John Redwood

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Local Hospitals Debate

Mr. John Redwood (Wokingham): I have declared my interests in the register.

The test I apply to a health policy is this: will it be good for myconstituents? I am a strong supporter of the NHS and its principles. I wantall my constituents who need health care to get access to it in a timelyway. I want them to receive high-quality care that is free at the point ofneed and use. I regret the way in which such debates are characterised byLabour Members, who make futile and inaccurate attacks on the Conservatives.Many of us are children of the NHS. We have received our care and attentionfrom the NHS when we have needed it. The Conservatives have a long record ingovernment of increasing money to the NHS year after year. We neverprivatised it or attacked it in the way that Labour Members claim, yet theyare still peddling the same old nonsense.

Nor is it the case that Conservative Front-Bench spokesmen are wedded to 20per cent. cuts across the board. I have seen a comment by the shadow ChiefSecretary to the Treasury, who would not be doing his job if he were notlooking for ways to improve and reduce spending, that he would like to findexamples of wasteful spending that he could cut by 20 per cent. I am happyto recommend one to him from my area. I should like him to get rid of morethan 20 per cent. of the regional government that is being foisted upon us.It is totally unnecessary and completely wasteful. I would rather have morenurses and doctors than more bureaucrats in Guildford misrepresenting ourviews and getting in our way.

I am delighted that the Royal Berkshire hospital, which serves myconstituency and adjacent ones, received substantially larger sums insuccessive years under Conservative Administrations and has received moremoney under the Labour Administration. I am confident that when aConservative Government are elected, they will not cut the amount of moneygoing to that hospital, but that they will accept the budgets they inheritand see the need to continue to increase them, as they always did in thepast. I wish that that were common ground between the parties.

Caroline Flint (Don Valley): The right hon. Gentleman says that the 20 percent. cut in public services proposed by his party over Christmas would notaffect the health service. What does he say to the member of the shadowCabinet quoted in The Sunday Telegraph-

Mr. Burns: It says here.

Caroline Flint: Yes, it does say here, in The Sunday Telegraph of 29December:

"It is a question of credibility. It is simply not believable to saythat we can cut spending by 20 per cent. simply by removing waste andbureaucracy."

Does not that suggest that some of the 20 per cent. cut will attack publicservices, including the health service?

Mr. Redwood: No, it does not suggest that at all. I repeat my firm promiseand expectation that the policy, when announced in the run-up to theelection, will not include a single cut to a hospital such as the RoyalBerkshire hospital, and that our pledge to increase the number of nurses,doctors and other important medical staff in hospitals will need to berenewed. I am sure that we will want to employ all those whom we inherit,and I am equally sure that we will discover that there are not enough. Thatis because almost six years into a Labour Government-a Government who cameto power pledged to save the NHS-we discover that the Royal Berkshirehospital is still chronically short of beds, consultants and nurses, waitingtimes are unacceptably long, and sometimes even the quality of care suffersbecause of the pressures the medical staff are under. I would dearly lovethe Government to sort that problem out. I thought that the one thing that aLabour Government might do for my local area was get enough money into thehospital to enable it to hire the staff needed, but, unfortunately, theyhave not done so.

When evaluating foundation hospitals, I ask myself whether they might be theanswer. I find that difficult to judge yet, because of the paucity ofinformation and the complexity of and imperfections in the details that haveso far come before us. Sometimes, I wake up thinking, yes, foundationhospitals could be the answer-they could be real reform, providing thefreedom we need to manage our hospital locally and the opportunity to raisemoney from private sources if we cannot get enough from public sources. Onother occasions, when I hear Labour Ministers and spokesmen and read theconflicting details that emerge, I think that foundation hospitals will bemerely an expensive charade.

What is needed to make the policy work? First, I would like my hospital andothers like it to be eligible, regardless of star ratings. If it makes senseto free good hospitals, would it not make sense to free hospitals that arenot doing well within the current structure, to see whether local managementwould be better than highly centralised management? I would like foundationstatus to be available to any group that wanted to improve the hospital andto exercise freedoms, whatever their current star rating.

Secondly, I would like genuine freedom to be given to those that gainfoundation hospital status to borrow against their assets as well as againsttheir revenue stream. An artificial distinction has been drawn. Today, weheard the Secretary of State say that it would be quite wrong to allowfoundation hospitals to borrow against their assets, because the wickedcapitalists might, in certain circumstances, then take the assets away, butit is perfectly reasonable to let them borrow against their revenue stream.I cannot see how that type of technical nitpicking will work in practice.

Dr. Stoate: The right hon. Gentleman believes that all hospitals should begiven the opportunity to become foundation hospitals. Is he suggesting thateven hospitals that are manifestly failing to deliver a reasonable serviceshould be given those freedoms, without any sorts of checks and balances toprevent their failing their local communities even more than some are doingcurrently?

Mr. Redwood: I do not think that they would fail their communities more. Ithink that they would fail them less if they had more freedom. Much of thefailure derives from central control, direction, intervention andbureaucracy, which is well above the heads of localmanagement. That must be the Secretary of State's view, because he nowwishes to trust local management more.

Next, I want real democracy to surround the idea of members of a foundationhospital. Some Labour Members are on to that real difficulty in theGovernment's position, and I am sure that they will not be satisfied by theSecretary of State's argument, which is that people should have to volunteerto be members of the hospital. That would mean that small groups of peoplewho are motivated in a certain way-not necessarily by the public interest orthe interests of everyone else-could take over a foundation hospital and,through the lethargy and inertia of everyone else, gain control overextremely important assets.

