Clause 176 - Abolition of NHS trusts in England

Health and Social Care (Re-Committed) Bill – in a Public Bill Committee at 1:45 pm on 14 July 2011.

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Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health 1:45, 14 July 2011

I beg to move amendment 198, in clause 176, page 155, line 10, leave out subsections (3) and (4).

Photo of Roger Gale Roger Gale Parliamentary Assembly of the Council of Europe (Substitute Member)

With this it will be convenient to discuss Government amendments 224 and 226.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

As I have said, the previous Government first created foundation trusts because they recognised that top-down management of all NHS providers was never going to achieve the best care for patients. Indeed, many speeches in which previous Government Ministers say just that are littered across the past six years of Hansard. Like them, we remain committed to supporting the pipeline for all NHS trusts to become foundation trusts in their own right, or part of one, so that all patients and staff can benefit from providers that are autonomous and locally accountable. Foundation trust status shows that a trust has demonstrated its clinical and financial stability and sustainability.

Our approach of setting a clear deadline for the repeal of the NHS trust legislation has already had an impact in countering the relative inertia that existed under the previous Government. That deadline has  been a key determinant in the change in mindset needed to support all NHS trusts in achieving foundation trust status. We have backed up the deadline with local focus and national co-ordination and support, and are looking at areas where specific help might be needed. We have already seen a change in the mindset, and most NHS trusts have agreed good plans for achieving foundation trust status. We must ensure that that momentum is not lost.

We have listened, however, and have heard the concern that quality and patient care could be damaged if NHS trusts are pushed to apply for FT status before they are ready. We discussed that concern only this morning. We can see that some NHS trusts may benefit from more time, rather than a change in plan or management. We acknowledge that the challenges of transition to an all foundation trust sector will be considerable, but just as it would be wrong to move too quickly it would not be in the interests of patients or the public to abandon the goal altogether.

Together, the amendments remove the 2014 deadline from the Bill, as well as the related reserve power for the Secretary of State to change the date and the current commencement provisions; they do not change the proposal to repeal NHS trust legislation, or Monitor’s authorisation powers. It remains the case that it will no longer be an option to stay as an NHS trust. We continue to expect the vast majority of remaining NHS providers to meet the high standards needed to become foundation trusts by 2014 and for them to benefit from the freedom that foundation trust status brings. To do this, we recognise that some NHS trusts may need to come together, merge with existing foundation trusts, or enter into franchise arrangements. However, if a small number of NHS trusts cannot meet Monitor’s test we will not arbitrarily abolish them in their current legal form in 2014. All NHS trusts are expected to become foundation trusts as soon as clinically feasible, with an agreed deadline for every trust.

NHS trusts applying for foundation trust status will continue to be subject to stringent tests set by Monitor and there will be no lowering of the bar. In order to succeed, applicants will need to have strong boards and be financially and clinically robust. We are all agreed that it is in neither the patient nor public interest for organisations that provide poor care or are not well run to become foundation trusts.

Photo of Jeremy Lefroy Jeremy Lefroy Conservative, Stafford

I fully understand the reason behind the amendment. I am probably not being very clever and I am no lawyer, but if we propose to remove subsection (3) of clause 176 and the Bill becomes law, does that not mean that NHS trusts will be abolished immediately?

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

No, because we are making changes to the arrangements in the commencement clause which mean that we will have the ability to commence that part of the Act—when it becomes one—at a time that can be specified later. I think that is how it will be dealt with—[ Interruption. ] I got a reassuring nod, which is always gratifying.

In conclusion, I have set out the purpose of the amendments and beg that the Committee approves.

Photo of Roger Gale Roger Gale Parliamentary Assembly of the Council of Europe (Substitute Member)

Amendment 49 has not been called because it is otiose; one cannot effectively negative a negative on stand part. Given, however, that the Opposition have indicated that they wish to oppose the whole clause I am proposing to take the stand part debate now as well.

