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NHS Services
6. Mr. Nicholas Brown (Newcastle upon Tyne, East and Wallsend): What plans the Department has to extend the private sector's role in the provision of NHS services in the coming year. [129953]
The Minister of State, Department of Health (Mr. John Hutton): We will use independent providers where it represents good value for money, increases NHS capacity and reduces the amount of time that NHS patients would otherwise have to wait for their treatment. In line with our manifesto commitments, my right hon. Friend the Secretary of State announced last week the preferred providers who will operate 26 new treatment centres for NHS patients, some of which will begin to operate later this year.
Mr. Brown : The national health service has entered into a contract with the American company, UnitedHealthcare, to pilot its Evercare system of care for the elderly in 10 pilot areas. Now that the pilots have been up and running for a while, will my right hon. Friend tell the House whether the Americans are achieving the substantial growth that they forecast in the annual report, and whether the NHS is achieving the 50 per cent. reductions and consequent savings in the pilot areas?
Mr. Hutton: I am afraid that I do not have that information to give to my right hon. Friend, but I shall certainly arrange to send it to him. On the Evercare arrangements, the American company is providing primary care trusts with a consultancy—a service and systems redesign service—to allow NHS staff to improve the care that they provide to NHS patients. It is a sensible and useful arrangement that has been entered into at a local level. All the research data in the US show the success of the Evercare model and I am confident that it will have a similar effect in England.
Dr. Evan Harris (Oxford, West and Abingdon): The Minister said that good value for money was a necessary factor for private sector operations, so does he accept that the cost per case at the Oxford eye hospital is less than £400 per cataract, whereas purchasers who want to buy services for patients at the best possible value are being forced to pay more than £750 per case under the private sector scheme, not counting the market forces premium? Why did the Secretary of State say that 20,000 people in the Thames valley were waiting for cataract operations when the Department's own website says that it is only 6,000? Is it not the case that only the dodgy figures make the position anything like value for money, and is not the proposal ideological rather than one that gives quality, value-for-money care for patients?
Mr. Hutton: No. I have had many questions from the hon. Gentleman, but I have yet to hear him put one sensible question to any Minister in the Department of Health. He is in the unique position of agreeing with everything in principle, but opposing everything in practice. Labour Members have one simple word to characterise that—opportunism.
On the specific example that the hon. Gentleman provided, if 6,000 people are waiting for their operation, that is 6,000 too many. By getting additional capacity into Oxfordshire, we are freeing the other capacity of the Oxford eye hospital so that it can concentrate on more specific procedures. The hon. Gentleman needs to get his act—and his figures—together, because he is talking complete and utter cobblers.
Mr. David Hinchliffe (Wakefield): Will the Government undertake a review of the concordat with the private sector and examine the extent to which NHS consultants who have private practices are seeing NHS patients in those practices and are being paid substantial amounts to do so? Some of my constituents have raised concerns about how they have had to wait to see an NHS consultant. They find it bizarre then to see them in private hospitals and private clinics paid for by the NHS, especially when many of the NHS waiting list problems arise as a direct consequence of consultants' private practice.
Mr. Hutton: We keep all those systems and arrangements under careful and close review. It might also be of some help to hon. Members, especially my hon. Friends, if I draw their attention to the new arrangements that I hope will apply in the new consultants contract, should consultants agree it, which would try to provide a better way to regulate the relationship between private and NHS practice. That is an important development that the NHS should seek to bring to a closure.
Tim Loughton (East Worthing and Shoreham): In a debate just before the recess, the Chancellor positively frothed at the mouth at the thought of moving patients into the private sector and he brandished a price list that claimed that operations by independent sector providers typically cost twice as much as in the NHS. If so, why have the Minister and the Chancellor already signed a concordat for 100,000 operations with private providers such as BUPA this year? Why are they now accelerating that process by signing up mostly foreign providers to perform an additional 250,000 operations in the new diagnostic and treatment centres? Or were the Chancellor's figures completely misleading? Will the Minister now publish the real comparable cost of all operations in the NHS, those purchased by the NHS from the independent sector in DTCs, and those performed on those NHS escapees sent to hospitals on the continent?
