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Last Updated: Tuesday, 8 July, 2003, 19:11 GMT 20:11 UK
Hospital shake-up scrapes through
A nurse working in an operating theatre
Rebel Labour MPs say they will continue their NHS battle
Tony Blair has scraped a narrow victory over rebels opposed to his controversial plans to create foundation hospitals.

A rebel amendment to wipe the new-style hospitals entirely from the Health and Social Care (Community Health and Standards Bill) was defeated by 286 votes to 251.

That left the government majority cut from 164 to 35 - its lowest since coming to power in 1997 - with 62 Labour MPs, including two tellers, voting against the hospital plans.

Despite all the arm twisting, the offers of concessions and warnings of electoral trouble ahead if they refused to back the government, most of the rebels refused to cave in

The size of the revolt came despite a series of concessions during the day to win over rebels.

Ahead of the vote, Health Minister John Hutton tried to encourage Labour would-be rebels not to vote in the same lobbies as the Conservatives, by claiming they only "want the NHS to fail".

But former health secretary Frank Dobson claimed the proposals would lead to a "dog eat dog" culture in the NHS and warned they would be damaging to the Labour party, since "virtually everybody" in the movement opposed them.

'Two-tier system'

David Hinchliffe, chairman of the House of Commons health select committee and one of the leading rebels, had hoped the strength of feeling against the controversial measure would result in it being removed from the bill.

Critics fear the creation of foundation hospitals - which gives top performing hospitals greater financial freedoms - would lead to a two-tier health service.

The bill gained its third reading by 306 votes to 57 - a government majority of 249 - and now goes to the House of Lords, where it is likely to receive a rocky ride.

I am concerned that this policy is part of the growing trend of policy making on the hoof
David Hinchliffe

Earlier, the prime minister fended off criticism that the government was making policy "on the hoof".

"The reason we think it's the right thing to do is not because it suddenly popped out of nowhere but having put national standards and accountability in place, it is right then to devolve as much power as we can to the front line," he told MPs during a grilling by the Commons liaison committee.

"I hope when people reflect on these benefits, people will see that to be correct."


In May, the issue prompted 65 Labour MPs to vote against the government - making it the third largest revolt of Mr Blair's premiership after Iraq and welfare reform.

Right up until the vote, Mr Hutton tried to placate would-be rebels by announcing a series of concessions.

David Hinchliffe, Commons health select committee
David Hinchliffe had hoped MPs' rebellion would increase in size
These included improving local accountability, allowing Parliament to question the independent regulator for the new hospitals and introducing a cap on the income foundation trusts can earn from private patients.

Mr Hutton stressed: "The government, I believe, has listened to the concerns that have been expressed about this part of the bill and we have acted on those concerns."

Ministers have moved to ensure the NHS in England "won't become a two-tier service because all trusts will have the opportunity to become foundation trusts over the next few years", he said.

Money spinner

The trusts would "embody a new form of social ownership", whereby health services will become more responsive to local needs because people and staff will have more say over them, he said.

But these soothing words failed to win over Mr Hinchliffe, who said over the last 20 years there have been 18 significant restructurings to the NHS.

"When people ask where has the money gone - it's gone on many of these restructurings," he told MPs.

Mr Hinchliffe said a central worry about the principles underpinning foundation status "is this market orientated approach to health care", with "hospital against hospital, doctor against doctor".

He added: "I am concerned that this policy is part of the growing trend of policy making on the hoof."

'Flawed' bill

Shadow health secretary Liam Fox said while the Tories had "never made any secret" of their support for the principle of foundation hospitals, the government's plans did not go far enough.

He believed foundation hospitals "should be free from political interference", targets and bureaucracy and should be able to set the pay and conditions they thought appropriate to attract staff.

He said the bill was "flawed" and "will actually lead to a much worse system of health care than we have at the present time".

Evan Harris, the Lib Dems spokesman on health, urged the Lords to put the policy "out of its misery".

"A government majority of 35 in this Parliament shows this to be a wounded policy now limping into the Lords."

Health Secretary John Reid said the choice MPs faced was between "reforming the NHS or breaking it up", "between massive investment or savage cutbacks, between modernisation or privatisation".

"When I consider that choice between a Labour Party that believes in health care free at the point of need and a Tory Party which now apparently believes that when you are ill they should take your money before they take your temperature and they should feel your wallet before they feel your pulse, all I can say is roll on the General Election."

Your comments

The creation of foundation hospital trusts will allow private patients to gain access to treatment before NHS patients because these new trusts will have to generate other forms of income. There is no obligation for foundation trusts to have a clinical admissions policy -that means private first NHS second
W. Stephenson, UK

How can one expect any changes to occur in an already failing system that we call the NHS if every radical move to improve it ends up being subdued in a revolt against the government?
Karan, UK

The NHS is overloaded with targets
Martin, UK

Foundation hospitals will create a two tier NHS, just as fund-holding did under the Tories. The NHS is overloaded with targets, and further change will just set back work already undertaken to improve the NHS. More funding has made a difference, things are beginning to improve. However new change will equal the creation of yet more managers, when what is needed is more Doctors, more Nurses, and a health service that is available 24 hours a day 7 days a week and not just 9-5 Monday to Friday
Martin, UK

Foundation Hospitals are a consequence of a Labour Government that lacks the guts or intellectual argument to resist privatisation by the back door. We will end up with a two tier system. One first class service for the rich and a grossly under-funded fourth rate, lip service, desolate and despairing apology for a service for the poor.
Derek Amory, UK

There will be some changes. Senior managers will be able to club together and give themselves huge pay increases. Also the number of complaints will soar. This little experiment in Spain resulted in a doubling of complaints for the foundation hospitals there. Shame on this "Labour Party".
David Hudson, England

The idea of a national health service is that it remains as that - national not segregated. I used to work within the NHS and I found it extremely difficult to justify to patients why we did not have enough air mattresses. This will only get worse if some hospitals have money raised and others not. It will be a medical version of the prince and the pauper!
Rachel, South Wales

The BBC's Niall Dickson
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