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Mr. Harry Cohen (Leyton): The hon. Gentleman makes a good point. I agree with him about secrecy in the management of the national health service generally, but, specifically on the Bill, there will be secrecy in the relation to the PFI contracts that are entered into, some of which, as my hon. Friend the Member for Rother Valley (Mr. Barron) said, can go on for 70 years and incur NHS and taxpayers' money.
In Committee, the Minister refused to give a commitment that that procedure would be opened out before the contracts were signed, perhaps even with the community health councils being consulted. Does the hon. Member not think that it is appalling that that secrecy in the signing of such contracts could cost the NHS and taxpayers a great deal of money?
Mr. Hughes:
I agree with the hon. Gentleman. The public might be concerned about all sorts of issues.
The hon. Gentleman knows as well as I that, in the public service, the more secretive financial contracts are, the more likely it is that bad practice or corruption will take place and all the rest of it. The same contracts are given to friends and to the people who happen to be part of the service, however well one tries to regulate it.I agree with him that that is a real worry.
That links to my third point. Let us not be naive about this. The reason why the Government are going helter-skelter down the road marked "PFI"--any Government might be in this position--is that the Treasury and the Chancellor of the Exchequer are saying, "We must cut and hold down public expenditure, so we must look for other ways of financing public projects."
The public's demand for public projects is going up. They are not saying, "We don't want more health services or public education," but, "We do want more health services and public education." The Government are therefore asking how they can find the money without raising taxes. Some of us subscribe to the view that a decent taxation level for people who can afford to pay is a prerequisite of a civilised society, as well as a fair and equitable distribution of wealth.
It will not surprise me if the next election is fought on this issue: should people who can afford to do so pay a decent level of taxes, and should people who earn an enormous amount of money pay an enormous amount of taxes? There appears to be a general, growing timorousness among hon. Members in the two largest parties about asking anyone to pay anything for anything. I am worried about that. That does not meet the public mood.
The public do not want Government and public services to waste their money, but they are willing to pay fair taxes if they know that the money is going towards decent public services. They are willing to pay for the health service and education, so long as the money goes on the health service and education.
If, at the next election, the Tory party says, "We are the tax-cutting party"--although no one believes it about that--and if the Labour party says, "No, we're going to be as good at tax-cutting as the Tory party"--I do not think that people will believe that either--I hope that some of us will go on saying, "You can't have decent public services supported only by cutting taxes."
There are short-term political pressures. I understand them and we should acknowledge them, but the foolishness is that, as the Treasury Select Committee makes clear--this is the fourth point--there is no guarantee that one achieves better value for money through the PFI. On the short section on the PFI in health, the Select Committee, to which the Government have not responded, gives warnings that the PFI may not provide the best value for money. First:
By the Chancellor's own admission, such spending is being cut, and we do not yet have a guarantee that the PFI will materialise. Secondly:
True--that is what we are all being told in our constituencies. Thirdly:
That is very worrying. It will be a bit like the decision that led to the Jubilee line extension being built:a particular project will be built because it is the one for which the most funding can be secured rather than the one that patients need most.
Fourthly--this point was made by the hon. Members for Rother Valley (Mr. Barron) and for Strathkelvin and Bearsden (Mr. Galbraith)--in the view of the Select Committee and the Department of Health:
They are as explicit about that as they can be, yet it is clear that clinical services are being provided under the PFI.
Lastly, the consequence is that
the trust--
We know the score: under the PFI, one contracts now, but pays later. The probability is that it will be no cheaper, and it may be more expensive. I will not go to the wall for saying that it will be, but it may be. All I say is that, until the Government--any Government--have the approval of the people and of Parliament to change the basis of the health service's funding, they should not do it.
Mr. Ronnie Campbell (Blyth Valley):
I have raised before the question of the Cheviot and Wansbeck NHS trust's Ashington hospital in my constituency. The other week, the trust met in secret to decide on phase two of the hospital, phase one of which has been open only about two or three years. The trust has been trying to get phase two off the ground.
Two weeks after it became a trust, it announced that it was £2 million in debt. We have discussed that on the Floor of the House. This time, however, the trust has decided that, to get phase two off the ground, it will put all non-clinical services out to tender. About 40 per cent. of the hospital will be privatised if it goes down that route. It has not made a final decision, but I understand that it is testing the water with tenders from private entrepreneurs.
It makes no difference what the Government say.I remember that, not long ago, they said that the health service was safe in their hands. I do not know what they
meant by that. If they meant that it was safe in their hands because they were going to privatise it, that was fair comment.
