Clause 1 — NHS Foundation Trusts

Health and Social Care (Community Health and Standards) Bill – in the House of Commons at 1:00 am on 19th November 2003.

Alert me about debates like this

Votes in this debate

Lords Reason: 1B.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I beg to move, That this House
insists on its disagreement with the Lords in their amendment.

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

With this it will be convenient to take Government amendment (a) to the Bill, Lords Reason 161CC, the Government motion to insist and Government amendments (a) to (bb) to the words restored.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

The House of Commons has now approved both the principle and the detail of the Government's proposals on NHS foundation trusts on five separate occasions. The will of this House is now clear, and it should always be the will of this House of Commons that must prevail.

We should all be clear about one other thing: the only point or purpose in the other place continuing to carry these wrecking amendments is to stop this part of the Bill reaching the statute book. No other reasonable interpretation can be placed on how Conservative and Liberal Democrat peers are behaving. They have nothing new to say on NHS foundation trusts. They have moved no new amendments for this Hosue to consider this evening. They have nothing new to offer. All they are doing is holding up the proverbial parliamentary finger to the decisions that we have made in this House.

That is not scrutiny. It is not revision of legislation. It is a naked attempt to thwart the democratic decisions of elected Members of Parliament.

Photo of Mrs Anne Picking Mrs Anne Picking Labour, East Lothian

My right hon. Friend and his Front-Bench colleagues will know that earlier tonight I voted against the Government on the particular issue of foundation hospitals. However, that fight has been lost. We are the democratic power in the House. We must decide what happens and I will abide by the collective responsibility of the House. The Lords should have no input in what we do. Does my right hon. Friend agree?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am grateful to my hon. Friend for what she has said. It is obvious that we face a simple choice. As I said, the House of Commons has decided, on five occasions, to support the proposals. My hon. Friend did not support them but I understand and respect her genuine concerns about the issue. However, the House of Commons must now assert its predominance and its will in these matters.

Photo of Patrick Cormack Patrick Cormack Conservative, South Staffordshire

There may be many more Tea Room conversions, but in case there are not, will the Minister remind the House of how many Labour Members of Parliament there are and how many of them voted for his proposal earlier this evening?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

That will be in Hansard and people can do the arithmetic. I think that about 80 per cent. of my right hon. and hon. Friends decided to support the Government tonight. Mathematics has never been my strong card and I am a simple soul, but that seems to be an overwhelming majority of my right hon. and hon. Friends.

Photo of Mr Paul Tyler Mr Paul Tyler Liberal Democrat, North Cornwall

A few days ago the Secretary of State for Health said that the House of Lords was not entitled to amend the Bill because the Lords are unelected. Can the Minister of State explain how many Labour Members were elected on a manifesto commitment to introduce foundation hospitals?

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

That is not what my right hon. Friend said—[Interruption.] No, it is not. The hon. Gentleman is quite wrong.

There is a simple issue for us tonight: whether the will of the House of Commons should prevail. My view is that the decisions that we made in this House should stand.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

No, I shall not give way.

We have looked in detail at every square inch of the measure. We have accepted 90 amendments to part 1. I am afraid that the debate that took place earlier this evening in the House of Lords completely failed to recognise that simple fact. As my noble Friend Lord Warner made clear in the other place earlier tonight, no Government can ever concede to the unelected House the right to tell this elected House what will or will not become the law of our country. There can be no question of the Bill proceeding unless clause 1 and the other provisions in part 1 are included. On that issue—

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am not giving way.

There can be no negotiation with unelected Conservative—[Hon. Members: "Give way."] I am not giving way—[Interruption.]

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. I think it is clear to the hon. Member for Banff and Buchan that the Minister is not giving way—[Hon. Members: "Why not?"] It is entirely a matter for any Member whether to give way to another.

This is acknowledged to be contentious business and the hour is late; it would be better if it were discussed in a calm and moderate manner.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am grateful, Mr. Deputy Speaker. During our earlier proceedings, Mr. Dorrell—usually an eloquent and respectful Member of the House—criticised my right hon. Friend the Secretary of State for speaking too long. In fact my right hon. Friend gave way to the right hon. Gentleman and his right hon. and hon. Friends on a generous basis. I am trying to make progress in the debate. I have given way to others but I am not giving way to Mr. Salmond.

There can be no question of the Bill's proceeding unless clause 1 and the other provisions in part 1 are included. We shall not negotiate with Conservative and Liberal Democrat peers on that matter. We will not detach part 1 from the Bill.

