Health and Social Care (Community Health and Standards) Bill

Part of the debate – in the House of Lords at 12:30 pm on 6th November 2003.

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Photo of Lord Warner Lord Warner Parliamentary Under-Secretary, Department of Health, Parliamentary Under-Secretary (Department of Health) 12:30 pm, 6th November 2003

My Lords, it has been a colourful debate: we have had reference to ships and barnacles and gothic architecture and buttresses. It has also been a pretty synthetic debate as regards contributions from some parts of the House. I am grateful for the wise and balanced contributions from my noble friends Lord Desai, Lord Hunt, Lord Dubs and Lord Turnberg, from the right reverend Prelate and from the Cross Benches, particularly the remarks of the noble Baroness, Lady Finlay. I am also grateful for the temperate and balanced response from the noble Lord, Lord Blackwell. I hope that I shall be able to detach him from his party, having heard what I have to say.

I wish my noble friend Lord Lipsey a speedy recovery despite his remarks. I share his views on the staff at St Thomas's hospital and on NHS staff generally, but not those on the Government's arrangements. I doubt whether I shall change his views with my advocacy. We shall not have time during this debate to go through the details of this group of amendments.

As I said, I believe that there is a synthetic quality to this debate. The Conservative opposition say that they believe that our approach is fundamentally right, but our proposals on NHS foundation trusts do not go far enough. They are in alliance with the Liberal Democrats, who believe that they go too far. From these totally different perspectives they want to combine to wreck a core element of the Bill, the establishment of NHS foundation trusts. Talk about my enemy's enemy is my friend!

The biggest would-be wreckers are the Conservatives, who do not appear to be content with deleting Clause 1. They appear to want to remove the whole of Part 1 of the Bill. At least the Liberal Democrats have confined themselves to Clause 1. It may be that they want the image of a mini-opposition. The noble Lord, Lord Clement-Jones, is reported in the Independent today as saying that we are cack-handed. But lining up with the Conservatives on this issue hardly seems to be a masterpiece of political coherence.

Perhaps I may briefly remind noble Lords opposite that the NHS needs a huge level of investment after the long period of neglect by the party opposite. It certainly looks as though the NHS would return to that parlous state if the new Conservative leader, crowned today, I believe, ever reaches No. 10 Downing Street. We have invested about £8 billion in capital since the 2000 NHS Plan, that is to say, over the period 2000–01 to 2003–04, and we are increasing revenue expenditure by over 7 per cent a year in real terms for five years in succession.

The noble Earl, Lord Howe, brushes these considerations aside and asserts that the needs of foundation trusts would deny the rest of the NHS access to the huge amount of extra money that we are providing. That is simply not true. If the foundation trust applicants remained as NHS trusts they would still be competing for the enhanced resources with other NHS trusts. There would be a priority system in that capital allocation process. We have not changed the rules of the game in that respect; all we have done is to give foundation trusts far more freedom.

The idea that we are damaging the NHS through this Bill and that the Conservatives are the saviours of the NHS by wrecking it will convince very few people other than their own supporters, whose morale needs to be maintained. Our huge investment in the NHS has to be accompanied by modernisation and reform with far greater local freedoms for the NHS at its heart. My noble friend Lord Hunt has put the case extremely well.

NHS foundation trusts bring these local freedoms, but removing Clause 1 would prevent that. We know that local staff and communities have often felt disempowered by top-down control of the NHS while a lack of local accountability has impeded local services being properly attuned to the differing needs of their communities. These are the important considerations to which the right reverend Prelate was alluding when he spoke about trying to produce the most satisfactory ethos for the NHS.

The scare-mongering approaches that I read in the paper and which were mentioned by others today, whipping up arguments about extremists in the BNP taking over boards of governors, do them no credit. We have brought in safeguards against that. It will also be possible to make further amendments in regulations, as I believe is well known. That is why I referred to the synthetic quality of some of the debate.

The party opposite does not appear to want local people to have a bigger say in how the NHS is run although it claims to want to have local sheriffs. If the noble Lord, Lord Clement-Jones, wants to improve the governance arrangements he should settle down with us today and tidy up Schedule 1 rather than endlessly looking for reasons for not trusting local people to have a bigger say in the NHS.

The creation of NHS foundation trusts is part of the process of moving from an NHS controlled nationally towards an NHS where standards of inspection are national, but delivery and accountability are local, with far more diversity of provision including the involvement of the private sector, offering more choice to patients. That will create the kind of beneficial ethos that the right reverend Prelate was rightly concerned about with far more local involvement by staff and patients in their local healthcare system.

The noble Lord, Lord Walton, and the noble Baroness, Lady Finlay, rightly drew attention to the concerns of the healthcare professions. These changes will give them far more autonomy and freedom than there is at the moment. They will have a bigger say in the way in which their local NHS is run. Despite whingeing about excessive control, throughout the consideration of this Bill some of the parties opposite have consistently wanted to stop the devolution of power, if their amendments are to be believed. They are certainly giving out the message to all those applying for NHS foundation trust status that their views and preferences do not count.

Perhaps I may turn to that point and remind noble Lords opposite of what I said on the first day in Committee. As we speak, 25 NHS trusts are consulting on proposals to apply for NHS foundation trust status from next April. Now, another 32 have applied to be considered in the next wave. They include many deprived areas where healthcare systems can be better adapted to local needs. If all those applications were successful, more than 25 per cent of the population in England would have access to NHS foundation trusts by the end of 2004. We have said that there is no reason why all NHS trusts should not achieve NHS foundation trust—