Foundation hospitals survived a key Commons vote last night. They were reinstated into the health and social care bill by the smallest of margins. The government's 160 majority which on this issue has been shrinking through the year - only 35 in July, the lowest since Labour came to power in 1997 - withered even further to a meagre 17 on the penultimate day of this session of parliament. The Lords, who removed foundation hospitals from the bill earlier this month, could keep playing ping pong with the Commons, but it was still unclear last night whether they would pursue it.
The health secretary should remember that the vote was not won on the merits of the case, but after intense pressure of the whips and by Mr Reid playing the loyalty card in parliament and the media. Labour MPs were publicly asked whether they really wanted to stand shoulder to shoulder with the Tories and the hereditary peers to hand Michael Howard an early political victory.
There were several false arguments run by John Reid yesterday. They began on the BBC Today programme, when he agreed with the hyperbole of the presenter, that if foundation hospitals were rejected by MPs, it would spell the end of Labour's health reforms. Far from it. As both the Commission for Health Improvement and the Audit Commission have noted in separate reports this year, one of the biggest threats to the continuing improvement of the NHS is the scale and number of organisational changes. There are so many that they are bumping into each other.
Foundation hospitals, which emerged some time after the launch of Labour's NHS plan in mid-2000, had dramatically shrunk in importance long before yesterday. This is partly because of the many concessions made since the proposal to create more independent hospitals was first floated - and partly because more important policies have gathered pace. The latter include the introduction of patient choice, more flexible professional roles, the new commissioning role of primary care trusts, new funding flows, and a much bigger role for the private sector. It would be encouraging if parliament would spend more time on these much more crucial changes.
Both devolution and choice - two key priorities of the health secretary - can be achieved without foundation hospitals. Mr Reid should heed the warning of the health inspectors and auditors. The NHS does not need yet another massive organisational change. The foundation project has survived, but it must still be modest and circumspect.
