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Lord Lipsey: My Lords, noble Lords may feel that in seeing me rise today they are seeing Dame Nellie Melba in action because for some time I have been saying that I will not be present for much longer. The Minister will be greatly relieved to hear that my surgery is booked for next week and so I shall be getting off his back.

As it is an important experience to go into our NHS hospitals, it is right that I should begin by paying tribute to John Coltart and Graham Venn and their wonderful team of nurses and technicians at St Thomas's. As the House would expect, they have shown to everyone wonderful professionalism, wonderful humanity and, more surprisingly to me, great efficiency. That is why, as we enter today's debate, I blink in disbelief at the Government's rank frivolity that will deliver such people into the hands variously of party hacks, single-issue fanatics and fascists. It will not happen everywhere, but it will happen to many of our greatest hospitals. That is why I trust that your Lordships will support the removal of Clause 1 today.

Let me make it clear to my noble friend that I am not opposed to foundation hospitals. If properly thought through, I can see their virtues. I do not accept all the strictures of the noble Earl, Lord Howe, against them. There is also common ground in that every one of us believes that there must be much more local and individual involvement in hospitals. We want to see more consultation and accountability. We want to see the use of focus groups and citizens' juries and all the devices which in a modern democracy can create a genuine stakeholding community in our hospitals. We want all that. But instead the Government have fixated themselves on a single method of accountability—namely, election—in a way which, in my view, will have all the adverse consequences to which I have referred.

They are doing that partly on a completely mistaken analogy with schools. There are problems with the greater accountability and local involvement which we now have in schools. In many areas, it is difficult to obtain governors. But the point is that a school is rooted in its community. Parents go to the playground every day and talk to each other. They know what is happening in that school.

A hospital is not like that. I hope to go in and come out cured. A waiting room is not like a school playground. I have three children who went through state education. When we went to the school playground, we talked all the time about how the school was doing. In waiting rooms, people do not talk about key performance indicators, standardising mortality rates or the kind of subjects that are discussed in school playgrounds. Indeed, something approaching silence is to be found there. That relationship simply does not exist among the members of the boards to make the concepts in the Bill stack up.

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I am afraid that we are seeing that now in the consultation process on this issue. I was told about the consultation on foundation hospitals that took place in Yorkshire. It was attended by the executive boards of the hospitals and the regional officer of UNISON but no one else—not one member of the local community. I do not say that all consultation has been like that, but that is an example.

How have we come to that situation? I shall tell noble Lords what I believe has happened. The very concept of foundation hospitals is not popular in some quarters in my party, for reasons that I understand. Therefore, the Minister was left to sell an uncomfortable concept and the Government thought up a jolly good wheeze. Local Labour groups and MPs love elections; that is what they are in business for. Therefore, they decided to introduce a load of elections without thinking through in any way how they were going to do that. But that is what they decided—they thought that elections would cheer up the troops.

We see that now in the talk about mutuals. I strongly believe in mutuals but not the kind that one finds in the other place. It was a political wheeze or fix to get the concept through the other place. I believe that there is too much politics in our health service rather than too little. When our hospitals become subject to a political wheeze of that kind, I tremble for their future.

In addition, the Government are in a tearing hurry. No one can read Schedule 1 to the Bill and believe that the issue has been thought through in any detail, as the noble Lord, Lord Clement-Jones, pointed out. It is a democratic disgrace that, while the Bill is still before our Houses of Parliament, the Government are pushing ahead, with crucial steps being taken in December to set up foundation hospitals so that some will be in action by next April.

One cannot legislate sensibly in that way. We have a model for dealing with legislation. It starts with a manifesto pledge, followed by Green Papers, White Papers, Joint Committees for pre-legislative scrutiny and scrutiny in both Houses. Then one can introduce legislation that works, as we showed when we dealt with the Communications Bill. One cannot introduce legislation in the way that it is being done in this Bill or at this speed and get it right. The House now has a chance to send the Government away to think through the matter.

