Foundation hospitals became law last week as the Health and Social Care Bill narrowly scraped through a hostile House of Lords and survived the largest Commons rebellion since Labour came to power. Just hours remained in the parliamentary year when the Lords bowed to the will of the Commons and passed the bill.
In an earlier Commons vote on the bill, in July, the government's majority was cut to a record low of 35. This time 62 Labour MPs rebelled, to set a new record low majority of just 17. The government's nervousness was signalled by the return of the minister for sport, Richard Caborn, who was recalled against his will from the rugby world cup in Australia to bolster the vote.
The House of Lords, which deleted the entire section concerning foundation hospitals when it voted on the issue two weeks ago, had threatened to send the bill "ping ponging" between the two houses until the end of the parliamentary session. But faced with a new Commons endorsement of the proposals the House of Lords backed down. The Tory spokesman for health in the Lords, Earl Howe, told the house: "An issue of this kind is essentially one of policy rather than constitutional principle. It is not for us to continue to resist the will of the elected house."
In the hours leading up to the vote the health secretary, John Reid, and Labour whips were telling the media they expected to lose. Their pessimism was seen by some as a ploy to drive nervous Labour MPs back into the ranks.
The government was helped by the recent change of leadership in the opposition Conservative party. Labour MPs were reluctant to hand an early victory to the new Tory leader, Michael Howard. Graham Allen, who voted against foundation hospitals in July, changed his vote this time for "political reasons." "I refuse to help Michael Howard get off to a winning start just 18 months before a general election," he said.
Dr Reid had explicitly warned MPs that the vote would be seen as a test of strength between the parties. "If people vote against the government they will be harming not only the National Health Service but . . . our own government by marching into the lobbies with the crowd opposite," he told the Commons.
Tim Yeo, the Tory shadow health secretary, said the Commons vote was a "constitutional outrage" because it had been partly carried by Scottish Labour MPs, even though foundation hospitals would not be introduced in Scotland. "The government did not win this vote by persuading anyone of their case. It won by deploying bully boy tactics," he said. A bullish John Reid, himself a Scottish MP, called Mr Yeo a "pathetically bad loser."
Mr Reid said that far from allowing creeping privatisation of hospitals the scheme would act as a bulwark against erosion of public ownership. "A thriving local hospital owned by local people in a way that national services have never been owned before will defend itself politically against any future Conservative government's plans to privatise the National Health Service."