These are probing amendments. They seek to explore ministerial thinking on the role that the foundation trusts will have in promoting involvement in the local community. The amendments are based on my experience in the co-operative movement. In my previous employment I dealt with a vast range of co-operative and mutual organisations. Their rules were based on a standard template, but there were amazing variations in the ways in which they were interpreted and in the levels of public involvement that arose from them.
Some co-operative societies took their membership role seriously and were very active in promoting community participation over a range of activities. By and large, there was a relationship between the success of each society and the level of member involvement. Others allowed their membership involvement to atrophy and, to a certain extent, were run by what I can only describe as self-perpetuating oligarchies.
It is obvious that the Government do not want the latter to happen. It would interest me to know exactly how they will obtain the maximum level of participation, which is essential to success.
Inner-city areas have their own problems. My constituency, which is probably quite similar to that represented by the Under-Secretary, is characterised by an unusually high percentage of relatively low-income and elderly people, and an unusually low level of car ownership and mobility. These are obvious issues in terms of foundation hospital trust involvement with the local community. This group has a potentially high level of need, but is potentially inaccessible to the various mechanisms that the
hospital trusts will need to operate to promote membership involvement.
Similarly, 15 per cent. of my constituency comprises ethnic minority communities of varying origin. Many of them are elderly, first-generation immigrants with a lower than usual level of literacy. There are obvious barriers to communication between them and the hospital trust, although their need as a group may well be far higher than that of others in the community.
We have already discussed entryism and the running of these trusts by '' the sharp-elbowed middle classes''.
The most effective way of countering this is for hospital trusts to have a policy and to develop relationships with genuinely representative groups in the community that will promote membership from as wide a range as possible. I look forward to the Minister telling us what exactly will be expected of trusts in those areas.
Amendment No. 217 also draws on my experience in the co-operative movement, and on my personal experience. The hon. Member for Westbury (Dr. Murrison) spoke about district hospitals being at the glamorous end of the service. I am sure that the professionals involved believe that to be true; however, for a humble layperson such as I, hospitals can be quite frightening. I must confess that I have always regarded them as a rather uncomfortable reminder of my own mortality and have tried whenever possible to avoid using their services. I confine my involvement with them to that which is commensurate with my professional responsibilities.
Last year, however, I had to bow to the inevitable and go to my local district hospital at Sandwell—it was subsequently declared a three-star hospital, although it is not in the first wave of applications—for major hip surgery. I assure hon. Members that as one lies on one's bed, nuzzling one's oxygen mask and caressing one's morphine drip, one has time to reflect on the benefits of the NHS. One also marvels at the huge range of professional skills that are needed for an effective hospital service. If one is not directly involved, one tends to think solely of doctors and nurses. Of course, many other skilled professionals are involved; radiologists, anaesthetists, physiotherapists and many others.
Many nationalities are involved in running the health service; I counted eight different ethnic origins. It struck me that people knew very little about their local district hospital unless they were involved either as a patient or as a professional. The new foundation hospital trusts could provide a valuable educational role in disseminating such information.
There must also be a means of monitoring how well hospitals are working with primary care trusts. Every area has its own health needs. In my area, low birth weight is a concern, as is the higher than normal incidence of early death from cancer and from heart disease, which is typical of inner-city post-industrial areas. In the first instance, that should be dealt with by primary care trusts, but services must be dovetailed with local foundation hospitals. Providing information on how that is to be done is essential in formulating a
comprehensive, effective health-care policy in the community.
The amendments are designed to promote the involvement of everybody so that health-care policies are truly reflective of the local community.
I support the Government in taking great steps to engage hard-to-reach groups. The hon. Gentleman's amendments would ensure that trust membership would give such groups access opportunity, and they are therefore to be applauded.
I thank the hon. Lady for her kind words. The best way to ensure that inclusiveness results in the most effective policies is to ensure that appropriate information is available and that public awareness is raised about the running of hospitals. I hope that the amendments will achieve that.
I support the amendments of my hon. Friend the Member for West Bromwich, West (Mr. Bailey). One of the main attractions of foundation hospitals is that they offer direct democracy and truly put the ''public'' back into public ownership. Fundamental to the democratic elements of foundation hospitals will be a thriving, active and substantial membership.
I am tempted to look to my experience of local hospital issues and to reflect in particular on the experience of Mount Vernon hospital, which serves the northern part of my constituency. Had foundation hospitals existed in 1995, when the Conservative party did not oppose proposals to close the hospital's much loved and important accident and emergency unit, we would have been able to stop its closure by sweeping the board of directors out of office for having allowed such a horrendous proposal to have been introduced.
I am sorry, too, that foundation hospitals were not legislated for two years ago. Had they been, Hillingdon hospital NHS trust, which now controls the Mount Vernon site, might have had foundation status and could then have rejected outright the daft proposal introduced by Bedfordshire and Hertfordshire strategic health authority to move the cancer centre from the Mount Vernon site to the deepest, darkest corners of Hertfordshire. That would have spared my constituents much angst. However, I am delighted to say that there has been significant movement on that issue. The North West London strategic health authority is seriously considering whether the cancer centre can be retained to serve the needs of north London, perhaps as part of a wider cancer network. I welcome that.
