I am grateful for that reply. Although I have no objection in principle to my right hon. Friend's plans to devolve power within the NHS, I still struggle to understand his proposals on accountability. How will candidates be selected? Will they nominate themselves or will they be chosen in some other way, as yet undecided? Is there not a danger that, if we are not careful, we shall end up with foundation hospitals that are less rather than more accountable to the public they serve? I know that that is not what he is aiming at.
My hon. Friend is right about that. The principle is that we want to ensure that local staff and local members of the community have a greater say in how local hospitals such as his own, which have applied to become an NHS foundation trust, are run. That must be right. If we are to achieve more responsive local services, with the best will in the world, that cannot be imposed from Whitehall or from the top down. There has to be a much greater local element of accountability than there has been to date.
On the provision for how people will be elected, obviously, the NHS foundation trusts are a membership-based organisation and we want to ensure, as far as we can, that as wide a swathe of the local community as possible become members of NHS foundation trusts. I think that my hon. Friend is aware that the Bill provides for secret postal ballots from among the members who will be involved in direct elections to the hospital governing board. He is also aware that local members of staff will have an opportunity to be represented on the governing body, so, for the first time, local staff and local members of the community will have a direct say in how the hospital is being run.
I welcome the Secretary of State saying that he wants to encourage the widest possible membership of foundation hospitals. In that spirit, will he consider extending membership to all people on the electoral roll in the relevant area? If he does not want to go that far, will he tell the House what active measures he will take to promote wide membership, which many of us would welcome?
The right hon. Gentleman makes a fair point. It is important that the membership of NHS foundation trusts is as large as possible, representing the local community. There are a number of options, and one is to achieve that through advertising in the local media, which would encourage local people to become members. Alternative options include allowing people to register to become a member of an NHS foundation trust when they register, for example, to vote in a local election.
As my right hon. Friend and I have discussed previously, the position of specialist hospitals is somewhat at variance with that of most district general hospitals, for example. [Interruption.] Although Dr. Fox laughs, he is the first to say that the NHS is not a uniform service. Indeed it is not. Specialist hospitals have a very different make-up and serve a very different catchment population from district general hospitals. That is why it must be right, as the Bill does, to allow some flexibility in the governance structure.
Specialist hospitals, in part, serve the local community, and members of the local community would have the right to become members of the NHS foundation trust. Equally, the vast majority of users of a hospital such as Christie are drawn not from the local community, but from patients and, due to the hospital's excellent services, those patients come from not only the north-west, but across the whole country. That is why the Bill gives flexibility—precisely so that patients and the public can be represented on the governing body of such organisations.
Will the Secretary of State reflect on criticism from the Labour-dominated Select Committee on Health? It said that the plans for the constituencies to elect the governing boards would be determined by unelected NHS organisations. As a result, the Committee said that the board of governors would function simply as focus groups, advisory panels or talking shops. On reflection, does the Secretary of State not think that it would have been better to be more consistent in deciding on the constituency bodies that would elect governing boards, and thus to avoid confusion, anomalies, disappointment and a system that prevents the boards from carrying out their functions effectively?
That sounds suspiciously like a return to precisely the centralised control and Government intervention that the hon. Member for Woodspring warned us against a moment ago. Mr. Burns is a member of the Select Committee as well as a Conservative Front Bencher—[Hon. Members: "Surely not!"] Indeed he is.
That is one way of putting it, although I am not sure it is the most appropriate.
Obviously we will consider the Select Committee's recommendations extremely carefully. Indeed, we are already doing so in Committee. It must be right, however, for local people to have a greater say in the running of their hospitals.
There is a straightforward choice. We can do what we have done for so many years under both Conservative and Labour Administrations, and presume that if we parachute people on to the governing boards of NHS hospitals we will create more locally accountable services; or we can do what we propose to do, and ensure that the democratic principle, which is good enough for social services, also applies to the way in which we run our health services, so that people have an opportunity to decide who is running the local hospital.