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7.47 pm
Dr. Howard Stoate (Dartford): I am pleased to be called to speak on the Bill as it is important to my constituents. One of the first schemes that will be built, I hope, after the Bill has been passed is that for the Dartford and Gravesham NHS trust. As my hon. Friend the Member for Gravesham (Mr. Pond) has already said, the people of north-west Kent have waited far too long for the hospital. They have waited more than 18 years for it--since the time I became a doctor in the region and almost exactly the period that the Opposition were in Government.
I am glad that the Secretary of State for Health and his colleagues have been able to find time in the first three months of the Labour Government to enact the Bill because it is so important, particularly for the people of Dartford and Gravesham and all the people throughout the country who are also waiting for their facility to be built. We pledged to make the PFI work and we will.
The Bill is short and to the point. It does its job of allaying the fears of the people financing PFI projects in the NHS about protection against the failure of NHS trusts. It is the Bill that has been needed to do that.
The National Health Service (Residual Liabilities) Act 1996 served a similar purpose. Under the Conservatives, I suspect that the bankers thought that they needed that legislation because, like many people, they did not wholly believe what the Conservatives were saying about their commitment to the NHS. I am sure that there is much less need under Labour, because everyone knows that we are committed to the national health service, which we founded almost 50 years ago.
In being short and to the point, the Bill does not address some of the concerns that are being expressed by the medical profession and others about the scope of the private finance initiative in the health service. I know that attempts were made in another place to amend the Bill, but I do not believe that this closely focused piece of legislation is the right means. I want the Bill to complete its passage through Parliament, so that work on new and improved facilities for the people of Dartford and other areas can start on time. I hope that my hon. Friend the Minister can join me in September to break the ground on this project.
The concerns cannot be ignored as they go to the heart of our understanding of what our national health service represents. One of the concerns is the nature of the services that will be run by the private partners in a PFI hospital. Of course, it is not a new concern, as services are already passing out of the hands of trusts to be run by private contractors. An attempt was made in another place to exclude clinical services from the scope of those that could be transferred to a private partner. The difficulty is in defining clinical services, as I believe my right hon. and hon. Friends on the Front Bench have already found, and which is the subject of tonight's debate.
The British Medical Association, of which I am a member, has already made a start and included in its definition of clinical services dietetics, physiotherapy, pathology and radiology--which my hon. Friend the Minister has already assured us will not be privatised. We must build on that and I am pleased that the Department is working on producing a definition of clinical services. I trust and hope that there will be wide consultation with the medical profession and with those working in the NHS, as well as with those representing patients.
Mr. Jack:
As a doctor, perhaps the hon. Gentleman could help me--[Laughter.] I always look to the right people for advice. That is why I am asking a question. Does the hon. Gentleman consider haemodialysis a clinical service?
Dr. Stoate:
Yes, I do, and I hope that that will be included in the definition of clinical services as eventually set out by the Government. As I said, it is the subject of discussion and negotiation. No doubt, a full statement will be made at some time in the future. I would certainly include it within clinical services.
In protecting clinical services, we must not lose sight of the importance of other services to the care of patients in the NHS. Old jokes about leaving hospital in a worse condition than on admission are not funny if the cause is poor cleaning or catering services that have been allowed to decline as a result of cost cutting. Further contracting out of those and other services, if they are not defined as clinical, must involve unions and community health councils to ensure that the interests of staff and patients are recognised.
Another concern is the involvement of private health care providers in PFI consortiums. Initially, the major hospital projects are mainly in the hands of construction companies. That is no bad thing as the construction industry has taken a severe drubbing over the past 18 years and so is now welcoming this boost to their fortunes. Once hospitals are built, will construction companies continue to be interested in the facilities of a hospital for the long term? In the private sector, such expertise lies mainly with private health contractors and providers. There are signs that companies in the United Kingdom and the United States are well aware of that and are looking for opportunities within PFI projects.
I want the best for the NHS, for the best price, and I am not afraid of private sector involvement where that is appropriate--but I do not want a takeover of health care by stealth. I would like the Minister's assurance that interest in PFI projects will not end with approval. I want to know that the Government will take a close look at any changes in PFI consortiums and the ownership of private partners, to ensure that they are for the benefit of the NHS. Trusts must not become secondary purchasers of health care with all the providers in the private sector.
Mr. Simon Hughes (Southwark, North and Bermondsey):
At 5.28 am today, with the hon. Member for Vauxhall (Kate Hoey), I drove the first Bakerloo line train through the tunnel from south bank to north bank, after nine months' closure.