I hope that in this case good sense will prevail. I am optimistic that a combination of good sense on the part of the strategic health authority and the power of local people's campaigning will achieve the result that the local community wants. In a case such as the one to which I have just referred, a thriving membership and active work by the local foundation hospital would not be necessary, because people would flock to join. Foundation hospitals generally need to take a much more active stance by recruiting a membership that reflects the community.
My hon. Friend the Member for West Bromwich, West mentioned the mutual sector's considerable experience of recruiting and servicing large memberships. I am sure that foundation hospitals can learn lessons from that experience. The point of the probing amendments is to stress that membership recruitment must not be optional. It must be taken as seriously as the other requirements of achieving foundation status.
Amendment No. 216 envisages that making the active promotion of membership recruitment a legal duty would help to lock the issue into the minds of the key players in foundation hospitals. Amendment No. 217 seeks to enable members to have access to the information they need in order to play a proper part in running their local hospitals. The amendments are probing amendments, and I look forward to my hon. Friend's response.
I am delighted to hear from the hon. Members for West Bromwich, West and for Harrow, West that the two amendments are intended to be probing. I hope that the Under-Secretary, in considering them—and those that follow in the name of her hon. Friend the Member for Ealing, North (Mr. Pound)—will ensure that foundation trusts do not end up being required to produce an endless stream of reports, many of which no one will ever read and will impose significant burdens of time and bureaucracy on their medical teams.
I am delighted to welcome the points made by my hon. Friends the Members for West Bromwich, West and for Harrow, West. Both have extensive experience in the mutual movement, and I am sure that they can usefully and constructively inform our principles and practice in the matter. That will be crucial. My hon. Friend the Member for Harrow, West has, this year, done a magnificent job as president of the Co-operative Congress and has made a useful contribution.
By establishing NHS foundation trusts, the Government are trying to create a new system of democratic involvement. We are progressing from consultation and engagement into direct elections, and that is a significant move. We have made it clear that we want the process to be as inclusive as possible, and my hon. Friends the Members for West Bromwich,
West and for Harrow, West referred to hard-to-reach groups, as did the hon. Member for Cheadle. I sometimes take issue with that phrase; if we engage in relevant issues, people will respond. People are sometimes hard to reach because we do not speak a language that they understand or because the issues are not close to their concerns. However, if local people have a real stake in an issue, they will respond and will want to participate, even if there are difficulties with mobility or language. I accept the points about ensuring that we support people with transport and translation of material, and that everything is as accessible as possible.
That is why we are determined to learn from the various groups involved. We have mentioned the external reference group, which comprises people from mutuals, from the Economics Foundation, and people from universities who are experts in drawing different groups into public involvement. Moreover, we have the experience of the Oxford, Swindon and Gloucester Co-op, which has a magnificent record on increasing active membership and which has made great strides in recent years. We can learn from the Royal Society for the Protection of Birds and the National Trust, each of which has an active and thriving membership. We should not rule out help from any sector.
We do not do this simply because it is the right thing to do. Hon. Members will recall the Wanless report on funding for the long-term future of the health service. In one of the report's scenarios, the public would be fully engaged in influencing health care, taking more responsibility for their own health and using technology to do so. Wanless saw that as the way to make our services much more responsive and to prevent the enormous rise in the cost of health care. Therefore, not only is it the right thing to do, it makes economic sense.
The amendments support the recommendation in the Select Committee on Health's report that foundation trusts should proactively attempt to extend registration to achieve real and representative community engagement. I agree with the Health Committee's sentiments and with the principles of the amendments tabled by my hon. Friend the Member for West Bromwich, West. The difficulty is that, as drafted, the amendments simply require reports to be presented; there is no corresponding duty on NHS foundation trusts to carry out active membership work. The effect desired by my hon. Friend would, therefore, not be achieved.
I am more than happy to consider these issues further and, if necessary, to make further proposals.
I am sorry to impede progress, Mr. Atkinson, but it will only be for a moment. I simply want to ask the Minister a question about clause 10. Returns sent to Companies House include a whole series of financial information, and details of the
directors are contained in the annual report. It will not surprise the Minister to learn that the disclosure of directors' home addresses is a matter of importance in Cambridgeshire, because of the work of Huntingdon Life Sciences and all the issues that flow from it.
I am not going to dwell on all the problems associated with that. My question is simply this: will the disclosure requirements for directors' home addresses in relation to NHS foundation trusts be the same as for company directors, with the same exclusions as company directors, given that there are proposals—and others might be made—for work in other research facilities in the Cambridge area, some of which use animals? The question might arise in relation to the directors of an NHS foundation trust. What do the Government intend to do?
The hon. Gentleman has raised an important point. Clearly the situation has caused a great deal of distress to many people. My understanding is that the names of the directors and an address where they can be contacted, which would not necessarily be their home address, would be required for the register. That will meet the requirements of public accountability, but at the same time will provide a degree of protection.
Question put and agreed to.
Clause 10, as amended, ordered to stand part of the Bill.