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Private Sector (NHS)
2.30 pm
Mr. Kevan Jones (North Durham) (Lab): I am pleased to have secured this debate. The use of the private sector in the health service is a topic of great interest not only in the House but in the country.
I shall start by making it clear that I am not against private sector involvement in the NHS per se. By calling this debate I shall no doubt be labelled as troublesome, lefty and against any reform. I am not against reform. I am open to suggestions that work for my constituents or those of other hon. Members.
If the private or independent sector is able to provide services that complement those provided by the NHS, at a competitive price, without affecting the standard of care or undermining the NHS's general principles, its involvement should be welcomed. It should be welcomed as long as we remain true to the principles of the NHS. In other words, the service should meet everyone's needs, be free at the point of need and be based on patients' clinical need rather than on their ability to pay.
I am almost sure that the Minister will refer to the fact that the private sector has been involved in the health service from its inception. I agree with that. The County Durham and Darlington Acute Hospitals NHS Trust is a good example of use of the private sector. At Bishop Auckland hospital and at Darlington memorial hospital, a private company called Lodestone has provided screening services for the past five years. At Bishop Auckland hospital, the waiting time for non-urgent scans is three weeks and at Darlington it is about four weeks.
However, where the private sector operates in the NHS, we must ensure that three main criteria are met: the founding principles of the NHS must be adhered to; the public must receive value for money; and NHS services must be complemented, not undermined. Unfortunately, the case to which I shall refer affects my constituency, where I wonder whether any of the three criteria are being met.
David Taylor (North-West Leicestershire) (Lab/Co-op): Would my hon. Friend add a fourth criterion to the three that he has given, and with which I do not disagree? The resources given to the private and independent providers in the NHS should be similar to the NHS units with which they compete. Independent sector treatment centres, for example, have no obligation to provide acute and continuing care. They are also given, on average, 40 per cent. more resource, so they are able to cherry pick, compete with and close down NHS units.
Mr. Jones : I strongly agree with that. If the private sector is to complement the health service, it should compete on a level playing field, not on an advantageous playing field, which clearly some parts of it are being set up to do.
Mr. Paul Farrelly (Newcastle-under-Lyme) (Lab): I do not want to make the list of criteria endless, but does my hon. Friend agree that there should always be, as a fifth criterion, proper, considered consultation and
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debate about wide-ranging proposals? It is unfortunate that we have not had that because the Government slipped out the paper a week into the summer recess.
Mr. Jones : I shall be referring to that later. It is important that local people have a say in the way in which their health service is run.
By way of background to how I got involved in this debate, in February of this year, a woman called Pat Hall who lives in Craghead in my constituency came to see me. She explained that she was experiencing a long delay in getting a magnetic resonance imaging scan and was confused as to why she was being sent to the James Cook university hospital in Middlesbrough rather than the University hospital of north Durham, which is very near to where she lives.
As most Members would have done, I wrote to the chief executive of the local NHS trust for an explanation. Very helpfully, a few days later, the chief executive, John Saxby of the County Durham and Darlington Acute Hospitals NHS Trust wrote back to me. What he wrote was illuminating. He of course apologised for the delay in Mrs. Hall's scan. He referred to some wider issues that affected not just this case but others in north Durham.
Mr. Saxby pointed out that the Department of Health nationally had agreed an initiative which resulted in the commissioning of Alliance Medical Ltd to provide additional scanning services to the NHS. He described how the mobile scanning unit provided by Alliance Medical had arrived at the University hospital of north Durham, only to find that the reinforced parking area required for it was not near enough to the electrical power supply. As a result the scanning unit was moved to Middlesbrough. My constituents had to travel down to Middlesbrough rather than to their local hospital. The distance is about 30 miles. Some might say that that is not very far, but my constituency has very low car ownership. People living in some of the outlying villages might as well be on the moon: 30 miles is a long distance for people with no access to cars.
Mr. Saxby described the problems with the contracts he was facing and I will return to that later. I found some of the wider issues he raised absolutely fascinating. I should like to read out some of what he describes as his "quibbles with the contract". He states:
"The MRI scanner at University Hospital North Durham is considerably under-employed and has been for some time, and it is the case that had the 'Alliance Medical' money been directed to us at the University Hospital North Durham we would have been able to put on a large number of scanning clinics, which would have almost eliminated in total our waiting times and waiting numbers."
"It was a disappointment for us when the Department of Health said that providing individual hospitals with additional resources was not an option, the additional resources had to be made available to the private sector."
"We are not alone in this as there are a number of hospitals up and down the country, which have spare capacity within their existing scanners."
I was concerned, as I am sure other hon. Members would be, by what Mr. Saxby said in his letter.
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First, there was the shambolic case of Alliance Medical arriving at the hospital and not being able to operate the service because the electricity supply was not laid on, forcing my constituents to travel 30 miles to Middlesbrough. Secondly, and far more seriously, the local NHS trust was seeing money that could have been used to operate an underused scanner diverted to a private company at the expense of the NHS. Finally, this was happening not only in north Durham but throughout the country.
Helen Jones (Warrington, North) (Lab): Does my hon. Friend agree that the situation is even worse? Many of the independent treatment centres are being paid above NHS costs as well as being able to cherry pick the easiest operations. Yet they have no responsibility and nothing built into their payments for the cost of training staff and ongoing staff developments.
Mr. Jones : I entirely agree. It is an area that I shall explore later. Trying to pin down exactly what the costs are is difficult as they are shrouded in mystery somewhere in the Department of Health. Following Mr. Saxby's letter, I asked a series of written questions to try to get the facts about this contract. I was keen to find out what the Department of Health's view of the contract was and, in particular, I wanted to know whether the contract represented value for money.
Contrary to press reports in The Sunday Telegraph of 27 March this year, I have not been gagged, and over the past six months I have asked more than 100 written questions to try to get to the bottom of this matter. I have not been reassured by the answers that I have received. Overall I have a number of concerns about the replies from the Minister and his predecessor, the Chancellor of the Duchy of Lancaster, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), and even the reply to my oral question to the Secretary of State herself a few weeks ago. I hope that by answering some of my questions, which the Department seems reluctant to answer in writing, the Minister can free up some of my time and ensure that I do not have to table five questions a day to the Department.
I suggest that any right hon. or hon. Member who wants to get to the bottom of an issue should keep asking parliamentary questions, because the way in which they are answered raises even more concerns. I have used this process to glean as much information as I can, and the information that I am about to give is the Department of Health's own—it is not my opinion. If the Department wants to deny the facts, it can happily look through my hundred-odd written questions.
My first concern is that, in commissioning a private firm to run the scanning service, the Department has made no assessment of existing capacity in the NHS—this is where things get a little boring, so I hope that everybody will stick with me. On 5 October, in answer to a written question, the Minister said that what he described as
"plans . . . based on understanding and meeting local needs for diagnostic services, which have been developed through working closely with local health communities to understand their needs for extra capacity."—[Official Report, 5 October 2005; Vol. 436, c. 2831W.]
I wonder how that answer squares with the facts at the University hospital of North Durham, whose scanner is only five years old and is used for only 50 per cent. of the time that it could be.
