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30 Jan 2008 : Column 116WH—continued
“to palliative care services...is inadequate and inequitable”.
I hope that the Minister will commit to the meeting with the delegation asked for by my hon. Friend the Member for Castle Point in his outstanding speech, and ensure that commitments are made in Lord Darzi’s review and in the end-of-life care strategy—whenever that is published.
3.47 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Castle Point (Bob Spink) on securing this important debate and on the passionate and authentic way in which he goes about championing the cause of hospices. Parliamentarians often do not focus enough on how we can make a major difference. There is no more important issue than this, frankly, and we can make such a difference to it.
The hon. Gentleman paid tribute to a number of organisations, and I join him in doing so. He mentioned the Association of Children’s Hospices, the Rainbow Trust, Help the Hospices, and Sue Ryder Care, and there are many other individual hospices to which we should pay tribute in a debate such as this. He also described the current Prime Minister, the previous Prime Minister, and the Secretary of State for Justice as great men. I can tell the hon. Gentleman that an application form is in the post.
More seriously, he dedicated his contribution to his beautiful sister Yvonne, as he described her. He spoke movingly about the experiences that she went through, and those of himself and his family. I had a similar experience last year when, unfortunately, my mum Gloria, who was only 64 years of age, died in April. It was one of the most difficult experiences that I have ever had to cope with. More importantly, I shall never ever forget my mum’s dignity and courage towards the end of her life. As the hon. Gentleman said, unless one has been there, the emotional rollercoaster that the person concerned and their immediate family inevitably go through is incredibly difficult to describe. I pay tribute to the hon. Gentleman for personalising the debate.
The hon. Gentleman was right to say that end-of-life care is a growing issue—inevitably so. Because people are living longer, because people’s aspirations and expectations are different from what they once were, because of medical advances and technological change, and because of our public service reform agenda and vision, we now have the capacity to offer end-of-life care that is very different from that offered in the past. I shall return to the hon. Gentleman’s speech—he raised a number of issues—but I want first to deal with some of the specific issues raised by other hon. Members.
The hon. Member for Eddisbury (Mr. O'Brien)—he was not described by the hon. Gentleman as a great man, but I am sure that that was an omission—paid tribute to St. Luke’s hospice, and I join him in that. More important, he spoke of his wife. She must be a wonderful woman for all sorts of reasons that it would be inappropriate to put on the record. She is a volunteer at a local hospice. We should remember that thousands of people give of their time selflessly in
order to make hospices work, working alongside some incredibly dedicated and skilled professionals. In paying tribute to Mrs. O’Brien, not only for living with the hon. Gentleman but for the tremendous contribution that she makes to the hospice movement, we pay tribute to many.
I do not know of any evidence that hospices are poorly managed. Of course it would be inappropriate to generalise, and I am sure that like any other public service sector some hospices could be better managed, but on the whole the hospice movement can be proud of its record of management, prudence and governance.
My hon. Friend the Member for Eccles (Ian Stewart) spoke movingly about St. Ann’s, a hospice that I know because it is not that far from my constituency. He also mentioned Francis House. He rightly spoke of dignity and serenity, but the most important point that he made was that a crucial measure of civilised society is the way that it treats people towards and at the end of their life. My hon. Friend was right that there can be no more important measure.
The hon. Member for Southend, West (Mr. Amess) mentioned Cicely Saunders, and he will doubtless have read my right hon. Friend the Prime Minister’s recent book on heroes, in which he identified Cicely Saunders as one of those who have made the most difference to our society.
The hon. Gentleman was uncomfortable about my body language at the mention of Basildon, so I shall pass over the subject rather quickly. However, it is good that he keeps in touch with his former constituents. He also challenged me on his local hospice and I shall respond to that challenge in the following way.
It is best practice for every primary care trust to sit down with the hospices and to seek three-year commissioning agreements in order to give the hospices a sense of long-term stability. That will be based on the needs of the local community. I urge the hon. Gentleman’s PCT—indeed, every PCT—to adopt that approach. To be fair, at the moment they have a one-year allocation, but within the next few months they will know their allocation for the next three years. Best practice will give them an opportunity, and I believe that they should take it. I hope that the Exchequer Secretary to the Treasury who has joined us, agrees with that principle.
Most of these issues are devolved, but the hon. Member for Ceredigion (Mark Williams) raised the important issues of specific project funding when hospices need core funding and their importance in rural areas. The hon. Member for Na h-Eileanan an Iar (Mr. MacNeil)—it is difficult to pronounce—raised the question of VAT. That, of course, is a matter for the Treasury; I would have said that anyway, but I shall stick to my script given who has just joined us.
