Select Committee on Public Administration Minutes of Evidence


Examination of Witnesses (Questions 60-79)

RT HON JOHN HUTTON MP

1 NOVEMBER 2005

  Q60  Kelvin Hopkins: If it was "in addition to" rather than "instead of" I would believe that, but the fact is that funding, which could and should have gone to staffing one of the scanners at my local hospital, has gone to this private provider.

  Mr Hutton: I know you have had some correspondence with the Prime Minister about that and I think there is some dispute about the basic facts there, but I think what is not in dispute is that the number of MRI scanners has nearly doubled in the National Health Service since Labour came to office. I have to say, with great respect, that I think you are barking up entirely the wrong tree.

  Q61  Kelvin Hopkins: We can pursue that at greater length another time. This Mr Ken Anderson, before he joined the Department of Health, was Director of Healthcare with Amey plc. His job was to bid for PFI projects in the NHS. He is now inside the Health Service levering services into the private sector. Is that not perverse? If a civil servant were to go into the private sector and do that, he might be in trouble. But to go from the private sector into the public sector and to lever public services from the inside into the private sector is apparently all right.

  Mr Hutton: Are you suggesting any impropriety?

  Q62  Kelvin Hopkins: No. I am asking an interesting question. You are the one answering the questions; I am the one asking them.

  Mr Hutton: No, you are suggesting that Ken Anderson is behaving unethically and improperly.

  Q63  Kelvin Hopkins: It just seems—

  Mr Hutton: And I think if you believe that you should contact the Permanent Secretary.

  Q64  Kelvin Hopkins: Well, I certainly will. It seems to me rather odd that somebody from the private sector, who recently was procuring PFI contracts, long-term contracts, from the public sector, is now inside, levering them out from the inside.

  Mr Hutton: I think there is only one question that really matters and that is whether Ken Anderson is doing a good job and whether he is acting ethically and properly. I have absolutely no doubt that he is acting ethically and properly and he is doing a good job. He is getting value for money for the NHS out of these contracts, and in part that is because he knows the private sector well and he has been able to convert that knowledge into beneficial use for the public service and the taxpayer. If you have any suggestions that he is acting improperly or in any other way in contravention to the Civil Service Code of Practice, you should not ask me those questions, you should be raising them with the Permanent Secretary who is responsible for his behaviour.

  Q65  Kelvin Hopkins: I shall certainly be writing to the Permanent Secretary and the Secretary of State for Health.

  Mr Hutton: Good. I think it is disgraceful that you have made those allegations.

  Kelvin Hopkins: I do not think I make allegations. I am asking questions.

  Mr Hutton: You are implying dishonesty.

  Q66  Chairman: I think the exchange has illuminated an issue which Kelvin, if he wants to, can pursue through the channels that you have described. On one of his points, could I ask you again very precisely. I know the privatisation charter is one that is hotly contested, but the Government does seem to believe that it does not really matter who provides services. I would like to know, and I think it would be helpful to people if you could try to say this directly: are there any services that you think intrinsically have to belong to the public sector in terms of provision? Or is it the case that virtually anything could be commissioned, contracted out, to anybody who wants to provide them?

  Mr Hutton: No, I think there are some core functions from Government that should always be in the public sector. I think the Armed Forces, criminal law enforcement. That is my view. I think there are other functions where we can take a different view. I think the basic position in relation to health and education and other services is what is going to provide the best service for the public.

  Q67  Chairman: Beyond the Police Service and the Army, it does not really matter who provides anything else.

  Mr Hutton: No. I think what matters is who is going to provide the best possible service.

  Q68  Chairman: I am just restating what you just told me, which is that it does not matter who provides the services beyond the core services you just mentioned in terms of law enforcement.

  Mr Hutton: If you want to have some correspondence as to what is a core service, we will have that. I am offering you at least a glimpse of what I think the core service is and I am sure there will be other things with hindsight we will probably want to add to it. When it comes to other services, I think the Government should have an open mind, yes, and it should pursue a policy that produces the best value-for-money for the taxpayer and the highest quality of service for the public who is consuming those services.

  Chairman: Thank you for that.

  Q69  Paul Flynn: You said you asked the public whether they wanted choice. Can you remember how many of them, what percentage, said they wanted no choice?

  Mr Hutton: I think a tiny number.

  Q70  Paul Flynn: There were some?