In other answers, the Minister refers to the capacity planning exercise that took place in 2004 with the strategic health authorities. Apparently, it concluded that MRI scanning services needed to increase by 100 per cent. over the next three years. Unfortunately, the Minister and the Department do not refer in their answers to any assessment of existing capacity—they talk only about expanding capacity. Furthermore, I spoke to my local strategic authority, which confirmed that no such planning exercise had been undertaken. Like the University hospital of north Durham, it has simply been told by the Department that it has to use a centrally procured contract with Alliance Medical and that that is the way to get the waiting list down in Durham.
That can lead to only one conclusion: the commissioning of Alliance Medical to provide scanning services was done on the basis of political dogma, not evidence. According to the dogma, if waiting lists are long, the NHS must be too inefficient to sort out the problems and a private firm should be given the money to tackle them instead. However, the failure to examine existing capacity has led to a problem, because, in north Durham, an NHS-provided scanner is sitting there unused.
The other problem is how we test whether the contract is good value for money. The Minister was unable to tell me the average cost of a scan on the NHS and, in a written answer on 22 June, declined for reasons of commercial sensitivity to tell me the average cost of a scan provided by Alliance Medical. In the same answer, however, he stated:
"The contract was secured at excellent value being approximately half the national health service equivalent cost for the total patient episode."—[Official Report, 22 June 2005; Vol. 435, c. 1091W.]
I therefore have a simple question: could the Minister define what he meant by value for money? I would be grateful it he could tell us today how he arrived at the statement that he gave. I say that especially because, having read various medical journals over the summer, including the magazine of the Society and College of Radiographers—that is how sad I am—I saw that the managing director of Alliance Medical had said:
If he can announce that in a national publication, why can the Minister not give the information to me, as an elected Member of Parliament?
It also appears that the Department of Health does not have much information about the impact that Alliance Medical has had on the scanning waiting lists. In a written answer on 21 July to a question asking how much Alliance Medical has reduced waiting times in the Durham and Darlington trust area, I was told that the information is not held centrally. That was a surprise to me, because I read an article in The Guardian by my right hon. Friend the Secretary of State for Health that stated that waiting times for scans, in Barnsley of all places, had been reduced substantially.
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It transpires—I have been digging—that the figures in the article were, to quote from another written answer,
"based on reliable information provided by Alliance Medical Ltd." —[Official Report, 21 July 2005; Vol. 436, c. 2178W.]
I am disappointed that such reliable evidence was not available for my area, either through the Department of Health or Alliance Medical.
I shall turn briefly to the performance of Alliance Medical. I was unable to determine how it was performing in meeting the obligations of the contract. I was told in a written answer that the contract
I was then told on 21 July that the annual review was taking place in July and that if a decision could be published consistent with commercial confidentiality, that would take place later. I am still waiting for that report to be published.
The House will also be interested to know that an article in the Health Service Journal in August spoke of how 70,000 scans had not been carried out by Alliance Medical, meaning that only 62,000 had been carried out. Alliance Medical has been operating at less than half its capacity under its contract with the Department of Health.
On more than one occasion I have had cause to wonder whether the Department of Health is in possession of the facts. The conclusion that I have come to is that it is clearly not. In an oral answer to a question that I asked in the House on 12 July, my right hon. Friend the Secretary of State made great play of the Government's desire to reduce waiting times. She said:
"We need both to reduce the unacceptable waiting times for scans and to meet our target of a maximum of 18 weeks from GP referral to hospital treatment by 2008."—[Official Report, 12 July 2005; Vol. 436, c. 685.]
However, when I asked how many trusts were meeting the target of no more than 18 weeks' wait from GP referral, the Under-Secretary of State for Health, the hon. Member for Birmingham, Hodge Hill (Mr. Byrne), replied:
"We do not currently collect information on the length of time from GP referral to start of treatment".—[Official Report, 5 October 2005; Vol. 436, c. 2843.]
How can we make statements about the efficiency of a contract if the Department is not collecting the information?
I have lost count of the number of replies that I have had from the Department of Health—all hon. Members will have experienced this—telling me that the information is not held centrally. How can we then monitor the contract with Alliance Medical? In these days of data sharing and communication between trusts, surely the Department of Health should be able to provide such basic information.
There is the issue of how the contract is undermining the NHS. Although it is obvious that the NHS is undermined when money that could have been used to reduce NHS waiting times goes to a private sector company, I am also concerned that the NHS is being undermined in two other ways. In signing up to the contract, Alliance Medical had to agree not to employ staff who had worked in the NHS over the previous six
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months. I believe that that is right. However, I am not convinced that any systems prevent that from happening.
In answer to another written question about the way in which the additionality clause is enforced, I was told that staffing is a matter for Alliance Medical. I am concerned that we are relying on the good will of the contractor not to breach the terms of the agreement. It would also appear from another answer that no monitoring system is in place to check whether staff are being poached from the NHS. Even if we assume, however, that staff are not being poached, we should bear in mind something that the Royal College of Nursing has pointed out—that the independent sector treatment centres are not obliged to follow the "Agenda for Change" agreement. I am concerned that the centres are mechanisms for delivering reform in the NHS through a two-tier work force, despite the many assurances from Government that that would not happen.
The operation of the Alliance Medical contract has been a salutary lesson in how not to use the private sector in the health service. None of the three criteria that I set out for assessing the viability of private firms' provision of NHS services has been fulfilled. Did the contract remain true to the founding principles of the NHS? No. People in my constituency were forced to travel 30 miles out of their way to get treatment that could have been provided locally, with the result that the service has not been open to all. It has been open only to those who could get in a car to get there.
Did the arrangement give value for money? It seems, from the replies that I have and the sketchy financial information that is retained in the Department of Health, that that is very unlikely. I have yet to see a scrap of evidence that the arrangement was good value for money. It is even clearer that in some respects the contract is not being adhered to.
Finally, are NHS services being complemented, rather than undermined? Again, I doubt that. Procedures to prevent poaching seem to be non-existent, and while a private firm is paid to provide scans, a pretty good NHS scanner that is less than five years old sits idle in the University hospital of north Durham.
I have said that I am not opposed to the use of the private sector in the NHS, but it should be employed only where it adds value in patient choice or in the service. Clearly, the contract is leading not to more efficiency, but to more inefficiency. Mike Sobanja, the chief executive of Alliance Medical, made a comment that seems to me to sum up what is wrong with the national top-down approach. He said:
"It seems to me a little sad that the centre is not able to create contracts that are really needed by the NHS."
If what I have described is a demonstration of efficiency in the way the NHS will use scanner services, it shows that those losing out are not only taxpayers but my constituents. I hope that I shall receive some answers to the points that I have raised—and that they may be more effective than the hundred-odd written questions that I have tabled.
Mr. David Amess (in the Chair): Order. This is a very well attended debate and I should like to call everyone who wants to speak. The only way to achieve that is if all
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speeches last 30 seconds, which will not happen. I have therefore decided to give preference to the seven hon. Members who wrote, according to when they wrote. I ask those hon. Members whom I call to bear in mind the circumstances of others. The winding-up speeches will start at 3.30 pm. If we appear to be running out of time, and hon. Members want to contribute, they will have to do so by way of interventions.
2.53 pm
Tony Baldry (Banbury) (Con): The hon. Member for North Durham (Mr. Jones) has done the House a service in obtaining this debate. It is a tragic reflection on the machinery of Government that it takes an hon. Member 100 questions to get some straightforward answers about matters pertaining to institutions and NHS facilities in his constituency.