Opposition Members should think very carefully about how they want to proceed, because there is a very great deal at stake: a delay in implementing the new GP contract agreed with the British Medical Association, the loss to the national health service of up to £150 million a year through the provisions relating to the injury cost recovery scheme, the new provisions on NHS dentistry, the reform of the welfare food scheme, and the independent inspectorates.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

The Minister is representing the choice before the House as being whether the whole Bill proceeds or not, but the choice before the House now is whether part 1 proceeds or not. We are debating whether we proceed with foundation trusts in their present form. The rest of the Bill, as the Minister knows, is in a form that we are happy to see proceed.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I would simply say two things to the hon. Gentleman. The House has already decided to proceed with part 1. We have had that debate on five separate occasions and on each of those occasions the House has approved it. The other thing I would say to the hon. Gentleman and all his right hon. and hon. Friends, is that the Bill as a whole stands before the House tonight. Of course it is true that these amendments are about part 1, but the Bill as a whole is one piece of legislation, and I have made it very clear to the hon. Gentleman and the House that the whole Bill stands before us tonight and we have to make a decision on that Bill. [Interruption.] It does.

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. I am sorry to interrupt the right hon. Gentleman. The hon. Member for Banff and Buchan must sit down if it is quite clear that the Minister is not taking his intervention.

Photo of John Hutton John Hutton Minister of State, Department of Health, Minister of State (Department of Health) (Health)

I am also moving one further consequential amendment this evening. It responds to the concerns of both peers and Members of the House about the representation of staff governors on the boards of NHS foundation trusts. At present, the schedule provides for at least one staff representative on the board of governors. My amendment—the amendment tabled by my right hon. Friend the Secretary of State—will increase that to a minimum of three. This emphasises our commitment to promoting the effective participation of elected staff representatives in the work of NHS foundation trusts and also demonstrates, I believe, the willingness of Labour Members to try to get a resolution to the matters before us tonight.

The further amendment I am proposing to clause 1 and schedule 1 deals with the issue of commencement and when the clause should take effect. I consider that we in the House should continue to disagree with the Lords over their amendments. We have made our position clear. We should stand firm in insisting now that this is the will of the House, which must and will in fact prevail.

Photo of Alex Salmond Alex Salmond Scottish National Party, Banff and Buchan

On a point of order, Mr. Deputy Speaker. As you are aware, Standing Order No. 97 allows the Speaker to certify Bills that make provision only for Scotland as such, so as to put them to the Scottish Grand Committee. If the Bill was considered to be only an English matter, could it not also be so certified; and if so, why have 43 Labour Members of Parliament for Scotland voted to impose it on England? If the Bill, as I believe, has serious consequences for the health service in Scotland, why have 43 Scottish Members of Parliament from the Labour party voted to impose a Bill that will undermine the health service in Scotland?

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

Order. The short answer is that there is no such provision in the Standing Orders.

Photo of Tim Yeo Tim Yeo Shadow Secretary of State for Health

I had hoped that, with eight hours for reflection, the Government might have come to their senses by now. The substitution of the Minister of State for the Secretary of State may reveal a lack of confidence in the Secretary of State's ability to put the case for the Government, and given the collapse in the Government's majority this afternoon that lack of confidence may easily be understood. The Minister of State said that the Government had taken this proposal through the House five times. I remind him that on each occasion the majority has been less than it was when it came before the House before.

By contrast, the majority with which this proposal was rejected in the other place an hour or so ago was substantially larger than the majority by which it was rejected yesterday. Those results make it clear to everyone, except perhaps members of the Government, that though they may have technically won the vote in the House—even though with the assistance of Scottish Members of Parliament to whom these provisions will not apply, as Mr. Salmond has just pointed out—they have without doubt comprehensively lost the argument.

Let me remind the House that the proposals have now been rejected by a majority of English Members of the House of Commons on two separate occasions. The proposals now command the support of considerably less than half the Members of the House, and these measures will harm, not help, the national health service and the patients whom it serves. Not surprisingly, they are opposed by a remarkable range of professionals, trade unions and other bodies. As many hon. Members pointed out this afternoon, they will create for the first time in half a century a two-tier NHS in England.

The privileges and advantages that the Government will bestow on just a fraction of NHS hospitals will not be extended for several years to the majority of hospitals that our constituents use around the country. Indeed, if the review that the Secretary of State announced in debate this afternoon is to mean anything genuine, there is now a question mark perhaps not just over the timetable for extending foundation trust status to non-foundation trust hospitals, but possibly over the question of whether other hospitals will receive foundation trust status at all.

