My Lords, like the right reverend Prelate—and, I suspect, many others in the House—I face a real dilemma over the Bill and the clause, a dilemma that was not helped by our discussion in Committee. I am not one of those who opposes the concept of foundation hospitals in principle; to the contrary, in concept it is a welcome first step in dismantling what, it is generally recognised, has become an inefficient state-managed monopoly. I welcome the fact that the Government have crossed the Rubicon by recognising that such command and control state management cannot deliver the health service that we want and that it must, sooner or later, be dismantled.
Indeed, I look forward to the day when all hospitals and other parts of the health service become independent. I am not too bothered by the argument that that will create a two-tier structure, because it should be possible to move all hospitals to independent status sooner rather than later. I should welcome an assurance from the Government that that is their goal.
As so many noble Lords have said, the trouble is that the proposals are flawed. The notion of a foundation hospital as an independent institution able to run and manage itself to serve the local community with medical practices at the forefront has been hobbled by the level of regulation proposed under the Bill, the financial restrictions to be imposed and the layers of government and the political interference to which the noble Lord, Lord Lipsey, referred so well.
So the proposals are highly flawed. The question in my mind is whether, nevertheless, they are a useful step in accepting the principle of independent provision of healthcare on which a future government can build.
I have a second point. As other noble Lords have said, hospitals are only part of the equation. The far more important part of reforming the health service is freeing up the purchasing of healthcare.
In Committee, I and others tabled amendments to test whether the Government were willing to accept that PCTs—commissioning units—should also be able to apply for foundation status. Those amendments were unacceptable to the Government, but I was encouraged by the response of the noble Baroness, Lady Andrews, to the noble Lord, Lord Clement-Jones—on Clause 5, I think—that the Bill does not restrict PCTs from applying for foundation status although, in fairness, she made it clear that the Secretary of State would not look favourably on that at present. I hope that I was right about that and that the Minister can confirm it when he comes to reply.
So, if one feels that a fundamental shift of the NHS provision structure from being a state-managed monopoly is the way to go, there are reasons to believe that the concept behind the Bill is worth supporting. As I said, the dilemma is that the current measures are deeply flawed. Like others, I shall listen carefully to hear whether, even at this late stage, the Minister suggests that the Government are sufficiently flexible and responsive to listen to those voices from all sides of the Chamber who say that there is a better way to do this, while maintaining the principle embodied in the Bill.