§ The Secretary of State for Health (Mr. Alan Milburn)
The Health and Social Care (Community Health and Standards) Bill published on 13 March sets out our legislative proposals for NHS foundation trusts. Subject 747 to Parliament, I expect that, in four to five years, every NHS hospital will have the opportunity of becoming an NHS foundation hospital.
§ Mr. Mackay
As the Secretary of State will be aware, Conservative Members strongly support foundation hospitals, so we were concerned to note that at least 115 of his Back-Bench colleagues have signed an early-day motion criticising them. Will he explain to the House why he has so singularly failed to sell his policy to them?
§ Mr. Milburn
I suppose that I should say that I am grateful to the right hon. Gentleman for his support. However, there is a small matter of difference between him and me on foundation hospitals, as he calls them: I believe that those hospitals should be part of the NHS. They should have greater freedom, greater local control and greater local accountability, but none the less they should be subject to national inspection systems and, most importantly, to national standards. Indeed, what is very obvious every time Conservative Members talk about foundation hospitals is that they use those two words, but they fail to mention the three words that are important: national health service.
§ Mr. Lindsay Hoyle (Chorley)
Obviously, as a person who has been treated by an NHS hospital—I received remarkable treatment at St. Thomas's—I can only congratulate the NHS on the service that it provides, and that is without foundation hospital status. If my right hon. Friend pursues the foundation hospitals policy, will he ensure that all hospitals can apply for that status and that real consultation will take place with the staff, patients and trade unions before we venture down that road?
§ Mr. Milburn
My hon. Friend is absolutely right. Incidentally, I wish him well and I hope that the other knee survives. When he reads the Bill he will see that we set out the process of consultation in it. If proposals are to come forward from NHS trusts that want to become NHS foundation trusts, they must have the local community on board. Clearly, it will be important to consult local Members of Parliament and elected local councillors, but equally, it will be important to consult local staff and other parts of the local health community: most notably, primary care trusts.
I can give my hon. Friend the undertaking that he seeks: our ambition has always been to try to raise standards of care in every single NHS hospital. We do not want a two-tier service, and we certainly do not want to pursue a sink-or-swim policy. That is why I believe that it is necessary to provide extra help and support so that every hospital, over a four-to-five-year period, has the opportunity to become an NHS foundation hospital.
§ Mr. Peter Lilley (Hitchin and Harpenden)
Will foundation hospitals be subject to the remorseless process of centralisation, mergers and closures being carried out by strategic health authorities across the country?
§ Mr. Milburn
Strategic health authorities, under the proposals contained in the Bill, as the right hon. Gentleman will see when he reads it, lose their powers of 748 direction—effectively, my powers of direction—over NHS hospitals. I believe that that is right. Although it is absolutely necessary, for equity purposes, to ensure that appropriate standards in the system apply in all parts of the country, ultimately, health care is delivered locally, not nationally. If we are to have better local health services capable of dealing with specific local problems in local communities and tackling some of the appalling local health inequalties that exist in our country, and which have been widening for decades, it is necessary to put local staff and local communities in charge of the hospitals that serve them.
Mr. David Hincbliffe (Wakefield)
In evaluating the expressions of interest in foundation status that have been received so far, what steps have been taken by the Government to establish whether there is genuine local community support at this stage for foundation trust status beyond a handful of very ambitious NHS managers?
§ Mr. Milburn
We will do precisely that. To continue the conversation that my hon. Friend and I had in the Health Committee a week or so ago, it will be extremely important, when I assess the proposals that come forward from NHS trusts that want to become NHS foundation trusts, that they genuinely demonstrate that they have support, not just in the local hospital but in the local community, too. That will be important because, ultimately, those hospitals will become owned and controlled by the local community. I want to ensure that as wide a range of stakeholders, and as many people in the local community and among local staff as possible, are involved in this process from the outset.
§ Dr. Liam Fox (Woodspring)
In the Prime Minister's speech and subsequent article, "Where the Third Way Goes from Here", he says that we mustset the parameters for the future partnerships we will need between tax-funding and personal contributions".Does that mean that in foundation hospitals and elsewhere in the NHS, the Government are considering co-payment?
§ Dr. Fox
How very interesting, because in the next paragraph of the article, the Prime Minister says:We should be opening up healthcare for example to a mixed economy … and be willing to experiment with new forms of co-payment in the public sector.Does that not entirely torpedo what the Secretary of State has just said?
§ Mr. Milburn
No, because, unlike the hon. Gentleman, I have read the whole article, not one section of it, and what the Prime Minister was clearly talking about was our proposals in relation to tuition fees. It is the hon. Gentleman who is making proposals for co-payment. Just this weekend, he went out of his way to suggest that the future of Conservative party policy on health care is clear. He wantsa pay-as-you-go market where patients pay for a single procedure or item of care. 749 That may be the Conservative policy for the future of health care. It is not Labour's policy.