Mr. Milburn:
The hon. Gentleman will need an early night then.
Mr. Hughes:
That is a good try, but the Minister ain't seen nothing yet.
This evening, the Government are trying to drive through, in one sitting, the first health service Bill of this Parliament. On behalf of my colleagues, I want to register our severe disapproval of yet another abuse of the powers of government. I believed that the Labour Government would try to conduct their business properly, but they are not. So far, six Bills have had a Second Reading. The Referendums (Scotland and Wales) Bill was the subject of a guillotine motion, and it was then pushed through on the Floor of the House. The latter action was, arguably, valid because it was a constitutional Bill. We have just debated a guillotine motion on the Finance Bill--not unheard of, but not always necessary. The Plant Varieties Bill went through all its stages in one day. It may not have been a Bill to shake the foundations of the globe, but it raised many important scientific questions. The Firearms (Amendment) Bill was rushed through on the Floor of the House instead of going into Standing Committee. Part of the Education (Schools) Bill has also
been dealt with on the Floor. That is not the fault of the Minister--I simply say to the Government that it is arrogance and they should not behave that way. The evidence to support why the Government should not behave with such arrogance has come in this debate from the hon. Member for Dartford (Dr. Stoate) and his neighbour the hon. Member for Gravesham (Mr. Pond), who have raised major concerns about the Bill.
I am surrounded by a significantly larger number of Liberal Democrat colleagues than I was before the election. One reason why they are here is that the public were extremely sceptical of both the Conservative Government's and the Labour Opposition's positions on the health service, and rightly so. Many of my hon. Friends were, in large measure, elected because we did not believe that a Labour Government would put enough public finance into the NHS, and the proof of the pudding is in what the Chancellor has been telling us ever since election day.
We take a fundamentally different position from that of the old Government and that of the new, both on the general structure of the NHS and on the Bill. I respect the Minister. We do not believe--and I hope that the Government do not believe--in a top-down health service. However, when he told the House recently that the Government do not intend to recreate regional health authorities, it sounded as though the obvious tier for strategic planning in England, elected and democratically accountable, had been abolished at a stroke.
We do not support the view of the hon. Member for Stratford-on-Avon (Mr. Maples) on the health service--that we simply let a thousand flowers bloom and allow anybody who thinks he wants a PFI project to dream one up and pop it up to the Government for approval, without any intention of seeing it as part of a strategic planning process. The approach has been proven to be far from right, not least because so few projects have been approved and because a system non-strategically planned--as my hon. Friends the Members for Newbury (Mr. Rendel) and for Hereford (Mr. Keetch) can show--has resulted in many projects in the pipeline never getting through, however strategically important they might have been. There was no prioritisation.
The Minister has said, and I accept that it is an improvement, that there will be central scrutiny and prioritisation. I hope that over the relatively long summer holiday, when the hon. Gentleman is lying on the beach, he will reflect on his words and realise that it would be far better for him--I hope that he keeps his job for as long as the Government are in office--to have regional strategic planning as that would make his job better and it would be better for the health service. Matters should not be decided only in Richmond house or Whitehall; they should be decided around the country.
We should not tonight rush through Second Reading, Committee stage, Report and Third Reading. The hon. Member for Stratford-on-Avon said that we have until 10 o'clock. I hate to tell him, but we have until 9 o'clock tomorrow morning. The Minister might wear a bit by then. My hon. Friends are in good spirits and good form and may well keep the Government up for some considerable time yet.
We want to ask hard questions partly because--as the hon. Member for Gravesham, my hon. Friend the Member for Hereford or I could tell the House--many schemes proposed under the PFI end up as scaled-down versions of what the commissioning authority wanted. The commissioning authority might say that it wants, for example, 500 beds, but it is told that it can have only 300 or 400 beds. In my own local hospital trust--Guy's and St. Thomas' Hospital NHS trust--the PFI scheme failed because the trust was presented with ever smaller proposals, and the trust finally said, "Thank you very much, but we can do it much better ourselves." Projects have therefore returned to the public sector, and the PFI has disappeared from the agenda.
We have to consider some very serious issues. Regardless of how undemocratic health authorities may still be--even after replacement of Tory nominees by other nominees, and however much they may consult and reach a view that they must provide 500 beds, for example--it will not be much of a planned health service if the private sector ultimately does not deliver what authorities have asked for. There are, therefore, severe doubts not only about the Bill's points of substance but even about some of its practicalities.
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