A similar story unfolded in Oxfordshire, where the ophthalmic treatment centre functions at only about 50 per cent. of capacity, but a block contract has been granted to the private sector as if it were operating at 100 per cent. capacity. All the money that is going to the private sector for operations that the treatment centre does not carry out is money that cannot be spent elsewhere in the NHS in Oxfordshire. In the meantime the excellent work that used to be done at the Oxford eye hospital is undermined.
The NHS in Oxfordshire is in freefall. The strategic health authority tells us that within this year—by March—the Oxfordshire health economy has to save some £35 million, of which £25 million must be saved from the Oxford Radcliffe NHS trust. That is simply not going to happen. There is no way that the trust can save £25 million between now and the out-turn of this year without a draconian slash-and-burn policy, which I am sure that the Minister does not want to see.
On the back of that, the strategic health authority has decided that it will put out the management of the primary care trust to the private sector. This week, I and other hon. Members received a letter from the chief executive of the PCT. A kind of NHS-speak seems to be developing, which is completely incomprehensible to most of us. What on earth does a phrase such as
mean? How the hell does putting out the management of a PCT to the private sector increase
Ministers and officials are simply deciding that a particular provider will run the management of a PCT. It is complete gobbledegook.
The strategic health authority proposes to procure the management services of Oxfordshire PCTs, and has made it clear that bids from the private sector will be welcome. On the Order Paper today, there are 16 questions from myself. I shall not detain the House for too long, but I want some assurances from the Minister. First, I want an assurance that if the contract is let to the private sector, we shall not have a situation where I and other hon. Members table questions, to be told that it is all commercial incompetence.
I had a proposal for an accommodation centre for asylum seekers in my constituency, which was to be let to Group 4. Whenever I tabled a question to ask
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Ministers about the contract, I was told that it was commercial incompetence. When I asked about certain matters of liaison with the local community, I was told that that would depend upon the contract. So who is going to draft that contract? Will it make it clear that if the private sector takes over the management of the PCT in Oxfordshire, it will have to be answerable to scrutiny committees of local authorities in the normal way? I do not want the chief executive of Oxfordshire county council to write to Capio or Universal Health, which I understand is run by a former policy adviser at No. 10, asking him to appear before the scrutiny committee of Oxfordshire county council, only to be told, "Terribly sorry. It's not in the contract. We are not obliged to come and answer for what we are doing in procuring the primary care trust in Oxfordshire, because that's not in the contract."
Secondly, I want to know what assessment Ministers have made of the redundancy costs on direct-line managers within existing PCTs that put such matters out to the private sector. Indeed, I should be interested to know what assessment of the effectiveness of the policy Ministers have made, because if a contract for putting out the management of a PCT to the private sector fails, what then are Ministers going to do? Is that not simply a cynical exercise where Ministers realise that the Oxfordshire health economy is in such difficulty that if it fails, they can simply blame the private sector? I should like to know what consultation and authority Ministers have already given to the strategic health authority to let the contract. In the letter to hon. Members, it says that there will be "a rapid appointment", which is hardly consistent with proper consultation.
Indeed, the Minister will not be surprised that bodies such as the Royal College of Nursing, and other royal colleges, are appalled at the way in which the policy is being taken through, and the fact that there has been no consultation. I shall read from a straightforward letter from one of my constituents:
"As you know, whenever there is a major configuration of services within the NHS, there is a duty on them to publicly consult, usually for a period of three months. To date there has been no consultation with the public, staff or trade unions locally. Whilst Thames Valley Health Authority plans to consult later this year on the boundaries of the new PCTs, Health Authority and Ambulance Trust, they do not plan to include the management arrangement within this consultation."
That is from a member of the Royal College of Nursing. It is appalling that staff have not been consulted. The strategic health authority says that there has been
I have yet to find anyone with whom there has been discussion, either informal or otherwise. That is craziness.
I realise that many hon. Members wish to speak, so I shall ask the Minister one simple question, and I hope that it will be supported by the hon. Member for Oxford, West and Abingdon (Dr. Harris). Will the Minister undertake to come to Oxfordshire in the next two or three months to meet its six Members of Parliament to discuss the Oxfordshire health economy in general and specifically the proposal to put to private tender the management of the PCT for the whole of
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Oxfordshire? As far as I am aware, it is the only PCT in the country where the proposal has been made. It seems to have been drawn up on the back of a fag packet somewhere in the strategic health authority, probably in consultation with some unit of which we have never heard in the Cabinet Office or No. 10, as being a whizzo idea, but it requires a sensible discussion and the six Members of Parliament for Oxfordshire want to be engaged in that discussion.
Dr. Evan Harris (Oxford, West and Abingdon) (LD): I endorse everything that the hon. Gentleman said, and through him ask why it is felt that the proposal has anything to do with competition or contestability. There will not be competition. Will not there be a huge vested interest if BUPA runs the commissioning in Oxfordshire on whom it buys from? Which private company will offer its prices to executives from BUPA or United Health? Yes, the proposal is radical—radically stupid.
Tony Baldry : My colleague makes a perfectly sensible point. There is a legion of policy questions that need to be considered and properly answered. The idea that the strategic health authority will make a "rapid appointment" of a team to run the PCT in the way proposed is appalling. It is an appalling use of the machinery and the process of government when the Oxfordshire health economy is already in freefall and when substantial cuts will almost certainly have to be made.
I ask the Minister to ensure that his private office digs out all the papers on the issue and puts them in his Box. I hope then that his diary secretary will get in touch with us and arrange a time when the Minister can talk to us, as perfectly intelligent Members of Parliament, about the policy implications. The hon. Member for North Durham has the opportunity of being in the same Division Lobby as the Minister and still has to table questions.
Tony Baldry : The hon. Gentleman says, sotto voce, not always. If the Minister is not prepared to meet us as Oxfordshire Members, we will simply hound him around the corridors of Westminster until we get answers to these very basic questions.
3.2 pm
Mr. Paul Truswell (Pudsey) (Lab): I, too, congratulate my hon. Friend the Member for North Durham (Mr. Jones) on securing this important debate. I shall try not to take nine minutes for my speech like the hon. Member for Banbury (Tony Baldry).
Like many on the Labour Benches, I am a zealous supporter of the NHS. I believe that as far as possible all its services should be provided by NHS staff and facilities. However, I recognise that in 1997 we inherited a situation in which the capacity of the NHS had been diminished. By and large, my constituents want to be treated quickly, effectively and as close to home as possible. Like many Labour Members, I accepted that there was a case in the short term for exploiting the surplus capacity—I stress surplus—in the private sector at marginal cost, but we have gone far beyond that.
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There has been a ten fold increase in the amount of NHS-funded care provided by the private sector. I shall focus on one practical example of how the proposed second-wave independent sector treatment centre for West Yorkshire might adversely affect the NHS in Leeds, and therefore my constituents.
We have an acute trust that has suffered from a chronic deficit for many years; it is attempting to address that challenge. That is not to say that there have not been major improvements since 1997. We have 850 more nurses, 125 more consultants and180 new junior doctors, and waiting times and waiting lists have fallen appreciably. However, these enormous gains are often overshadowed by the short-term measures that are necessary to address the deficit.
