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Mr. Deputy Speaker: Order. The right hon. and learned Gentleman has had his time.
Mr. Frank Dobson (Holborn and St. Pancras): Unlike the Conservatives and the Liberal Democrats, many Labour Members have been against the foundation hospital proposal from the outset. We believe that it will be damaging and divisive, not just for the NHS, but for the Labour party as well. Events have borne out what we have said from the start. Nothing significant has changed since foundation hospitals were announced. My right hon. Friend the Secretary of State's proposal to revert to the original proposition of 25 foundation hospitals followed by another 30 without extending that opportunity to every hospital automatically within four years is a withdrawal of what was originally announced as a concession to those of us who were against the proposal.
A review has been announced, but we should not need it because if the first round of hospitals is not a success, surely no sensible Government will proceed with the second round. It has always worried us that the review will consider only the impact of change on the foundation hospitals, not the possible adverse impact on the hospitals nearby.
The principal objection to foundation hospitals is that they are intended to reintroduce competition into the NHS, setting hospital against hospital, as the Tories did under the right hon. and learned Member for Rushcliffe (Mr. Clarke). That proved immensely expensive and damaging for patients. If anyone doubts whether it was damaging, the one academic study on the subject concluded in relation to recovery rates from heart attacks that
- "competition is associated with higher death rates."
Foundation hospitals will clearly have more money, which will allow them to poach staff from hospitals that do not have enough money. Ministers have said that foundation hospitals will be bound by the "Agenda for Change" document, chapter 7 of which sets out additional freedoms for NHS trusts to negotiate local arrangements, to have special bonus schemes and benefits, and to award recruitment and retention premiums above 30 per cent. of basic pay. They can do all of that without referring to anyone else. Ministers have said that other hospitals may be able to do that, but it would be possible only with someone else's permission. That is the substantial difference.
Foundation hospitals will be given the power to determine their priorities and strategies. No longer will they have to reflect the priorities and strategies that we have said should be laid down by primary care trusts. They will, indeed, become cuckoos in the nest, which will be very damaging. That is why most Labour MPs, the Labour party conference, most people who work in the NHS and the organisations representing them have rejected the concept of foundation hospitals. The major trade unions have rejected it, as have most of the professional bodies, including the British Medical Association, the National Health Service Consultants Association and the Royal College of General Practitioners. Ministers tell us to ignore them because they are, they say with disdain, "producers". That reminds me of Kipling's poem on Tommy Atkins, his paean of praise for common soldiers and his despising of the people who criticised them when they were not fighting. I would adjust it to say, "Then it's producer this, an' producer that, an producer 'ow's yer soul? But they all turn into heroes when the ambulances roll." Those are the people we are talking about—ambulance staff, nurses, midwives, cleaners, catering staff, doctors, radiographers and therapists. They are all opposed to foundation hospitals. Even the Tories never achieved such unanimity against any of their proposals.
4.45 pm
Mr. Adrian Bailey (West Bromwich, West): Will my right hon. Friend give way?
Mr. Dobson: No, I am sorry, but I do not have time.
We are rejecting the views of the very people who do the work in the NHS and who have always stuck up for the NHS. Many hon. Members will remember that in late April 1997, 53 doctors wrote a letter to the Daily Mirror saying that we had 24 hours to save the NHS. A survey of them has found that nine out of 10 reject the idea of foundation hospitals, and a random sample of
NHS consultants shows that they do not like the idea. No patient organisation has come out in favour of the idea.Who is for foundation hospitals, apart from the Government? It is a few academics and a few think-tanks, which appear to be more tank than think. A few extremely ambitious NHS managers are in favour of foundation hospitals, but even the NHS managers' body has said that 65 per cent. think that it will be more difficult for people in the NHS to co-operate with one another in future because of the introduction of foundation hospitals. Ministers say that they want to appeal over the heads of the producers and the Labour party to the public, but all the opinion polls show that at least 60 per cent. of the public reject the idea.