  Mr Hutton: When I said we asked the public for choice—

  Q71  Paul Flynn: The point being that it is a fairly stupid question, is it not? Asking the public whether they want choice is like asking whether they favour mother love and thornless roses.

  Mr Hutton: Yes, I think it confirms that choice is a popular idea.

  Q72  Paul Flynn: Having asked them whether they want choice, do you not think there is a danger that it would keep the problem with targets (which you seem to have said were more a measure of failure than success in many cases) by offering them choice which is not deliverable in many instances.

  Mr Hutton: We should offer choice where we know we can deliver it.

  Q73  Paul Flynn: We offer choice in schools. Like many constituencies, I have half a dozen comprehensive schools. Some have a better reputation than others. 90% of the parents would go for one or two schools and a tiny percentage would go for the unpopular schools. How do you deliver on that?

  Mr Hutton: I think we should not make the mistake of assuming that choice is not going to have some limits. Of course there are going to be limits on choice. We have always made that clear.

  Q74  Paul Flynn: It is a marketing ploy, is it not? You offer choice but in most cases it is not deliverable—I mean, of the examples you have had here. But it is an approach, it is a way of selling something, is it not?

  Mr Hutton: No. No. It is more fundamental than that. It is not a way of selling anything. It is a way of trying to improve the quality of the service and respecting the consumer of those services as a modern citizen who should be offered choice because we have choice in every other walk of life.

  Q75  Paul Flynn: Do you accept that targets distort priorities in a damaging way in many cases?

  Mr Hutton: What targets are you implying?

  Q76  Paul Flynn: Say, in local hospitals. A word goes around now at certain times in emergency areas which is "breach"—"We are about to breach"—and it means that they are about to breach the times for waiting for a patient. When that cry goes up—and it is part of everyday life in the emergency areas—the attention is given to the person who has been waiting the longest, regardless of how serious their complaint might be. Because the target is important, they have to make sure that patient is attended to straight away, rather than another who is in more urgent need of help. That is a distortion of a more serious problem.

  Mr Hutton: That can happen, and if it does happen we have a responsibility of going away and making sure that we make the system work in the way that we intended it to work. The four-hour target in A&E has been a hugely important success actually. It has created some difficulties, I accept that. When we started out on that path of establishing a target for how long people should wait in A&E, we started from a proposition that no-one should wait for more than four hours. We reduced it to 98%. We did that because the medics told us that there would be some category of patients you might genuinely want to keep in hospital for longer in A&E if it was a case of looking at symptoms and making sure you were tracking the patient properly. It is not the case that every patient has to be seen within four hours. There is a very substantial element of medical flexibility around that for patients who need longer. But, clearly, if the target were simply being used as a device, then it would not be working properly. Where it has worked well it is because the whole hospital has reconfigured the way it works, so that it has proper admissions units where patients can be admitted and kept under proper observation, and they have managed their discharge arrangements properly from the medical and surgical wards to free up capacity when and where they need it. I do not accept the proposition that the four-hour target per se has been a bad thing for the NHS. If you talk to medics in the emergency areas, they say it has been a very important tool for improving the performance of the NHS.

  Q77  Paul Flynn: With the approval of all parties in the House of Commons, the Government set out targets in 1998 for the reduction in the use of all illegal drugs. The direction has not been even towards the target: in fact, it has been in the reverse direction in some places. There has been absolutely no progress and those targets were impossible and described as such at the time. What should we do now? Should we set targets?

  Mr Hutton: I think we have reached a high water-mark of national targets—and I have made that clear on a number of previous occasions, as other ministers have. I think we have to look at driving up performance in new and different ways. Some of it will involve clear national targets, and I think we should always have them and aim for them, but I think performance needs to be driven up by a variety of other ways as well. We have talked about choice, and I think that can help to stimulate improved performance in the public service. I think contestability can as well. I think proper incentives in the public service to reward good providers is another way of making sure that we meet targets.

  Q78  Paul Flynn: I recall the late Alan Clark answering a question from the late John Smith. When talking about the Tory manifesto at the time, he said: "Neither he nor anyone he ever cared to dine with had ever read a manifesto". What percentage of the voters do you think voted for their parties of choice because they read the manifesto?

  Mr Hutton: I do not know, is the short answer. I have never seen any research done on that.

  Q79  Paul Flynn: Minute?

  Mr Hutton: I would think it is relatively small.


 
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