Will the NHS improve?

Health Secretary Alan Milburn has tried to win over critics of his foundation hospital plans ahead of a crunch Commons vote.

Opening the House of Commons debate on the plans, which face stiff opposition on Labour's back benches, Mr Milburn told MPs the NHS had to change to keep pace with the modern world.

Pressure on the government to persuade its own backbenchers has been increased by the Conservative decision to vote against the plans.

The vote comes after an influential Commons committee warned the plans could lock some hospitals into a "downward spiral of poor performance".

As money follows patients, poorer-performing hospitals will see their revenue streams dry up David Hinchliffe MP Foundation trusts at a glance How changes affect you

Top performing hospitals will be the first to be offered new freedom by becoming foundation trusts, but the government says it wants all hospitals to follow within four or five years.

The Commons health select committee says that target may be "too ambitious" and in the meantime the best hospitals may improve at the expense of other parts of the NHS.

Labour MP David Hinchliffe, the committee's chairman, said the trusts would have better access to resources, meaning GPs and patients would be more likely to choose to use their services.

"As money follows patients, poorer-performing hospitals will see their revenue streams dry up and will have even less to invest in improving services, locking them into a downward spiral of poor performance," he warned.

'Dog eat dog'

Tony Blair has already seen 134 of his MPs sign up to a Commons motion opposing the move.

The Conservatives say they will abstain on the rebel amendment but vote against the bill's second reading on Wednesday.

Tony Blair is urging MPs to accept the plans

Shadow health secretary Liam Fox said: "This is not the programme of a bold prime minister but is a pale imitation of what has been done elsewhere."

He claimed the details of the bill would create a "dog eat dog" culture, with borrowing by foundation hospitals meaning other trusts would get less.

In his appeal to Labour sympathies, Mr Milburn accused the Tories of wanting reform to fail because they wanted to abolish the principle of "care for free".

Facing questions from all sides, the health secretary said the bill was not about elitism but about raising the standards in every hospital.

"We would be failing both the public and, I believe, ourselves if we did anything other than to press ahead with these reforms," he said.

Taxpayers' money

The Liberal Democrats also oppose the plans, with leader Charles Kennedy using prime minister's questions to say they would inevitably result in a "two-tier health service".

That was a claim denied by Mr Blair, who said doctors and nurses supported the change.

Earlier, Mr Blair told reporters people should realise taxpayers had been asked to put large amounts of money into the NHS.

"It is absolutely vital that we make the changes and reforms to make that money work," he said.

Mr Blair faces an outside chance of one of his flagship policies suffering defeat.

Upping the pressure

About 60 Labour MPs are expected to rebel on Wednesday's second reading vote, with others likely to wait until the detailed plans are debated.

The committee's report is likely to increase the pressure on the government but Downing Street said it was not the "simplistic rejection" of foundation trusts that many had predicted.

The MPs raise fears that foundation hospitals could aggravate staff shortages in other parts of the NHS, especially in areas of high mobility.

Their report suggests there could be wage inflation or "aggressive staff poaching" in areas of staff shortages where local health organisations do not work well together.

Red tape fears

The committee also says that if the plans go ahead, there should be an extra trial where all trusts in a geographical area are given foundation status.

That test would help assess how the plans would work in the long-term.

It acknowledges that many prospective foundation trusts want the extra freedoms the changes could offer.

But they say patients in foundation trusts will only see genuine improvements if there are changes to the current government plans.

In particular, the committee worries that foundation trusts could face too much bureaucracy and fears arrangements for public and patient involvement could be confusing.