| Previous Section | Index | Home Page |
Mr. Dorrell: As a citizen of Worcester, I was eager to give the hon. Gentleman the opportunity to clarify Labour's policy about the projects that rely on the continued commitment of the Government to the PFI. The citizens of Worcester need have no doubt about this Government's commitment. We are determined to deliver hospital projects through the PFI. What the citizens of Worcester--myself among them--want to hear from the hon. Gentleman is whether he is committed to those projects or whether all the £2 billion plus of projects being carried forward under the PFI would be ditched if there were a Labour Government. If that is the Labour party position, the hon. Gentleman owes it to the electorate to make it clear. Will the schemes go ahead under the PFI? Will the hon. Gentleman produce the money from the right hon. Member for Dunfermline, East, or are we talking about taking £2 billion out of patient care to allow those hospitals to go ahead? Or--by far the most likely option--are we talking about schemes that will go out the window if the country is misguided enough to elect a Labour Government?
Sir Raymond Whitney (Wycombe): In pursuance of that question, to which my right hon. Friend has conspicuously had no answer from the Opposition, will he remind the House that, over five years, the last Labour Government cut capital spending on the health service by 28 per cent? Does that not give us a clue to the answer to the important questions that my right hon. Friend poses?
Mr. Dorrell: My hon. Friend is right. It was not merely the capital budget that the last Labour Government cut, however. When nurses are considering the prospects under a Labour Government, they might remind themselves that nurses' pay fell in real terms by 3 per cent. and doctors' pay by roughly a quarter under the last Labour Government. That is what the right hon. Member for Dunfermline, East has got lined up for the hon. Member for Islington, South and Finsbury. The right hon. Gentleman is refusing to provide him with any money for the national health service.
Mr. Gerry Steinberg (City of Durham) rose--
Mr. Dorrell: I have given way a great deal and I think that the House will want me to get through my final point.
The final question is one that Labour has invented for itself. Labour fought local management and trust management in the health service. Now the Opposition say that they are in favour. At the same time that they fought the introduction of local management of hospitals, they were also fighting the introduction of the purchaser-provider arrangement. The present shadow education spokesman said in 1993, which is not that long ago:
21 Jan 1997 : Column 767
Labour is in a state of total confusion. Every time the hon. Member for Islington, South and Finsbury speaks about health, he reveals new depths of his own ignorance. With every passing day, it is becoming clearer that the hon. Gentleman is determined to continue to act like the Opposition spokesman he is destined to remain.
Mr. Richard Burden (Birmingham, Northfield):
I am pleased that the Secretary of State finished by talking about the private finance initiative. Such matters are part of the debate and I want to discuss them.
The title of the White Paper launched shortly before the Christmas recess, "Choice and Opportunity", was rather interesting. My constituents, and people throughout the country, would appreciate a little more choice and opportunity in the national health service than the Government have given them over the past 17 or 18 years.
On the previous two occasions on which I spoke on national health service issues in the Chamber, I mentioned the proposed primary health care centre in my constituency. It was promised on several occasions many years ago by the then regional health authority--now swept away by the Government--and every time that I speak on health service issues, I ask the Government when it will be built.
The delays have arisen because of precisely those matters on which my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) was questioning the Secretary of State: the operation of the internal market, organisational structures in the health service that simply do not work and, most recently, the private finance initiative of which the Secretary of State has been singing the praises today.
The latest but one phase was when the plan to build the centre was forced to go through the private finance initiative. Some time ago, I asked the Secretary of State and the Minister what were the administrative costs associated with processing that health centre, which had not yet been built, through the private finance initiative. The answer was £50,000.
21 Jan 1997 : Column 768
When I asked the Minister what the administrative costs--supposedly associated with a value-for-money exercise--consisted of, I received the usual answer about the information not being held centrally, or something to the same effect. I was therefore referred to the trust, which told me that the £50,000 was spent on consultants' fees. Was the £50,000 well spent? Clearly not, because now we have been told that the project will go ahead with public money, because the private finance initiative did not work.
As a result of that merry-go-round, not only has something that was promised to local people years ago been delayed time and again, but public money that could have been spent on patient care has been put into the pockets of consultants, even though the project was never appropriate for the much vaunted private finance initiative.
That is the reality of the scheme by which the Secretary of State sets so much store. He challenges us on whether we intend to go ahead with the PFI projects, but I would like to know whether they would go ahead in the very unlikely event of the Government being re-elected. The plain fact is that projects promised under PFI do not get confirmed: not one has started in bricks and mortar.
I want to give the Secretary of State another example of how bureaucracy has gone mad in the health service under the Conservatives and of how the PFI is operating. In Birmingham, there used to be several health authorities. Later, we had the North Birmingham and the South Birmingham health authorities, which recently merged, with the family health services authority, into a single authority for Birmingham.
There was a problem with premises, because each of the former authorities had its own headquarters. It clearly made sense, in the interests of patient care and of ensuring that NHS resources were spent appropriately, to rationalise the buildings and save money. The health authority considered the most cost-effective and economical way of providing a single headquarters, and found an appropriate set of offices that was competitively priced and would enable it to get rid of the expensive former premises. In one of its buildings, owned by someone else, it had been given notice to quit, and in another it had installed some tenants to bring in some revenue; and it proposed that the third building could be sold. It was a rounded plan that made economic sense.
The authority sent a costed business case to the Department of Health for moving into the new rented offices. After several weeks, or even months, it received an incredible letter saying that its plan to save money had to be processed through the private finance initiative.
The end result is that the problem of the Birmingham health authority's accommodation is still unresolved. The only reason why it will not be sorted out is the crazy, bureaucratic rules laid down by the Department of Health. If the problem is not sorted out, the health authority will have to move out of the building that it occupies because it has been given notice to quit and does not own the building. It will have to move back to the place that it has sub-let and get rid of the tenants, thereby losing income for the NHS. It will have to pay more in rent than the cost that would have had to be paid had the Department accepted its original suggestion. That is the reality of the bureaucratic nightmare of the Government's way of running the NHS.
One health authority, admittedly a big one, and one set of buildings--how did we get to this stage? Because the health authority was unable to pursue a simple transaction, the health service will have to pay more--money that should be going into patient care. The PFI is not a miraculous way of finding new investment for hospitals, as Ministers and Conservative Members claim. It is an incredibly expensive bureaucratic morass with unclear rules that has not yet produced one hospital, health centre or health service establishment. I am all in favour of attracting private finance to public projects and of proper partnerships, but they must work, they must be clear and they must be designed to do the job. They must not delay things and cost more money.
"I am vehemently against the notion, currently in vogue, of splitting administrative responsibility for health from delivery of care--divorcing regulation from provision."
That was the position of the Labour Front-Bench spokesman a little more than three years ago. The hon. Member for Islington, South and Finsbury has changed that and I give him credit for it. He is now in favour of
The letter goes on and on in that vein. It is comical to read, but it is the outcome of that bureaucratic madness. The letter was dated 27 November 1996.
4. The former establishes the need for the investment and identifies a preferred option (assumed at this stage to be a publicly funded option), whilst the latter evaluates methods for funding the preferred option (based on the results of the PFI procurement process). I presume this is submitted as an OBC. Apart from this difference, an FBC would also address issues centred on the management of the project (ie Benefit Realisation Plan, In-Project and Post-Project Evaluation Plan, Risk Management Plan and Contract Management Plan)."
| Next Section
| Index | Home Page |