Mr. Hutton: The hon. Gentleman has moved from using the language of total politics last week to talking complete rubbish this week. The treatment centre programme will introduce significant additional capacity into the NHS at good value for money prices—[Interruption.] The hon. Gentleman does not want to listen, and for good reason, because I will put him right on those matters. The big difference that he should recognise—the Opposition like to think of themselves as people of business—is that the NHS obtains a better price for the operations if they are bought in bulk, instead of being purchased on the spot market. The prices will be significantly lower. The final prices have still to be agreed, but my right hon. Friend and I are of
the one view that this approach represents a sensible direction for the NHS that will provide value for money for NHS patients.Private Health Insurance
7. Shona McIsaac (Cleethorpes): What plans he has to introduce private health insurance for non-emergency health care; and if he will make a statement. [129954]
The Secretary of State for Health (Dr. John Reid): I have no plans to introduce private health insurance for non-emergency health care as it would be inefficient and unfair, and would prolong pain for many people who could not afford it. The Government stand by the founding principle of the national health service of providing equal access to health care, free at the point of need.
Shona McIsaac : I am glad that my right hon. Friend has put it on the record that the Government have no plans to introduce such a grossly unfair system into our NHS, or to introduce any barmy ideas such as the patient passport, which would destroy the NHS. Apart from being philosophically flawed, are not such plans financially flawed, because they would put an extra burden on the taxpayer to the tune of millions of pounds?
Dr. Reid: Indeed, my hon. Friend is right. Those plans would divert up to £2 billion from the NHS to subsidise those who, in many cases, are already paying for private health care. The difference between what we are doing by using the spare capacity of the private sector to supplement the big increases in capacity in the NHS, and what the Opposition would do, is that we are buying in bulk at a price that is near, at or below the NHS tariff and we are providing the service free to everyone. The Opposition would create a position—[Interruption.] Let us ask the hon. Member for Woodspring (Dr. Fox). Why should old-age pensioners have to pay £5,300 for a hip operation, which is what they would have to pay if the patient passport were introduced? Perhaps he could tell us why someone should have to pay £6,700—
Mr. Speaker: Order. Perhaps the hon. Gentleman could tell us another time.
Miss Anne McIntosh (Vale of York): Does the Secretary of State now regret scrapping, in 1997, the tax rebate on private insurance—taken out voluntarily in many cases—for those over 65, and thus placing a huge burden on the NHS and adding to the increase in waiting lists when the Government came to power?
Dr. Reid: No, I do not. I have cited previously the US example, where 40 per cent. of all personal bankruptcies are related to the inability to pay medical costs. That reinforces my point. I repeat: this Government will not charge up to £1,700 for a cataract operation, or £9,000 for a heart bypass. People in this country should have their health care provided free at the point of need. This Government will provide that.
NHS Recruitment
8. Sir Sydney Chapman (Chipping Barnet): What his strategy is for recruiting professionals in the NHS. [129955]
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): The Government are implementing a range of measures to recruit more health care professionals. They include improving pay and conditions, encouraging the NHS to become a better, more flexible and more diverse employer, increasing training, investing in child care, and attracting back returners.
Sir Sydney Chapman : May I direct the Minister's attention to the serious shortage of midwives in the NHS? Will she confirm that today there are 5,000 fewer midwives than there were 10 years ago? That has led the prestigious Royal College of Midwives to say, with typical professional restraint, that that is putting mothers at unnecessary risk. Will she describe the Government's strategy for overcoming this undoubted crisis?
Miss Johnson: Our target is to take on an extra 5,000 midwives, and I am sure that the hon. Gentleman will be pleased to learn that so far we have taken on an additional 3,000 towards that target.
Mrs. Louise Ellman (Liverpool, Riverside): Will my hon. Friend support the work being done by the Liverpool School of Tropical Medicine, which is training medically qualified refugees and asylum seekers to enable them to work in our health service?
Miss Johnson: I am grateful to my hon. Friend for the information about that training programme. It is important to get new input into the NHS from people from diverse backgrounds. They will bring new ideas into the NHS, and some of them will be able to return to their own countries and take some of our best practice back with them. We welcome a diverse work force, and we are working to encourage that. I congratulate Liverpool on the scheme being run there.
Dr. Liam Fox (Woodspring): In an earlier answer, the Secretary of State said that consultants do not want the Government's diagnostic and treatment centres because they will reduce their private practice income. Does the Minister really believe that that is consultants' main objection to the scheme? Is such rhetoric likely to help or hinder acceptance of the consultant contract, which is so crucial to the Government's delivery of their health plans?