If we are to take the democratic route-there is much to recommend doingso-it must be done as a democracy of all the people in the area served bythe hospital. That surely means using the electoral roll and havingelections to the board of those institutions. I suggest, for cost reasons,holding them at the same time and in parallel with elections to the localcouncil, so that the normal democratic apparatus can be used without muchbeing added to the cost burden.

It would be far more democratic to provide the chance to cast a vote whenmaking important choices about people who will offer guidance in animportant sector of public service, and thus influence the lives of thosewho need health care, to the electorate as a whole than to give it only toself-selecting and self-interested groups of people. I do not want my localhospital to become a foundation hospital based on a limited number of peoplewho expressed an interest because they happened be in the right place on theright day to see an advertisement in the newspaper. I want democraticinvolvement to be extended far more broadly, to all the electors in thearea, who are, after all, the paymasters of the organisation because theypay the taxes.

Mr. Dawson: How would the right hon. Gentleman achieve the involvement of myconstituents who live in the rural Over Wyre area, who have a greatallegiance to and need to use the services of the excellent BlackpoolVictoria hospital, but who do not live within its immediate area?

Mr. Redwood: That is an interesting complexity, but I would bedemocratically generous and give them a vote in the affairs of anyfoundation hospital that served their area. That might mean their having avote in respect of more than one foundation hospital, which brings me neatlyto my third important point.

In some of the Government's rhetoric I have noted words and phrases that Ifind a little surprising, but welcome-those attacking what they call "themonolith". When, before I became a Minister, I wrote a pamphlet setting outwhy I thought the NHS monolith had many defects and was rather oldfashioned, Labour was horrified. Now, we discover that that is language thatboth the Prime Minister and the Secretary of State for Health are happy touse, but they must think through what they are saying, which is that it isthe monopoly elements of the NHS that are serving patients badly. I agreewith that.

One of my disappointments is that amalgamations, mergers and closures underGovernments of both parties over the past 20 years have resulted in my areahaving, in effect, only one hospital offering services. I would prefer avariety of hospitals of different shapes, sizes and styles offeringdifferent choices. I deeply regret the closure of many of the smallerhospitals, maternity hospitals and accident and emergency centres. UnderGovernments of both parties, the argument ran that the health service neededto specialise, concentrate and create those large monopolies, but monopoliesare not the normal mode of operation in other sectors of public service. Itherefore want the Government to extend their dislike of monoliths and tounderstand that what we need are foundation hospitals of a variety of stylesand sizes serving local communities-a plurality of foundation hospitals.

The Government have not gone that far, because doing so would get them intoideological dispute with many of their supporters. Labour Back Benchersbelieve that a command-and-control system, with monopoly hospitals guidedfrom the centre and the Secretary of State being responsible for everybedpan, is the way to run the health service, and they are extremely unhappyabout the freedoms that are now being offered to local hospitals throughthis potentially interesting scheme. The Government will not go the distancebecause they will find it difficult to persuade their supporters thatoffering real choice-having smaller hospitals as well as bigger ones, andhaving more than one hospital in an area and a contrast of styles-is a goodidea.

I can understand the dilemma. The Labour party desperately wants to createcommon standards across the country so that everyone has access to treatmentthat is of the highest possible quality. So do I-if only. However, I happento think that choice drives that system better than monolithic and centralcontrol. Labour Members who are most critical of the Government fear thatfoundation hospitals will introduce a two-tier health service, but do theynot realise that we already have a multi-tier health service? We have agreat deal of postcode rationing: certain treatments can be obtained in someplaces, but not in others, and in others still a long wait is required. Eventhe distribution of medicines, despite the intervention of the NationalInstitute for Clinical Excellence, has an element of local differentiation.The Labour party has to accept that if it chooses the route of localismthere will be variations and diversity-but its document on foundationhospitals does not deal with that central dilemma. The Government say thatthey want both diversity and common high national standards, both strongcentral regulation and freedom for individuals to make local decisions. Mypoint is that the Government have to choose; they must decide whether theyreally believe that a system of diversity and choice delivers the bestaverage results-that is my view-or that a bit more money, or a bit morecommand and control, will deliver better results. If the latter, they shouldchoose that route.

The danger is that the foundation hospital will fall between two stools, andbe neither one thing nor the other. It could end up as an expensive charade.It could spend a lot of money on recruiting members and appointing the boardand the new management team, only to discover that it does not have all thepowers that it needs to pledge the assets and borrow the money to negotiate the rightcontracts and deals, to sell its assets and buy different ones that might bebetter for its purposes, or to hire the staff that it wants.

Other hon. Members have pointed out the awful contradiction between localterms and conditions of employment, which I strongly welcome and recommendin my local area, and the idea that there must not be any poaching ormovement of staff around the former NHS system. Again the Government aredemonstrating muddle, and they must make up their mind. I strongly recommendthat they go for more choice and diversity and more local determination.That means foundation hospitals based on a full democratic electorate, withfull power to borrow and to pledge their assets. It means allowingfoundation hospitals to sell and buy assets as they see fit, in pursuance oftheir duty to provide health care for their areas. It means allowing them tochoose not only the staff they wish to employ but the way in which theyremunerate them. Yes, that does mean allowing them the right to attractstaff from other health institutions. Where else are health staff likely tocome from? That will be good for the staff because it means new ideas andnew people spread around-and of course, the better staff will be paid moreunder that system, which I also happen to think is a rather good idea, whichwill help innovation and drive higher quality.

My fear is that the Government will do few of those things, and we will endup with another expensive bureaucracy and there will be a multi-tier healthservice. Foundation hospitals will be given not only greater freedoms butmore money to try to make them work, to create a favourable impression. Thatwill leave other hospitals, such as my local hospital, struggling. I wouldlike to see a system open for all and free for all the patients, with manymore freedoms for the managers, based on proper local democratic mandates.