Health and Social Care Bill (Programme) (No. 4)

No, because the overarching duty is that the service remains free at the point of use. Also, there are protections—[Interruption.] The hon. Gentleman asks a question, but when I try to give him an answer, he shouts and screams at me. That does not help the debate. What I wanted to say was that when it comes to mergers and acquisitions, there are clear requirements to protect NHS assets from a transfer out of the NHS and out of the state sector. The powers that I was describing would be retained as long as Parliament considered necessary, and they could not be removed before 2016 at the earliest and would then be subject to criteria that Monitor determines, with the Secretary of State's approval. On the amendments to part 4, which we have started to debate, we have listened carefully to the concerns expressed to us that, following the removal of the private patient income cap, foundation trusts could engage in more private work, to the detriment of their NHS patients. The Government have therefore made amendments to require every foundation trust to explain in its annual report how its non-NHS income has impacted on NHS services. The Bill will now also require governors, who represent NHS staff and the public, to be satisfied that any proposal by a foundation trust to earn non-NHS income must not significantly interfere with the trust's principal legal purpose to treat NHS patients. Where a foundation trust proposes to increase by 5% or more the proportion of total income that it derives from non-NHS income—this is not just patient activity; it could be research and other things as well—the Bill now requires this to be approved by a majority of governors in a vote. Opposition Members have tabled two amendments on this matter which appear, on first reading at least, to duplicate each other. Both provide for Monitor to have to approve any action by a foundation trust that would result in the trust's increasing its income from non-NHS activity as a proportion of its total income by more than 5 percentage points. In the first amendment, this would be in addition to the foundation trust's governors having already voted to approve the increase; in the second, Monitor would take over the role completely and locally elected governors seem to be excluded from the process. As a result, the public would not get direct representation in their locality in decisions that would affect their local foundation trust's ability to provide innovative NHS services that respond to their needs. Their views would be completely disregarded in favour of Monitor exercising this function. Contrary to Labour's own manifesto, these amendments would fetter foundation trusts' freedom to make decisions about raising income from non-NHS sources which they could use to provide innovative, locally responsive services for their patients and the public they serve. Governors of foundation trusts are in a far better position than Monitor to know what their local communities want and need. They should be allowed to approve their directors' decisions in the light of their local knowledge—local knowledge that the Labour party when it was in government and introduced foundation trusts thought was a very good thing. Now that it is in opposition, Labour thinks it is not a good thing. We expect Monitor to oversee foundation trusts' proposals to increase their income from non-NHS activity. As my noble Friend the Minister said in the debate in the Lords on Report, if a foundation trust is increasing its non-NHS income by more than 5% of its total income in a year, we will expect Monitor in every instance to review whether there is any cause to intervene in order to safeguard the ongoing provision of NHS services. That is a proportionate and reasonable response and a proportionate role for Monitor to assume.