The Secretary of State did not explain what he would do if the review that he announced finds that foundation trusts are not working properly. I doubt whether it is worth asking him to explain this now, because his knowledge of the Bill this afternoon appeared to be somewhat sketchy, but we must recognise that there is now a real chance that foundation trusts will not work well because of the serious flaws in the Government's proposals. On top of the way that they are now creating a two-tier NHS, the nature of the foundation trusts that the Bill will establish is so far from the concept originally proposed by the former Secretary of State—the concept originally endorsed by the Prime Minister and then undermined by the Chancellor of the Exchequer—that it will not achieve the benefits that the Government claimed for it.

Foundation trusts will not enjoy the freedoms that true independence brings. They will be subject to the same star ratings that have plagued the lives of doctors, nurses and managers for the past few years. They will be strictly regulated by a body that is itself controlled tightly by the Secretary of State. They will be forced to operate a management and governance structure that is irrelevant to the needs of patients, ill defined and confused in its concept, and expensive and cumbersome to operate. The only gains that foundation trusts will make are those that they will achieve at the expense of other hospitals.

What makes these damaging proposals all the more offensive to English MPs is that it applies to their constituents, but not to the constituents of those Scottish Members on whom the Government relied for their majority.

Photo of Alex Salmond Alex Salmond Scottish National Party, Banff and Buchan 1:15 am, 19th November 2003

Is the shadow Secretary of State aware not only that 43 Scottish Labour Members voted to impose foundation hospitals on England, but that these proposals were vigorously opposed by the Labour party in Scotland, including in the constituency of the Secretary of State for Health?

Photo of Tim Yeo Tim Yeo Shadow Secretary of State for Health

I am most grateful to the hon. Gentleman for pointing that out, and it puts into context the use of the word "hypocrisy" by members of the Government earlier today in relation to this issue.

The Secretary of State knows that the Opposition would like to give our support to measures that give greater freedom to doctors, nurses and managers in the NHS. He knows that, unlike him and most Ministers, I have direct personal experience of chairing an independent charitable trust that successfully transformed an ailing NHS hospital, using the freedom that release from ministerial control bestows.

I therefore now make the Secretary of State an offer on behalf of the Opposition—I do so in good faith in an attempt to rescue the Bill. If the Government make concessions on two important aspects of the Bill, the Opposition are prepared to end their resistance to the Bill's passage through the House. First, the Government must abandon the costly, muddled, expensive and cumbersome governance procedures set out in schedule 1, and replace them with a simple management structure that does not involve elections by badly defined and probably unrepresentative constituencies. Secondly, they must change the rules relating to borrowing, so that borrowing by foundation trusts will not prejudice the ability of non-foundation trusts to access funds that they need to maintain and improve their services. That change will have to be accompanied by explicit Treasury consent.

Those changes would go a long way towards avoiding the creation of a two-tier national health service, and my hon. Friend Mr. Lansley is available to discuss the details of our proposal through the night and tomorrow morning if necessary. I appreciate that time is not on the Government's side. That is a problem that is entirely of their making. The two aspects of the Bill that we believe should be changed are ones that have caused concern in both Houses during the Bill's passage through Parliament, and have been widely criticised outside Parliament. It would have been helpful if the Government had listened to the concerns expressed by a great many people at an earlier stage, and acknowledged the strength of opposition to their proposals not only on the Opposition Benches, but in the Labour party. Nevertheless, it need not be too late to save this Bill.

Even if agreement cannot be reached on those two points, I confirm that the Opposition will be happy to let the rest of the Bill, apart from part 1, go straight into law. Our aim throughout these proceedings has been to avoid damage to the national health service. We believe that our proposal responds to the concerns of a great many people who are worried about what this Bill will do to the NHS. If by any chance the time scale proves too tight to reach an agreed settlement before the House prorogues, we will of course be happy to set out the basis on which a new Bill could be introduced early in the new Session and given the swiftest possible passage through Parliament. In the absence of progress along the lines that I have indicated, however, we will continue to fight against this motion.

Photo of Frank Field Frank Field Labour, Birkenhead

My right hon. Friend was clearly right when he said earlier—although I would put it in slightly different language—that the two Houses must at some stage come to some agreement on this Bill. I want to make a plea to my hon. Friends, including my hon. Friend Mr. Hall, as to why we should use this opportunity to think again about our stance.