I return to the contribution made by the hon. Member for Castle Point. It was he who raised most of the substantive issues—and he did so most appropriately. Hospices are part of a network of palliative care in every community. Sometimes, however, the whole of palliative care is presented as hospice treatment. We have to remember that an increasing number of people choose to end their lives at home. In that context, we should pay tribute to Macmillan and Marie Curie nurses, and others who do such a remarkable job. There are also residential nursing homes and hospitals.
My view is that we should not be neutral about the matter. Given a choice, the vast majority would choose to end their lives in a hospice rather than a hospital. That has implications for some of the commissioning decisions that PCTs have to make. If people want to die at home, unsupported, they should be allowed to do so. If the choice is between hospital or hospice, I believe that the vast majority would choose the hospice, because it is personal, sensitive and intimate. Primary care trusts should accept that fact.
We have made £27 million available for children’s palliative care, as the hon. Gentleman said. We have conducted a review, and I can tell the House that we will be publishing a national strategy for children’s palliative care in the middle of February. That is confirmed today. The hon. Gentleman was right to speak about Diana nurses, who do an important job. We are looking at ways to support and develop their continued contribution to children’s palliative care.
I turn to the end-of-life strategy. It is very simple. One of the major streams of Lord Darzi’s review of the NHS is end-of-life care. When considering world-class end-of-life care, every strategic health authority area is talking about what it should offer people. It would be nonsense to produce a strategy in advance of that process being concluded. When Lord Darzi publishes his final report on the future of the health service, which will be this summer, we will publish the first national end-of-life strategy. That is a clear commitment, but we want to get it right, and it is worth each strategic health authority spending the coming months discussing the subject.
The question of funding has been raised. The Government’s record is excellent, relatively speaking, but a tremendous amount remains to be done. Help the Hospices shows that NHS funding for adult hospices in 2004 was £97.8 million, an increase of about 50 per cent. over 2000. Funding increased further to £113.7 million in 2006.
The only partisan contributions made during the debate were made by the hon. Members for Cheadle (Mark Hunter) and for Leeds, North-West (Greg Mulholland). They turned it into a party political issue. They talked about a real-terms cut in the amount of funding for hospices based on those figures. That was absolutely opportunistic and disgraceful.
Greg Mulholland: Will the Minister give way?
Mr. Lewis: Will the hon. Gentleman be writing a blank cheque to the hospice movement? Is he saying that if the Liberal Democrats ever formed the Government, they would meet all the hospice costs at 100 per cent. recovery? Of course not, but that is the impression that Liberal Democrat Members always give when contributing to debates.
Greg Mulholland: Will the Minister give way?
Mr. Lewis: We are all fed up with it. I return to the substantive issues.
Greg Mulholland: Will the Minister give way?
Mr. Lewis: I will not give way.
On regulation costs, I shall consider the question of the consultation that the Healthcare Commission is undertaking—
Greg Mulholland: He’s an a*******.
Mr. Lewis: —and the nature of regulation costs. That was not very parliamentary language, Mr Williams.
Mark Hunter: Will the Minister give way?
On the question of future funding, let us be clear. As part of coming up with an end-of-life strategy that is fit for purpose, we have to resolve a fundamental issue. What is the appropriate balance of responsibility between the state and other forms of funding for hospices? We also have to consider the relative contribution of hospices to palliative care in every local community. Those are the fundamental issues that we have to resolve. We then have to take account of the fact that every locality will make different decisions, depending on population need and historical provision. We must also take account of the fact that the hospices want to retain some independence from the state, which is quite appropriate.
As part of the publication of that national strategy, I commit to seeking once and for all a final settlement that is clear about the respective responsibilities of the state, the voluntary sector and other forms of contribution for the funding of the hospice movement in the context of how palliative care is funded on a long-term basis. When we have come to that settlement, it will be transferred into the policies and actions applied by PCTs.
Bob Spink: Will the Minister speak with the delegation and will he repeat what he said about regulation costs?
Mr. Lewis: I am willing to look at the consultation that the Healthcare Commission is currently engaged in on the regulation costs. I will, of course, be willing to grant the hon. Gentleman a meeting.
Private Equity/Venture Capital Industry
4 pm
Mr. Mark Field (Cities of London and Westminster) (Con): Change is afoot in the world of private equity. Only a diehard few would now oppose the principle that there should be some tightening of the generous capital gains tax regime for private equity investment. The Government have made an utter mess of their capital gains tax reform, culminating in the need for clarification only last week. That confusion risks further anti-avoidance measures being required.
