Health and Social Care (Community Health and Standards) Bill

Part of the debate – in the House of Lords at 11:45 am on 6th November 2003.

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Photo of Lord Dubs Lord Dubs Chair of Labour Peers 11:45 am, 6th November 2003

It happened. Those of us who still remember will know what it was like. One has to put the arguments as well as one can. I do not want to make this in any way personal, but I have to say that the noble Earl, Lord Howe—who is reasonable, balanced and measured—had to use arguments that came to a conclusion with which, I do not think, he fully agreed. I am surprised at that. He could well have reached a different conclusion and supported the idea. Anyway, I do not want to make it a personal point.

The local management argument is crucial. When I served on an NHS trust, the welcome change from the old AHAs was precisely that we, as non-executive directors, got nearer to where management was. Those of us who remember the AHAs will remember that we did not have a chief executive. We had an administrator, a chief medical officer and a chief finance officer. Occasionally, as members, we asked questions. Those three would look at each other, and it was difficult to pin down accountability. Yet, they were all excellent high-calibre individuals. With hospital trusts, we, as non-execs, got nearer to the management issues. I certainly felt that we unearthed a history of not much management before the trusts. Management matters had been neglected. Yet, when we wanted to make key decisions, we were stymied because we had to go through the region and the department.

I give an example. The mental health hospital trust of which I was a non-executive director had a great deal of land which we did not need any more. We wanted to dispose of it. We could dispose of it, but the money would go to the region or the department. We would not get the money, even though there was a cost to us in selling the land and transferring services from that land further into the community. We were stymied. I thought, "I hope that the day will come when we can make local decisions and benefit from them ourselves, not do so with no benefit—in fact, as a burden—to us".

When I heard about foundation trusts, I thought, "If that brings management to the level at which it can be effectively exercised, that must be a good thing". That is why the Government's proposals are right and I am unhappy with the amendments. Yes, of course there are concerns about governance. There have been ever since the NHS began; we have always been unhappy about it. This is a move in the right direction. We may later discuss points of detail that the Government must consider, but essentially, it is right.

I say that because when I was a member of an area health authority, I was a local councillor. I felt that I was local; my ward was within the health authority area; I was confident that I spoke for the needs and concerns of local people. That gave me a strength that I did not have when I was on the board of an NHS trust, where I did not have quite that sense of local accountability. If we can get more accountability into governance, that must be a good thing.

In conclusion, for all the difficulties that have been described about foundation trusts, they will give us a good chance to make the NHS better for the people that matter: the patients.