Plans to give limited operational and financial freedom to some hospital trusts in England have been narrowly agreed in the Commons, despite a huge Labour rebellion.
The bill for the controversial government proposals for foundation hospitals now returns to the Lords where peers, who have rejected it before, are likely to reject it again.
There is expected to be several hours of parliamentary "ping-pong" before the Bill finally clears all its hurdles.
The proposals, which face opposition from both politicians and many in the medical establishment, are backed by Tony Blair.
What do you think of the idea of foundation hospitals? Are they the best solution?
This debate is now closed. Read a selection of your comments below.
The following comments reflect the balance of views we have received:
Foundation hospitals just a method for the government to wash its hands off of the NHS, an organisation that does not make any money for them.
Kam, London, UK
Aha - the question started about foundation hospitals and in general, it seems, no one really knows what that means in detail. The 'debate' has now turned into one of the 'Midlothian Question'. Why should Scottish MPs vote on matters that they are not accountable for by their constituents? This is the New Labour 'divide and conquer' strategy that will see Wales and the North of England, and no doubt eventually the Midlands, have their own 'puppet' parliaments. The confusion can only help New Labour avoid hard questions by diluting the original debate.
Having family in the US and the UK provides a look at both healthcare systems. Based upon family experiences with the NHS I can honestly say that the UK healthcare system is definitely superior. Foundation hospitals appear to be an attempt to emulate the US healthcare system.
Having in-depth, personal experience with the US systems, I would highly recommend anyone to avoid them at all costs.
I was injured on the job in 1994 and still waiting for some resolution. For two adults we pay $600 USD/month for primary care.
If you bring in foundation hospitals you will no longer recognize the NHS.
Quality does not automatically come from money paid in. For-profit does not mean better care.
Thomas Clark, USA
With MPs changing their votes on foundation hospitals to save the government embarassment, rather than because they had become convinced that foundation hospitals would be good for their constituents - are politicians putting party before people?
The NHS now reminds me of the award winning hospital in Yes Minister. Fantastically efficient, incredibly well organised, superbly equipped, and no patients. As my neighbour puts it "All shoulder-pads and seminars".
Opponents keep stating it will create a two tier system. Well what's so wrong with that providing that the top tier is an improvement and the lower tier is no worse than what we have at present? It's a step in the right direction and perhaps all the hospitals can aspire to be in the upper tier!
Richard Speight, Barnsley, UK
To Richard Speight, think about what a two-tier health service would mean. It would mean some people have less chance of dying of certain conditions then others depending on where they are and how much their local NHS trust can afford? This isn't like other major 'industries' that can be privatised and toyed with by New Labour, this is the delivery of a basic human right.
Back-door privatisation which will simply result in better funded hospitals stealing staff from the less well funded ones, and to hospitals closing less profitable sections. "Sorry we have had to close A&E because it's not returning us value for money... please get a taxi 50 miles to the next hospital".
Nathan Hobbs, UK
The vote on foundation hospitals shows once again the lack of democracy in this country. The Midlothian Question needs to be sorted out once and for all, to stop the abuse of the law by government. I think if we look at the list of Labour MPs who voted against the Foundation Hospitals, we find the true Labour Party, not "New Labour" aka the left wing of the Conservative party.
Stewart Cotterill, UK
Did you realise that Foundation Hospitals are able to sell off assets if they so desire? Whether I agree with the principle or not I do strongly oppose abuse of the democratic system by the government. Any fundamental change should be debate fully by the ELECTED members of the house.
Dave Bedwell, UK
I personally think that foundation hospitals are an awful idea. They create a two-tier system and a post-code lottery. The freedom for hospitals to spend as they wish is dangerous and likely to lead to even clearer class divisions. The whole thing is another absurd Labour policy that has been pushed through simply via the undemocratic majority that they have in parliament.
Another recipe for the disaster.. And yes the tax payer end up clearing it up afterwards. Privatise it and remove the liability from the tax payer!
Bipin Patel, England
To say that it would make a two tier system, one for the rich one for the poor, well we have that already don't we, there are already many private hospitals. I think the NHS needs a bit of a kick, these foundation hospitals is a step in the right direction, I really hope that they are successful. What has the Conservative party come up with? Nothing.
Ian Fisher, UK
The idea stinks. Those opposing who have fudged a deal and now support it are cowards. Large companies who offer Private Medical Insurance for the privileged few employees should show commitment to the NHS and plough the money they have into it.
Roy Sheward, UK
I do not know enough about foundation hospitals to give an opinion. I would say this; the way democracy is operated in this country needs to be sorted out, England needs devolution to run its own affairs and Scotland shouldn't vote on our issues (and vice versa; second, MPs should vote the way the public want and not the party line.
