Health and Social Care (Community Health and Standards) Bill

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Dr. Murrison: An even better example is the orthopaedic hospital at Oswestry, which is even closer to the Welsh border than Chester. The difference is that its tertiary centre provides highly specialised services to a wide area, which, I suspect, includes most of Wales.

Chris Grayling: Absolutely. That is a tremendously important and topical point. Committee members may have seen references at the weekend to a new arrival to the country's population; a young lady called Gemma. The Committee sends Gemma's parents our warmest congratulations on the arrival of their new child. Gemma's parents are the England football striker, Michael Owen, and his girlfriend. What makes Mr. Owen, his girl friend and their new daughter distinctive? The baby was born in the Countess of Chester hospital. However, the family lives in the small north Wales border village of Ewloe. Are we saying that one of England's leading footballers, who chooses to live across the border in Wales, should not be part of any future planning for his local hospital? Are we saying that the national health service should not encourage Mr. Owen to attend his local hospital?

Mr. Lansley: I hesitate to speak, as I may be anticipating something that my hon. Friend intends to

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say. However, I may be more aggressive than he is about such matters. With regard to the Countess of Chester hospital, I had assumed that, rather than my hon. Friend, the hon. Member for City of Chester (Ms Russell), who is a member of this Committee, would be making these points. After the hon. Lady spoke in the House the other week—an almost unprecedented event—I thought that she might have made a contribution to the Committee on behalf of her constituents; but no, she is not to be found at this moment.

Chris Grayling: I am grateful to my hon. Friend for that insightful comment. We are graced with occasional appearances by the hon. Member for City of Chester. The House is enriched by those occasional contributions, and it is a shame that they cannot be more frequent.

The implications of the Bill are more significant than its impact on the provision of treatment. We must consider the constitutional provisions of the Bill, and the establishment, constitutions, and membership of the trusts. If the Bill makes it the responsibility of foundation trusts in England to provide services for England only, how will the membership of a border trust be determined? Are we denying people in Wales who live just across the border from the Countess of Chester hospital NHS trust the right to be members of that trust?

If we are not denying people that right, are we creating a situation in which a person who lives in north Wales could become a member of the board of the trust of the local hospital, but would have a duty not to provide health care planning and health care provision for the community in which he or she lives? If that were the case, the situation would be nonsensical and absurd.

Fundamentally, if the Government's aspirations were achieved and foundation hospitals were to offer a first-rate service, would that in itself not cause distortions in the provision of health care, as people would flood across the borders to hospitals in England to seek treatment? The amendment would allow the hospitals to provide that service, and to be paid for doing so. Without it, would there not be a nonsensical situation in which hospitals would be unable to do the job that is normally asked of them, which is to provide a universal, high-quality service to all patients who can get to the hospitals?

This element of the Bill—inadvertently, I am sure—will create anomalies in border regions. It will create difficulties for the people who live in those areas, and it will create constitutional contradictions. I hope that Members will recognise that, and concede that the amendment tabled by my right hon. Friend the Member for North-West Hampshire is a simple way of rectifying that situation.

Dr. Murrison: The debate brings new meaning to the phrase ''médecins sans frontières''. It seems that many of the Bill's provisions would establish artificial boundaries, so I am surprised that there are several items in the Bill that cut across some laudable actions

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that the Government are trying to bring forward, particularly in relation to primary care and clinical networks.

With regard to medicine, geographic boundaries are becoming almost an irrelevance. I am happy to say that the Government are encouraging clinical networking so that specialists, whether they be in Scotland, Wales, Northern Ireland or England, can collaborate at a highly specialised tertiary level. Amendment No. 100 would encourage trusts to operate in a collaborative way. It would dissolve a barrier that the Bill appears to be setting up. Several hospitals that operate in this way have been mentioned. The classic tertiary centre is probably the Royal Brompton hospital, which provides highly specialised services of a pioneering nature to patients throughout the United Kingdom.