One of the most valuable things that the labour movement has given to this country is the NHS. The NHS now is a prisoner of our success. In every election that I have fought, I, and those who fought elections before me, knew that the NHS was behind our lines. It was untouchable. It had a Teflon defence. The defence was that although we loved this institution, it did not have the money to deliver the job. Therefore, whatever problems, difficulties or failures it presented to our constituents, we all knew that it could not do better. The great success of this Government is that the NHS now has more funds and a larger increase in funds than any other Government have ever provided or asked taxpayers to provide. However, by doing that, we have stripped away that great defence—the defence that the NHS, this great nationalised industry, cannot deliver in the way that our constituents want it to deliver.

With the NHS moving from behind our lines into political no man's land where it faces attack from quarters who could never before attack it, we have to judge whether this small part of the Bill, which is causing such dispute within and between parties, will answer one key question that our constituents will ask. When we go to the polls, will they have seen that the money that they have willed from their wage packets and purses has been used as effectively as possible to increase the performance of this body that we have moved from behind our lines into political no man's land?

Let us consider the Bill, and I ask my hon. Friends to examine one aspect of setting up foundation hospitals. Before the spring of next year, the larger hospitals must from nothing create an electorate. Some of them will be searching for up to 3 million voters. We can imagine the legal disputes from some of those factions in our constituencies if they are not successful should we have a vote. We know what would happen. We all know from this institution to which we are so committed—

Photo of Jim Knight Jim Knight Labour, South Dorset

Is my right hon. Friend against democracy?

Photo of Frank Field Frank Field Labour, Birkenhead

If my hon. Friend will allow me, I will continue as this is the first opportunity that I have had to contribute.

What will happen when we go to our local hospital to use it and look at the health side of its performance? Yesterday, I took my mother to St. Thomas's hospital. She had been some months before to see what was wrong with her heart. There was no follow-up appointment, so I phoned. Something had gone wrong, so we were given an appointment quickly—wonderfully. We then turned up and her file was there, but the results of the tests that she had had were not there. We had to wait while there was a search for those papers. The X-ray could not be found, so it had to be taken again. That hospital is under enormous pressure and it is trying to deliver a better service to our constituents and to our families, yet on the key issue of patient records this wonderful institution was losing things. If we pass the Bill tonight, we will also say to that hospital that it will have to set up an electorate. As well as trying to find and link papers to the patients who have come in for treatment, it will have to find up to 3 million people to take part in an election.

Of course, at some stage there will be a deal with the House of Lords. We are not quite sure what that deal will be. It will partly depend on our vote. However, I make a plea to Labour Members to maintain their opposition to the clause on foundation hospitals. I do not do that as someone who has opposed reform of the health service. Perhaps my Front Benchers found me annoying in suggesting ways in which we could be quicker in transforming this old nationalised industry into one that is responsive to consumer demand.

I pressed the Government to allow patients to go abroad, and 16 months later the Government, to some extent, conceded that. I asked them to take one target that everyone could see so that there would be no question of spin—that we would abolish day waiting lists before the next election and that we would bring in teams from abroad to achieve that objective. In doing so, we would break the Scargillite tendency among the consultants who have a vested interested in making sure that there are large waiting lists so that they can get private practice. There has been some movement, but precious little.

I speak and make my plea not as someone who has made the traditional defence of the NHS that we heard earlier. I believe passionately that, if it is to have a future, it is the Labour party's job to transform it from this old nationalised industry—the only nationalised industry for which the voters had any affection—to one that serves them in this new century.

Photo of Mrs Anne Picking Mrs Anne Picking Labour, East Lothian 1:30 am, 19th November 2003

I thank my right hon. Friend for giving way because many of his remarks seem to be directed at me. I was a nurse—a front-line public service worker—for all my days until I came to the House, so I know what it is like to do that job. Our debate is not about foundation hospitals any more because we have debated that issue and voted on it—my personal position did not win the vote. However, we are now considering the democracy of this House, which must be sacrosanct.

Photo of Frank Field Frank Field Labour, Birkenhead

I apologise if I was looking at my hon. Friend while making my remarks, but if she cares to look at the circle of hon. Members sitting around her, she will understand that it was more preferable to look at her than her colleagues. I was not sending her a personal message in any way because I accept her honourable position. At the end of the debate, I hope that we will all know that we voted in the way in which we believed to be right.