The advent of independent sector treatment centres has provided some short-term gains in terms of reducing waiting lists and times, but we appear to be moving into an era where the private sector is simply being grown for its own sake, as my hon. Friend has already suggested. The goalposts have been moved; they have been widened as a target for the private sector and narrowed as a target for the NHS.
I understand that the Department of Health carried out an assessment of contestability in West Yorkshire and has concluded that we need more of it. Will the Minister comment on that? We already have contestability in Leeds. The Leeds PCTs are commissioning more activity from outside the Leeds acute trust than ever before, which represents a £14 million reduction in that trust's income.
The Secretary of State has approved a strategic outline case for a new children and maternity hospital, to be built at St. James's hospital in Leeds. That is a very welcome and long-overdue move, but its progress depends on the trust being able to put together a successful outline business case. The trust therefore obviously needs to maximise its income. It has made allowances for the loss of commissioning from the local PCTs and for the proposed second-wave treatment centre, but there will be real concerns if its income diminishes further.
I was very concerned to discover that the proposed second-wave treatment centre for West Yorkshire is to have a guaranteed minimum income of £45 million, underwritten for each of its first five years. Where is the contestability in that?
Jon Trickett (Hemsworth) (Lab): Like my hon. Friend, I am a West Yorkshire MP. Have health service officials told him, as they have told me, that although the Department has said that there is a need for more contestability in West Yorkshire, there is no evidence for that statement, which is simply dogmatic? Does he therefore conclude that the argument is driven by dogma from the centre rather than by reality on the ground?
Mr. Truswell : I am a charitable individual, and I understand my hon. Friend's interpretation, but I did start by saying that I understand that there has been an assessment. Otherwise, I agree that the argument is based purely on dogma.
As I said, the £45 million, which is underwritten for each of its first five years, is £20 million more than the figure given in the earlier proposal, which incidentally
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the trust supported on the basis that it was intended to help the delivery of the 18-week access targets by 2008. One is bound to ask where the money for that underwriting is coming from, and, again, how that relates to contestability. Ironically, it now appears that the treatment centre will not be available until after 2008, so that any extra capacity that it provides will not contribute to achieving access targets by 2008.
The trust has also been asked which specialties that it currently provides might be transferred to the new independent sector treatment centre. Transferred work, of course, does not represent an increase in capacity. It goes without saying that to acquiesce would be suicidal for the trust.
The trust must retain and maximise its income in order to address its deficit and to compile a robust outline business case for the children's hospital. When a hospital loses patients, the drop in its income will generally be greater than its drop in expenditure because of the national tariff process.
I conclude my remarks with these few comments. I leave it to other colleagues to paint the wider picture of concerns about the promotion of the private sector, but I share their fears, which I am sure more of them will express, that it will leave the NHS with the most costly and complex cases and emergency work, that it will lead to higher cost, that it will divert staff and distort work force planning, that it will redistribute existing work loads rather than increase capacity, and that ultimately it will reduce choice by threatening existing providers, such as the Leeds acute trust. That is without even mentioning the current proposals for PCTs.
Ideally, therefore, the impact of this drive towards the private sector and its longer-term effects should be properly evaluated, and the first wave should be properly assessed before we move to the second. If Ministers are not inclined to do that, at least the potentially damaging aspects of the initiative, which I have tried to tease out today, should be fully explored.
3.9 pm
Kelvin Hopkins (Luton, North) (Lab): I am delighted to contribute to the debate, and I congratulate my hon. Friend the Member for North Durham (Mr. Jones) on raising such an important issue, which has become very hot this week.
Some months ago, I asked my right hon. Friend the Prime Minister about MRI scanners at Luton and Dunstable hospital. A certain amount of sand was thrown in my face, but there were no adequate answers. Those scanners have come on-stream this week, but there is no funding for radiographers to operate the second scanner. The first scanner replaced an old scanner, and the second scanner was new. The Government had been encouraging hospitals to increase their scanner capacity, and we are still decades behind many other developed countries. I think that Britain is at the bottom of the league table for numbers of scanners compared with other developed countries, so we need additional capacity.
Luton and Dunstable hospital has provided just that. However, money was not set aside for radiographers; it was earmarked for a mobile private scanner at the hospitals in Stevenage and Bedford. That scanner is literally on the back of a lorry. It is not a good service
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and it has been featured on television as such. Patients and funding have been guaranteed, but the service is so poor that patients are often referred back to Luton and Dunstable hospital because the quality of scanning required cannot be provided. That is not a market; it is ideologically driven, to force public money into private pockets at the expense of quality public provision.
I raised the matter with a Health Minister. I will not mention the Minister's name, because that would be too embarrassing. I questioned the Minister at length on why that had been done in Luton and why it is being done elsewhere in the country, and after every single answer had been broken down, the only answer was, "Well, people might be able to take advantage of moonlighting staff." In other words, the Government want to persuade a few NHS staff to do a bit of extra overtime in the evenings without telling the hospital that they are doing it.
Helen Jones : Does my hon. Friend agree that the problems of dealing with staff will become more acute with the second wave of independent sector treatment centres, because the Government will relax the restrictions on those companies taking on NHS staff? That does not increase capacity one iota.
Kelvin Hopkins : Absolutely. I thank my hon. Friend for her very helpful intervention.
My local primary care trust has done a tremendous job in dealing with serious health problems in the locality. Luton has a degree of deprivation in certain areas, particularly affecting some of our minority populations, but the PCT has become a specialist at targeting such health problems. If the PCT is broken up and merged with others, we will lose that specialism; it will be dissolved into surrounding areas, which are quite different from Luton.
Setting that to one side, however, the PCT has done a tremendous job in two respects. First, it has established a walk-in centre in the town centre, which has been a fantastic success. It sees 50,000 patients a year. There has been a shortage of GPs, which we were not able to address, but that facility is making up the gap. That is public enterprise and it is a real success. The PCT has also set up a treatment centre with qualified nurse practitioners, who take some of the burden off the accident and emergency department at the local hospital. It also has outreach programmes to do advanced primary care in the community. It is doing a fantastic job. The PCT has recruited 28 skilled nurses from outside the town.
That additional capacity is all in the public sector and everything is done brilliantly. That is exactly what the Government said they wanted in the "Choosing Health" White Paper. The PCT is doing a tremendous job in difficult circumstances. It was even, until recently, able to overcome its financial difficulties, despite being £10 million a year below its fair funding target. It has had problems this year, along with many other PCTs throughout the country.
However, the PCT will be forced to privatise those services, as well as all the other traditional services that it provides, because it will not be permitted to provide
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direct services. Not only will the services be lost to the private sector; we must ask whether the private sector will be interested in dealing with poor people with difficult diseases and old people. I think not. It will be interested in what is profitable, and what is profitable is not necessarily what is needed.
I asked my right hon. Friend the Prime Minister another question last week about Balfour Beatty, a private sector company that took over public sector work and has just been fined £10 million for negligence. I believe that it should have been prosecuted for corporate manslaughter, but we do not have a law governing that yet. That private culture will be inflicted on the health service as well as on our railways. That is wrong and should be reversed.
