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Mr. Frank Field (Birkenhead): My right hon. Friend was clearly right when he said earlier—although I would put it in slightly different language—that the two Houses must at some stage come to some agreement on this Bill. I want to make a plea to my hon. Friends, including my hon. Friend the Member for Weaver Vale (Mr. Hall), as to why we should use this opportunity to think again about our stance.

One of the most valuable things that the labour movement has given to this country is the NHS. The NHS now is a prisoner of our success. In every election that I have fought, I, and those who fought elections before me, knew that the NHS was behind our lines. It was untouchable. It had a Teflon defence. The defence was that although we loved this institution, it did not have the money to deliver the job. Therefore, whatever problems, difficulties or failures it presented to our constituents, we all knew that it could not do better. The great success of this Government is that the NHS now has more funds and a larger increase in funds than any other Government have ever provided or asked taxpayers to provide. However, by doing that, we have stripped away that great defence—the defence that the NHS, this great nationalised industry, cannot deliver in the way that our constituents want it to deliver.

With the NHS moving from behind our lines into political no man's land where it faces attack from quarters who could never before attack it, we have to judge whether this small part of the Bill, which is causing such dispute within and between parties, will answer one key question that our constituents will ask. When we go to the polls, will they have seen that the money that they have willed from their wage packets and purses has been used as effectively as possible to increase the performance of this body that we have moved from behind our lines into political no man's land?

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Let us consider the Bill, and I ask my hon. Friends to examine one aspect of setting up foundation hospitals. Before the spring of next year, the larger hospitals must from nothing create an electorate. Some of them will be searching for up to 3 million voters. We can imagine the legal disputes from some of those factions in our constituencies if they are not successful should we have a vote. We know what would happen. We all know from this institution to which we are so committed—

Jim Knight (South Dorset): Is my right hon. Friend against democracy?

Mr. Field: If my hon. Friend will allow me, I will continue as this is the first opportunity that I have had to contribute.

What will happen when we go to our local hospital to use it and look at the health side of its performance? Yesterday, I took my mother to St. Thomas's hospital. She had been some months before to see what was wrong with her heart. There was no follow-up appointment, so I phoned. Something had gone wrong, so we were given an appointment quickly—wonderfully. We then turned up and her file was there, but the results of the tests that she had had were not there. We had to wait while there was a search for those papers. The X-ray could not be found, so it had to be taken again. That hospital is under enormous pressure and it is trying to deliver a better service to our constituents and to our families, yet on the key issue of patient records this wonderful institution was losing things. If we pass the Bill tonight, we will also say to that hospital that it will have to set up an electorate. As well as trying to find and link papers to the patients who have come in for treatment, it will have to find up to 3 million people to take part in an election.

Of course, at some stage there will be a deal with the House of Lords. We are not quite sure what that deal will be. It will partly depend on our vote. However, I make a plea to Labour Members to maintain their opposition to the clause on foundation hospitals. I do not do that as someone who has opposed reform of the health service. Perhaps my Front Benchers found me annoying in suggesting ways in which we could be quicker in transforming this old nationalised industry into one that is responsive to consumer demand.

I pressed the Government to allow patients to go abroad, and 16 months later the Government, to some extent, conceded that. I asked them to take one target that everyone could see so that there would be no question of spin—that we would abolish day waiting lists before the next election and that we would bring in teams from abroad to achieve that objective. In doing so, we would break the Scargillite tendency among the consultants who have a vested interested in making sure that there are large waiting lists so that they can get private practice. There has been some movement, but precious little.

I speak and make my plea not as someone who has made the traditional defence of the NHS that we heard earlier. I believe passionately that, if it is to have a future, it is the Labour party's job to transform it from this old nationalised industry—the only nationalised industry for which the voters had any affection—to one that serves them in this new century.

