieties we will set our face against any modernisation of the health service, which plays right into the hands of the Opposition. We know that a precondition of their plans is that they must portray the health service as creaking, moribund and useless. If we overdo our criticism of any modest proposals for change, we play into their hands. That is what I am worried about.
What is being proposed tonight, with all the qualifications attached and compromises offered by the Secretary of State, is a little bit more autonomy for local hospitals—a lot less than we happily give to chief constables—
Kate Hoey: We didn't need an Act to do that.
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