We have had a brief debate so far. I will not say much more, although I could do. I am concerned about the impact on my constituents in Luton and, in particular, on the poor people of Luton who have serious health problems. They will suffer. We are rapidly moving towards the US system of health, whereby 40 million people have no health cover at all. When New Orleans was flooded, it took six days to get a single doctor into the city. That is what we are moving towards. I want a public health service that is committed to serving everyone at the point of need, whoever they are and whatever their circumstances.
I have just attended and spoken at a meeting of ASLEF and I learned a new term for something that is particularly mad. ASLEF talks about something being "Dagenham, East"—two stops past Barking.
3.14 pm
Dr. Richard Taylor (Wyre Forest) (Ind): I, too, congratulate the hon. Member for North Durham (Mr. Jones) on his forensic exposure of so much that is wrong with the Government's rush into the extra use of the private sector.
I shall speak for a few minutes on the importance of the level playing field, which has been mentioned many times already. Back in the 1980s, when domestic services were privatised, the staff in my hospital were persuaded to put in a bid. It was a level playing field and the staff won. On a level playing field, I believe that the best of the NHS could win every time.
I want to draw to the attention of the House some of the snags of the independent sector treatment centres, in addition to excess cost, which has already been mentioned. Those issues have been raised with me by the previous president of the British Orthopaedic Association. Some of those concerns were addressed in my Adjournment debate in June, but many of them were not.
I shall speak first about accreditation. Accreditation in some countries in Europe is not of the same standard as that in the UK, where surgeons are accredited to have full responsibility. Consultant appointments under the NHS are made by committees with Royal College and university representatives and, if there is no suitable appointee, no appointment is made. Professional recruitment agencies, when recruiting for the independent sector treatment centres, virtually have to make an appointment, and they seek surgeons from countries where they may be paid a mere £10,000. The attraction of the UK is that surgeons can earn £70,000, and so we are robbing other countries.
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There are still no specific arrangements for the handling of complications. Should they be handled by the NHS? Who will deal with complications that occur in the independent treatment centres? In January, the British Orthopaedic Association sent a large dossier to the Department of Health, raising problems of process. That has been partially answered. More recently, it has sent a more important dossier of patient complaints about the independent sector treatment centres, but as yet has had no response.
The major issues of training and tariffs have been mentioned. I understand that some specialist hospitals fear that they could lose their training recognition if there are reductions in training opportunities,
The Government claim that independent sector treatment centres are largely responsible for the improvement in waiting lists. That claim must be challenged. I have tabled a parliamentary question to try to confirm what I was told by an ophthalmic surgeon just a few days ago: that in 2003–04 the NHS performed more than 300,000 cataract operations, due to huge efforts from NHS doctors and nurses. The mobile independent sector ophthalmic provider, since it started about two years ago, has undertaken between 10,000 and 14,000 cataract operations. It has not really had the chance to make that much difference.
I believe that, if there were a level playing field and it came down to competition, the NHS could compete. However, I am passionately opposed to any form of competition in health care, and to the purchaser-provider split, which I believe did a vast amount of damage.
I am encouraged that so much resistance is being demonstrated this afternoon to the Government's rush to privatisation, which I think would be a disaster.
3.19 pm
Tony Lloyd (Manchester, Central) (Lab): I am sure that my hon. Friend the Minister is delighted today to be surrounded by his hon. Friends. I congratulate my hon. Friend the Member for North Durham (Mr. Jones) on securing the debate. He has done a great service, because this issue has touched a deep and raw nerve among hon. Members on both sides of the political divide.
I shall try to be brief, and I shall reiterate some of the points that have been made, but in relation to the Greater Manchester surgical centre. Like others, I am passionately committed to the concept of a public sector national health service, and think that it has served the nation well. The ideological arguments for it are sound, but those for the intrusion of the private sector have been neither well made nor properly researched or established. That concerns me because what is happening is an ideological move mainly by stealth. The Greater Manchester surgical centre is an example of that.
When the idea of the surgical centre was first mooted, there was no public consultation with Members of Parliament or any proper consultation with the referential public bodies involved with health. The primary care trusts in Greater Manchester were effectively dragooned into playing a part—some were acquiescent and some were resistant. Hon. Members will understand that because of micro-politics in the health service, information was not always placed in the
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public domain. Therefore, debate about the surgical centre was low key. At no point was any public justification or explanation given as to why that capacity was needed in Greater Manchester when existing hospitals could provide for the needs of local communities effectively. Indeed, had the investment from public money that went into the surgical centre been available to the health service, it is certain that we would have significantly improved the capacity and competence of those national health service operators.
The main issue that I want the Minister to address today is that of contracts. Will he tell us which complete imbecile drew up the contracts governing the surgical centre? It might be invidious if Ministers were to name names, but questions must be raised about the competence of the people who draft contracts for the national health service.
The contract for the surgical centre not only pays over the odds relative to the cost of treatment elsewhere, but gives a guaranteed minimum price to the surgical centre, which receives that money whether it performs the operations or not. That means that the national health service will spend about £1.4 million on operations that have not been performed in the surgical centre, because there are not the patients. Who in their right mind would draw up a contract that is so open-ended and unfair to the public and so massively favourable to a private sector provider? If present trends continue, the surgical centre will, in a year of operation, cost the national health service, and therefore the public, £6 million. One might say that that is a trivial amount in the grand scheme of the health service budget, but about 40 per cent. of the value of that contract is being poured down the grid. That is unacceptable.
Hon. Members will have different views on the role of the private sector. I would sooner that that role were narrow, constrained and more tightly controlled than in the example that I have given, but I know that the surgical centre, now that it exists, will be offered protection into the future. The consequence of that, in an area where there simply is not the demand for those services, will be the erosion of services in our hospitals, which means cutting back the public national health service to defend the private sector. That is simply intolerable.
3.24 pm
Lynda Waltho (Stourbridge) (Lab): I congratulate my hon. Friend the Member for North Durham (Mr. Jones) on securing this debate, and I welcome the fact that he is not ideologically opposed to private involvement if it passes the founding-principles test.
When I first saw the subject of the debate, I was concerned that it would be along the lines of "all private, bad; all public, good." Stourbridge is served by Dudley South primary care trust. For some years, the private sector has successfully provided it with counselling services. It provides young people with drug counselling and help with sexual problems at The What Centre. Private physiotherapy treatment has also been successful.
A more important example is that of audiology. I know that many areas have problems employing audiologists, but Dudley South PCT has brought in the private sector to help reduce waiting lists. The average
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waiting time was about 18 months. I know that it is higher in some parts of the country, but Dudley South PCT recruited additional audiology professionals to help. It has also set up night clinics, as well as making a contract with the private provider Ultravox which successfully assists with services that are already provided.
People wanting an audiology appointment need an average of three appointments. First, the ear is moulded; a fitting appointment is necessary; and a further appointment is often needed. The contract, which was set up after a bid in July 2004, has been overseen by the Royal National Institute for Deaf People.
The modernising health service programme has been important in the Dudley South PCT. I am a new MP, and I have dealt with only a few audiology surgery cases, but I can see what a difference the programme is making in my constituency. I am concerned that we do not throw the baby out with the bathwater. It is important that we do not reject services simply because they are private. In my constituency, the programme is making a difference, although I accept that that may not be the case elsewhere.