Miss Johnson: My right hon. Friend did not say that. He made a comment about some consultants, and the hon. Gentleman is seriously distorting that remark. The hon. Gentleman does not mention patients in this matter. We believe that we need to nurture staff in the NHS, but most of all we need to ensure that the service provides the best treatment for patients, free at the point of need. The needs, pain and conditions of those patients are our first and foremost concerns. We are meeting that target. I appreciate that the hon.
Gentleman may have difficulty with that, as neither he nor his party supported the investment that makes many of those developments possible.
Dr. Fox: One difference is that I have worked in the NHS and treated NHS patients. That is a lot more than any member of the Government Front Bench has done. The Government's attempt to characterise the medical profession in the way that they do is deeply disturbing. They lack understanding of the motivation of many staff. For example, I draw the Minister's attention to the proposed ophthalmology DTC in Thames valley. Nine consultants have written to say that the Thames Valley health authority assessment
- "shows that there is no mismatch between capacity and demand for cataract surgery"
- "Nevertheless managers in Wycombe PCT . . . have taken the lead in discussions with the Department . . . about a cataract surgery private DTC, based on information"
- "Throughout these discussions there has been no reference to the Buckinghamshire Hospitals NHS Trust ophthalmic department".
Mr. Speaker: Order. We are going a long way from recruitment. If the hon. Gentleman can mention recruitment, that might help me.
Dr. Fox: The essential point is that, without professional satisfaction, there will be no further recruitment of any staff. When consultants, talking about their patients, say:
- "Our ability to manage chronic ocular disease, provide sub-specialty care and an ophthalmic casualty will be severely curtailed",
Mr. Speaker: Order. I think that the Minister might manage an answer.
Miss Johnson: First, the hon. Member for Woodspring (Dr. Fox) is completely wrong in his first assertion. I have worked in the national health service—not treating patients, it is true, but I have worked in the NHS. Perhaps he would like to research a few more of his facts so that he gets something right.
Secondly, the hon. Gentleman's preoccupation with what is happening in Thames valley only highlights the fact that the area has some of the longest waiting lists in the specialties that he is talking about. Patients are experiencing the problem, not consultants. It is the experience of patients, the fact that they need treatment and that we want them to have that treatment as soon as possible that drive the sensible changes and developments that we are undertaking. I remind him that we have more consultants in the NHS, which is something that his party could not afford to do. We have had over 4,500 more between September 1999 and March of this year, and many more are in training. We have 55,000 more nurses since 1997 and more of many of the other professions and therapists who work in the NHS. The overall picture is focused on the needs of
patients and actually delivering for those patients. The hon. Gentleman and his team seem to have entirely lost sight of that objective.
Andrew Mackinlay (Thurrock): What work has been done regarding the accreditation of health service professionals who gained their qualifications in European Union applicant countries, especially, but not exclusively, in relation to dentistry and stomatology? Is there not a chance that some of the UK royal colleges will drag their feet and not facilitate things so that such people can work in this country from 1 May to our benefit and theirs? What is the position for professionals from EU applicant countries?
Miss Johnson: We need to make sure that the quality of people coming to work in our NHS is up to our standards. I am sure that my hon. Friend entirely shares that view. We also need to ensure that recruitment of professionals from elsewhere is not to the detriment of countries that are experiencing difficulties, which is why we have agreements, for example, with the Governments of the Philippines, Spain and India on those issues.
Andrew Mackinlay: What about the European Union?
Miss Johnson: I was just coming to that. Within the EU, we are recruiting a lot of general practitioners and other doctors, but that tends to be where there are surpluses. My understanding is that there is no major difficulty, but if my hon. Friend has evidence of difficulties we shall, of course, look into them, to cut them down and make things easier.
Angela Watkinson (Upminster): How will the Minister encourage GP recruitment in outer-London boroughs such as Havering, where the primary care trust has found that newly qualified GPs are attracted either to inner cities or to rural areas but not to suburban areas? In Upminster, in particular, GP practices offer salaries well in excess of the average yet still cannot recruit.
Miss Johnson: Over the past few months, we have recruited another 300 GPs. We recognise that there is an issue in London. For the first time, we are improving the standard of primary care right across the capital in a marked and systematic way. A lot of investment is going in. For example, there are golden hellos for GPs returning to or coming into the NHS. There is also the LIFT—local improvement finance trust—scheme, which is especially designed to improve recruitment and retention in the London area.
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