I disagree with my hon. Friend on one point—if I may look at her again. Although it is quite proper for her to say that we have made our point and that we should insist that the Commons prevail, there is quite a long time until the opening of the new Session next Wednesday, so a lot of haggling could go on. There must be agreement at some stage and that must be satisfactory to the Government. My only plea is that when we consider how we vote, we do not do that on the traditional grounds of defending the old national health service, which is passing from our midst.

I make a plea as an ardent advocate of modernisation. We will succeed only by modernising, but I cannot for the life of me understand how it can be in our long-term interest to push more hospitals down the route of having to encourage more of our constituents to vote for various boards, especially given that some people who are sitting not far from me find it difficult to explain how they will operate.

I end my speech as I began it. We have moved the NHS from behind the safety of our lines into political no man's land. The electorate's test will be how we use their money to improve the service that the NHS provides. Will foundation hospitals have any influence on that before the next election? It will take a great deal of the time of some of the cleverest people in the NHS to get the scheme off the ground, but I wonder whether it will make any difference to a single one of our constituents. On that basis, I hope that at least some of us will insist on opposing this part of the Bill.

Photo of Paul Burstow Paul Burstow Shadow Secretary of State for Health

I rise to respond to the Minister, because he tried to say that we had a straight choice—take the Bill or leave it. That is not the choice before us, because we are debating part 1, which sprang up fully formed without any consultation. It did not appear in the Labour party's manifesto at the general election and did not form part of the NHS plan.

The Government must understand—they have not addressed this worry at any stage during the Bill's passage—that the Bill will not ensure equity, or safeguard universality, in the national health service. It will not require decisions about foundation trust status to take account of their impact on the rest of the NHS on such hospitals' patches. It will not prevent a foundation trust from adopting a predatory approach towards non-foundation trusts in its neighbourhood, and especially towards services and staff.

We are talking about establishing an NHS in which competition, not co-operation, determines the form that it takes and how it progresses. The Bill confers a privileged status on foundation trusts in respect of borrowing and capital. The early wave of foundation trusts will have an easier ride when gaining access to capital at the expense of the rest of the NHS. The Bill still does not clearly deal with the cap on private activities within the NHS. The word used is "may", not "must". I urge Labour Members to read clause 15(1), which makes it plain that that is the case.

The House of Lords has considered foundation trusts a number of times. It has given us a chance to reflect on the issues again. I encourage hon. Members to take this opportunity to reject foundation trusts in the Lobby.

Photo of Desmond Turner Desmond Turner Labour, Brighton, Kemptown

I hope that Labour Members can divorce the debate from a confrontation either between Labour and the Opposition or between this House and the other place. The central issue is, if we insist on having foundation hospitals, will that advance the great Labour project, to which I fully subscribe, to improve public services and, in particular, to make the health service what we want it to be? In that spirit, I ask my Front-Bench colleagues to think again and my hon. Friends to think carefully about how they vote. I realise that the Government will probably carry the vote, but they should bear that request in mind.

My Front-Bench colleagues have regrettably failed to answer the serious criticisms levelled against foundation hospitals. The rest of the Bill does not depend on them and is acceptable to the House. I ask my Government to think again. I also ask my hon. Friends, who share my reservations, to stand by their concerns. Otherwise, I fear that we will be in danger of passing legislation that future Labour Governments—I am not worried about Governments of other parties—may wish we had not enacted.

Photo of Quentin Davies Quentin Davies Conservative, Grantham and Stamford

We have got familiar over the past five or six years with the fact that we have an arrogant Government. They always have to have their way. If they do not, they get petulant and bad-tempered. I am afraid to say that the Minister behaved like that. In that petulance and bad temper, they forget, or show less than regard for, our constitution. He said that the other place had no right to turn down the Bill, but of course it has a right to do that. Our constitution and the Parliament Act are clear on that point. The other place is entitled to use its constitutional powers. If the Government wish to do so, they can use the Parliament Act in the next Session, but they have no grounds for such petulant resentment at the other place for simply fulfilling its constitutional mandate.

The substantive question is whether the House of Lords is right to take the view that it has. No one who has taken part in the debates on this matter today can be in any doubt that on this issue we need the other place to take a different view. At best this is an extremely muddled Bill, and at worst it is thoroughly dishonest. Its whole premise—as the Government introduced it—is that foundation hospitals can enjoy some real benefits by achieving that status, but other hospitals will not suffer any disadvantages. That is an implausible proposition to begin with, but it has been clearly exposed today as bogus. We have learned that from the financial point of view it will be a zero-sum game. If the foundation hospitals are able to raise more capital, it will be pound for pound at the expense of the capital available to hospitals that do not have that status.