Photo of Owen Smith Owen Smith Shadow Minister (Wales)

I think we could call this the “shambles clause”—or the “shambles amendment”—because it is one of the clauses in the Bill that shows very clearly what an utter mess the Government have made of this legislation. It is an absolute, complete and utter shambles. Only a couple of months ago they were proposing to set the hard date of 1 April 2014. That was going to be the point at which trust status would fall, with everybody ready to be a foundation trust by then. We said at the time that that was a very bold and foolhardy commitment from the Government and so it is proven, because they have had to remove it from the Bill. In excising subsection (3) from clause 176—the date, 1 April 2014—they are clearly acknowledging that trusts will not be ready. In particular, the 20 trusts that we understand are in financial difficulty will not be ready to move to foundation trust status. This shambles is important because the Government, in creating an unholy mess and such chaos in the NHS, have made it far harder for those 20 trusts, and for other trusts that are not foundation trusts, to get ready to take on foundation trust status.

It is absolutely not true to say that the previous Government did not push as hard as they could to get the trusts ready to adopt foundation trust status, if they so chose. The uncertainty that this Government have sown with the Bill—on top of the stringent, unprecedented savings that both this Government and the previous Government asked the NHS to make over the comprehensive spending review period—makes taking on that status far harder. The chaos makes it much more difficult to imagine that those trusts will be ready, which is why the Government have had to change the clause; it is their acknowledgement that it is extremely unlikely that all those trusts will be ready to assume foundation trust status. In proposing the amendment, the Government recognise that they are making a mess of the NHS, and they should be decent enough to say so explicitly.

Photo of John Pugh John Pugh Liberal Democrat, Southport 2:00, 14 July 2011

I may be in a minority of one, but I was never seriously convinced that turning every NHS trust into a foundation trust was a good idea. I was never convinced, actually, that foundation trusts were a good idea, which is why I voted against them and why I am relatively unrepentant now. They offer strong autonomy to the organisation with a very weak model of accountability, but this afternoon, the Government have strengthened that accountability.

The advantages that I can see of foundation trusts are primarily that they put behind us the sad history of brokerage in the NHS, whereby inefficient hospitals are bailed out by a bond from a strategic health authority at the end of the financial year, and certain financial freedoms are offered. I will not rehearse those arguments, but I want to make the point that the hon. Member for Pontypridd has said that it will be very difficult for the Government to stick to their original remit of trusts becoming foundation trusts by a particular date, which  is entirely true. I do not want to pre-empt my Adjournment debate next week, but one reason why that is true—and this was stated by the hon. Gentleman—is that the previous Government insisted on a £20 billion efficiency target. That is one express reason why the deadline would be tight.

What the hon. Gentleman has not said, and our views may differ on this, is whether he thinks it is a wholly good idea for all trusts to become foundation trusts. Although I assume that that is Labour Members’ point of view, it is not mine, and it is clearly not the Government’s, so we have that in common.

Photo of Kevin Barron Kevin Barron Chair, Standards and Privileges Committee, Chair, Standards and Privileges Committee

I want to echo some thoughts of my hon. Friend the Member for Pontypridd. This group of amendments distinctly reveals the shambles of a Bill—not this re-committed Bill—that was introduced a few months ago. The deadlines that were laid down were impractical. The fact that the Minister says that he has been listening makes me wonder why the Government did not listen before.

Subsection (4) of clause 176 gives the Secretary of State the power to bring in an order to use a date beyond what was originally laid in the Bill, which prompts the question of why it was not just left out. Perhaps the Minister did not want to propose an order with, potentially, dozens of hospitals included that could not make the deadline, and therefore, the Government did not want to expose problems in the original Bill by getting rid of the deadline altogether. That is no way to legislate.

It is clear in everybody’s mind that the original Bill—now re-committed—was more driven by ideology than common sense, and the clause and amendments show exactly that. What faith can people have in the Bill? In particular, there are areas that lie dormant, unamended, which we have asked questions about in the re-committed Bill proceedings. I hope, given the tight time scale—which was not altered—we have been given to scrutinise the rest of the Bill, that if changes cannot happen on the Floor of the House, they happen in another place. Somebody needs to pick up on the defects in the Bill, because some remain, in my view. It would be wrong to let this clause go, and particularly these amendments, which show what hasty legislation this is, and how different it is to what was said in manifestos, or even coalition agreements. That just shows how bad it is.