It makes no sense for legislation to be drafted in such a way as to make it inward looking, focusing purely on England. That would go against the grain of some of the good and laudable action that the Government are trying to encourage with regard to clinical networking and the dissolution of some of the barriers that have traditionally existed in the NHS. In all candour, I encourage Members to study the amendment closely. It would be a positive step that would work with, not against, the grain of what the Government are trying to achieve.

Mr. Lansley: I support amendment No. 100. It seems necessary, and my right hon. Friend the Member for North-West Hampshire set out the argument very clearly, as did my other hon. Friends.

At the risk of antagonising Labour Members, when the Committee was constituted I considered the extent to which its members represented the hospitals that had to consider applying for NHS foundation trusts in order to resolve issues in practical terms. That is a practical example of the way in which a hospital would deliberate matters according to its own circumstances, as the Countess of Chester hospital would do, and reach a conclusion.

I approach the matter from that point of view. Two hospitals in my constituency, the Addenbrooke's NHS trust and the Papworth Hospital NHS trust, have applied for NHS foundation trust status. On the Government's side, I think that only the hon. Member for City of Chester has an applicant trust in her constituency. It seems to me desirable that the hon. Lady should be here to represent that applicant's point of view as we begin the discussion.

10.45 am

Mr. McCabe: I can offer the hon. Gentleman some reassurance, because I have here the preliminary application to the Department of Health for NHS foundation trust status from the University Hospital Birmingham NHS trust, which is my local hospital. There are people there with whom I have a great deal of contact and whose interests are deeply involved with the Bill.

Mr. Lansley: That may be so. I understood that that hospital is not physically located in the hon. Gentleman's constituency, but is in the constituency

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of the hon. Member for Birmingham, Selly Oak (Lynne Jones). We could engage in a debate about geography, but perhaps the hon. Gentleman will correct me if I am wrong.

Mr. McCabe: The trust serves south Birmingham, which incorporates more than one constituency. I should have thought that the hon. Gentleman would have experience of such a situation, in common with several others.

Mr. Lansley: I agree entirely with the hon. Gentleman's point that the area served by any individual NHS trust is very wide. That is precisely the point that we are discussing. The hon. Member for Cardiff, Central talked about the amendment in terms of the geographical area that is to be served by hospitals. As a specialist hospital, Papworth Hospital NHS trust serves patients from throughout the country. Tertiary hospitals are not located in London only. More heart transplants are done at Papworth hospital than in any other cardiothoracic institute in the country. I take the point that it has a wider range and I hope that we will bring those experiences to bear. However, as the Member of Parliament in whose constituency the Addenbrooke's and Papworth hospitals are situated, I regard myself as having a special responsibility towards them.

Jim Dowd (Lewisham, West): I am somewhat startled by the hon. Gentleman's ludicrous parochialism. Two hospitals in south London, King's College hospital and Guy's and St. Thomas' hospital, have indicated their intention to apply for foundation trust status. They serve large numbers of people across south London and beyond. Most people in the west of my constituency go to King's rather than to Lewisham hospital. Lewisham hospital is itself a three-star hospital. It will be watching keenly to see how events unfold in order to decide whether to apply for foundation trust status. The hon. Gentleman is being far too narrow in his definition of who has an interest in their local hospitals.

Mr. Lansley: I am sorry to be chided by the hon. Gentleman, whose opinion I always value, because I was seeking not to exclude the interests of hon. Members whose constituents are served by those hospitals, but to emphasize the responsibility of those of us who have such important institutions in our constituencies. In that context, I am sure that he will not dispute the responsibility that, for example, the hon. Member for Vauxhall (Kate Hoey) has towards Guy's, St Thomas' and King's College hospitals. On Second Reading, I noticed how anxiously she sought to speak in the debate but did not have the opportunity to do so. On reflection, that was a pity.

I have been chided from the Labour Benches, but I hope that we can agree about the breadth of service offered by NHS trusts that are applying to be NHS foundation trusts. That service spreads across something so ephemeral as a constituency boundary to something so substantial as a boundary between England and Wales, or between England and Scotland. There is everything to be said for our agreeing that the amendment entirely captures that

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point and gives effect to it, and I hope that the Minister will agree to it.

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