Health Bill [HL]

One thing that has not changed in the past six years is that the best children's hospital in Europe, if not the world, is not a foundation trust. That is not insignificant because part of the problem with this debate is that it is wholly out of context. The noble Lord, Lord Campbell-Savours, tried to allude to the complex discussions around the establishment of foundation trusts. What he did not say, although it is right, is that at that time the ability to do private patient work was one of many inducements to make trusts become foundation trusts. In totality, people began to baulk at the extent to which the Government’s policy of foundation trusts was being introduced. The noble Baroness, Lady Meacher, is to be commended for taking something that is arbitrary and inconsistent and replacing it with something that is arbitrary but consistent. That provides the answer as to why this can be only a temporary measure. It is not principled—I do not think the noble Baroness makes any claim that it is principled—nor is it worked out on the basis of any kind of sustainability. It is just an interim fix to enable some foundation trusts to generate more income. Are we prepared to put up with that in the context? With some reluctance, I think I am. I am not persuaded by some of the arguments that have been made about foundation trusts and their need to generate income. I would be more compelled by them if that argument applied to all NHS trusts. The key part of this amendment is subsection (2A) which states that any powers to raise money from private patient income, ""must be exercised subject to the principle that the provision of goods and services in return for private charges must in all circumstances be in the interests of the National Health Service"." That is what is important. Whether this amendment will achieve what in practice has been difficult to achieve, and sometimes impossible to achieve, since 1948, I am not sure. That is why there is a case for having a thoroughgoing review of this matter. I have no doubt that an incoming Government of whatever hue will not leave this one alone. I am not given to betting, but if I were, I would suggest that in three years’ time, there will be a completely different proposal before your Lordships' House. However, as a very interim measure, I am prepared to accept, albeit with some reluctance, the argument put by the noble Baroness, Lady Meacher.