Photo of Quentin Davies Quentin Davies Conservative, Grantham and Stamford

The Minister of State shakes his head, but I doubt whether he will be brave enough to rise to contradict me. What I contend has been established beyond peradventure.

Another peculiar feature of the Government's propaganda on this subject is the claim that foundation hospitals somehow represent the recapture of hospitals for local democracy. In practice, all the powers will be drawn back into the bureaucracy by the regulator. Indeed, as the bureaucracy will determine which hospitals are allowed to become foundation hospitals, the Bill will increase centralisation, which is the exact opposite of the propaganda line. The Government have been disingenuous about the Bill.

The most dramatic revelation this afternoon was when the Secretary of State was forced to make concessions to his Back Benchers. He made contradictory and irreconcilable concessions to various groups in his own party. He told one group that if it did not like foundation hospitals, it should not worry because the Government would have a review after 12 months and possibly go back on the whole idea. However, he told another group—one that did not like the exclusivity of the concept—that all hospitals could become foundation trusts within four years. The Secretary of State does not seek to contradict me, and it is obvious that those two assurances contradict each other.

When incompatible, and I am tempted to say dishonest, promises are made on a Bill, it is important that the other place should take the opportunity to call a halt and say that we should not go ahead with it. Not only does the House of Lords have the constitutional right to take the view that it has, but it is clear from the way in which the muddle that the Government are in has been exposed by the debates today that the Lords are right. Thank heavens they have used their powers to ensure that the Government's contradictions and the Bill's shortcomings are laid bare. The House of Lords has done a great service to the country this evening. I hope that the other place will continue to stand firm and courageous, and send the Bill back again. If the Government have the courage of their convictions, they can use the Parliament Act in the next Session.

Photo of Kate Hoey Kate Hoey Labour, Vauxhall 1:45 am, 19th November 2003

I shall be brief. [Hon. Members: "Hear, hear."] Well, I may go on longer, if that is the attitude. The House of Lords has done what it has the right to do.

If we do not like what the House of Lords is doing, we have to change the constitution, because the current constitution gives the Lords that right. To be frank, I am pleased that, apart from the provisions relating to foundation hospitals, the Lords have made several other amendments that improve the Bill.

In my view, the Bill has no credibility. It has no real support within the national health service or in the country. I cannot understand why Ministers in my Government are not listening to what people throughout the country are saying. Their handling of this issue has been extremely short-sighted. Already in my area, thousands of pounds have been spent on a consultation exercise, not on the principle, but on the detail. That that has happened—that the money has been spent before the proposal has even been passed by Parliament—is quite disgraceful. The money being spent now and that will be spent in future could have been added to the money that the Government are already putting into our national health service.

We have an excellent trust in Guy's and St Thomas's. Members of the board live in the community and forums bring in people from all parts of the community. At every consultation meeting that I have attended, I have not seen a single hand rise in favour of foundation trusts. We are doing something that has no support in the country, and the Government will rue the day if the Bill goes through tonight.

Photo of George Young George Young Chair, Standards and Privileges Committee, Chair, Standards and Privileges Committee

Kate Hoey and Mr. Field have just had the courage to articulate reservations which we all know are widely shared by Labour Members. I hope that, even at this late stage in our debate, Labour Members will reflect on what those two Members have said. The first time we voted on this issue, the Government majority was 35; the second time, it was 17. At that rate of progress, the vote later on could be quite tight.

I say to the Minister of State, Department of Health, Mr. Hutton, who opened the debate, the issue is not whether the Bill reaches the statute book, as he implied; the issue before the House now is whether the Bill reaches the statute book with part 1, or without it. All the other beneficial measures in the Bill will go on to the statute book if, in a few minutes' time, the House agrees with the Lords in their amendments.

Two issues that have run through the debate this afternoon and evening remain wholly unanswered by the Government. The first relates to funding. If a foundation trust successfully raises money privately and uses those resources to construct a building that would not otherwise have been built, the consequence will be that another hospital does not get a building that was in the Government's plans, because the overall public expenditure ceiling cannot be breached. Every single addition, every single success scored by a foundation hospital, will be compensated for by a failure by another hospital. It is no good the Secretary of State pointing at his head. He and the Minister of State have had debates this afternoon and this evening to answer that point, and neither has done so.

Hon. Members:

Answer him!

