Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 190 - 199)




  190. Can I welcome you to this meeting of the Committee. Can I particularly welcome our witnesses, the Secretary of State, Mr Hutton and Mr Reeves. We are trying to find you a nameplate, it will be here in a moment. Would you each mind introducing yourselves to the Committee.

  (Mr Milburn) Alan Milburn, Secretary of State for Health.
  (Mr Hutton) John Hutton, the Minister of State for Health.
  (Mr Reeves) Colin Reeves, the Director of Finance of the NHS Executive.

  191. When we met Mr Reeves last week we briefly explored the Concordat, amongst other things. I wonder if I could begin by raising one or two specific things about the agreement last week with the private sector. I am interested in why the Government has entered into this Concordat. In particular, it is common knowledge that the health service has made use of the private sector for very many years. My understanding is we currently spend around one and a quarter billion pounds in the private sector at the present time, 4.8 per cent of the total spend. As that is already happening, why have you had to specifically sign this Concordat in the way that you did last week?
  (Mr Milburn) I think for a pretty simple reason, Chairman, and that is that right now the NHS is short of capacity. I think it is fair to say that given the levels of investment that the Government is now making, it is important that colleagues remember that the investment over these four or five years is going to be pretty substantial set against the historic trend, and certainly the historic trend has been running at around three per cent in real terms for the last 30 or so years and over the Spending Review years it is going to be running at about six per cent in real terms. There is a very real opportunity here to expand the capacity of the service. I think most people looking at the NHS today will recognise that although there is a big opportunity to expand the range of treatments that we can offer and the speed of treatment that we can offer to people, right now we have what is an under-doctored, under-nursed and arguably under-bedded system. Certainly in the short-term we have very clear capacity constraints. Clearly it takes time to put these right, it takes three or four years to train a nurse, it takes double that to train a hospital doctor or a GP. We also know that there is spare capacity in private sector hospitals, for example. I think this Committee has expressed concerns in the past about the occupancy levels in NHS hospitals which are running at around 82 or 83 per cent on average. I am told by the independent sector, by private sector providers, BUPA and the like, that their average occupancy levels are around 50-55 per cent and arguably falling. What you have within the National Health Service is, I think, a system that frankly is not so much short of cash now, which has certainly been the position for very many decades, but a health care system that is short of capacity. It seems slightly anomalous to me that if there is spare capacity that is available within private sector hospitals, for example, that we should not be taking advantage of that for the benefit of NHS patients. This is a key point. The care under the Concordat, and remember the Concordat is a national framework agreement between the Department of Health and the Independent Health Care Association, the nuts and bolts of how the relationships are going to be bedded down in practice will be hammered out on the ground between local NHS Trusts and private sector providers. Nonetheless, if there is spare capacity there we should be taking advantage of it. The patient, regardless of the setting, will remain an NHS patient and the care will be provided for free.

  192. You mentioned that the NHS is under-doctored and under-nursed, and one of the reasons is that the NHS trains staff, trains medical staff, trains nursing staff, and they disappear into the private sector. What consideration have you given to the way in which you are effectively boosting the private sector, and in some areas that will result in staff being further lost to the National Health Service?
  (Mr Milburn) I think there are a couple of responses to that. First of all, the situation in regard to doctors and nurses in the private sector is slightly different. It is true that by and large private sector hospitals do not employ their own medical staff, with one or two exceptions, maybe a medical director here and a clinical director there. It is true that largely for their day-to-day work they rely on NHS consultants, that is absolutely right. As you know, the Government has very clear proposals on NHS consultants in private practice for the future.

