| Health and Social Care (Community Health and Standards) Bill
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Sir George Young: To take the example mentioned by my hon. Friend the Member for Epsom and Ewell, if a trust that had no income from the private sector derived some income in the next two years and subsequently became a foundation trust, would that have to stop because the base year is 2003? Mr. Hutton: Yes. In that scenario, the trust would have to stop, because the base year is set at 2003. That is how the system would operate in that example. All the amendments relate to that issue; the need for—
Column Number: 420 Chris Grayling: Will the Minister give way?Mr. Hutton: I will not give way, because I have made the point perfectly clearly. All the amendments relate to the need for a safeguard and a cap, clarity about the cap and the calculations on which the cap is based. It is a clear and simple proposition. There is no doubt about how it should apply. Mr. Lansley: Although the Minister keeps repeating that point, he has not answered the question. The burden of my contribution was that there is a safeguard, which is that, through authorisation, the independent regulator could provide that the capacity of an NHS foundation trust should not be used for private patients in circumstances in which any NHS commissioner required that capacity. Why can the Minister not accept that as an adequate safeguard, providing greater flexibility? Mr. Hutton: The hon. Gentleman's proposals raise interesting technical issues— Dr. Murrison: So do these. Mr. Hutton: Certainly. I agree, but the hon. Gentleman's solution is not a perfect one. We are trying to construct a simple, transparent and clear framework in which all trusts that are applying to be foundation trusts will know exactly what the position is with regard to their private practice income. In this case, the benefits of simplicity and clarity are important. The hon. Lady for Cheadle was asked whether amendments Nos. 252, 253 and 254 circumvented the need for the cap. They do not. The independent regulator must apply the private patient cap, although he can use his discretion to restrict further services. When coming to a view about authorisation, there is no question but that the regulator has to apply the cap. Mrs. Calton: I accept what the Minister says, but I am unclear about where precisely in the Bill that is said. The words will be there in legislation long after we have all gone, and will be interpreted at face value. We should be absolutely clear about what those words mean. Mr. Hutton: We are being clear, and I have tried to be clear to the Committee. Amendments Nos. 253 and 254 do not affect clause 15(2), and no one should be confused about the intention. The hon. Member for Epsom and Ewell asked why no similar provision is being made for non-NHS trusts applying to be NHS foundation trusts. I made clear why there was no equivalent provision in relation to public benefit corporations coming into NHS foundation trust status under clause 5; simply, there would not be a baseline year of activity on which to base their cap. It would not be possible to apply the provision in the same way to non-NHS organisations that wanted to be NHS foundation trusts. The provision makes perfect sense in that respect. There has been a long debate on clause 15, and I accept and acknowledge the importance of the issues involved. The debate has revealed an interesting Column Number: 421 division of opinion across the Committee about the need for this type of safeguard. There are different points of view on this. On the Opposition Back Benches, there is an acknowledgment in principle of the need for safeguards of some kind, although they are equally problematic. The right hon. Member for North-West Hampshire's suggestion of a 25 per cent. cap on private income would probably mean a twentyfold increase in the volume of private patient activity that a typical NHS trust might be able to take part in were it to become a foundation trust. That would not be sensible. From the Opposition Front-Benchers, the argument has been that there should be no safeguards whatsoever.This side of the Committee has a choice between accepting the need for some safeguards or for none at all; I believe that there is a need for a safeguard. The safeguards that we have in the Bill are clear, simple and transparent. Mr. Lansley: The Minster has been gracious in giving way. When he began, he said that there was something on which he may inadvertently have misled me. He seems to be about to conclude, but I have not yet discovered what it was. Mr. Hutton: That was obviously my intention. I believe that it was the point about spare capacity and whether it could be offered to private patients. The answer is that it could be, provided that it did not breach the patient cap in clause 15(2). If I gave the hon. Member the impression that the spare capacity could not be offered, that was clearly wrong. It may have led him to assume that I did not need clause 15(2). I do not wish to repeat myself. The case for the cap on private patient income is clear, and I take comfort from the interventions that my hon. Friends have made to support the Government's view that such a safeguard is necessary. Mr. Grayling: The Minister has done a good job of reminding me why I sit on the Opposition Benches and why I will do everything that I can to remove this Government from office at the earliest possible contingency. What an absurdity these arguments are. The Government are saying that they will make it illegal for a trust that is seeking to achieve, or has achieved, foundation status to invest in a piece of equipment such as a scanner and to pay for part of the bill through private revenue. I have given the Minister examples. The proportion of private income might not be zero; it might be 1 per cent. or 0.5 per cent. Regardless of the figures, in making that investment, a trust that pushed its proportion of private income above its baseline threshold would be breaking the law. Mr. Hutton: No. Chris Grayling: The Minister said that a trust that was not on the initial list and invested in a new MRI scanner and then sought to achieve foundation status would have to scrap that scanner if its private income increased from the base year as a result of purchasing that scanner. What an absurdity that is. On that basis, Column Number: 422 I have no compunction about asking my right hon. and hon. Friends to support amendment No. 8. It is an act of monumental stupidity, and one that the Government will live to regret.Mrs. Calton: I would ask the Committee to allow us not to move amendments No. 266, 414 and 415. However, we would like a vote on Government amendments Nos. 253 and 254. Amendment agreed to. Amendment made: No. 149, in
The Chairman: I do not propose to hold a stand part debate on clause 14 as amended. The Committee has debated the issue for one hour and 40 minutes. Mr. Lansley: On a point of order, Mr. Griffiths. During the debate, we have not touched on whether the independent regulator would, under clause 14(7)(f), be able to undertake regular reviews as was suggested in the ''Guide to NHS Foundation Trusts.'' If you allowed a debate, I would at least be able to ask the Minister that question. That is the limit of my intention. The Chairman: As I recall, that matter was briefly referred to during debates on clause 14(7). The issue got an airing; very briefly, I admit. I feel that we do not need to go into it in any greater detail. Clause 14 (as amended) ordered to stand part of the Bill.
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