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

I shall speak slowly, because even after three explanations, hon. Members obviously do not get it. It is quite easy for those who can do arithmetic. The envelope for capital expenditure is sufficiently big to contain all of the demands because, unlike the Conservatives, Labour is building up investment, not cutting it.

Photo of George Young George Young Chair, Standards and Privileges Committee, Chair, Standards and Privileges Committee

With the greatest respect for the Secretary of State, I have to say that that does not answer the point that has been made time and again, for the following reason: he will never be able to get from the Treasury the totality of the money that he would like to spend on the NHS. If foundation hospitals were to be allowed to spend in addition to the provision made, there would be some advantage in their creation, but I repeat what I said a few moments ago: every success by a foundation trust will be matched by another building for a hospital that is not a foundation trust having to be dropped from the plans. That is the charge that the right hon. Gentleman has failed to answer throughout the debate.

The second point was touched upon by the hon. Member for Vauxhall. The Secretary of State wants to make services more responsive to the needs of patients. We agree with that. However, he has democratised the wrong body. It is not hospitals that determine the shape or the volume of services that are consumed. It is the primary care trust that commissions the services from the hospitals. If the right hon. Gentleman wanted to make the NHS more responsive to local needs, he should have applied his corporate government measures to the primary care trust, not to the hospitals.

Some Labour Members are cautious about voting with the Opposition. I have voted with Oppositions in previous Parliaments when there were Conservative Governments. If a Government Member thinks that it is right to vote with the Opposition because he or she believes that the amendment under question is right, he or she should do so. It seems to be perverse to rebel if it is thought that there is no chance of success, but to pull back on the one occasion when there is a real prospect of making a change. I understand that Labour Members have cover from their party conference if they want to vote in favour of the Lords amendment.

If Labour Members want a satisfactory resolution—if they want all the measures in the Bill to reach the statute book but not part 1—they should vote with the Opposition. They know in their hearts that that is the right thing to do, and they should not listen to the bullying from the Secretary of State.

Photo of Tom Levitt Tom Levitt Labour, High Peak

I intervened earlier to point out how a Liberal Democrat Member was supporting foundation hospitals in her locality but voting against them tonight. I do not want to criticise her or to make political capital out of that, but she was right to support foundation status for the Stepping Hill hospital in Stockport. It is an up to three star hospital that requires two new operating theatres in short shrift. It is a hospital that needs to replace two more of its existing theatres within three or four years. Should that hospital have the right to decide when, where and how it replaces its operating theatres, or should it be a small fish in the big pool of Greater Manchester, never rising to the top and never being able to secure the operating theatres that it requires?

On behalf of the people of Stockport and High Peak, I want Stepping Hill hospital to be able to make its decisions about the services that it provides. The decisions on operating theatres would not be taking resources away from other hospitals and other trusts.

Photo of Mr George Stevenson Mr George Stevenson Labour, Stoke-on-Trent South

Has my hon. Friend given any consideration to the effect that his argument would have on North Staffordshire hospital trust and not the foundation hospital?

Photo of Tom Levitt Tom Levitt Labour, High Peak

I grew up in north Staffordshire and I had treatment in north Staffordshire hospitals, and I sympathise with my hon. Friend. I am explaining why no other hospitals will suffer because of my local hospital getting extra facilities.

Mr. Davies explained how he did not think that the model worked. He is living in the past. As long as there is more money going into the health service, conditions will not worsen in non-foundation hospitals. He is right in his analysis if there are cuts in the health service, as there were under Tory Governments in the past and as there would be under future Tory Governments. That is when his model would work.

I say to my hon. Friend Kate Hoey that there are plenty of Vauxhall voters on the Government Benches. We have been listening to her extremely carefully.

Photo of Tony Baldry Tony Baldry Chair, International Development Committee, Chair, International Development Committee

In their own interests, Labour Members should reflect on whether today will be their NHS poll tax. I shall explain why.

In Oxfordshire, we have the Oxford Radcliffe NHS trust, which is a low starred trust. That is through no fault of the staff, the doctors or members of trade unions who work there. There are many structural reasons involving the bringing together of hospital sites and the Oxford teaching hospital. However, the hospital produces some very good medicine. It is a no-star trust, so it has little chance of becoming a foundation hospital. That is exactly the sort of hospital that should receive help from the Government, yet it will not.