I know that the Whips and many other hon. Members are concerned about the impact of defeating the Government on this issue today, because it might be damaging to the Labour party, but I say to all my right hon. and hon. Friends that, until now, the arguments have been conducted at a national level. If this goes through, there will be rowing, trouble-making and bother for people in the Labour party all over the country. Labour MPs without foundation trusts will face their Tory opponents saying that they are useless because they did not manage to get their hospitals made into foundation trusts. When the first doctor or nurse moves from a non-foundation trust hospital to the nearest foundation trust, there will be a huge row in the local papers and Labour will be blamed.
We have a brilliant record in putting more money into the NHS, with more new hospitals than ever. We have increased the number of beds and the number of staff—including those in training—and people who work in the NHS want just to be left alone to get on with their day jobs of looking after patients.
Mr. Dorrell : It is absurd, given the importance of this Bill, that we should be debating our response to a Lords amendment against a two-hour guillotine. The Secretary of State alone took up 48 minutes. The idea that we can hear full contributions from the Opposition or from Government Back Benchers within two hours is absurd.
In the limited time left to me, I want to point out that the Secretary of State began his speech with two points. First, he said that there was no dispute on his side of the House—I would say on either side of the House—about the importance of the principle that the NHS was established as the means for delivery of health care on the basis of clinical need and without regard to ability to pay. That principle is supported by both sides of the House and by the overwhelming majority of the British people. I acknowledge that that principle is accepted by Labour Back Benchers and he should acknowledge that it is also supported on this side of the House.
The Secretary of State's second point was that in this day and age the best way to deliver that public policy objective is to follow a decentralisation policy in NHS management, trusting professionals and allowing those who deliver health care greater opportunity to match the service they deliver to the needs of their patients. If the Bill could be conceived of as a means of delivering that policy objective, I have no doubt that all my hon. Friends and I would support the Secretary of State. The
problem is that the Bill does not deliver what he claims it will. It does not decentralise within the health service—in fact, it does something that, until I read the Bill, I thought was impossible: it succeeds in making power in the NHS even more centralised and bureaucratic than it is now. In that more centralised and more bureaucratic health service, the Secretary of State gives foundation trust hospitals an entirely unfair advantage over all other institutions. His Bill does not deliver his objective, but does real damage to the management of the health service.Let me give two important examples to demonstrate the truth of that statement. The Secretary of State was kind enough to allow me to intervene during his speech, but he did not respond to the point that I made. My point was that under the capital allocation procedures that he is to introduce, foundation trust hospitals will get priority, favoured access to capital from a cash-limited sum, the practical effect of which will be that those hospitals that are not foundation trust hospitals will come second in the queue and have less advantageous access to capital than they currently have.
Mr. Dorrell: No, I will not give way to the Secretary of State during my five minutes, because I know what his answer to my point will be. I did not try to intervene again during his speech, but I shall now respond to his answer.
The right hon. Gentleman said that the capital budget has increased; therefore there are no choices to be made. No Member of Parliament believes that any Government will ever create a world in which there are no choices to be made in capital allocations. The Secretary of State has created a world in which foundation trust hospitals will be at an entirely unfair advantage in terms of access to a cash-limited sum.
The second point that the right hon. Gentleman did not answer during his speech relates to employment terms. As my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) said, Labour Back Benchers are told not to worry—"Agenda for Change" is an entirely rigid straitjacket from which no element of the NHS will be able to depart. Opposition Members are told that the proposals are flexible and that all hospitals in the health service will be able to evolve local employment terms. The truth is that what the Secretary of State has delivered—
It being two hours after the commencement of proceedings, Mr. Deputy Speaker put the Question already proposed from the Chair, pursuant to Order [this day].
Question put, That this House disagrees with the Lords in the said amendment:—
The House divided: Ayes 302, Noes 285.
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