NO! I don't think the average person who depends on the NHS has any idea of what this bill will mean for health care across the board.
Lorna West, Cornwall, UK
Who pays if the creditors call in their debts and the hospital is forced into receivership? More hospital closures is all I can see on the horizon. Health for the rich, suffering for the poor. I dread to see the healthcare system in this country ending up like the USA. Sad.
Najem Hasan, Scotland, UK
What concerns me is that these proposals would not have been passed without the support of Scottish MPs who have no interest in this debate. They have their own health system, with more spend per head than English hospitals, and paid for by the English tax payer. This would be the perfect opportunity to get an answer to the Midlothian Question - where do these MPs get their constitutional mandate to vote on issues which do not affect them, and on which their constituency representative already votes on in the Scottish Parliament ?
Graham Ridler, Hong Kong
Handing greater control to successful, well managed hospitals has to be a good idea. Why else would so many hospitals apply to become foundation hospitals? We are talking about the people who understand the workings of the health service making the decisions, overseen and monitored by members of the public.
David Ainsworth, UK
I was given a Liver Transplant at Kings College in Dec2001. This is a world recognised centre with foundation status they can plan their own destiny and improve on what is already a very high standard. This will be to the benefit of those in the Catchment area and will allow their standard of Care to improve. Kings is already fantastic Foundation will improve on this.
Geoff Sperling, England
These hospitals are a precursor for privatisation in the long term. The rich will get priority, there will be a two tire system, and the poor will loose out. They will become elitist. This has nothing to do with the funding program, of the NHS, this is all about being self sufficient, and the executives will ensure the rich get privileged services. Gordon brown, said, at the CBI dinner, he wants to embrace every thing that is American.
It's disgraceful that the only way Tony Blair could get this through the commons was by the votes of Scottish MPs, yet it won't affect Scotland. Scottish MPs should be banned from voting in the Commons on issues that only affect England (and Wales), otherwise they should allow English MPs a say on health policy in the devolved Scottish parliament. I can hear the uproar now if the situation was reversed.
Can people stop going on about the Scots MPs' votes. Some of us haven't forgotten having the Poll Tax shoved onto Scotland alone by English MPs. Similarly, I get the feeling that this health policy will come North in the same way that Poll Tax spread South.
Yes, anything that takes medical development out of the hands of the government and puts it into the hands of doctors and hospitals is a good thing.
I would like to say to posters - how many of you actually understand how foundations will work? Probably very few, you have just got sucked into the trade union banter. As long as pay is the same between foundations and non-foundations, which currently seems likely, there is little or no difference between what we have now and what we will have. We already have good and bad hospitals, and people always want to work for the best ones! The positive thing is that the good ones will not be tied back by the NHS anymore. Why is it everyone is so keen to keep everyone on the same mediocre level?
Linda, London, UK
An unpopular bill that seems to be setting up the most successful hospitals for privatisation, thank goodness the Lords have put the brakes on it for now. To allow Scottish MP's a vote on a bill that will have no effect on the population of Scotland is completely inappropriate and indeed undemocratic, this is not an issue for all the MP's of Westminster to vote on it is an English/Welsh issue only.
D. Llewellyn, UK
Foundation hospitals are a wasteful diversion of NHS staff, time and resources from the provision of high quality hospital services. If we want a better NHS, and I do, the government should have started with a Green Paper and enabled a proper public debate. My preference would have been a majority of Primary Care Trust board director/governors elected by universal franchise i.e. all of us eligible to vote. Instead we will have a mockery of local accountability for a pilot period with Whitehall bureaucracy over laden by the 'Regulator'. I have signed up for my local hospital with the express intention of campaigning to preserve the integrity of NHS provision.
Peter Kenyon, UK
One thing is certain, the managers, and chief execs will cash in, while people get poorer service. We are talking about people lives and quality of life here. I'm sure people will die needlessly. Very sad. There will always be cash problems with the NHS, it is a bottomless pit, especially adding several new layers of management. I agree with some of the posters here, non profit will mean by the time the top salaries are deducted there will be no visible profit. R.I.P. NHS.
James Elston, England
The plans are divisive and have almost no support. I object to Scottish Labour MPs forcing a two-tier health service on us in England when they won't have them in Scotland. Our democracy seems so flawed we have to decide whether or not we want the decision to be made by elected people who will not be affected, or non-elected Lords who will actually have to live with the consequences. On this occasion I think the Lords should prevail - its the least worst outcome.
Does 'not-for-profit' mean that the top managers are so highly paid that the company always makes a loss?