The Nuffield Orthopaedic Centre up the road has the highest star rating and will be in the first wave of hospitals to get foundation status. Unto them that have will be given, and from those that have not will be taken away even that which they have. Nurses working at the Nuffield Orthopaedic Centre in one part of Oxford will be paid more than nurses working in the Oxford Radcliffe Hospitals NHS trust. Where is the equity in that? Where is the national health service in all that? The measure is a totally unfair way of proceeding. If Labour Members believe that that—

Photo of Tony Baldry Tony Baldry Chair, International Development Committee, Chair, International Development Committee

No, I am short of time.

If Labour Members believe that that is the way forward for the national health service, they will seriously regret that they put part 1 into legislation, if that is what they choose to do.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

As somebody who has worked in the NHS for rather a long time, I am dedicated to it as a service for the patient. I agree that it is vital to decentralise control, but the proposal is the wrong way of decentralising services. It is wrong because it drives a wedge between primary and secondary care, and between hospitals, at exactly the time when the Government are looking for partnerships, collaboration and networking. It is ill thought out because of the lack of patient forums, at exactly the time when the Government are trying to improve patient and public involvement in health. I do not believe that the members of boards of governors of foundation trusts will be entirely independent of their executives.

There is an alternative way. One has only to go back 17 of the 18 re-organisations that we have had in the past 20 years, to local district health authorities, which had locally elected members in the form of councillors, representatives of local bodies, a locally elected consultant and a locally elected GP, to see that they worked. With the resource management initiative that was abolished almost as soon as it was drawn up, they would have produced an efficient service. Even now, the Commission for Healthcare Audit and Inspection would have been able to prove that those organisations were living within their means or were underfunded.

I would like us to forget about foundation trusts and consider other reforms while there is still time. A vote against the Government is not a vote against decentralisation; it is a vote against the wrong sort of decentralisation.

Photo of Kenneth Clarke Kenneth Clarke Chair, Tax Law Rewrite Bills (Joint Committee), Chair, Tax Law Rewrite Bills (Joint Committee)

I hope I have a chance to remind the Secretary of State, who appeared to believe the reply that he gave to my right hon. Friend Sir George Young about the effect of the financing of foundation hospitals on other hospitals, that that was not the view of his predecessor. When foundation hospitals were proposed, it was not the intention to cap capital spending. Borrowing was to be enlarged. It was the Treasury that insisted on a cap. Why does the Secretary of State think the Treasury insisted on putting a cap on capital spending, if there is now unlimited funding, no choices to be made, and all can have the investment that they wish? It was the Treasury that insisted that capital investment in foundation hospitals would be at the expense of other hospitals. He cannot seriously deny with a straight face, even at this hour of night, that he has lost that argument and several others as well with those in another place.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health 2:00 am, 19th November 2003

I have a considerable respect for the right hon. and learned Gentleman, but there is one significant difference between the position that he faced and the position that we face now, which is that there is an increase in investment—[Interruption.] Opposition Members may not like it, but the difference between the Tory Government cutting the capital investment envelope and a 7.4 per cent. real-terms increase for five years means that every feasible application for capital requirements, even counted against the envelope, can be met under the Labour Government, while they were consistently refused under the cuts of the Tory Government. That is the point.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

The Treasury insisted not on a cap, but that any borrowing made by the foundation trust counted towards the general envelope. [Interruption.] That is not—[Interruption.]

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

That is not an individual cap for a hospital; it is—[Interruption.]

Photo of Michael Lord Michael Lord Deputy Speaker (Second Deputy Chairman of Ways and Means)

Order. I remind the House that these are serious matters, and they must be dealt with accordingly. May I also remind the Secretary of State that he is intervening?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

My intervention would be briefer if Opposition Members were prepared to accept the answer for which they have constantly asked. There is not an individual cap on hospitals, foundation trusts or otherwise—

It being one hour after the commencement of consideration, Mr. Deputy Speaker put the Question already proposed from the Chair, pursuant to Order [this day].

Question put, That this House insists on its disagreement with the Lords in the said amendment:—

The House divided: Ayes 290, Noes 249.

Division number 388 Health and Social Care (Community Health and Standards) Bill — Clause 1 — NHS Foundation Trusts

Aye: 289 MPs

No: 248 MPs

Ayes: A-Z by last name

Tellers

Nos: A-Z by last name

Tellers

Absent: 117 MPs

Abstained: 1 MP

Absents: A-Z by last name

Abstaineds: A-Z by last name

Question accordingly agreed to.

Lords amendment No. 1 disagreed to.

Government amendment (a) in lieu of Lords amendment No. 1 agreed to.

Lords amendment No. 161 disagreed to.

Government amendments (a) to (bb) to the words restored agreed to.