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The Secretary of State for Health (Dr. John Reid): I have today announced that 32 more trusts, which for the first time include mental health trusts, have been successful in their preliminary application for NHS foundation trust status. Decisions on the next phase of the applications are scheduled for the autumn of this year, after I have had the opportunity fully to consider the outcome of the review of the policy by the Healthcare Commission. Twenty-five acute and specialist NHS trusts have so far been awarded NHS foundation trust status. A further group of 10 trusts are seeking authorisation this April.
Dr. Reid: Indeed, in many cases foundation status has meant a dramatic reduction in waiting lists and waiting times. Of course, it is true that right across the national health service there has been a significant reduction in any case, as a result of, first, decentralising decision-making to the front line and, secondly, introducing the prospect of more patient power and choice of provider, allied with the investment that the Government have put in. So the capacity and the reform, including NHS foundation trusts, have resulted in more, quicker and better quality health care for most people. I recognise that there is still a long way to go, but I promise that this Government, God and the electorate willing, will continue to improve[Laughter.] It appears that Conservative Front Benchers believe in neither of those two personages, but I assure them that both will sit in judgment on the Conservative party in due course.
Chris Grayling (Epsom and Ewell) (Con): May I seek a point of clarification? Are the Government willing in principle, subject, obviously, to all the quality issues that arise, to consider an application for a foundation trust that wraps together secondary and acute care, with some primary care services, too?
Dr. Reid: At this stage, we have extended just from acute secondary care to mental health trusts. The hon. Gentleman might know that we have commissioned a review of the early experience of foundation trust status, which will be carried out by the Healthcare Commission and will, no doubt, examine extending such opportunities further. In general, however, the principles of a diversity of providers, decentralising power to the front line as far as possible and, crucially, giving patients more information and power in relation to which provider they choose, whether in the secondary or primary sector, are an integral part of our reform programme.
Most Members on both sides of the House share the principles that I have outlined, but there is one other principle that, I am afraid, divides usthat people in
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this country, in line with the founding principle of the national health service, which they still support, should continue to have equal access to health care, free at the point of need. We are absolutely committed to that, and we absolutely refute charging for any operations through the national health service, which is the proposal[Interruption.] As Conservative Members are trying to intervene, let me read from their document on the right to choose[Interruption.]
Mr. David Hinchliffe (Wakefield) (Lab): One of the positive aspects of foundation status was the devolving of local decision making to local people, enabling local people democratically to elect those who run foundation trusts. What steps have the Government taken to analyse what happened in Bradford, where the locally elected chairman, a popular local figure, has been removed by the regulator, and people have come in from New Yorksome distance from Bradfordto run the foundation trust?
Dr. Reid: The matter is being investigated by Monitor, the organisation that was established precisely to ensure that foundation trustswe hope that all hospitals will obtain foundation status in futurecomply with rigorous financial inspections. I would therefore prefer to leave it to that organisation, and to say only that this is not an aberrationMonitor was set up to discover exactly where hospitals are running huge financial risk. In previous decades, before we set up the organisation, that could have gone on for some considerable time. The expectation then was that the rest of the system would bail out those who found themselves in that position. I am afraid that we can no longer tolerate that. Along with the rights to make decisions at the front line, people must accept the responsibility to run a rigorous, financially viable organisation. We expect that of all, not just Bradford.
Mr. John Wilkinson (Ruislip-Northwood) (Con): Does the Secretary of State intend to add to the number that he has quoted by the designation of foundation status to the new hospital that he plans to build in the Paddington basin, combining the Royal Brompton, the Harefield and St. Mary's hospital, at a cost of more than £1 billion, without planning permission, and for which the outline business case required by the National Audit Office seems to indicate that it will not be in service until 2013?
To suggest that the NHS would plough ahead with any project, whether it costs £1 or £1 billion, without planning permission is to stretch the credulity of the House. As far as foundation status is concerned, I can confirm two things: first, we intend all NHS trusts to get foundation status; secondly, the services that NHS trusts provide will be free at the point of need. We do not intend to allow 50 per cent. of the NHS tariff to be used where hospitals charge patientsthose are the words of the Conservative party, which I was trying to quote earlier.
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Ms Gisela Stuart (Birmingham, Edgbaston) (Lab): I welcome the announcement that another hospital in Birmingham has been granted foundation status. The hospital in my constituency was granted foundation status last year, and patient services have improved. Will the Secretary of State ensure that the hospitals in the new round use the financial freedoms that they have been granted to benefit patients in their localities and to build on services? They have been given the power and should use those freedoms.
