|Health and Social Care Bill
Mr. Denham: As the hon. Gentleman, who has just made his first contribution from the Opposition Front Bench, has suggested that he would welcome a clause stand part debate, I shall keep my remarks narrow and relate them to the amendments.
The hon. Gentleman makes the simple proposition that the assets and liabilities arising from the clauses relating to public-private partnerships and income generation should be in the public domain. I assure him that they will be. The amendments are unnecessary. Any assets or liabilities, including contingent liabilities, will be disclosed in the relevant annual accounts. Any assets or liabilities held by the Secretary of State will be disclosed in the Department of Health's resource accounts, which will be published in compliance with the Government's resource accounting manual.
In the case of clause 4, for a health authority or PCT, or clause 5, for NHS trusts, any assets or liabilities would be disclosed in their annual accounts, which they are required to publish under the National Health Service Act 1977. In addition, any public-private partnership set up under the provisions as a limited company will be required to produce and publish annual accounts in compliance with the requirements of the Companies Act 1985. Those accounts will detail all assets, liabilities and recognisable contingent liabilities.
NHS and Department of Health bodies that want to set up companies to exploit intellectual property will have to comply with guidance set out in a financial framework, which will be published as official departmental guidance. Monitoring arrangements on intellectual property in the NHS that are already in place supplement existing accounting arrangements in the annual accounts of the bodies involved.
The purpose of the hon. Gentleman's amendment is achieved by existing arrangements for disclosure. Issues surround how the Secretary of State's liability might be limited through the use of limited liability companies for the proposed public-private sector partnership and how risk over the exploitation of intellectual property rights is managed in clause 5, but it might be better to return to those matters in more detail later.
Mr. Swayne: The Minister's comments offer a measure of reassurance. I assure him that our concern has been prompted by a desire to ensure that the Secretary of State is not ripped off. I am convinced that we have the best civil service in the world. It will, of course, advise the Secretary of State with all its expertise, but with all due respect, that expertise is not, or has not been in the past, commercial expertise. It is undoubtedly a jungle out there. The partners with which the NHS negotiates will seek precisely the guarantees that I described.
However, having heard what the Minister said about the way in which the contingent liabilities will be measured, I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Mr. Burstow: I beg to move amendment No. 23, in page 4, line 15, at end add
The amendment is designed to elicit assurances from the Government about how we can ensure, in the context of public-private partnerships, that patients' interests are safeguarded at all times. It would ensure that commercial interests were not put ahead of patient interests. The amendment would place a regulation-making power in the Bill, with a duty to consult prior to the publication of regulations about arrangements to ensure that there was transparency in dealings involving public-private partnerships in terms of how care standards are safeguarded and the information that is provided.
We are concerned that, beneath the cloak of commercial sensitivity or confidentiality, issues that are of public interest, that the public have a right to be informed about and that go to the heart of safeguarding patient interests will not be in the public domain. We therefore seek a mechanism that will enable the House further to scrutinise arrangements for monitoring and reporting on the operation of public-private partnerships set up under the clause.
The explanatory notes make it clear that the Government intend to use that power in the first instance to establish an organisation called NHS Local Investment Finance TrustNHS LIFTwhich is not about the construction of many lifts in health service buildings, but about investing in new primary care premises. Perhaps some will have lifts.
I hope that the Minister can answer some questions that seem relevant to the way in which the public-private partnerships that provide the premises might operate. First, can he tell us what the incentives will be for private companies to invest in under-doctored target areas? Secondly, are there any implications for the control of such premises through the involvement of private partners? Thirdly, will private companies that become involved in the arrangements have any say over how and what care is provided in establishments built through that mechanism?
I hope that the Minister can also say a little about whether the entities that will be createdthe public-private partnershipswill in all cases work under a charging regime and the same employment and service conditions that pertain in the NHS. It appears that there is a question mark over whether that is the case, so we would like the Minister to give us some assurances on that.
The amendment is fundamentally about the need to ensure that there are procedures to allow the House to conduct scrutiny and to allow proper consultation by Ministers. There must be a system that ensures that patient interests are safeguarded when public-private partnerships bring in new money and that they cannot use commercial interests solely as a device to avoid public scrutiny.
Mr. Denham: I agree that the interests of the patient must always be paramount, but I am not convinced that the amendment is necessary to safeguard those interests, because the reality is that the existing obligations will apply where the Secretary of State or NHS bodies use this power. The power represents an additional way of improving facilities that are available to those who are providing NHS services and does not provide any excuse for ignoring patients' interests. All the current regulatory checks and financial and legal requirements that exist within the NHS will continue to apply. For example, the legal duty of quality of care on commissioners and providers applies, as will the guidance on clinical governance issued to the service. The role of the Commission for Health Improvement in looking after patients' interests will apply.
I can reassure the hon. Gentleman that the patients' interests will be paramount, and just because a public-private partnership is used to improve GP premises there is no reason to believe that that should lead to any diminution in the quality of patient care, any more than it would do if a purely private arrangement were entered into, or if those facilities were provided directly by a health authority through a health centre. The issue that the hon. Gentleman raises is a fair one, but because the checks and the obligations on the provision of services apply as they would in any other circumstance, there is no need to accept the amendment.
Mr. Burstow: Can the Minister assure us that, so that those checks and obligations actually operate in the interests of the patient, there will be no need for those who act on behalf of patients to scrutinise the system at a local level? Does he believe that there will no need for them to have to navigate their way around the system to gather the various aspects of the information of the various checks that he was outlining?
Mr. Denham: The point is that services that are provided through new primary care facilities provided by NHS LIFT, and the issues that arise from the point of view of patient service, are exactly the same as if those premises had been directly provided by an NHS trust or a health authority or through a private arrangement made by the general practitioner: the patient is in the same position. Later, we will discuss a new system of patient scrutiny. That will be relevant, but only in the sense that we are looking to that to cover primary care in all its settings, including those that are provided here.
The hon. Gentlemen asked what incentives there are to invest in under-doctored areas. NHS LIFT will deliver good-quality primary care facilities because the nature of public-private partnership is that it can offer economies of scale and economies of financial skills. There will be an ability beyond that which an ordinary GP could normally handle to attract pharmacists and other health investors who want to become partners in the venture. It could be possible to raise additional capital to provide other facilities on a site such as flats or retail developments. There will be economies of operation for NHS LIFT, in that it would be able to tender for local authority or other personal social services facilities at the same time as providing health care properties. It might be able to offer other health care provision, such as minor injury units or intermediate or step-down care beds. Because of the involvements of the Department of Health and the NHS, we hope that it would be able to take advantage of the higher credit rating that the Department is able to bring to the company.
The acid test is that there is significant interest in the private sector in taking part in NHS LIFT. It is clear that it is the under-doctored and deprived areas in which we wish to invest, and there seems to be no shortage of potential private sector partners to take part in it.
The hon. Gentleman asked a number of questions, which hung around the idea that the nature of the services would be determined by the fact that this was a public-private partnership. I know that he does not agree with me, but it is important to stress, as we do with PFI, that this is an alternative route to making the provision; it is not an alternative provision. It is exactly the same with LIFT or any other use of this clause to develop a public-private partnership: it gives us an alternative means of achieving the same outcome for patients. We do not expect to cover all the investment that is necessary in primary care premises.
The hon. Member for New Forest, West referred to the existing arrangements for funding GP premises. Those will continue, but there are areas of the country where LIFT will not operate, certainly in the first instance, and where alternative routes which have been tried, tested and worked will continue.
|©Parliamentary copyright 2001||Prepared 23 January 2001|