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Mr. Andrew Lansley (South Cambridgeshire): The Minister is representing the choice before the House as being whether the whole Bill proceeds or not, but the choice before the House now is whether part 1 proceeds or not. We are debating whether we proceed with foundation trusts in their present form. The rest of the Bill, as the Minister knows, is in a form that we are happy to see proceed.
Mr. Hutton: I would simply say two things to the hon. Gentleman. The House has already decided to proceed with part 1. We have had that debate on five separate occasions and on each of those occasions the House has approved it. The other thing I would say to the hon. Gentleman and all his right hon. and hon. Friends, is that the Bill as a whole stands before the House tonight. Of course it is true that these amendments are about part 1, but the Bill as a whole is one piece of legislation, and I have made it very clear to the hon. Gentleman and the House that the whole Bill stands before us tonight and we have to make a decision on that Bill. [Interruption.] It does.
Mr. Hutton: No, I am not giving way.
I am also moving one further consequential amendment.
Mr. Deputy Speaker: Order. I am sorry to interrupt the right hon. Gentleman. The hon. Member for Banff and Buchan must sit down if it is quite clear that the Minister is not taking his intervention.
Mr. Hutton: I am also moving one further consequential amendment this evening. It responds to the concerns of both peers and Members of the House about the representation of staff governors on the boards of NHS foundation trusts. At present, the schedule provides for at least one staff representative on the board of governors. My amendment—the amendment tabled by my right hon. Friend the Secretary of State—will increase that to a minimum of three. This emphasises our commitment to promoting the effective participation of elected staff representatives in the work of NHS foundation trusts and also demonstrates, I believe, the willingness of Labour Members to try to get a resolution to the matters before us tonight.
The further amendment I am proposing to clause 1 and schedule 1 deals with the issue of commencement and when the clause should take effect. I consider that we in the House should continue to disagree with the Lords over their amendments. We have made our position clear. We should stand firm in insisting now that this is the will of the House, which must and will in fact prevail.
Mr. Salmond: On a point of order, Mr. Deputy Speaker. As you are aware, Standing Order No. 97 allows the Speaker to certify Bills that make provision only for Scotland as such, so as to put them to the Scottish Grand Committee. If the Bill was considered to be only an English matter, could it not also be so certified; and if so, why have 43 Labour Members of Parliament for Scotland voted to impose it on England?
If the Bill, as I believe, has serious consequences for the health service in Scotland, why have 43 Scottish Members of Parliament from the Labour party voted to impose a Bill that will undermine the health service in Scotland?
Mr. Deputy Speaker: Order. The short answer is that there is no such provision in the Standing Orders.
Mr. Tim Yeo (South Suffolk): I had hoped that, with eight hours for reflection, the Government might have come to their senses by now. The substitution of the Minister of State for the Secretary of State may reveal a lack of confidence in the Secretary of State's ability to put the case for the Government, and given the collapse in the Government's majority this afternoon that lack of confidence may easily be understood. The Minister of State said that the Government had taken this proposal through the House five times. I remind him that on each occasion the majority has been less than it was when it came before the House before.
By contrast, the majority with which this proposal was rejected in the other place an hour or so ago was substantially larger than the majority by which it was rejected yesterday. Those results make it clear to everyone, except perhaps members of the Government, that though they may have technically won the vote in the House—even though with the assistance of Scottish Members of Parliament to whom these provisions will not apply, as the hon. Member for Banff and Buchan (Mr. Salmond) has just pointed out—they have without doubt comprehensively lost the argument.
1.15 am
Let me remind the House that the proposals have now been rejected by a majority of English Members of the House of Commons on two separate occasions. The proposals now command the support of considerably less than half the Members of the House, and these measures will harm, not help, the national health service and the patients whom it serves. Not surprisingly, they are opposed by a remarkable range of professionals, trade unions and other bodies. As many hon. Members pointed out this afternoon, they will create for the first time in half a century a two-tier NHS in England.