In fairness, it is worth looking at the issue in some perspective. A capital gains tax regime that is simplified is something to be welcomed, especially if it is simplified at a relatively low level, historically, of 18 per cent. It is fair to say that most business folk who operated during much of the period between 1945 and 2002 would have rejoiced at the prospect of a sale of business giving them some 82 per cent. of tax-free gains.
In relation to private equity, it is crucial that we do not undermine the future prosperity that will be generated by the industry, not least in invisible exports. It is an industry in which the UK has become a world player second only to the United States. Some 60 per cent. of Europe’s private equity industry comes from these shores. The political and fiscal decision makers must recognise the appeal for many players in the industry of working in what is now a truly cosmopolitan environment.
Barely 12 months ago, few people in the UK had heard of private equity. Indeed, even in the United States, it was only the listing last year of Blackstone, which is widely regarded as one of the three leading practitioners of the dark arts of private equity, that helped to create a culture of greater public scrutiny.
For a time last summer, thanks to people such as the Minister, who was perhaps playing a somewhat different role then, as a member of the trade union-loving Treasury Committee, from the one she might play today—we look forward to hearing her comments later—the newspapers, and not just the business pages, seemed to talk of little other than private equity matters. Although the catalogue of Government misfortunes, from Northern Rock to the credit crunch to domestic economic difficulties, has taken private equity out of the news today, I think that that situation will change.
The tax treatment of businesses bought up by private equity firms is likely to remain a hot political potato. For sure, that will largely be down to campaigns orchestrated by trade unions that are worried about job losses, but it will also be because the issue of private equity firms has been a backdrop to the recent contest for the deputy leadership of the Labour party. However, the real catalyst for public debate has been the concerns expressed, often by middle-class professionals outside the financial services industry, about the astronomical wealth earned by affluent private equity principals in the industry. In short, the controversy about private equity is, to my mind, a symbol of the increasingly nagging concern that the benefits of globalisation have not been spread either equally or fairly.
Much of that discussion belongs to a far broader debate; indeed, I suspect that it will be the backdrop to quite a lot of debates that will take place not just in this
Chamber but more widely in this country and across the western world in the decades ahead, particularly with the emergence of China and India as great economic superpowers of the future. I think that we will return to that issue—the way the spoils of globalisation appear to be very unequally spread—during many of those debates and they will no doubt agitate public policy makers. However, the important issue, and it also applies to private equity, is not to take too much of a short-term view. There needs to be a sense of perspective, taking in both the past and the future, to determine what is in the broader interests of this country.
Over recent years there has been a relatively generous tax regime for private equity investment, about which I will say a little more later. That regime was designed in part to reflect the value that was added by innovative venture capitalists and the risks that they incurred. On balance, I believe that it is difficult to fly in the face of the evidence. Generally, although not exclusively, businesses owned by private equity concerns have grown considerably faster, created considerably more jobs and generated vastly higher profits than the public companies from which they were originally spun off. Indeed, the evidence is plain: leading management in public companies display less motivation, innovation or flair than decision makers in companies where private equity involvement has restored value and undone the damage caused by previous managerial deficiencies. More often than not, the transformed businesses are more profitable and grow faster. The positive effects of private equity result in enhanced corporation tax receipts and, of course, a boost to broader employment.
Contrary to the views of some of its more vocal critics, private equity rarely brings with it job losses and asset stripping, except for those struggling businesses that otherwise would probably have gone under without the resurgence that often accompanies radical business restructuring. Indeed, for the financial year 2006-07, the last for which we have reliable and up-to-date statistics, it is estimated that private equity-backed companies generated total sales of some £310 billion, created exports of £60 billion and contributed some £35 billion in taxes to the UK economy. That is all very much a good news story, and one that perhaps has been somewhat lost in some of the negative publicity that venture capital and private equity have received.
It seems that the real problem is that, even after recent economic hiccups, the financial services sector is increasingly regarded by a sceptical and bemused general public as a one-way bet to untold riches. That perception is leading to enormous resentment, not least from the middle classes, whose material expectations, particularly in London and the south-east, are becoming increasingly bleak.
The fact is that London’s financial services industry is a leading global performer. The rewards that flow to its most talented players reflect that fact. By contrast, the civil service, the senior rungs of the NHS and education, and indeed many respectable private sector professions fail to offer such astronomical rewards. As a result, the markets in housing and private education, to name just two, have spiralled out of control and out of the reach of those who, in a previous generation, might have expected to enjoy such returns from their often highly skilled qualifications.
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