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We need to assess the basic elements one by one. On foundation hospitals, we do not have a problem with the concept. Indeed, we are keen on the model of foundation hospitals in other countriesSweden, for example. Swedish hospitals have freedom to borrow according to their own plans and in terms of their own investment needs; they have freedom from political interference in setting targets and freedom to set their own pay and conditions. The Secretary of State described us as scuttling around Europe, as if we in Britain had nothing to learn from other countries in Europe, many of which provide better health care than we do in the United Kingdom. If we examine countries such as Germany, we find that they have far better quality care than is received by poorer groups in the United Kingdom. We have much to learn from the social insurance model in other parts of Europe.
We could have argued today that we were in favour of the move closer to the internal market and the potential proto-legislation that Labour has introduced, because such are the secondary powers in the Bill that an incoming Conservative Government could move much faster towards the sort of model that we would like to see, without having to introduce primary legislation. However, we laid out the reasons why we were unhappy with the Bill as regards foundation hospitals, and why we supported the relevant amendment earlier. I shall elaborate on those reasons.
Dr. Fox: I know that to answer that question would be to stray on to the issue of European legislation, and therefore you might not approve, Mr. Deputy Speaker. However, if we are to have such rights, they should be genuinely reciprocal. For example, British patients in France should be treated as French patients would be treated in this countryin other words, free at the point of use. At the moment, British patients go to France but have to pay, but the French can come to Britain and be treated free. We should have genuine reciprocal rights, not the loaded dice that we have at present.
What do we see when we compare the freedoms of foundation hospitals in other countries with what we will have here? Here, we see borrowing curtailed by the Treasury. In fact, it is worse than that, because any borrowing will be curtailed within a single envelope. Any foundation hospital that is able to access more money will do so at the expense of other hospitals. That is a recipe for what Labour Members have called a two-tier system. The whole point of being able to borrow outside Government limits is to be able to raise expenditure without affecting the resources available to others in the publicly funded sector. However, the Government fail to understand that. The freedoms will be rolled out for only a few hospitals, rather than as a programme for all of them, and that is a recipe for maximum instability in the system.
On the issue of the regulator, the Minister of State told us that the Government had taken increasing measures throughout the passage of the Bill to guarantee the independence of the regulator. What sort of independence is it when the regulator will be hired by the Secretary of State, fired by the Secretary of State, has his rates of pay set by the Secretary of State, and cannot give agreement to a foundation hospital unless it has first been agreed by the Secretary of State?
We did not receive sufficient explanation of several areas of the Bill in the debates earlier today. We asked, frequently, about pay and conditions. What freedoms will foundation hospitals have to alter pay and conditions that other hospitals will not have? If foundation hospitals will not have those freedoms, what is the point of the exercise? If they will have those freedoms, they need to be defined at the outset. How will those freedoms impact on the Chancellor's regional pay
Mr. Allen: On freedoms and the ability of hospitals to set their own parameters, I assume that the hon. Gentleman refers also to the freedom of individuals to be charged £5,000 for a hip replacement or £9,000 for a heart bypass under the Conservatives' passport scheme. He mentioned looking to Scandinavia, including Finland, but is that giving another meaning to the phrase "finish the NHS"?
Mr. Lansley: My hon. Friend was talking about the role of the independent regulator. We only really understood in Standing Committee that the regulator is going to have to exercise his functions in a way that is consistent with the performance of the duties of the Secretary of State under the 1977 Act. As the Minister admitted in Committee, that means that the Secretary of State will be able to issue guidance to the independent regulator on the exercise of all his functions.
Dr. Fox: I imagine that this is plumb in line with the previous Secretary of State's well known way of running the health service along the lines of earned autonomy, which meant, "You can do whatever you want, as long as it's what I want". This is the same doctrine, and it is now being extended to the independent regulator, who could not possibly be regarded as independent in any normal sense.
It is interesting that the question of governance caused the most trouble on the Government's Back Benches. We got no answer to many of our questions on this issue. What is the logic of having an electoral system for the providers, but not for the commissioners, of care? Several Labour Back Benchers asked today how this provision would impact on their constituencies. People will have no ability to change the basis on which services are configured, because that configuration will be dependent on the allocation of resources. To establish electoral formats for the providers will therefore make no difference whatever.
The Secretary of State says that this is all about public ownership, but I always thought that the national health service was in public ownership, so why we have to redo it is quite beyond me. What are the great constituencies going to be? In relation to the regional and national hospitals, we are still waiting for an answer on who the voters are going to be, what the constituencies are going to be, and what the cost is going to be. Not once have Ministers denied our indicative figure of up to £250,000 per trust per year, simply to run the system. The Government say that they are decentralising and cutting red tape and bureaucracy, but they are creating a whole new tier of bureaucracy and red tape, in which hospital managers will be more concerned with running elections than with running hospitals. This is a disaster in the making.
The Secretary of State talked about what the Government were doing on capping private health care. That was one of the most profoundly dishonest parts of the passage of the Bill, because the Government have changed the provisions in the Bill on capping private income from "must" to "may". They state that the power is to be exercised
On CHAI, we have argued since the first Government Bill when they came to office in 1997 that there should be a single regulator across all parts of health care, regulating on the basis of the patient's experience and not according to who the provider is. The Government have belatedly caught up with us on this issue, and we welcome that.
Part of the Bill that has changed since Second Reading is the section relating to the GP contract, and this makes a profound difference to the Bill as a whole. I should perhaps declare an interest as a member of the Royal College of General Practitioners. Following substantial negotiations between the BMA and the NHS Confederation, and the overwhelming votean absolute majorityby GPs that this is what they want, it is clear that this is the model of health care that we will take forward. It is unfortunate that we did not have more time to discuss these matters in the House of Commons, but we shall certainly have plenty of time to consider them in detail in the House of Lords.
The Prime Minister said that the Bill was of historic importance. It is historicit is an historic waste of opportunity. The Government will have to come back and remedy it, because it is deeply flawed and was made up as they went along. It therefore gets the worst of both worldsit has the worst possible financial framework, and that fault is augmented by Whitehall control. It truly is a wasted opportunity that the Government will live to regret.