Jon Trickett : I am listening carefully to my hon. Friend, but does she agree that the private sector should not be deployed if that occurs at the expense of existing NHS provision, as we have heard happens elsewhere in the country?
Lynda Waltho : It should not be at the expense of the national health service, and I am sorry if I gave that impression. In my experience of the Dudley South PCT, however, it is not being done at the expense of the NHS; it is helping to solve problems. The main fact that I want to get across is that it has been helpful.
I have not yet dealt with scanners and other problems, but the provision that I have mentioned has certainly helped in the surgery cases that I have dealt with. The proof is that my constituents tell me, "Thanks for flagging it up. Thanks for pointing me to that service. I have an appointment." For me, it has worked. I am less experienced than my colleagues, but I speak from my experience.
My constituents have benefited also from the hospice movement. Acorns children's hospice is based at Selly Oak in Birmingham, but it serves my constituency and south Birmingham and the black country area. That, too, is in the voluntary sector, but it is in danger of being lumped into the "private, bad" group, which is not the case. In fact, it gives such a brilliant service that it has helped almost 2,000 families in the past 16 years.
Mr. Robert Flello (Stoke-on-Trent, South) (Lab): The hospice movement might be a private sector provider, but does my hon. Friend agree that we should consider with care the perversity that a private sector provider such as that mentioned by my hon. Friend the Member for North Durham (Mr. Jones) is getting money for old rope—although I would not, of course, use such an expression—whereas a hospice such as Treetops in my
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constituency, which gets no funding from the NHS, loses out despite the fact that many think that its services should be funded through the NHS?
Lynda Waltho : Absolutely. I agree with my hon. Friend, and I know that Treetops does as good a job in his constituency as Acorns does in mine. When I visited Acorns and spoke to the chief executive, I learned that it receives less than 10 per cent. of its money from the health service. It costs some £4,500 per day to fund the excellent services that it provides. They include jacuzzis; hydrotherapy; bedrooms designed for life-limited children, as they are called; facilities in bedrooms to assist with moving children from their wheelchairs into bed and so on; and a respite service for families. It also provides care after death, in that it has bedrooms, which are cold, where residents and family members can go to say goodbye to the child. That is a brilliant facility compared with a mortuary. Those services are brilliant, and more than 90 per cent. of the funds are provided by fundraising. That long answer is my way of saying, "Yes, I agree."
It is perverse that money is provided for old rope at one end of the scale, yet at the other end brilliant services such as those provided by the child hospice movement are desperate for the funds with which they could extend their help to thousands more families. In my limited experience since becoming an MP in May, I have seen good private provision. I acknowledge that I am at the beginning of my career, and I might yet see the other side, but that needed to be said.
Mr. David Amess (in the Chair): Order. I apologise to all those whom I have not been able to call. Perhaps the Minister will be generous to colleagues.
3.33 pm
Steve Webb (Northavon) (LD): I, too, begin by congratulating the hon. Member for North Durham (Mr. Jones) on a superbly begun debate. The very large attendance at a debate in which not everybody knew that they would be able to speak is indicative of the importance of the subject. That is one reason that the Government should have initiated the debate—at far greater length, and in Government time. Another is that, as has been said, a major reform of the primary care trust system was slipped out at the end of July when we had all left for the summer recess, and that has not been debated properly in the House. A great deal of rapid change is taking place in the heath service, and it is our job to scrutinise it. The Government should facilitate that process, rather than relying on the issues being brought before the House by energetic Back Benchers such as the hon. Gentleman, who has done us a great service.
I start where the hon. Member for North Durham started—by saying that we are not saying today, "Private bad, public good." Rather, we are concerned that there are those who might say the contrary, "Public bad, private good," and that the pendulum has swung too far. I agree with the hon. Member for Stourbridge (Lynda Waltho) that we should have no problem with the idea that some high-quality health care should and
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can be delivered by people who are not direct employees of the NHS. I had already written "hospices" on my notes before she spoke. She also mentioned counselling, and many of us encounter people who receive good-quality care in private nursing homes. If it were so important to us that staff be strictly employees of the NHS, not many of us would ever visit a GP or a dentist. It is not simply a matter of being employed by the NHS.
If the private sector is to have a part to play in the NHS, it must pass a number of tests, several of which have been mentioned. We have ended up with about six. I shall clarify the key tests. We must start with accountability. For me and for many of my constituents—I am sure that it is the same for many hon. Members—accountability in the NHS seems to be diminishing. We are told that we cannot find out about so much of what goes on because it is commercially confidential, and that we cannot challenge decisions. If we ask in the House about certain decisions, we are told that they have been made by the trust. If we ask the trust, we cannot get rid of its management. Where is the accountability? If the private sector were more extensively involved, what would that mean for accountability?
My hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) made a powerful point when he referred to the contracting out of commissioning in Oxfordshire. As the hon. Member for Banbury (Tony Baldry) rightly said, what would that mean for accountability? This week, Nigel Edwards of the NHS Confederation argued that the NHS not doing health commissioning was a little like British Airways saying that its core business is air miles and that the running of planes was too difficult for it. Why does the NHS exist, if not to determine dramatically the provision of health services? If we are to go down that route, why have an NHS at all? We have not received an answer to that question.
If the private sector is to be involved in the NHS, it must be competitive on the basis of costs. However, as we have heard, it has been given a favourable deal on cost in too many cases. It has been given guaranteed business. There is an irony in the way in which the Government use the rhetoric of the market and the drive up in standards by fierce competition, but then mollycoddle the private sector with guaranteed contracts and prices. How does the giving of subsidies to generate a market constitute fair competition and a level playing field? Hon. Members must make no mistake. That is what is happening. The Government are determined that there shall be a market; unaided, the private sector will not enter it. It has to have its hand held. The Government's determination to form a market is creating unfairness.
The hon. Member for Banbury and others asked how we specify a contract. That is essential. If the contract were not specified correctly, the private sector provider would cherry pick and choose the cheapest cases. As the hon. Member for Warrington, North (Helen Jones) said, private sector providers will not undertake training unless they were required to do so under the contract. Sometimes the answer can be, "Well, we can deal with that. We shall draw up better contacts", but the world moves on. Life changes. In effect, a contract can be rewritten if it was in respect of an organisation in the public sector. It can be asked to do something different,
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because the world is different. However, if a contract were drawn up five or 10 years ago, it would be difficult and expensive to change. Will the private sector be as responsive as the public sector when the world changes? I fear not.
What about quality? Clearly, if the private sector is to provide NHS services, the quality must be as good. There is no reason to suppose a priori that it will not be, but there might be a danger of it not being as good. The hon. Member for Wyre Forest (Dr. Taylor) referred to accreditation. NHS provider services and NHS employees go through a process of accreditation. However, when services are contracted out—possibly using overseas staff—can we be confident that all the medical staff involved will be of the same quality? So far, I do not think so.
What about scanners? Over the summer, I visited several hospital trusts. I heard about a mobile scanner unit in a car park that had two problems: first, people had to go up three steps to get into the unit. People who were sick could not access it. Secondly, because it was a mobile scanner, it was not as big as the regular scanner and, thus, tall people could not access it. Essentially, it was a scanner for short, healthy people. I have nothing against short, healthy people per se, but I do not think that they are a priority of the NHS.
