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9.10 pm
Dr. Peter Brand (Isle of Wight): This is a fascinating debate about a very small Bill. I am amazed by the amount of support that it enjoys on both sides of
the House, because hon. Members have very different ideas about what the PFI achieves and what the Bill encompasses. I was brought up to believe that words mean what they say and, as a new Member of Parliament, I thought that legislation should say what it means.
I have received many assurances from the Minister today and in another place about what may form part of the PFI definition and what powers the Bill confers. However, it is difficult to see how the Government, in their new role, are clarifying their approach to the private sector. Today's debate has been confused: the PFI is not equivalent to private sector involvement. The PFI is a form of private sector involvement, but it is not the only form.
The private sector has been involved in the NHS for many years. I suppose that I should declare an interest in the debate: I am an NHS general practitioner and I have two surgeries that are part of a mini-PFI scheme. We buy in several clinical services from the private sector, such as pathology, radiology and diagnostic imaging. The private sector provides many magnetic resonance intensifier services in this country. The great test of private sector involvement is that the private sector can make a profit only if it can attract patients or work from those who purchase its services.
I am confused about Conservative Members' attitudes to the PFI. Accountability must be written in by contract. Those who are involved in PFI delivery will confirm that such contracts are long term. There is nothing wrong with involving the private sector, but it must be accountable. I have problems with the Bill as it stands because the Government have not yet defined how they will operate the purchasing-providing split in the NHS.
Under the previous Government, private sector involvement depended on competition to deliver quality and value for money. If we are to have not purchasing-providing, but a form of cosy commissioning and delivery by favoured friends, we must become very good at guessing what the national health service will need not just in two years or five years, but in 10 years.
Hon. Members may remember a wonderful television programme in which Jim Hacker gave out an efficiency award to a hospital that was fully staffed and fully equipped but without any patients. It is bad enough to have a white elephant building in the district, but if that building has services attached, it is so embarrassing that people will fill it and use the service even though, clinically, the need for that service may well have been superseded.
A valuable point was made about the community care element developing much greater units to look after older people than we would like to see, because that is the only condition under which the private sector is prepared to deliver that service at the cost that we are prepared to provide. That is a big lesson for us about the PFI.
I am very disappointed that an amendment to restrict the PFI element for trusts to their NHS services was not accepted. With the way in which the regulations are set out at the moment, there is an enormous risk that a trust encouraged by a private sector partner may develop yet another private wing. We have one in my local hospital and it has lost an enormous amount each year. That loss has to be found from the money that goes in, which should be spent on the NHS and acute services.
The Bill is, I am afraid, too short. It is nice to have a short Bill, but it needs to define slightly more what it is trying to do. The Labour party has not spent the past 18 years working out an alternative to the PFI to get more capital funding into the NHS, which many other public services get.
When the Deputy Prime Minister was in opposition, he used to appear frequently on the "Today" programme, telling us that the public sector borrowing requirement was an artificial straitjacket and that he had all sorts of schemes to get round it. There are indeed schemes to get round it, and I hope that some will be found. The idea of having a bank for the health service estate makes tremendous sense. Assets could be held against the borrowing by the organisation very much along the lines of housing associations, which receive both private and public money. It would be a very good way to expand our building programme.
Mr. Peter Atkinson (Hexham):
I do not share the Liberal Democrats' concern about the Bill. It is a relatively simple matter. The concern of most of us is where the Government will go with the private finance initiative.
I listened very carefully to the Minister, particularly to the end of his speech and the "soundbitey" section where he said that the Government would fulfil the people's priorities for the health service. The question that I ask him is the question that the people of Hexham ask me: will they will get a new general hospital?
Hexham general hospital was proceeding towards a successful conclusion in the PFI when the Minister put it on to the "do not proceed" list. There was widespread anger in the area when that happened, because the people of Hexham had campaigned for years for a new district general hospital. When it was within our grasp that we would get one, it was then put on the "do not proceed" list. The campaign had run for six years. There are cars throughout the constituency that still have stickers on the back saying, "Save our general hospital service in Hexham". It is a huge concern to the people locally because Hexham district hospital serves one of the largest rural catchment areas of any hospital, ranging from some of the most isolated parts of the country right up to the boundaries of the city of Newcastle. It is the only hospital that lies between Newcastle and Carlisle. Therefore, if patients have to go for treatment in Newcastle, in many cases it will mean a 60-mile round trip. The Minister will appreciate that the hospital is of enormous importance.
There was a feeling in Hexham that the hospital was doomed. It is a small district general hospital and there are real problems in maintaining adequate levels of service in such a small hospital. The feeling was that the national health bureaucracy did not like small hospitals and that it thought that big was always beautiful.
It was an exciting idea when the previous Government agreed that the district general hospital at Hexham should be linked with a large teaching hospital in Newcastle--the Royal Victoria infirmary--in a joint trust. All the support services of a big, expert and nationally recognised hospital could help the small district general hospital fulfil its important health care role. The consultants would travel from Newcastle to Hexham rather than patients having to travel from Hexham to Newcastle to see consultants. It was an imaginative idea. Only better physical surroundings were needed.
The hospital--I hope that the House will forgive me for perhaps being parochial, but I am raising an important local issue--was a wartime emergency provision. It was built to treat soldiers who had been wounded during the second world war, who returned for long periods of treatment. The majority of the buildings date from that period. Providing an adequate level of health service in such physical surroundings is extremely difficult. The maintenance staff have perpetual nightmares over provisions such as heating to keep the building warm during the winter for the benefit of patients.
Within the core fabric that I have described, however, is an excellent hospital. The nursing and medical care is renowned. The people of Hexham and of surrounding areas value the hospital as a facility of enormous importance.
There was great concern about the way in which the hospital was scored under the new prioritising system that the Government have produced. It scored three out of five on the health services scale. That is what the people of the hospital cannot understand. The service provided by the hospital is of supreme importance and those concerned feel that such a low score cannot possibly be right. It may be that because the area scored well for those hospitals that were approved there was concern about putting too many schemes forward at one time, thinking that the area would have too large a share of the cake, and accordingly Hexham was scored down.
The hospital has appealed, if that is the right word, against the rating of three out of five. I wish the Minister to give an assurance that he will revisit that scale. If the hospital does not feature in the next wave, to be announced in the spring, we shall have real problems in providing an adequate health service in a rural area.
The building has not had maintenance money spent on it because a new hospital was within sight. It is clearly not sensible to pour a large amount of money into the fabric of a time-expired building, but if there is now a huge delay in reconstruction there will be difficult times in maintaining patient care in Hexham.
This is not merely a parochial matter. The hospital treats 10,000 or more patients a year. When the reorganisation of health services in Newcastle was planned, the near closure of the Newcastle general hospital was based on the ground that many patients would continue to be treated in a hospital on the site at Hexham. If Hexham were to fail to operate, that would have a severe implication for medical services throughout Newcastle.
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