Here we are, with only a few minutes and hours left, looking at a Bill that has all these other amendments. It is wholly unsatisfactory, Mr Gale. I know it is not your problem, but as a legislator, I think it is wholly unsatisfactory that an institution like the NHS has been thrown to the wolves. We have had competition clauses and everything else thrown into this Bill; and here we see people who cannot and dare not even keep the legislation as it was, because it would expose what a tight and unrealistic timetable the original Bill gave us.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

The right hon. Gentleman has made that speech several times during our consideration of the Bill. Can he or any other Opposition Member name a single non-hybrid Bill introduced between 1997 and 2010 that received more scrutiny over as many sittings as this one? I can tell them the answer: none. We have had 40 sittings, 28 in the original Bill Committee and a  further 12 on the recommitted Bill. The reality is no number of sittings would be enough to satisfy him. Fundamentally, the Opposition are not here to scrutinise and improve; as we heard in the original Bill Committee, they are here to delay and confuse. I thought it would be worth getting that on the record.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

No, I am making progress. [ Interruption. ]

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I am responding in kind to the points that have been made by Opposition Members.

Photo of Kevin Barron Kevin Barron Chair, Standards and Privileges Committee, Chair, Standards and Privileges Committee

The Minister says that the Opposition are not taking the Bill seriously. This morning and in previous sittings, Ministers have resubmitted amendments that they turned down when Opposition Front Benchers tabled them in the original Bill Committee.

Photo of Nick de Bois Nick de Bois Conservative, Enfield North

Opposition Members may not like to be reminded that we had a lot of clarity from the Member for Islington South and Finsbury, who regularly highlighted what she considered her wrecking clauses. We would do well to remember that.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I remember. The essence of the arguments—

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

Because the hon. Lady was named, I will do so.

Photo of Emily Thornberry Emily Thornberry Shadow Minister (Health)

The Minister asked—not rhetorically, I am sure—whether another Bill between 1997 and now has had the same amount of scrutiny as this one. I ask him: has there been a Bill that has been more controversial up and down the country than this one, which is undermining our greatly loved national health service? In those circumstances, the amount of scrutiny that we have been allowed to give it is pathetic. Yes, we are against this Bill, but we also want to scrutinise and improve it, as we have done, and we have been entirely honest with him: we voted against it on Second Reading and we continue to be against it.

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

I was not clear what was pathetic—the scrutiny or something else. To respond to the hon. Lady’s question whether any other Bill in the last 13 years has been controversial, in a way, the Bill that introduced  foundation trusts was controversial at the time, particularly on the Labour Benches, which is interesting. She asked the question, there was the answer.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

I am struggling to perceive the coherence in what the Opposition are doing. The hon. Member for Islington South and Finsbury said earlier in the Committee’s proceedings that she was actively trying to put in, as one my colleagues described, wrecking clauses. Now we are hearing complaints about not making quick enough progress. That does not add up. The hon. Member for Pontypridd has, quite rightly, been advocating in favour of patient choice, but in our previous proceedings, the hon. Member for Islington South and Finsbury questioned the basis of patient choice, which her party’s Government introduced. Does the Minister not agree that that is incredibly intellectually incoherent, and it is difficult for us to follow where the Opposition are coming from?

Photo of Roger Gale Roger Gale Parliamentary Assembly of the Council of Europe (Substitute Member)

Order. True or not, that is nothing to do with clause 176. We have had our fun. Can we now get back to the matter in hand, please?

Photo of Paul Burstow Paul Burstow The Minister of State, Department of Health

Thank you, Mr Gale. My hon. Friend’s points stand on the record, and would bear repetition, but I will not repeat them.

The essence of the critique offered by the hon. Member for Pontypridd seems to be that we are to be condemned when we do not listen, we are to be condemned when we do listen, and we are to be condemned when we listen at a time that the Opposition think is inappropriate. The reality is that the Government have listened and reflected, and we have tabled amendments to the Bill as a consequence. I urge the Committee to accept them.

Amendment 198 agreed to.

Clause 176, as amended, ordered to stand part of the Bill.