My Lords, I hope that noble Lords will not follow the advice of my noble friend Lord Lipsey. I have tremendous admiration for him and I am delighted that he has taken part in our debates on the National Health Service because he brings a very refreshing intellectual mind to bear.
This is a very important reform for the National Health Service. It would be devastating if the House were to reject the whole concept of foundation trusts and if that were to be confirmed in another place. We cannot continue to run the health service as we have done for 50 years through a command and control approach, with Ministers supposedly held to account by Parliament for every aspect of the running of a huge organisation. By 2008 the NHS will spend over £90 billion. It employs 1.2 million people and has a management structure that makes it impossible to run effectively and efficiently, with the ludicrous concept that everything that happens in the NHS is, in the end, forced to be held to account in this place and another place.
Such a situation leads to the fact that we have had so much restructuring over the past 20 years. I see a number of noble Lords in their places who have had a hand in that restructuring, including myself. It has lead to the concept of targets, targets and targets, central interference and micro-management. The very people to whom one wants to give space to run the health service effectively at the local level are disincentivised; their morale breaks down because they cannot carry out an effective job in the quite ludicrous over-centralised structure that we have.
The whole point about foundation trusts is the transfer of accountability from Parliament to local people. That is why the issue of democracy is so important. I say to my noble friend, having had a small role in the development of that policy, that the idea of democracy was not tacked on at a later stage. It was at the heart of the whole process when the policy was devised. Responsibility cannot be transferred from national level to local level without a transfer of accountability as well. To be accountable locally a democratic base is needed. That is why a membership structure is required for those foundation trusts that will enable the transfer of accountability to take place.
It is true that I, too, have had concerns about the Government's structure. I have made that clear on a number of occasions. I, too, do not understand why the board of governors is not the sovereign body in this legislative programme. I have never received a convincing response to that point. I share with the noble Lord, Lord Peyton, concern about the huge groupings. I can assure noble Lords that I intend to speak fully on my amendments in those groupings and I shall expect a full response. However much Front Benches may try to curtail debate and try to sort out the timing of votes, as individual Members we are permitted to debate our own amendments.
Here we are talking about the substance of the debate on foundation trusts. There are faults and flaws in the legislation, but my noble friend Lord Warner, in Committee, responded—I think very positively—to many of the points put forward. The noble Earl, Lord Howe, is a very fair person and often he acknowledges the fact that the Government have moved on many issues. I put to him this point: I would understand a principled opposition to the issue of foundation trusts if, in Committee, my noble friend had simply pushed away all the issues and concerns that had been raised. But he has been generosity itself. Not only does he bring forward today a swathe of government amendments responding to points raised, but he also accepted in Committee a number of amendments that improve the governance structure. On that basis, that is fair dos. I ask noble Lords whether they really believe, in the light of that flexibility, that it is in the tradition of the House to reject the whole concept of foundation trusts.
At the end of the day, if we want an excellent health service, we need to give those running the health service locally the responsibility and the trust to do a good job. Surely foundation trusts are one major way to do that. I hope that the House will support the concept.