The privileges and advantages that the Government will bestow on just a fraction of NHS hospitals will not be extended for several years to the majority of hospitals that our constituents use around the country. Indeed, if the review that the Secretary of State announced in debate this afternoon is to mean anything genuine, there is now a question mark perhaps not just over the timetable for extending foundation trust status to non-foundation trust hospitals, but possibly over the question of whether other hospitals will receive foundation trust status at all.
The Secretary of State did not explain what he would do if the review that he announced finds that foundation trusts are not working properly. I doubt whether it is worth asking him to explain this now, because his knowledge of the Bill this afternoon appeared to be somewhat sketchy, but we must recognise that there is now a real chance that foundation trusts will not work well because of the serious flaws in the Government's proposals. On top of the way that they are now creating
a two-tier NHS, the nature of the foundation trusts that the Bill will establish is so far from the concept originally proposed by the former Secretary of State—the concept originally endorsed by the Prime Minister and then undermined by the Chancellor of the Exchequer—that it will not achieve the benefits that the Government claimed for it.Foundation trusts will not enjoy the freedoms that true independence brings. They will be subject to the same star ratings that have plagued the lives of doctors, nurses and managers for the past few years. They will be strictly regulated by a body that is itself controlled tightly by the Secretary of State. They will be forced to operate a management and governance structure that is irrelevant to the needs of patients, ill defined and confused in its concept, and expensive and cumbersome to operate. The only gains that foundation trusts will make are those that they will achieve at the expense of other hospitals.
What makes these damaging proposals all the more offensive to English MPs is that it applies to their constituents, but not to the constituents of those Scottish Members on whom the Government relied for their majority.
Mr. Salmond: Is the shadow Secretary of State aware not only that 43 Scottish Labour Members voted to impose foundation hospitals on England, but that these proposals were vigorously opposed by the Labour party in Scotland, including in the constituency of the Secretary of State for Health?
Mr. Yeo: I am most grateful to the hon. Gentleman for pointing that out, and it puts into context the use of the word "hypocrisy" by members of the Government earlier today in relation to this issue.
The Secretary of State knows that the Opposition would like to give our support to measures that give greater freedom to doctors, nurses and managers in the NHS. He knows that, unlike him and most Ministers, I have direct personal experience of chairing an independent charitable trust that successfully transformed an ailing NHS hospital, using the freedom that release from ministerial control bestows.
I therefore now make the Secretary of State an offer on behalf of the Opposition—I do so in good faith in an attempt to rescue the Bill. If the Government make concessions on two important aspects of the Bill, the Opposition are prepared to end their resistance to the Bill's passage through the House. First, the Government must abandon the costly, muddled, expensive and cumbersome governance procedures set out in schedule 1, and replace them with a simple management structure that does not involve elections by badly defined and probably unrepresentative constituencies. Secondly, they must change the rules relating to borrowing, so that borrowing by foundation trusts will not prejudice the ability of non-foundation trusts to access funds that they need to maintain and improve their services. That change will have to be accompanied by explicit Treasury consent.
Those changes would go a long way towards avoiding the creation of a two-tier national health service, and my hon. Friend the Member for South Cambridgeshire
(Mr. Lansley) is available to discuss the details of our proposal through the night and tomorrow morning if necessary. I appreciate that time is not on the Government's side. That is a problem that is entirely of their making. The two aspects of the Bill that we believe should be changed are ones that have caused concern in both Houses during the Bill's passage through Parliament, and have been widely criticised outside Parliament. It would have been helpful if the Government had listened to the concerns expressed by a great many people at an earlier stage, and acknowledged the strength of opposition to their proposals not only on the Opposition Benches, but in the Labour party. Nevertheless, it need not be too late to save this Bill.Even if agreement cannot be reached on those two points, I confirm that the Opposition will be happy to let the rest of the Bill, apart from part 1, go straight into law. Our aim throughout these proceedings has been to avoid damage to the national health service. We believe that our proposal responds to the concerns of a great many people who are worried about what this Bill will do to the NHS. If by any chance the time scale proves too tight to reach an agreed settlement before the House prorogues, we will of course be happy to set out the basis on which a new Bill could be introduced early in the new Session and given the swiftest possible passage through Parliament. In the absence of progress along the lines that I have indicated, however, we will continue to fight against this motion.
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