There is no doubt that this is a back-door method of privatisation by the Tories, as has been mentioned. I cannot understand why they are doing it, because public opinion does not want it. I expected that they would try to make themselves popular before the elections, but they are making themselves unpopular.
My local newspaper, The Journal, mounted a campaign against non-clinical services being privatised, and against the Bill. It was surprising for that newspaper to have a go at a Tory Government. Coming up to a general election, the Government should want to be popular. One opinion poll after another has shown that people do not want the health service to be privatised; but hospitals are being pushed into corners because, as my hon. Friend the Member for Rother Valley has said, their money has been savagely cut by the Government, and they are being forced into privatising non-clinical services--40 per cent. in the case of Wansbeck.
Ms Hilary Armstrong (North-West Durham):
I am grateful for this opportunity to take part in the debate. I shall try to take the Minister back to his previous incarnation in the House, when he represented a constituency that was known as Gateshead, West. At that time, he represented the Labour party. I am sure that he may have tried to wipe out all memory of that. Part of the western boundary of that constituency must have edged on to bits of my constituency, which is large.
Shotley Bridge hospital, which I am sure the Minister knew in those days, certainly services the Derwentside part and some of the area on the northern banks of the Tyne. That hospital is now part of North Durham health trust, and the Government approved the building of a new hospital that would eventually link Dryburn hospital and Shotley Bridge hospital. Against my advice, the chosen site for that is Dryburn, and my constituents were promised that, when Shotley Bridge hospital was closed as a district general hospital, other good hospital functions would move to Shotley Bridge.
I do not want to go into my concerns about the process, but local GPs have come up with a good scheme for the development of Shotley Bridge. All this hinges on promises to my constituents about what would happen to the new hospital at Dryburn. It was approved over two years ago, before the Government had thought of the private finance initiative.
My complaint about the Government is that they have demonstrated time and again that they do not know what they are doing with the PFI. The Minister said that it would mean less risk to the public sector. That may be true in terms of the Government's overrunning and over-borrowing, which have led to the PSBR being much higher than anyone ever imagined, but it will not mean less risk for the public or for my constituents and their health care.
They are suffering enormously because of the Government's dithering, indecision and lack of understanding about what they were entering into when they told the trust that it had to go down the PFI route. That has delayed the new hospital at Dryburn, and, what is worse, it is now threatening any development at Shotley Bridge.
Last weekend, because the trust had overspent in the acute areas, it closed five wards in Shotley Bridge hospital. That is totally counter to all the promises it gave to my constituents and me about the way in which the amalgamation of the two hospitals would proceed.
Staff morale is at rock bottom, and constituents are angry, because they never wanted to lose their hospital, as the Minister will know if he remembers his previous incarnation. Instead of going to Shotley Bridge, people from the top of the Tyne valley and Weardale will have to travel about 30 miles to Dryburn. The accident and emergency service was closed before the commitments were given, and that was out of line with earlier commitments.
Far from the public being reassured, the Government's actions are a betrayal of the people of north-west Durham and of Derwentside. The Bill has been presented because the Government have made such a mess. If the PFI was working, the Bill would not be before us. If there was confidence, if people thought that the Government knew what they were doing, there would be no need for it. The Government try to tell us that the Bill will put into law what has always been happening, but the reality is that nobody knows the practice, because the PFI procedure has not been tried before.
The Government do not know the nature of the contracts, because the people who draw them up are not publicly accountable. The Minister said that we have to respect commercial confidentiality. He is asking us to agree that the services and their nature and delivery for the next 25 years will be secret. How on earth can we justify that in the public sector? By all means we should work with the private sector to get money to support the public sector, but when that is done in a way that betrays and breaks the trust between the public and their health service, it will fail dismally.
I beg the Minister to reassess what is going on. My constituents face the worst of all worlds: every promise made to them by the trust and by previous Ministers will have been broken. It is their health service and their hospital. What we have worked out together, and the GPs' plan for a GP-led community hospital, are now in jeopardy because of the overspending of the acute trust and because of anxiety to get the PFI right. The rest of health care and support is likely to disappear, and that will mean that the acute service will not be able to meet the needs of my constituents.
"The concern is that capital spending in health will be cut on the basis of expected PFI investment that has yet to materialise."
1 May 1996 : Column 1196
"A further criticism of PFI is that in some circumstances it has delayed rather than encouraged investment."
"This raises the concern that the ability of the Trust to plan effectively the provision of its services could be lost as decisions will be determined by the method of funding rather than an objective assessment of need."
"clinical services should not be provided under the PFI."
"PFI was forcing it"--
"to introduce a false split between 'clinical' and 'non-clinical' services which, hitherto, had been successively provided together, in some cases by the same people."
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