Shaky foundations
Despite the latest in a series of backbench revolts in the House of Commons, the government managed to secure a victory on proposals to grant foundation status to British hospitals. The success came in the 11th hour; the day before the parliamentary session ended.
A lack of support for the bill, which was facing its second Commons vote having been defeated in the Lords, reduced the government’s majority of 166 to just 17. A total of 62 Labour MPs walked into the opposition lobbies alongside the Conservatives and Liberal Democrats.
Opposition to the introduction of foundation hospitals has been evident much further afield than within Westminster. Former Conservative Chancellor, Kenneth Clarke, indicated the existence of an ‘amazing combination of opponents’. Even the Health Secretary, John Reid, conceded that support was lacking from the British Medical Association, the Royal Colleges, and some unions. Some Labour MPs extended this list to include staff organisations, pensioners, and the public.
Critics of the government’s plans claim that this legislation will lead to the creation of a two-tier national health service. However, spokespersons for the Department of Health deny that the introduction of foundation hospitals will mean the creaming off of the best resources and the most funds to those hospitals in affluent areas given a degree of autonomy. They deny that the result will be to set hospital against hospital. The granting of foundation status is instead intended to reform the NHS structure.
The controversy surrounding the bill was heightened due to claims made by the shadow Health Secretary, Tim Yeo, about the role played by Scottish MPs in the vote. He labelled the participation of Scottish MPs a ‘constitutional outrage’ because foundation hospital legislation will not have an effect in Scotland.
As a result, foundation hospitals have been added to the arguments surrounding the wider ‘Scottish Question’. Commentators and MPs alike, point to the overlap in the powers of those individuals elected to represent Scottish constituencies.
Since Scotland was granted executive and legislative devolution in 1999, its population has been simultaneously represented by Members of the Scottish Parliament (MSPs), and Scottish MPs elected nationally at each general election. The Parliament at Holyrood has command over legislation affecting Scotland in areas such as health and education. Yet as the dispute surrounding foundation hospitals highlighted, Scottish MPs retain the right to influence the outcome of legislation in areas of policy that will not affect their constituents.
The bill was once again defeated in the House of Lords that evening, but a deal reached that saw its ratification in the Commons the following day. The government has proposed a timetable of six years in which all hospitals in England will be given foundation status.
Despite being ultimately successful in passing the bill, the difficulty encountered will serve to warn the government that implementation of its agenda is no longer as straightforward as in previous years. Foundation hospitals now take their place in a list of legislative measures which have faced backbench disapproval. While the government was eventually successful, proposals about the war on Iraq and tuition fees could not be passed simply with reliance on its parliamentary majority. Top-up fees are predicted to be the next area of contention. Especially on the back of ever declining support for the government’s position on Iraq, some predict that this will be the vote it will lose.
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