Alliance Medical has a contract, yet the Government have been so determined to avoid embarrassment that they said to the NHS, "If you use an Alliance Medical scan, you can have it for free. We shall not compel you to use the scan. You can choose someone else. If you want to pay the price, that's fine, but the service will be free from Alliance Medical." I wonder which company would be chosen in those circumstances. Is that good value for money for the taxpayer?
We must bear in mind that getting the private sector in the NHS on a subsidised basis will generate a market, and that means gainers and losers. The losers might be in the NHS, if that is not properly protected. As the hon. Member for North Durham said, what will be the impact of such issues on the core NHS, the NHS ethos and on the universal public service that we want? We do not know what the transition mechanisms are. The NHS needs keyhole surgery, but it is getting amputation. One department will close and then another; the unit cost to the rest of the hospital will be too high, so it will not be able to compete and it will go. Is that the transition mechanism? What will happen? We have not been told.
As has been said, this process is driven by dogma. The funny thing is that one might have imagined from the title of our debate that the dogma would come from the person who sought it, but it has not, because the hon. Member for North Durham has said that he is willing to consider private sector involvement. The dogma is coming from the Government, who are in a desperate rush to get the market in because the Prime Minister wants a legacy before he retires.
3.40 pm
Mr. John Baron (Billericay) (Con): I, too, congratulate the hon. Member for North Durham (Mr. Jones) on securing this important debate. I also congratulate other hon. Members, who have made important contributions. I am delighted to hear that the hon. Member for Northavon (Steve Webb) has nothing against short, healthy people or tall, healthy people.
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It will be interesting to hear the Minister's response to the series of questions that he has been asked. I hope that he will pay more attention to the views of his colleagues in the House than the Secretary of State did to ordinary Labour party members when the vote on this important issue was held at the conference in Brighton.
Conservative Members welcome the fact that the Government are talking much more about the need to introduce patient choice. However, choice is a meaningless term if we do not have spare capacity. That is where the private sector will become increasingly important in delivering NHS services.
The Government have issued some statistics regarding their intentions. About £3 billion will be spent over the next five years to pay for about 1.7 million operations in the private sector, mostly via independent treatment centres, as we have heard. Conservative Members believe that the private sector could play a much greater role for the benefit of the NHS and that the Government's approach is not the way to proceed; indeed, it is fundamentally flawed. In essence, they are block-booking capacity and deciding where capacity will be needed. That runs the severe risk not only of being inefficient, but of ignoring what patients want and need.
The example given by the hon. Member for North Durham clearly illustrates the point. The chief executive of a university hospital is claiming that the Government have contracted out MRI scans despite the fact that his own scanner was "considerably underemployed" and that he could practically have eliminated waiting lists if he had been given the cash instead. That is complete nonsense; it is not how the system should be working.
As we have heard from several Members, another problem is that the evidence suggests that the Government's approach is more costly. I commend the hon. Member for North Durham on his tenacity in extracting answers from the Government, and according to a recent parliamentary answer to a question from one of his colleagues,
"it is estimated that procedures purchased under the ISTC programme cost on average 9 per cent. more than the national health service equivalent cost".—[Official Report, 16 March 2005; Vol. 432, c. 273W.]
As several hon. Members have said, the Government's nationally agreed targets with the private sector have been poorly drawn up and have resulted in valuable NHS resources lying idle. The contract with Alliance Medical is one such example.
To create downward pressure on prices in the private sector and encourage more competition, the Government need to create a right to supply the NHS. Otherwise, the result will be exactly what we have at the moment—private companies selected by the Government continuing to be paid to cherry pick easy operations from the NHS. That is not the right way to proceed—it is neither sustainable nor sensible. It also risks antagonising staff and alienating them from the private sector and the benefits that it has to offer.
Kelvin Hopkins : Will the hon. Gentleman give way?
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Mr. Baron : I shall make some progress because I want to ensure that I give the Minister plenty of time. If there is time at the end of my speech, however, I will take the hon. Gentleman's intervention.
The Government are wedding themselves to a particular approach and are reluctant to relinquish control from the centre. That is why the NHS has not made the progress that it should have done in recent years. It would be churlish not to accept that some progress has been made, but despite a 70 per cent. real-terms increase in funding, average waiting times have lengthened by five days—that is the Department of Health figure—and the number of hospital treatments has risen by only 5 per cent., despite the hard work of NHS staff.
The Conservative approach to the private sector is in complete contrast to the Government's, and I know that it will not find wide acceptance in this place. Under our right to choose policy, the decision to involve the private sector would ultimately be made not by the Government or the primary care trust, but by patients and GPs. Our right to choose policies would allow any patient to go to any hospital, free of charge, that can perform the operation at the NHS cost. Such a policy would iron out the great variations that exist in the provision of NHS health care at present. One example of that was brought out last year by the Dr. Foster medical research company which showed that patients had to wait 390 days for a hip replacement at Norwich university hospital yet at Basildon and Thurrock University Hospitals NHS Foundation Trust, which is only 90 miles away, the wait was less than half that at 182 days.
By empowering patients in this way, resources will find their way to where they are most needed. Such a policy would also allow patients to go to private hospitals if they met NHS costs and standards. This policy would send out a clear signal to the private sector to increase capacity. For too long the private sector has been used by the NHS simply as an "overspill" facility. This does not encourage long-term sustained investment. That needs to change. On the continent, the private sector plays a much greater role in the provision of health care than it does here, but nobody grumbles about it because there are very few waiting lists. The patient benefits.
Stockholm in Sweden is a good example of what happens when a genuine choice programme is introduced. In the early 1990s, centrally allocated budgets were put to one side and payment by activity was introduced, enabling patients to take their budget to any hospital that could provide their care for that price. What was seen over a relatively short period was a major mushrooming in the number of care providers coming into the market and competing for patients. With more than 200 new care providers set up since 1992, there are very few queues in Stockholm to this day.
I take this opportunity to raise briefly with the Minister two other important issues that have been alluded to by other hon. Members. The first is the document "Commissioning a Patient-led NHS", which proposes a shift in role for PCTs from providing to purchasing. That announcement has created great uncertainty and confusion among NHS staff. Many hon. Members have referred to the lack of consultation on this issue. Many staff are unsure as to what will happen to them. In my constituency they are unsure whether they are to become independent providers
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themselves, work for a private or voluntary company, or join foundation hospitals and sell their services back to the PCT.
Will the Minister provide clarification by saying what proportion of health professionals will cease to be employed directly by the trusts? What exactly will happen to community nurses? Will they be required to join private companies? Will chiropodists be expected to set up private practices like dentists? Will the NHS staff no longer employed directly by trusts still benefit from the pay and conditions of "Agenda for Change"? Will the Minister take this opportunity to explain why such a major proposal affecting so many staff, and which includes both PCT reconfiguration and the outsourcing of provider functions, was launched by a simple letter from Sir Nigel Crisp to local trusts? Surely a more detailed paper produced by Ministers was warranted when we are considering such an important issue.
Mention should also be made at this point of the 17.5 million people who suffer from long-term medical conditions. The Government's approach of block booking reflects their thinking, as it does when it comes to targets in that it is focused almost exclusively on the acute sector. Once again, those suffering from long-term medical conditions are being neglected because of the Government's focus on what they perceive to be politically sensitive medical conditions. That has to be wrong. What will the Government do to put this bias right within the health care system?
