Clause 1 - NHS foundation trusts
Health and Social Care (Community Health and Standards) Bill
9:30 am
Dr Evan Harris (Oxford West and Abingdon, Liberal Democrat)
In that respect, I understand why the amendment has been tabled. However, amendment No. 66 would remove the words ''is a body corporate'', presumably because the hon. Gentleman's idea of a public interest company would, by definition, not be a body corporate but something more than that. That is my understanding of the matter.
In our proposals for creating a diversity of providers or a mixed economy of providers in the health service—published in a document last year—we suggested that public benefit organisations be introduced. Our objection to the Government's proposals for NHS foundation trusts was not the status of the provider organisation. I do not want to rehash Second Reading arguments, but we believe that the Government's proposals for NHS foundation trusts are deeply flawed in several areas, but not in respect of their being public benefit organisations.
We prefer to use the more generic term ''public benefit organisation'', partly because—perhaps we share this belief with the Government—it will be very difficult, especially in the NHS, to interest staff and patients in something called an ''interest company'' rather than in something called a ''benefit organisation''. Perhaps that is a matter of appearance rather than law, but to gain support for necessary changes to the NHS—such as the introduction of different models of provider services—appearance is important.
If the legal definition of the foundation trust as contained in subsection (2) is that it is a body corporate, I want to go beyond the original question posed by this amendment and ask why the Government, in subsection (1), could not have used the term ''public benefit organisation'', and then defined it as a body corporate in subsection (2). It may be a minor issue, but if this is the basis for the Government's careful use of language—this is a Government who take great care to use language carefully—many people may not want to be part of a corporation when previously they saw themselves simply as a part of an NHS hospital.
The hon. Member for South Cambridgeshire (Mr.Lansley) made an interesting point about the difficulties and complexities of trying to create a public benefit organisation that mixes producer and consumer interests among the stakeholders. I agree with that. Our model for mutuals in the health service proposes that staff should be predominant in this mutual organisation and that the public interest should be served through massive decentralisation and democratisation of the commissioning side of the health service. If one ensures that the public interest is protected and that the public are able to participate democratically, playing an advisory role on the commissioning side—which provides almost all the work of even these public benefit organisations—it would not be necessary to try to shoehorn them into representation in the provider organisation in an untidy, clumsy and not particularly democratic way.
There will be a conflict, and although it may be considered appropriate to try to resolve conflict in the organisation rather than through the commissioning process, the whole argument for separating commissioning from provision is to separate clearly the consumers' or patients' interest from matters connected with the most efficient way to deliver to that commissioned service. In that respect, I share the view of the hon. Member for South Cambridgeshire, and we have published relatively detailed proposals on the issue.
I should be grateful to hear the Minister's response to the hon. Gentleman's question about whether there is a precedent for this type of mix. I should also like to know whether the mutuals that were referred to have generally been bottom-up and not imposed centrally. Do they look to ensure that innovation comes from staff, and that the commissioning side deals with the needs of patients and the way in which consumer interests can be represented in the process?