Health and Social Care (Community Health and Standards) Bill

Part of the debate – in the House of Lords at 1:02 pm on 6th November 2003.

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Photo of Earl Howe Earl Howe Conservative 1:02 pm, 6th November 2003

My Lords, I tabled this same amendment in Committee and was pleased that the idea underlying it, if not the amendment itself, found some favour with the Minister. He kindly said that he would think about the matter further, and he has just referred to that.

My views and those of the Government on what is a sensible and appropriate governance model for foundation trusts are poles apart and are likely to remain so. But we might be able to agree on two points: first, this is brand-new ground for the NHS, and foundation trusts may not get things right first time. Secondly, if it is left to foundation trusts to devise their own systems of democratic governance, we are likely to see a patchwork quilt of arrangements spreading out all over the country. Local flexibility is one thing, but what if the results are flawed or in some way unfair?

We have been told by the Minister that a review of governance arrangements will be carried out by the regulator after the first wave. That is of some comfort. However, I cannot help thinking that for those trusts, a review is likely to be a little late. How would a foundation trust be expected to put its arrangements on to a different footing if those arrangements were found wanting in some way? What would that do to the legitimacy of the board of governors and the directors? I suspect that at present there is no real answer to that. It would be helpful if the Minister could tell us what specific ideas he has had for ensuring that governance arrangements across foundation trusts are fair and that they work as well as they can. That is the concern here.

I welcome what the Minister said about the Joseph Rowntree Foundation, which is an excellent organisation. However, we may need to go further than that. If there is to be a role for the regulator in looking at these issues, I wonder whether that should not be on the face of the Bill. I beg to move.