Foundation plans narrowly escape defeat
pharmafile | November 20, 2003 | News story | |Â Â Â
The government has won a crucial House of Commons vote on foundation hospitals with a majority of just seventeen votes.
The margin of victory is even smaller than when Labour MPs first rebelled over the plans when the government's majority was reduced from 161 to only 35.
The new vote was made necessary by the recent rejection of the foundation hospital plans by the Lords. Lord Strathclyde, Tory leader of the Lords, had called the proposals "shambolic" and gained support from across the political divide.
Only a last-minute climbdown by the Tory peers prevented further delay to the bill progress.
Labour MP and former cabinet minister Clare Short was one of the many critics of the plans, voicing the concern that allowing greater freedom for the best hospitals would create a two-tier health system.
"Can you explain why we don't decentralise across the system and only to the most privileged hospitals?" she asked Health Secretary John Reid.
Mr Reid replied: "Even if your premise were correct, your conclusion would be wrong because we don't intend to limit in only to the first wave.
"We intend, within four years, to raise every hospital in this country to the level by which we can then free them up from some of the central restrictions."
Meanwhile opposition among doctors has stiffened, a motion at the BMA annual conference being carried to oppose the bill.
In a personal letter to the health secretary sent before the vote the chairman of the BMA James Johnson made clear doctors' growing opposition to the plans.
"I am in little doubt that their establishment will prove divisive, exacerbate inequalities in the NHS and encourage competition when there is an overwhelming need for cooperation and collaboration," he wrote. "Foundation trusts pose a real threat to the principles of equity and fairness on which, for good reason, the NHS has always been based.
"In addition, giving more power and a greater democratic element to providers in principle appears to conflict with the aim of shifting power to commissioners and making primary care one of the government's priorities."
Mr Johnson went on to list a number of flaws in the current proposals, including no obligation on foundation trusts to set up patient forums, a lack of clarity in the role of the locally elected board of governors, and their relationship with the permanent executive board.
He added: "There is a danger that the only people to be elected to the board of governors will be those active in local special interest groups. It is entirely possible that less organised and less vocal groups in the community, including vulnerable groups who may have specific health needs, will be under-represented."
Despite such opposition, and considerable uncertainty about the details of how the system will operate, 58 three-star trusts have now applied to become foundation trusts, with the first wave gaining the special status between autumn 2004 and spring 2005, depending on the course of the legislation.
The Conservative Party's new health spokesman Tim Yeo has now offered to hold talks with the government to improve the bill.
