Clause 16 - Protection of property
Health and Social Care (Community Health and Standards) Bill
12:15 pm
Mr Chris Grayling (Epsom and Ewell, Conservative)
The amendments are designed to address specific elements of the provisions that the Government are aiming to put in place for the protection of property. We do not want foundation hospitals to dispose of their core assets. Many are in city centres, and most are in prime locations where
they have a large real estate value. We do not want trusts to take advantage of that asset base to raise revenue for whatever purpose they choose.
Equally, we do not want to see them in a straitjacket that would make it impossible for them to modify their asset base to reflect the reconfiguration of services, to change the nature of their asset base or to dispose of any spare property that they do not need. It is their duty to continue to be able to deliver the basic core hospital services. The amendments are designed to address elements of the management of their property portfolio.
Amendment No. 12 relates to later acquisitions of land that might be acquired through the rights that will come up in clause 17 to make further investments. The amendment would add
''but does not include property acquired subsequent to the date of its establishment as an NHS foundation trust.''
That allows a trust to modify its investment portfolio. Let us say that a trust acquired a clinic and chose subsequently to dispose of part of the land; perhaps it chose to close that clinic down on a separate site and to move its facilities to its core site. It is then left with an asset that has been providing a core service to the trust.
I gave an example earlier of a trust using a cataract clinic that it had acquired; if it had been able to do so under the restrictions we discussed earlier. The trust might subsequently choose to move the cataract service to its own site. Arguably, under the definition of protected property, that cataract clinic would be a protected site, because it is a core part of the service that the trust is using to provide basic health care services to its patients. Our argument is that where the trust subsequently invests in a property and chooses to reconfigure its services, it should have the freedom to dispose of that property if it chooses to do so.
I hope that the Minister can either explain that he does not envisage the protection measures applying to property acquired subsequently or say that he is prepared to offer some flexibilities so that when trusts make subsequent investments and acquisitions, those acquisitions are not automatically pulled into the core straitjacket afforded by the provisions under protective property.
Amendment No. 14 concerns the power of the regulator. Clause 16(4) states:
''The regulator may give approval under subsection (1) on any terms he considers appropriate.''
Imagine a situation in which a trust comes forward with a proposal to the regulator to make a property disposal as part of a reconfiguration of its services. It has met all the criteria for doing so, it is proposing changes in a way that will not affect its core services and it is meeting all the requirements expected of it by the regulator.
However, the Bill still only gives the regulator a general sense of the direction his decision must take; it is not an obligation. The regulator ''may'' give approval even if all the criteria have been met. We want to be able to say that if an NHS foundation trust has done its homework, put together a credible proposal for a reconfiguration of services that involves
changes to its property portfolio and met all the sensible criteria that it should be expected to meet, the regulator should, at that point, be obliged to accept it. The word ''shall'' should replace the word ''may''. It is simply a matter of finding where the balance of power lies.
Our view is that foundation hospitals are about local freedom and not centralised freedom, subject to reasonable safeguards in a number of areas. The balance of decision-making and the balance of power should reside with the trust rather than with the regulator. If a trust does its job properly, the regulator should not be able to turn around and say that he does not want it to go ahead anyway. That is the purpose of amendment No. 14.
Amendment No. 15 further addresses the issue of the circumstances of disposal of property. We tabled it because of the nature of our national health service at the moment. If the Government pursue their current strategies, it is inevitable that the NHS will see a significant reconfiguration of services over the next few years. The document ''Keeping the NHS Local—A New Direction of Travel'' sets out a vision of a number of services that are currently carried out in hospitals, and will be carried out in foundation hospitals once they are established, moving into the community.
In a number of areas, including mine, primary care trusts are setting out a clear strategy to change purchasing patterns; to buy more services for community hospitals; to devote more resources to the primary care sector and to community hospitals; and to reduce the workload and the capacity problems in major hospitals. In some areas, that is likely to lead to the closure of hospital sites. In my constituency, we are debating the future structure, location and provision of hospital services at Epsom General hospital, St. Helier hospital and a theoretical future third site.
We are going into a period in which NHS services will be under major review. Purchasers may ask trusts to reconfigure services, to do less and to allow services to be bought in through community hospitals. We must not place a protective straitjacket around those trusts that would make it difficult for them to respond to the changing requests of their purchasers. That is why we fear the scale of the straitjacket being proposed in clause 16.
The purpose of amendment No. 15 is to change the balance of power and to make the regulator a watchdog rather than a decision-maker. The purpose of the amendment is to show that we accept that trusts will make decisions in the next few years that will involve changing their sites, changing the configuration of services on their sites and changing the way in which they work.
We must ensure that the foundation hospital status that this Bill would afford those trusts is not abused in a way that would remove assets from the health service that could no longer be used for patients. We must not tie foundation trusts up and create a situation in which they cannot respond to a national strategy, through directions like that in ''Keeping the NHS Local—A New Direction of Travel''. Equally, we must ensure
that they can respond to the pressures that will come from primary care trusts to change the way in which they operate.