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Mr. Burns: The Minister is correct. I was using shorthand, which, on reflection, was probably a mistake. I used it because—as I hinted later on—there is great sensitivity about the idea of ''companies''; particularly on his side of the Committee and the House. The Secretary of State's speech early last year gave rise to confusion about companies. I used shorthand so as not to reopen that aspect of the debate with the amendment.
Mr. Hutton: I am very grateful to the hon. Gentleman for not wanting to reopen that issue. However, this is a question that does not come down to principle but to common sense. What is the easiest way to facilitate the widest possible access to the relevant information? The choice is between the regulator and the registrar of companies. We opted for the registrar of companies for a variety of reasons. Most importantly, the registrar of companies is where most people look for information about organisations.
Some NHS foundations trusts, just like NHS trusts, will be free to enter into joint ventures with other providers and to set up companies themselves. If one wanted information about those organisations, one would not go to the regulator but to the registrar of companies. Rather than have people pursue information around the system, which is essentially what the amendment would require, we chose the option of having them go to just one point. The registrar of companies will hold the relevant details regardless of whether companies are set up by NHS trusts or NHS foundation trusts. It was simply a pragmatic decision, Mr. Atkinson, to keep all the information in one place. It is certainly not a back-door route into the argument to which the hon. Member alluded about whether foundation trusts are companies or not.
Mr. Gary Streeter (South-West Devon): I accept that this is not some sort of back-door admission that the NHS foundation trusts will be companies. We have dealt with that issue. However, does the Minister agree that the registrar of companies keeps a record of companies that are limited by shares or by guarantee as well as of not-for-profit organisations but does not keep records of charitable trusts' trustees or partnership agreements? Has the Minister made the right pragmatic choice? Most people who want to find out more about these public benefit corporations, knowing that there is a regulator, might think that the regulator would be the first port of call to find out how to obtain copies of their constitutions. Perhaps the Minister would think about this matter again.
Mr. Hutton: I am always happy to think again when serious points have been made, and I am happy to
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think about that one. The hon. Member's point about charitable trusts and partnership arrangements is accurate; the registrar of companies does not retain such information. However, I do not understand the point of that observation; that does not impact upon the basic issue that we must resolve, which is where to seek information about an NHS foundation trust. Finding information about a charitable trust is a separate issue. As my hon. Friend the Under-Secretary has just reminded me, the NHS foundation trust will keep all the information as well, so there will be local access to it too.
This is not a huge issue; it is largely a debating point. The simple question that we had to resolve in the Bill was whether or not there should be one main portal of access to the information.
Mr. Lansley: The Minister did not use the argument that I expected, which was that it is possible for an organisation to be a public benefit corporation and not an NHS foundation trust, if only in so far as that corporation has been established to pursue an application to become an NHS foundation trust. In that case, it would be inappropriate for the regulator to keep the details of a public benefit corporation to which he has not given authorisation. I wonder, therefore, whether I am wrong.
Mr. Hutton: I am grateful to the hon. Gentleman for making that helpful contribution. I will ask my officials why that was not in my notes, because it is a very effective point.
The hon. Gentleman and Committee members will know that that is an interim stage. I do not want a lengthy period between the establishment of the public benefit corporation and the authorisation for that corporation to act as an NHS foundation trust. There will be some time between the two, but that should not necessarily be lengthy. However, the hon. Gentleman is right; it would be inappropriate in those circumstances for the regulator to keep such details.
As usual, I have spoken for longer than I intended. The hon. Gentleman made a fair point and his hon. Friend the Member for South-West Devon asked me to have another look at it, and I will. However, on balance, I think that the right decision has been made.
Mr. Burns: In the light of the Minister's assurances, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 8 ordered to stand part of the Bill.
Clause 9
Variation of authorisation
Mr. Burns: I beg to move amendment No. 139, in
clause 9, page 4, line 20, leave out 'is to' and insert 'must'.
