Foundation hospitals will not undermine the NHS

If hospitals in affluent areas are not allowed to utilise this advantage, they will opt out altogether

Tomorrow, we are promised, momentous things will be happening in the House of Commons. Tomorrow, plucky backbenchers will unite and show their strength. Tomorrow, the Health and Social Care Bill will come to a vote in the Commons, and a huge Labour revolt, perhaps the biggest ever, may even manage to defeat it.

What is it then, that bold, modernising, innovative Tony Blair is proposing, to so upset the rank and file? The answer, actually, is nothing much. But, thanks to the chorus of woe singing out from the Labour party and the unions, it doesn't look that way. In fact, one could almost suspect that the Labour revolt is actually being orchestrated by the Government, in order to make it look as though their Bill is more radical than it really is.

Sadly, though, that's not the case. Labour MPs, led by the hapless Frank Dobson, are implacably opposed to the introduction of foundation hospitals, which essentially is nothing more than a plan whereby hospitals that are being managed efficiently can be left to get on with it, without running to Whitehall every time they want to refine their cross-referencing systems.

As foundation hospitals, such innovations will only need the nod from a locally elected board, instead of from some far off wonk in Whitehall. There will be other freedoms too – like the power to manage their own assets, and keep any profit for investment in the hospital, or to decide for themselves what their specialisms ought to be.

But there's nothing explosive in these plans. In fact, the Tories are going to vote against foundation hospitals, on the grounds that such a piddling little reform is not worth the upheaval, because any pretensions towards it being a free market reform have long since been weeded out.

So what is the passionate objection to foundation hospitals that so many of the left seem to share? Alas, the passionate objection is that it's "the thin end of the wedge" and will "tear through the Labour ethos of a co-operative society and introduce a competitive approach". This will lead to a "two-tier system", and hence to the introduction of charging for services, vouchers and a compulsion to take out private health insurance.

Now, I don't find it much of a comfort to learn that Alan Milburn, the Health Secretary, has promised to resign if foundation hospitals charge for services. After all, that's not going to be much of a disincentive to Machiavellian foundation hospital directors keen to make massive profits. They're not, when it comes to the crunch, going to think: "Well, it's tempting, but if I do this heinous thing, that nice Mr Milburn will step down."

But I do marvel at the lack of faith and trust in NHS professionals that the leftist attitude betrays. First, there's the idea that people who have chosen to work in the health service are secretly champing at the bit to dismantle it. In my own peregrinations around the service, I find that those who work in it are hugely loyal to the ideas inherent in the NHS and can be trusted to defend them. I frankly doubt whether a hospital that smashed up the ethics that underpin the NHS could maintain the goodwill of the staff it employs and the community it serves.

Second, there's the sheer negative logic of this sort of attitude. In talking about the two-tier system, in which the foundation hospitals thrive, and the Whitehall-controlled hospitals wither on the vine, the left shows as much belief in the reputed dynamism of private management as the most diehard neo-liberal, and a similar degree of contempt for state-run institutions. Except, of course, that their counsel of despair is to keep them all state-run, when actually, if there were fewer hospitals under the auspices of the state, they might end up being run better.

Anyway, now that Mr Milburn has decided that all hospitals will become foundation hospitals within five years – in an attempt to assuage the two-tier doubters – there will have to be a concerted effort from Whitehall to get the failing hospitals back on track, which can only be beneficial to them.

Third, there's the grotesque implication in this resistance to change that while it's tolerable to have a two-tier system, it is not tolerable to formalise this undeniable fact. Just as people knew perfectly well which schools were good and which were hopeless before league tables, they also knew that some hospitals were miles better than others before hospitals started to receive the star ratings that will determine their ability to switch to foundation status.

Therefore, the idea that suddenly all the decent staff will want to work at foundation hospitals, and the poor old state-run hospitals will no longer be able to attract good staff, is anomalous. This already happens. Every professional prefers working in a well-run, well-equipped, well-motivated environment, and the idea that these sorts of choices aren't already made by staff is nutty.

And, yes, it is true also that the health of a hospital is usually linked to the wealth of the community it serves. The Government is at pains to stress that three of the 32 hospitals that have already applied for foundation status are in poor areas. That means, however, that 29 are not. It is easy the see why this is, even beyond the basic fact that the more affluent a community is, the healthier it is.

Enter any hospital ward and there will be notices up asking for charitable donations to fund this piece of equipment, or volunteers to take part in that piece of research. In a wealthier community, with more money and time, these appeals are much more readily answered, and the hospital benefits. At the Chelsea and Westminster hospital, where the Prime Minister's wife gave birth, the list of names which have given generously to this glamorous, shining edifice reads like a birthday honours list. In most hospitals, though, the idea that some slabs of marble should be purchased, and a mason employed to carve out the names of the institution's benefactors would be seen, quite rightly, as pointless profligacy bordering on insanity. At the Chelsea and Westminster, though, it blends in nicely.

It appears to me that this revolt is symbolic in the worst of ways. It is against an acknowledgement within the NHS that some people and some communities can look after themselves better than others. But, practically speaking, it is utterly counter-productive to believe that the refusal to accept reality will make it go away.

The truth is that hospitals already use their good fortune in being in mixed or affluent areas to their advantage. How could they do otherwise? Yet if they are not allowed fully to utilise this advantage, then more people in those communities will choose to opt out altogether, and go private. This is happening in schools as well as hospitals, and both systems would benefit from being allowed to give freedom to those who can fend for themselves and extra help to those who cannot.

If this doesn't happen, the real two-tier system that already exists, and is developing more strongly each day, will become worse. The better-off will all go private, in education and in health, and they'll never, ever vote for a government that wants them to pay tax for services they don't use, when they're already paying for alternatives. That's the two-tier system that Labour backbenchers should fear. Instead, they're ushering it in.

d.orr@independent.co.uk