It is rather concerning that some MPs are only voting in favour of the proposal because they do not want the Tory leader to get off to a good start and their vote is not related to their opinion of the best course for the NHS or the people.
Foundation Hospitals are yet another attempt at stealth privatisation. Bad news for staff and patients, good news only for the same fat cat firms already skimming taxpayer subsidy out of our rail network, schools and other local services. But the close Commons vote (and the earlier Labour Conference defeat) shows the tide is turning. Time for all opponents of privatisation to make our voices heard. Keep the NHS public!
Ben Drake, York, UK
Under the Tories the NHS was ripped apart. Labour has gradually been successfully putting it back together. Why then is Blair doing this? It will end up same as the Tory NHS internal market. With successful NHS organisations spending lots, while unsuccessful organisations loose out and falter. Consolidation and cohesion is the answer.
Please stop it! Before it is too late.
Like so many Labour policies it seems a good idea from a high level view but when you look at the detail it proves to be not well thought out and the impending problems are apparent. For this reason I am glad the Lord have proved their role as quality control. What really annoys me is that the proposal will not affect the devolved Scots but that their MPs can vote on the issue. If a policy will not affect a constituency then their MP should not be permitted to vote. I am sure the Scots would not like my MP turning up in Edinburgh to push through an unpopular bill!
Phillip Holley, UK, Cambs
Well, clearly a lot of labour MPs thought foundation hospitals are a bad idea. Sadly though, many of the potential rebels were talked into supporting the government with the argument that voting against would hand a victory to Michael Howard. Now, I don't find it in the least bit surprising that so many MPs think that scoring party political points is more important than the future of the NHS, but I do find it terribly depressing.
Whilst I have no real feeling about this - as the Health Service is in such a mess why not try it - can't get any worse? However one thing I strongly object to is Scottish Members of Parliament voting for something that only affects England. If they want their own Parliament then they should have no say in English affairs especially as we English are paying for their Parliament Building!
John Huntley, England
One big issue needs to be dealt with if improvement in our hospitals is going to become a reality. We need an increase of beds in sheltered accommodation / nursing homes for the elderly would be a leap forward. The elderly are taking up huge numbers of vastly more expensive hospital beds when they could be better taken care of in specialist care and nursing homes, for less money than in hospitals.
I don't see why a new law is required to deliver more operational and financial freedom to hospitals. All it requires is a relaxation of the Whitehall's influence.
Here we go again! If this is anything like Network Rail the only objective that will be achieved is the 'Not for Profit'.
Foundation hospitals may start off as not-for-profit but would soon become cash cows for the 'suits' voting themselves huge pay rises. The NHS needs stability to implement the existing reforms, not more whizz bang ideas from theorists.
David Jones, England
One thing is clear is that the NHS needs reform. Foundation hospitals appear to me to be another nibble or maybe it's a big bite into the existing system. I would much prefer a thorough, comprehensive apolitical review of the country's health needs. Let's then have a plan for the 21st century not some ideological tweaking by the 'brains' of Westminster and Edinburgh.
Paul Day, Scotland
It's probably not a bad idea in principle, but it smacks of red-tape and over-complication, and I think this is why the public at large isn't keen. If foundation status is so good, why not give it to all hospitals? We want to see one system for all hospitals, that is simple and effective.
Another hot potato added to Labour's juggling act.
Patrick V. Staton, Guildford, UK
As one of the remaining monolithic nationalised industries created by the Atlee Government, of course the NHS must be broken up to make health care responsive to consumers. However, I was really hoping that the Commons would give Blair a bloody nose in the vote last night.
Good on the House of Lords I say. Someone has to stop Blair who seems to be hell bent on wrecking the health service by introducing a system which is fundamentally the Internal Market he abolished under a new disguise.
Mike Kirk, UK
Although opponents of foundation hospitals claim that a 2-tier service will emerge from the foundation proposals, no-one has suggested a viable alternative. The current system isn't working, why to we want to hold onto an outmoded system? Scrap the lot and let's get some value for money.
William Blower, UK
I still do not understand the issue here, along with quite a few people I know. What are Foundation Hospitals? How much will they eventually cost over and above the private money going in? How much profit is to be extracted by the investors? These are questions that I have, and yet there is little in the public domain. Is this to do with ancient old Labour doctrine? Who knows.
One thing is for sure, if it is not good enough for the Scottish, why should it be good enough for the English and Welsh? At least this will bring to a head the disgrace of Scottish Westminster MP's voting on legislation that they would not impose on their own electorate. Like Europe, we are told very little by our esteemed leaders.