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NHS (Private Finance)
3. Mr. Colin Breed (South-East Cornwall): What assessment he has made of the impact of private finance within the NHS. [482]
The Secretary of State for Health (Mr. Alan Milburn): The private finance initiative is making a major contribution to the biggest hospital-building programme the NHS has ever seen. Through the PFI, six major new hospitals have opened and another 17 are under construction, representing capital investment in the NHS of more than £2 billion.
Mr. Breed: The Secretary of State will be aware that the people of Liskeard, in my constituency, have been waiting for their new hospital for a very long time and that it is hoped that that will be provided very shortly through a private finance initiative scheme. Will he confirm that, should that PFI scheme fall through for any reason whatsoever, other resources available to him will be used so that the hospital can be brought on-stream at the very earliest opportunity?
Mr. Milburn: I will need to examine the individual case that the hon. Gentlemen mentions. However, whenever the go-ahead is given to a new hospital--as he will know, for very many years the go-ahead was given to very few hospitals, and there is an enormous backlog in new developments, renovation and rebuilding--we test to determine whether the private finance initiative or funding through the Exchequer route would be the best value for money for patients and the taxpayer. Very often the PFI comes up with the goods, but sometimes it does not. I assure the hon. Gentleman that we shall consider each and every such case to ensure that local communities receive the services that they need and that taxpayers receive the value for money that they require.
Mr. David Hinchliffe (Wakefield): On the concordat with the private sector, does the Secretary of State have any idea of the proportion of doctors working in the private sector who also work part time in the national health service? What steps are the Government taking to ensure that those doctors' patients who are on health service waiting lists are not being disadvantaged by those doctors' involvement in the private sector?
Mr. Milburn: I am grateful to my hon. Friend for his question and his continual guidance on the subject. He keeps me on the straight and narrow.
Dr. Evan Harris (Oxford, West and Abingdon): No, he does not.
Mr. Milburn: That is a matter of opinion.
There are two answers to my hon. Friend's question. As he is aware, we are in the middle of a quite complex and difficult negotiation with the British Medical Association on a new contract for consultants. Like many people in the profession and the national health service, I think that a new contract is long overdue. A very simple deal is on offer for the BMA and for consultants; we will pay more money to NHS consultants for working in the national health service in exchange for their giving up
some of the work that they do on privately paid-for patients. That seems a good deal for both doctors and patients.As my hon. Friend also well knows, the vast majority of doctors working in the private sector also work in the national health service. By and large, private sector hospitals do not employ their own doctors but take advantage of the doctors whom we employ. It seems to be right and proper that, wherever care is provided, whether in a private sector hospital or in an NHS hospital, we do not end up with the absurd situation in which we transfer NHS doctors and nurses away from treating NHS patients. It is NHS patients who should come first.
Mr. Philip Hammond (Runnymede and Weybridge): The Secretary of State will know that there has been a great deal of interest in the clinical staffing of elective surgical units to be provided by private partners under public-private partnerships. He himself--although not the Prime Minister--seems to have ruled out the provision of clinical staff by the private sector. Can he confirm whether that includes ruling out the use of clinical staff employed by a private agency to work in those units?
Mr. Milburn: I think that both sides of the House agree that the biggest problem in the NHS is not so much a shortage of cash as a shortage of capacity. As we said in 1997 and repeated in the just-finished general election campaign, there is therefore no case for transferring NHS doctors, nurses and clinical staff out of the national health service. It is important that we keep clinicians, clinical services and clinical staff inside the NHS.
I should, however, clarify one other point as I know that the hon. Gentleman is rather obsessed with the idea that public is bad and private is good. We take a completely different view. Our view is that we will use the private sector when it is appropriate to do so and when the private sector can bring something to the table, whether that is expertise or finance, although there are clear boundaries around that involvement. Moreover, reform of the national health service has to be led by people within the national health service.
Mr. Win Griffiths (Bridgend): Are any NHS medical services, equipment or treatments being provided by means of private finance but under contract to the NHS?
Mr. Milburn: Medical equipment is being provided by private sector suppliers, as has long been the case. People sometimes say that private sector firms should not be making a profit out of the national health service, but that is simply one of the absurd arguments about the issue. Who do hon. Members think have long been building national health service hospitals? Private sector firms have been making a profit out of that, as have equipment suppliers.
We must judge what is in the interests of the NHS, and there are some clear tests: can the private sector bring something to the table for the benefit of NHS patients, can we assure patients in the NHS that they will get the highest standards of care wherever they are treated, and most importantly, is the taxpayer getting a good deal?
Autism
4. Mr. Tim Boswell (Daventry): What the place of persons with autistic spectrum disorders is in the national strategy for learning disabilities. [483]
The Minister of State, Department of Health (Jacqui Smith): Those who also have learning disabilities will benefit directly from the national strategy set out in "Valuing People". Furthermore, the Government are working with the Medical Research Council, professional bodies and other experts to examine current knowledge on autistic spectrum disorders and to consider how screening, diagnosis and early intervention can be improved.
Mr. Boswell: While thanking the Minister for that answer and welcoming her to her new post, may I ask her to acknowledge, with her prior knowledge of disability issues, the concern of the National Autistic Society that the present, rather ritualistic definition of learning disabilities in the learning disability White Paper is likely to exclude 80 per cent. of people within the autistic spectrum who are able or, in certain cases, highly intelligent? Will she have particular regard to the reference in the White Paper to the need for a proper assessment of communication and social skills in determining whether or not services should be provided, to ensure that local authorities do not, as they have threatened, withdraw those services because they have read one item and not another?
Jacqui Smith: I certainly agree with the hon. Gentleman that it would be unreasonable of local authorities to withdraw services from people on the autistic spectrum on the basis of a very narrow definition. Of course the implementation of the learning disability White Paper proposals will improve services for those with learning disabilities, but by bringing together health, social care and educational agencies, we will have the scope to improve opportunities and services for people on the autistic spectrum. I recognise the concerns of the NAS, and my officials will be meeting the organisation in the near future to talk about their concerns in detail. We will, as we are committed to do, work on what more we need to do to improve services for people on the autistic spectrum.
Mr. Tom Clarke (Coatbridge and Chryston): In giving a warm welcome to my hon. Friend the Minister in her new post, can I ask whether she agrees that people who experience autism are often gifted as well--for example, in art or music? Will she confirm that to help those people achieve fulfilment, the Government will continue with their commitment to advocacy, which was so important in the field of learning disabilities in the last Parliament?
Jacqui Smith: My right hon. Friend makes an important point concerning the wide range of needs within the autistic spectrum. I agree that for those high- functioning people with autism, it is extremely important that, when developing services, we enable them to have a voice on the way in which those services are delivered. That is why advocacy is at the centre of the learning
disability White Paper and the way in which we will develop all services, which will be centred on the users and will reflect their needs.
Mrs. Marion Roe (Broxbourne): How does the Minister intend to speed up the early diagnosis of those with ASD? What support services will be available to the families of children who have ASD, because they, of course, are very important?
Jacqui Smith: My previous experience in this area suggests to me that we need to develop good working relationships between social services departments and education services. The hon. Lady will be aware that the Department for Education and Skills is consulting on and publishing the special educational needs code of practice, which will be very important in terms of the early identification of children with ASD. We are looking across Government at how we can develop help for children below the age of two by bringing together education and social services. As the hon. Lady rightly points out, our work to support carers and families through the NHS plan will be important in this area.
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