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Mr. Simon Hughes: I am grateful to the Minister. We hope to respond to what he says, and obviously we shall not push things if he is able to assure us. Can he tell us, first, whether that promise applies from now on and immediately, and not only at the end of the review? Secondly, can he confirm that a proper consultation exercise has not been carried out if only the health authority and community health council have been consulted?
Mr. Milburn: Of course I want full and meaningful consultation to take place, and when there is a significant change in the make-up of local health services being planned for the local community, of course it is right and proper--indeed, a statutory obligation--for health authorities to consult the local community health council.
Whatever Liberal Democrat Members think, I believe that, by and large, CHCs do an extremely good job as the patient's watchdog, and have a duty to represent the interests of the patient when it comes to the major changes in service provision that a PFI scheme, especially a new hospital, represents. Although it is impossible to consult every member of the public about every major change to the provision of local health services, I would expect key stakeholders to be consulted in future, and I say to the hon. Member for Southwark, North and Bermondsey that in future, when significant changes in services are proposed, we shall expect that proper consultation exercise to be carried out.
Mr. Hughes:
I am just trying to ensure that I am clear in my mind that this will apply from now on, and not only
Mr. Milburn:
There is already a vehicle for local stakeholders--the CHC, local trusts, local commissions, local authorities and others--to make representations. That is the annual contracting process between the purchaser and the provider, in which the health authority must assess whether developments that are taking place in providers are appropriate to meet local health care needs.
The hon. Member for Twickenham (Dr. Cable) referred to the recent British Medical Journal article about bed numbers. When it comes to annual contracting between the health authority and the trust, I would expect issues about bed numbers to be properly considered. Other stakeholders should have an opportunity to be involved in that process and make appropriate representations.
The other important issue raised by the hon. Members for Southwark, North and Bermondsey and for Richmond Park (Dr. Tonge) was trust establishment orders. I am well aware of the concerns. Indeed, I have met ACHCEW--the Association of Community Health Councils for England and Wales--on a number of occasions to try to deal with its concerns directly.
We propose to issue directions to NHS trusts to make it clear that their income generation activities should not be to the detriment of their NHS patients. The 1990 Act is extremely clear: the interests of NHS patients come first, and the primary duty of NHS trusts is to look after the interests of NHS patients. Income generation activities, including private patient facilities, are secondary. I hope that the directions we propose to issue in the near future will help to address some of the concerns that have been expressed tonight.
The Bill's purpose is to provide reassurance to the banks that propose to lend into the PFI that NHS trusts have the power to enter those contracts, and it has the support of those banks.
I wish to make a general point at the outset of our Committee stage. To introduce amendments for which there is no substantive need achieves precisely nothing, and serves only one purpose: to create uncertainty on the face of a Bill intended to eliminate doubt. I hope that Opposition Members will bear that in mind.
Mr. Simon Hughes:
I am keen that we should act in good faith. On amendment No. 5, I accept what the Minister said about consultation with health authorities. He may have worked out already that the original intention was that we should have proper consultation at regional level, but, because the Government inherited no regional health authorities and have not yet put them back, they cannot consult something which does not exist and which I have not yet persuaded them to re-create. I therefore accept that the lower health authorities are not there to be consulted.
On the consultation issue, we accept that the Minister's response is a sign of his good faith. I simply ask that, before the guidance is finalised, we can discuss those issues with him and offer our practical experience of how
changes in the process mean that we must be very careful. Sometimes, the annual contracting process, or the annual report, does not occur sufficiently quickly, and the ball game changes between the time when the proposal is made and when the decision is taken. On that basis, and given the Minister's willingness to have the widest possible consultation with the appropriate people, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Mr. Jack:
I beg to move amendment No. 1, in page 1, line 15, at end insert
I hope that the Minister will take this amendment in the spirit in which it was tabled--as a constructive contribution to make his new arrangement work better.
The terms under which a certificate can be granted are not defined in the Bill. If the circumstances under which the Secretary of State can grant a certificate were more tightly defined, that would benefit the Minister and the Secretary of State, and help them achieve their objective of using this useful piece of legislation to ensure that they not only gave comfort to the banks, but enabled all the ducks of the agreement to be put well and truly in a proverbial row.
Our amendment seeks to ensure that the Secretary of State does not grant a certificate until he is satisfied that all the terms of the agreement have been met and, importantly, that the necessary finance has been committed. In the past, the finance appeared to be in place, but sudden disagreement between the construction side of the consortium and the bankers led to the bankers' withdrawing and the project falling to pieces. The Secretary of State should make it clear that, although he has the power to grant the certificate, he will not do so until all the necessary elements are in place. That would be the ultimate carrot, and would ensure that deals were concluded properly.
The remaining part of the amendment states:
I hope that the Minister will confirm the circumstances under which the Secretary of State will use those powers. We believe that our amendment is constructive. It would add value to granting powers by way of certificate and ensure that deals, once arranged and negotiated fully, proceeded to financial closure. The fact that there could be no alteration or amendment thereafter would add greater certainty to the legislation.
Mr. Richard Allan (Sheffield, Hallam):
I hope to persuade the Committee of the importance of the finality issue, which is introduced by the amendment, in terms of local health planning. Most of my criticisms will be directed at the previous Government's handling of capital investment in the national health service. However, if this Government are to improve matters, they must learn from those failures and respond to them in the legislation.
I shall illustrate my point by referring to the example of Sheffield's proposed new hospital for women, to be situated on the Stone Grove site. Despite achieving a top mark in terms of NHS need, it was not chosen for fast-track development. The Minister kindly received the delegation comprising me and the hon. Members for Sheffield, Attercliffe (Mr. Betts) and for Sheffield, Hillsborough (Helen Jackson), and explained the decision to us. I shall not rehearse the issues tonight, but I hope that the proposal will qualify for the substantial public funding that the Minister said that his Department would generously provide.
The history of the project to replace Jessop hospital, where I was born, demonstrates the need for Government to make any future decisions final and binding. The new hospital was proposed more than 10 years ago, when the PFI was only a twinkle in the Prime Minister's eye. Four or five years ago, the parties were on the verge of signing a Treasury-funded deal but, in response to NHS guidelines, they decided to wait a few months for the outcome of a local strategic review. By the time that review backed the project and found that it would meet desperate local need, the rules had changed again. The parties were sent down the "thousand flowers" route, pursuing the elusive quarry of a new publicly funded hospital--which was rather like joining the previous Government in a hunt for a unicorn.
'and
'(c) he is satisfied that all the terms of the agreement have been finalised and that the necessary finance has been committed;
and no certificate given under this section may subsequently be withdrawn or amended.'.
"no certificate given under this section may subsequently be withdrawn or amended."
It addresses a perceived deficiency in the Bill. Although it may never be the Secretary of State's intention to deny granting the seal of approval, the Bill does not say that. In theory, we believe that an assurance that no certificate given under this section may subsequently be withdrawn or amended provides added security for the financial contracting parties to the arrangement and underpins further the benefits of the legislation.
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