Subsection (2) of clause 9 states:
''In deciding whether or not to vary an authorisation the regulator is to have regard (among other things) to—''
the overview and scrutiny committee of local authorities and the Commission for Patient and Public Involvement in Health. Both of those proposals are eminently reasonable.
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However, I am concerned about the use of the words ''is to''. They are ambiguous, and I should like to toughen up the wording to ''must''. That would make clear that if there were variations of authorisation, the regulator ''must'' have regard to any recommendations that have been made to those two bodies, rather than ''is to'' have regard, which is a weaker and more lax instruction.
The use of the word ''must'' would impose an absolute duty, but if ''is to'' were used, some safeguards that one had assumed were implemented might not be—because of the variation of authorisation—particularly with regard to the provision of a trust's core services. One such example is the Royal College of Midwives. I am sure that Ministers are aware of a recent article in The Times concerning the provision of midwifery services throughout the country, and that maternity services are a core function of the NHS. The Under-Secretary of State for Health, the hon. Member for Tottenham (Mr. Lammy) is certainly aware of that, because he is quoted in Hansard of 7 May 2003 as making that point. The figures certainly back that up. Approximately 555,000 babies were delivered in England in the most recent year for which figures are available.
The Chairman: Order. The hon. Gentleman is confusing me on this amendment. How exactly does he think that this is relevant to amendment No. 139?
Mr. Burns: I am sorry, Mr. Atkinson. What I was trying to do—inadequately as you rightly pointed out—is to give an example of a service that could be removed by a foundation trust. In my understanding, that would require a variation of authorisation. I suspect that a local authority overview and scrutiny committee would think that the withdrawal of maternity services from a foundation trust would not be in the local community's interest. The scrutiny committee would make its views known to the regulator. As clause 9 is drafted, if the regulator ''is to'' have regard, he can take the committee's views on board but not necessarily agree with them, and thus allow the withdrawal of a maternity service.
Amendment No. 139 proposes that the regulator ''must'' have regard. The word ''must'' would strengthen the hand of a local authority overview and scrutiny committee to allow it to ensure that such a service would not be removed from local health care provisions in a foundation trust. The example I cited may be common in foundation trusts, and the hand of overview and scrutiny committees must be strengthened to ensure that the regulator would not have this apparent widespread freedom to have regard to the views of the scrutiny committee rather than abiding by them.
9.30 am
Sir George Young (North-West Hampshire): I shall speak in favour of amendment No. 139 because it raises issues that may be more important than my hon. Friend the Member for West Chelmsford realised. This is the first point in part 1 of the Bill at which the involvement of local government and social services is mentioned, and it underlines the need for the regulator
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to have regard to the views of local government. The Government are keen for good co-operation between health services and social services.
Concern has been expressed to the Select Committee on Health that when the concept of foundation care trusts is being developed, emphasis may be placed on acute services, and the needs of the wider health economy may be disregarded. The King's Fund posed the following question about foundation trusts:
''Has foundation trust status had any impact on relationships within the local health economy, particularly with respect to collaborative working, predominantly for the care of older or chronically ill patients?''
We have discovered that social services will not have a place, as of right, on primary care trusts; that is a matter for discretion. However, it is essential that foundation care trusts have regard to the needs of social services. If the route of foundation care trust were taken, there is a risk that loyalty to a popular local institution—namely the district general hospital—would be promoted, and other claims on the health economy disregarded. For example, there may be a focus on the reduction of waiting times for elective treatment—an issue that we all understand—but there may also be other priorities in the local health economy. Unless the regulator or someone else stands back and examines the broader picture, there is a risk that resources will not be applied as they are best needed.
If the focal point is the district general hospital, a community hospital that comes under the wing of a foundation trust may be sacrificed for the perceived interests of the DGH. I suspect that many constituencies have both DGHs and outpost hospitals. In my constituency, the DGHs are in Winchester and Basingstoke, but there is also a community hospital in Andover.
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