I have one other question for the Minister. Social care is being neglected in areas such as rehabilitation services for the visually impaired, where local authorities are struggling to meet their responsibilities. According to the Guide Dogs for the Blind Association, 20 per cent. of local authorities are not providing any services at all. There is much scope for outsourcing some of the responsibility to charities and the private sector. Greater use of direct payments will help that, and I hope that the Minister will ensure that such a system will eventually realise its full potential for all concerned.
In conclusion, there is a fundamental contradiction at the heart of the Government's thinking. On the one hand, they are moving closer to our view that patients should be given genuine choice. However, on the other—perhaps because of dogma, as has been mentioned—they are clinging on to their old policy of centrally deciding where the extra capacity should be placed. That muddled thinking is causing confusion, not least among NHS staff, and, most importantly, it will not service the patient well. I therefore ask the Minister to directly address the questions he has been asked.
3.50 pm
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : I am grateful for the opportunity to discuss these matters this afternoon. Of the 10 minutes that I have, I will spend about half responding directly to the concerns raised by my hon. Friend the Member for North Durham (Mr. Jones). I will then try to cover the other points. Where I fail to do so, I will write to hon. Members.
This afternoon reminds me of when I got to my feet to make my maiden speech, and the Whips surrounded me with my hon. Friends. A voice from across the Chamber said, "What are you doing surrounding him?" Someone else said, "We are just keeping him warm." I feel in good company and very warm this afternoon.
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My hon. Friend has been assiduous in his investigation of the matter. Indeed, rarely has an evening gone by when I have not signed another parliamentary answer, drafted by my noble Friend, Lord Warner, in response to another line of inquiry. After such a long and tantalising build-up, it is satisfying to have the full consummation of an hour and a half's debate. If my wife allowed me to smoke, I would ask my hon. Friend to share a cigarette if not a cigar with me when we are finished.
The truth is that this debate and the matter raised by my hon. Friend are important not only because they affect the health and well-being of his constituents but because they touch on a much broader issue of national significance: how the Government will fulfil their big promise to the country in May to cut the waiting time for treatment from the scandal of 18 months—which we inherited in 1997—to just 18 weeks. When we were elected in 1997, waiting lists contained more than 1 million patients. Waiting times were out of control. Many people waited 18 months, but unacceptable waits were another part of life for many patients—long waits to see a consultant and in accident and emergency, and longer waits still for a GP. Thanks to our extra investment, our changes to the system and a lot of hard work from NHS staff, that is beginning to change.
Mr. Baron : Will the Minister give way?
NHS staff must never and will never by this Minister be labelled a producer interest. They have been instrumental in creating a Britain in which waiting lists have fallen. If we take the constituency of my hon. Friend the Member for North Durham as an example, mortality rates have decreased by 13.5 per cent. between 1997 and 2003. That is about a third higher than the national average.
Helen Jones : Will my hon. Friend give way?
Mr. Byrne : I have so many points to cover that I will not give way.
At the heart of the debate and the points raised by my hon. Friend the Member for North Durham is the scanning contract with Alliance Medical. For the benefit of the Chamber, I should explain that under that contract about 65,000 scans have been provided to NHS patients much faster than would otherwise have been the case. My hon. Friend raised concerns about the local scanning facility in his constituency being underutilised and asked a good question about why we do not just give that trust more money to employ more staff and put on extra scanning sessions.
By way of introduction to my five quick points of response, I should say that money is available in PCTs. Questions are often asked about the availability of radiographers, in particular, when the Government have invested and will invest to fund more. My hon. Friend made a non-ideological argument about putting the founding principles of the NHS into action. After an
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extensive deconstruction of his argument with the Department over the past two or three days, I am able to reply with five points. If I have missed out bits of his analysis, I will write to him afterwards.
First things first. By 2008, if not before, the University hospital of north Durham, in common with all NHS hospitals, will need to use its scanning capacity to the full, either by employing extra staff or by making more effective use of NHS staff. As I said, where there are staff shortages, we shall continue to invest to overcome that.
Secondly—and this will probably make the biggest difference—funding is in the system for delivery of the 18-week target, which, for the first time, includes diagnostics. Durham and Chester-le-Street PLC will have its funding increased by more than £30 million—18.5 per cent.—over the next two years. We cannot reach the 18-week target unless we use the money to ensure that local scanning capacity is used to the full. I know my hon. Friend's methods of persuasion and argument and I am sure that he will help his local PCT to see the logic and wisdom of directing the extra funding into the university trust.
Thirdly—and this may be the coup de grâce—we are introducing a programme called choice of scan, which is a catchy name for something that means that from November, any patients waiting for an MRI scan who do not have a date scheduled within 26 weeks will be offered the choice of going to another provider, with the money following them. I have no doubt about what that will mean in my hon. Friend's constituency, because at the moment, as he says, patients are forced to go to Middlesbrough, but they should have the choice and the chance to go somewhere local, if that is better for them.
Fourthly, we must ensure that we approach the questions with our eyes wide open. Last year, we specifically included diagnostics in our capacity planning exercise. In particular, we asked strategic health authorities two questions: how much MRI scanning do they need to hit the 18-week target and how much of it do they need to obtain from the independent sector? We want to know how much capacity they already have—which they need to use to the full—and what the gap is, representing what they will need to obtain elsewhere.
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Finally, my hon. Friend made several reasonable points about answers that he received, suggesting a lack of information centrally. Most importantly, data on waiting times for MRI scans—which have been a particular bugbear for him—are not currently collected centrally, but the Department will introduce such data collection later in the year, to examine the waiting times for some diagnostic tests and procedures.
In the three minutes left to me I shall try to cover some of the more general points that were made. I have nothing further to add about PCT reform to what my right hon. Friend the Secretary of State has talked about.
Paul Farrelly : I wanted to ask about the imposition of commissioning on PCTs. Newcastle-under-Lyme PCT employs scores of community nurses and runs a community hospital, and is already addressing market failure by employing salaried GPs; it will also employ a salaried dentist. What case has been made for possibly removing those functions from PCTs such as the one in my constituency, resulting in demoralisation? The Minister is a management consultant. Prima facie what is better and more efficient—one provider with a good record of managing services directly or a proliferation of organisations managing indirectly through a plethora of contracts and a battery of lawyers?
Mr. Byrne : As my right hon. Friend the Secretary of State has said in the past couple of days, there are two aspects to the question of commissioning in a patient-led NHS. One is the question of ensuring that democratically elected local voices are heard in the debate about reorganisation of boundaries. We shall make sure that that happens. The other is the prime opportunity offered by the primary care White Paper that will be published at the turn of the year to reflect on what hon. Members have said about how primary care services will be provided in the future.
I have only one more minute for my remarks and I recognise that I have not been able to answer many of the points that were raised. I shall be making several visits, including to Manchester, Stoke and Stourbridge, where I shall be happy to deal with detailed issues in more depth with hon. Members.
Debates of this sort are invaluable for ensuring that we pursue effectively our policy for achieving the change that we want in the national health service and tackling health inequalities.
19 Oct 2005 : Column 293WH
19 Oct 2005 : Column 295WH
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