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1.30 am

Anne Picking: I thank my right hon. Friend for giving way because many of his remarks seem to be directed at me. I was a nurse—a front-line public service worker—for all my days until I came to the House, so I know what it is like to do that job. Our debate is not about foundation hospitals any more because we have debated that issue and voted on it—my personal position did not win the vote. However, we are now considering the democracy of this House, which must be sacrosanct.

Mr. Field: I apologise if I was looking at my hon. Friend while making my remarks, but if she cares to look at the circle of hon. Members sitting around her, she will understand that it was more preferable to look at her than her colleagues. I was not sending her a personal message in any way because I accept her honourable position. At the end of the debate, I hope that we will all know that we voted in the way in which we believed to be right.

I disagree with my hon. Friend on one point—if I may look at her again. Although it is quite proper for her to say that we have made our point and that we should insist that the Commons prevail, there is quite a long time until the opening of the new Session next Wednesday, so a lot of haggling could go on. There must be agreement at some stage and that must be satisfactory to the Government. My only plea is that when we consider how we vote, we do not do that on the traditional grounds of defending the old national health service, which is passing from our midst.

I make a plea as an ardent advocate of modernisation. We will succeed only by modernising, but I cannot for the life of me understand how it can be in our long-term interest to push more hospitals down the route of having to encourage more of our constituents to vote for various boards, especially given that some people who are sitting not far from me find it difficult to explain how they will operate.

I end my speech as I began it. We have moved the NHS from behind the safety of our lines into political no man's land. The electorate's test will be how we use their money to improve the service that the NHS provides. Will foundation hospitals have any influence on that before the next election? It will take a great deal of the time of some of the cleverest people in the NHS to get the scheme off the ground, but I wonder whether it will make any difference to a single one of our constituents. On that basis, I hope that at least some of us will insist on opposing this part of the Bill.

Mr. Paul Burstow (Sutton and Cheam): I rise to respond to the Minister, because he tried to say that we had a straight choice—take the Bill or leave it. That is not the choice before us, because we are debating part 1, which sprang up fully formed without any consultation. It did not appear in the Labour party's manifesto at the general election and did not form part of the NHS plan.

The Government must understand—they have not addressed this worry at any stage during the Bill's passage—that the Bill will not ensure equity, or safeguard universality, in the national health service. It will not require decisions about foundation trust status to take account of their impact on the rest of the NHS on such hospitals' patches. It will not prevent a foundation

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trust from adopting a predatory approach towards non-foundation trusts in its neighbourhood, and especially towards services and staff.

We are talking about establishing an NHS in which competition, not co-operation, determines the form that it takes and how it progresses. The Bill confers a privileged status on foundation trusts in respect of borrowing and capital. The early wave of foundation trusts will have an easier ride when gaining access to capital at the expense of the rest of the NHS. The Bill still does not clearly deal with the cap on private activities within the NHS. The word used is "may", not "must". I urge Labour Members to read clause 15(1), which makes it plain that that is the case.

The House of Lords has considered foundation trusts a number of times. It has given us a chance to reflect on the issues again. I encourage hon. Members to take this opportunity to reject foundation trusts in the Lobby.

Dr. Desmond Turner (Brighton, Kemptown): I hope that Labour Members can divorce the debate from a confrontation either between Labour and the Opposition or between this House and the other place. The central issue is, if we insist on having foundation hospitals, will that advance the great Labour project, to which I fully subscribe, to improve public services and, in particular, to make the health service what we want it to be? In that spirit, I ask my Front-Bench colleagues to think again and my hon. Friends to think carefully about how they vote. I realise that the Government will probably carry the vote, but they should bear that request in mind.

My Front-Bench colleagues have regrettably failed to answer the serious criticisms levelled against foundation hospitals. The rest of the Bill does not depend on them and is acceptable to the House. I ask my Government to think again. I also ask my hon. Friends, who share my reservations, to stand by their concerns. Otherwise, I fear that we will be in danger of passing legislation that future Labour Governments—I am not worried about Governments of other parties—may wish we had not enacted.

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