  193. Which do not seem to square up with the Concordat, they seem contradictory.
  (Mr Milburn) I do not think they are. Let me come back to that specific issue in a moment. Let me deal with the specific issue of capacity and this charge that is made against the Concordat, and I suppose against the Government by definition therefore, that somehow or other we are about transferring resources from the National Health Service, and I mean staff resources, into the private sector. I do not think that is the case. Nurses are in a slightly different position. There are around 8,000 nurses employed by the private sector hospitals—employed by them. There are many more, as you know, employed by private sector nursing homes and so on. The option that we favour and the option that we would like to see actively pursued, certainly in the short-term, is for private sector facilities—operating theatres that are lying idle or hospital beds that are not being used in private sector hospitals—to be made available to NHS patients and, if you like, to be staffed by NHS doctors and possibly by NHS nurses.

  194. Possibly by NHS nurses?
  (Mr Milburn) Yes, possibly by NHS staff.

  195. Not necessarily?
  (Mr Milburn) Not necessarily. That is the option that we would favour. Let me give you a concrete example. This winter, as in previous winters down the ages, the National Health Service will largely move quite rightly, as many health care systems do, from elective work to emergency work, it will put emergencies first. By and large nobody would have an argument with that, it is the right thing to do. However, some surgery will be displaced and we already know that elective operations, for example ear, nose and throat operations, will be displaced. I do not say for a moment that ENT surgeons are going to be sitting around twiddling their thumbs, because by and large these are pretty busy people and working damned hard for the National Health Service, but if they are displaced and if the patients who should be receiving treatment are displaced, and if there is labour that is available, if we can match that with capacity that is available in private sector hospitals for the benefit of NHS patients then that seems to me to be a sensible thing to do.

  196. You do not think that what you are proposing will end up drawing into the private sector staff currently working in the NHS?
  (Mr Milburn) No. If you go back to the starting point of this, this is about how you take advantage, for the benefit of the National Health Service and for NHS patients, of capacity that is currently lying idle. As you are aware, the Concordat actually covers three areas: elective work, what we have been talking about now; so-called intermediate care, which we may come back to in a moment or two; and then critical care is the third area. There is spare capacity there and it would seem anomalous to me, and I would guess pretty perverse to patients, if we did not take advantage of that. Let me answer the specific point that you raised in relation to our policies in regard to NHS consultants and the future of their private practice and our policies in relation to the Concordat with the private sector. In fact, far from pointing in opposite directions, they are pointing in the same direction. That is about maximising capacity. As far as NHS consultants are concerned, we are going to massively expand the number of NHS consultants over the course of the next few years, a huge increase of 30 per cent, 7,500 more consultants than we have now, and by and large that is pretty welcome. It has been welcomed in the service and I think it is even welcome to those representing consultants. They would probably like to see more and if we can do more we should certainly do more. There is a quid pro quo here. If, as everybody wants, we want to see more patients treated more quickly then we have to ensure that as we are growing NHS consultants we are taking maximum advantage of their skills for the benefit of NHS patients. If you like, what we are trying to do here is produce for newly qualified consultants a new career structure, a new career path for them. So in the early years of their career when they have just qualified, and frankly when they are at their most eager, we maximise their contribution to the National Health Service by, for example, saying to them that for up to seven years they have got to be working exclusively for the National Health Service. In the middle point of their career, when they are perhaps in their forties and so on, then, sure, they should be able to get access to private practice providing, of course, they can demonstrate compatibility with NHS service objectives. In the later stages of their career, rather than working them hard, as we continue to do now in their fifties, as hard in their fifties as in their thirties, what we envisage is consultants moving over, after they have worked hard for the National Health Service, to more mentoring and training and, frankly, less front line clinical work. The net benefit of that will be that we will get more out of our NHS consultants when we want to and actually we will end up retaining more of them.

  197. You have mentioned that private sector nursing staff could be used to treat NHS patients, but what about consultants who may be NHS part-time consultants who are also working in the private sector on a private basis? Could they be used working in a private hospital?
  (Mr Milburn) Existing consultants, yes.

  198. I am not talking here in terms of their NHS work, I am talking in terms of their private work.
  (Mr Milburn) Yes.

  199. They could be?
  (Mr Milburn) They could be.

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