Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 440 - 459)



Mr Amess

  440. So you have not got an idea how that would be reflected?
  (Mr Stone) It is so far off the agenda at the moment, we have not gone right the way down that route. But we need to look at the evidence. As for how the dickens we manage things, I have not got a clue at the moment, it is not one I am competent to address.

Dr Naysmith

  441. Mr Davis, you were very careful in what you said about not wanting clinical services as a personal opinion, does that mean that Catalyst as a company which you represent might be thinking about it?
  (Mr Davis) No, I think it is reflected very much in our policy, and again the maturity of our thinking and our ability and experience now means we are concentrating in the next few years on large inner city teaching hospitals, particularly those associated with regeneration, and we think both in terms of urban regeneration and reproviding facilities which are extremely complex, that we have learnt a lot from capital projects and we can recycle that for the benefit of the NHS. I was very interested in the comment from the Chief Executive of Battle because our experience is that it is now no problem at all to include a high percentage of refurbishment within PFI procurements, and perhaps colleagues from Manchester can talk about that because there is a large element of the retained Estate to be refurbished or not refurbished, so refurbishment is no longer an issue in PFI.

Mr Burns

  442. Mr Stone, you said that clinical services were "so far off" the agenda at the moment, suggesting you would be quite pleased to see them come on to the agenda at the right moment. As a matter of interest, have you been having any discussions with the Department of Health to get the item on the agenda?
  (Mr Stone) Not specifically, is the direct answer to your question.

  443. And the indirect answer?
  (Mr Stone) The indirect answer is that I am, whenever possible, encouraging open and honest debate about setting the boundary where it is of best benefit to the taxpayers as a whole.

  444. How are you doing that?
  (Mr Stone) It is just part of the general conversation one has with one's clients.

  445. With clients?
  (Mr Stone) On both sides, both public and private sector.


  446. So you have not specifically discussed it?
  (Mr Stone) No.

  447. It might have been part of a general discussion?
  (Mr Stone) In general, part of what I think a number of people are involved in—

  448. They have not closed the door?
  (Mr Stone) It would be unfair to say we have had any formal conversation with the Department about the involvement of the private sector in delivering clinical care. As in all circumstances, there are plenty of conversations which happen privately to look at the way in which the boundaries may or may not be relaxed. The expectation at the moment from practitioners is that we will be long in the tooth and very grey by the time we seek clinical services being involved in the process. For the time being, for the industries at large and for us as advisers on both sides, it is an irrelevancy because it is not in our medium-term vision.

Mr Burns

  449. Even if there had been informal private discussions with the Department of Health, would they have been with officials or with ministers?
  (Mr Stone) I think practitioners is the best way to put it.

  450. I do not understand the term "practitioners"?
  (Mr Stone) People involved in the PFI process.

  451. But ministers are involved as well as officials.
  (Mr Stone) Not at the practical level they are not.

  452. So we can take it, can we—
  (Mr Stone) I have not spoken to ministers.

  453.—you have not spoken to ministers at the Department of Health?
  (Mr Stone) Absolutely.

Mr Amess

  454. But special advisers you have? You have, obviously. Come on, you can tell the Committee!
  (Mr Stone) I think the correct and proper answer to your question is we have spoken to people in the normal course of our work about where the boundaries might lie in the long-run on the basis that it is incumbent on all of us to make sure we do not find ourselves stuck in the process for the sake of the process itself.

Mr Burns

  455. Does that mean you have spoken to special advisers in the Department of Health or not? With respect, your answers are very circuitous.
  (Mr Stone) They are, on the basis that the conversations are entirely off the record and entirely private.

  Mr Burns: You brought up the subject.


  456. We have confined these questions to your dialogue with the Department of Health, what about other elements of Government? Is there any other dialogue with other departments or other areas of the Government on this issue?
  (Mr Stone) There are conversations with people in the Treasury about the whole process in general and to the location of the boundaries and as to whether or not they should be examined more carefully, but nothing more specific than that. We are certainly not advocating a specific course of action other than one based on evidence.

Dr Naysmith

  457. What about the shadow Secretary of State for Health? Have you had discussions with him?
  (Mr Stone) I have not personally, no.

Andy Burnham

  458. Still on the theme of the extent of the PFI in the NHS, but changing to primary care, we are interested in the lessons which can be learned from PFI and acute hospitals within the LIFT scheme in primary care. I would be interested in the view of KPMG, Mr Stone and Mr Davis, on the LIFT scheme, whether you think we are talking about very different schemes so the lessons which can be learned are much smaller, or whether you think the fact they are simpler means there is much more scope to roll out the PFI in primary care?
  (Mr Stone) The important point is that those people who have been involved in the development of the LIFT concept all the way across the board are people with substantial practical experience of deals which work and do not work historically, so there is a lot of historical expertise being brought into this. By expertise, I do not mean process-specific but much more how the processes were built, how we have developed the PFI process and the PPP process generally over time. So the lessons which have been learnt from that, for example approaches to standard contracts, approaches to standard payment mechanisms, understanding how to create a deal, all that experience has been built within the advisory community and within the NHS.

  459. Because we are talking about much smaller localised schemes, we are not talking about the reputation of some of the big, blue chip companies involved in PFI, we are talking about different operators.
  (Mr Stone) There is potentially a wider scope of operators involved, in that we are primarily focusing here on the inner cities and we have something like 35 per cent of our GPs retiring between 1998 and 2005, and there is a real issue in terms of sorting out primary health care in inner cities. As to the schemes overall on an individual basis, it is likely that when contracts are let they will be on a basis as has been pioneered in the schools environment, but again we are learning very much from all the previous health care schemes and other attempts at bundling to create a mechanism which will deal with many small schemes in a relatively small geographical area. It is not yet at the stage where it will address in principle anyway those issues of widely geographically scattered schemes.

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