Dr. Reid: I hope that that will increasingly be the case. Seven of the 20 NHS foundation trusts are already using their borrowing freedoms to fast-track capital projects, and seven of the 20 are already using non-capital freedoms to extend patient choice projects. The proof of the pudding is in the eating: we now have 450,000 more operations every year; we have halved the maximum waiting time for operations and will halve it again over the next three years; and we have taken 314,000 people off the waiting list that we inherited from the Conservative party. Let us not pretend that everything is perfect, but let us not pretend that substantial and significant progress has not been made in the NHS.
The Secretary of State for Health (Dr. John Reid): Recent guidelines have set out a framework that gives patients greater choice of where to have their treatment. Patients will be able to choose to go to hospitals offering faster access to treatment, offering a fairer system to everyone.
Mr. O'Brien: I have been asked to bring this case to the House on behalf of Mrs. Mayfield, who has been denied choice. She had the choice between a hospital in Wakefield or a hospital in Leeds, and the PCT directed that she should be treated in Leeds, which meant a 36-mile round trip in the ambulance provided by the PCT. Mrs. Mayfield has recently undergone tests at Clayton hospital in Wakefield and is now waiting for further treatment. If that treatment can be provided at Pinderfields hospital, will my right hon. Friend assure me that Mrs. Mayfield will be able to choose the hospital in Wakefield rather than the hospital in Leeds?
I thank my hon. Friend for giving me notice of his question through one of my hon. Friends. For obvious reasons, I am reluctant to discuss individual cases by name on the Floor of the House, but I shall make a general point and go as far as I can on the individual case. Although we want to give greater power and choice to the patient, it must be in the context of national standards and best medical practice. For example, a local constituent who is receiving treatment for rheumatoid arthritis must be offered treatment within the guidelines outlined by the best clinical advice. West Yorkshire PCTs have decided to
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commission that particular service from Leeds Teaching Hospitals NHS trust because they want to meet the guidelines issued by the National Institute for Clinical Excellence, which has a worldwide reputation for guidance on best treatment. The NICE guidelines state that the prescription of the agents that some patients with rheumatoid arthritis have to receive
In my hon. Friend's local area, the consultant who specialises in their use is currently situated at Leeds hospital. This is being done with the best of intentions, best practice and best medical guidelines. My comments will be noticed, and I am sure that the local authorities will consider whether there is any way of making the service even more convenient.
Mr. Peter Lilley (Hitchin and Harpenden) (Con): May I congratulate the Secretary of State on his U-turn on patient choice in the health service? Does he regret that the initial policy of the Labour party was to remove patient choice, to stop money following patient choice and to abolish what it derided as the internal market? Is it not a shame that for seven years we have had no patient choiceand consequently nothing driving up efficiency and improvementsand hence there has been so much money spent and so much waste? I welcome the Secretary of State's belated, inadequate and over-bureaucratic conversion to patient choice.
It is certainly true that when one introduces real choice, as opposed to the theoretical choice that we all possess to buy a Rolls-Royce or dine at the Ritz, it has to be made real by increasing capacity and investment. The right hon. Gentleman is right that for the first two years of our Government, from 1997 to around 1999, we did not increase that investment and stuck to the Tory spending plans, for the very good strategic reasons that we wanted to create a stable economy, reduce unemployment and so on. In that context, we did not introduce a great deal of reform. Obviously, I would have liked to do it earlier.
Nevertheless, I welcome the fact that the right hon. Gentleman welcomes the fact that we are now doing this and doing it robustly. I only hope that he also welcomes the fact that we are doing it within a context in which we are retaining the founding principle of the national health servicethat all care will be free at the point of need. Would he and his colleagues concur with me on that important principle?
Mr. Brian Jenkins (Tamworth)
(Lab): I recall that at the time when I became a Member of Parliament, my local paper carried a front-page headline saying that a man had remortgaged his house in order to be able to afford a heart bypass operation. Today, we are discussing patient choice: what progress we have made. Will my right hon. Friend ensure that when people make such choices they do it in consultation with their GPs and medical practitioners, who can give them guidance on the most appropriate course rather than allowing them to make a misinformed choice?
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Dr. Reid: Choice is never an absoluteit is always subject to best medical standards and is only made real if the capacity is put into the system to allow people to compensate for any lack of money in their own pockets. I never again want us to go back to the days when people were forced to spend between £10,000 and £20,000 to get heart bypass operations in a speedy fashion. That is why I am so absolutely opposed to the so-called patient passport plans, which would force people who want a speedy operation to take half the money out of their own pocket. It is an absolute disgrace to undermine the national health service with such charges.
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