This proposal is Alan Milburn's bathtub musings turned into half-baked legislation. We now have a different Minister, a very sound Government and a sound Minister in this House. Let us take this opportunity to change foundation hospitals so that they work.

What does someone in my position do? I remember the story of the boy who never spoke. He reached the ages of five, six and seven and was seen by all the specialists, but he never spoke. One day, he turned to his mother at breakfast and said, "Mother, this porridge is too cold". His mother said, "That's marvellous. You haven't spoken up till now". He said, "Well, nothing has been wrong up till now, mother".

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I have been in the House for more than four years. Until this Bill came before us, I never voted against the Government. I did not even abstain on any proposition before the House. I hope very much that I shall not have to break that record today. In this grouping is a set of amendments tabled by me and by noble Lords on the other side which I believe would draw the fangs from this animal. It would make it just about workable; it would not be ideal but it might be tolerable.

If, in replying to the debate, the Minister indicates that he will accept the amendments that I and others have put forward, I shall be spared my dilemma. However, if not—I fear that that will be the case—I shall be faced with a difficult choice between my loyalty to my party, which I hope has been great, and my loyalty to the National Health Service, on which my life and that of millions of our fellow citizens depend. In those circumstances, I am afraid that I shall not hesitate to vote to save our National Health Service.

11.30 a.m.

Lord Desai: My Lords, unlike the boy in the story told by my noble friend Lord Lipsey who did not speak until the porridge was cold, I was born screaming, crying and protesting. My record on supporting the Government is, I should say, patchy. However, on this occasion, I stand proudly behind my noble friend. I stand behind the Bill, and I hope that the House rejects this set of amendments.

Listening to the noble Earl, Lord Howe, and the noble Lord, Lord Clement-Jones, one has the feeling that somehow policy is born absolutely perfect with not a blemish on it. One has the impression that, until now, we have done nothing but fashion perfect policies and that, once a policy is perfected, we never revisit an issue. It is as though, in history, we have had only one education Bill, one health Bill and one criminal justice Bill and so on.

We are making a major change that worries many people. The people who are worried about such changes are wrong, in the sense that they want to maintain the old National Health Service. We are saying that it is time to move on and to make—this is a horrible cliche a really radical change. In doing so, we must take people with us. If there are doubts, we must admit that there are doubts—we cannot have the whole loaf now.

Of course, the foundation hospitals that I want to see are not set out in the Bill, but there is something here on which we can make progress. The important point is: are we going to do it now or are we going to wait for everyone's perfect dream world and then, perhaps a few years later, once again go through this debate?

I was surprised by the argument that the noble Lord, Lord Clement-Jones, made against local democracy. As a boy, I used to hear people in colonial India say, "You can't trust these people with democracy. You never know who might capture the government. All sorts of corrupt people may capture government—even fascists". That is very interesting. Why do we not

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simply trust the people to know their own interests, to look inside their own stomachs, hearts and livers—whatever it is that people look into—and trust them to do the right thing? That is better than saying, "We are never going to have democracy until we write down here a condition in such and such a schedule that only perfect people will vote, and those perfect voters will do only what we, the great and the good, tell them to do. Of course, we shall not have any control over them. We are going to decentralise. We want to devolve and decentralise so long as they don't take part".

Schools are not like hospitals. Indeed, secondary schools are not like primary schools. When my children went to primary school, I went to the playground. When they went to secondary school, I did not go to the playground. Each parent-teacher association reacts differently. I was a governor of primary schools and secondary schools and have taken part in many meetings. A parent-teacher association meeting to which no one comes makes a very happy school.

I believe that foundation hospitals are a good experiment. Problems are involved, but let us launch the scheme. In the National Health Service let us give back some ownership to the patients and the professionals. That is the essence of this measure. For a little time when I was young, I believed that the revolution would come before I died; now, I am very happy when a radical change occurs. Therefore, I shall support the Bill, and I hope that the House will reject the amendment.

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