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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