Clause 4 - Application by NHS trusts
Health and Social Care (Community Health and Standards) Bill
3:30 pm
Mr Andrew Lansley (South Cambridgeshire, Conservative)
Clause 4 is about applications—[Interruption.] I thought that the Government had abandoned clause 4, but I am reminded that it was rewritten, and we shall rewrite it again.
The structure of clause 4 does not cause me any difficulties, although later clauses may. My four amendments have a specific purpose, which is to broaden the scope of those NHS organisations that can apply to become NHS foundation trusts.
Amendments Nos. 106 and 202 apply to clause 5 and are consequential on the other two amendments. Therefore the first two in the group, amendments Nos. 103 and 201, are the ones that matter. Amendment No. 103 relates to the beginning of clause 4, which states:
''An NHS trust may make an application''.
The amendment proposes to insert after ''NHS trust'' the words,
''a Primary Care Trust, or any combination of trusts''.
That amendment takes up one of the principal arguments, which, as the Committee may recall, was discussed in January when the House debated a Conservative motion on hospital foundation trusts. One of the strongest arguments for consideration at that early stage concerned the question of with whom responsibility and accountability should lie—that is, where patients' proper control should lie in the NHS. If, as I hope is the case, NHS patients have a clear mechanism for controlling the structure and the way in which the NHS is delivered in their locality, then primary care trusts are the obvious starting point. Primary care trusts are the commissioning bodies that operate on behalf of patients.
I have annual discussions with the primary care trust and the hospitals in my area about service level agreements. Although there is negotiation between the hospital and the primary care trust, technically speaking, the operation is primary care trust-led. However, if the hospital is essentially a monopoly provider—as is the case in some places—and offers services to the primary care trust with the expectation that they must simply take what they are given, we are not getting the primary care-led NHS in the form in which the Government have told us it should be structured. If the NHS is to be primary care-led, it will have to be primary care trust-led, and the involvement and the accountability of patients should be focussed on primary care trusts. I will not argue that point at length because the hon. Member for Oxford, West and Abingdon (Dr. Harris) made a similar argument on an earlier group of amendments, and that was set out then and on Second Reading.
I suspect that Ministers must agree, in theory, and are minded to say, ''Make us logical, but not yet.'' They want to keep primary care trusts out, on the grounds that they have only recently been established and therefore need to bed down before being given the opportunity to become NHS foundation trusts.
That is slightly odd in two respects. First, the Select Committee report details the frequency with which NHS bodies are subjected to an additional administrative overhaul. The Government's desire to get all the mechanisms of primary care trusts thoroughly bedded down, before digging them all up again and turning them into something different, is perverse. If we know where primary care trusts are travelling, and if that route is one of accountability to patients through direct membership of a foundation trust by NHS patients in their area, why not move there more quickly? Why not quickly make the primary care trusts accountable?
Alternatively, the amendment may commend itself to Ministers on the grounds that, although they do not wish to carry it out now, they will wish to do so at some later stage. Unless a later amendment that I support were to succeed, an NHS trust or any other trust could make an application to become a foundation trust only if it were supported by the Secretary of State. If Ministers want to hold primary care trusts back—even for years—there is absolutely nothing to stop them doing so.