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Moved, That a Select Committee be appointed to consider Community proposals, whether in draft or otherwise, to obtain all necessary information about them, and to make reports on those which, in the opinion of the Committee, raise important questions of policy or principle, and on other questions to which the Committee considers that the special attention of the House should be drawn;
L. Ashbourne, L. Barnett, L. Bridges, L. Elis-Thomas, L. Geddes, L. Gisborough, L. Haslam, B. Hilton of Eggardon, L. Hoffmann, L. Hussey of North Bradley, L. Kingsland, L. Marsh, B. Ramsay of Cartvale, L. Reay, L. Tordoff (Chairman), L. Wallace of Saltaire, L. Walpole, B. Williams of Crosby, L. Willoughby de Broke;
That the Committee have power to appoint Sub-Committees and to refer to such Sub-Committees any of the matters within the terms of reference of the Committee; that the Committee have power to appoint the Chairmen of Sub-Committees, but that such Sub-Committees have power to appoint their own Chairman for the purpose of particular enquiries; that two be the quorum of such Sub-Committees;
The Chairman of Committees: My Lords, I beg to move the second Motion standing in my name on the Order Paper. In doing so, I must apologise to your Lordships for a printing error on the Order Paper six lines from the end of the Motion where the word "from" has been omitted. The sentence should read,
L. Carmichael of Kelvingrove, L. Craig of Radley, L. Dainton, L. Dixon-Smith, L. Flowers, L. Gregson, B. Hogg, L. Howie of Troon, L. Jenkin of Roding, L. Kirkwood, L. Perry of Walton, L. Phillips of Ellesmere (Chairman), L. Porter of Luddenham, L. Soulsby of Swaffham Prior, L. Tombs, L. Winston;
Baroness Jay of Paddington: My Lords, I beg to move that this Bill be now read a second time. The purpose of this short Bill is clear and specific. It is to break the gridlock in the NHS building programme which we have inherited. This Government want to see new hospitals built and the Bill before your Lordships today ensures that NHS trusts have powers to enter into PFI contracts. If enacted, the leading banks will have the confidence they need to provide funding for the most advanced hospital development projects. Building work can then begin as part of this Government's commitment to renew the National Health Service.
The Bill should also be seen as a first important step in our programme to develop new forms of public/private partnership--of which PFI is one model. These proposals were set out in a 12-point plan in our business manifesto which was so resoundingly endorsed at the general election.
Clearly, the NHS needs high quality facilities in order to deliver world class services. The private finance initiative has the potential to provide some of these facilities but, regrettably, not a single major PFI hospital deal has reached financial close since the initiative was introduced in 1992.
The Government have always accepted that the principle of PFI is a useful one. In theory, under PFI the public sector does not pay to build a hospital; it pays for the delivery of a specified building to agreed quality standards. No payment is made until the building is provided. This is a concept whose benefits the public and private sectors have been quick to recognise.
But in practice PFI has manifestly failed to deliver the goods. A number of small schemes have been brought to fruition--for car parks, accommodation blocks, and so on--but the urgently needed major hospital building programme has been stopped dead in its tracks. Time and money have been spent wrestling with what seem to be apparently insurmountable problems.
The new Government draw no pleasure from the fact that the previous Administration were unable to make PFI work in the NHS. The people who suffered most were the patients in need of treatment, and the doctors, nurses and other health professionals who tried to work in inadequate facilities. In the past I have described in your Lordships' House attempts to make PFI work as "unproductive chaos".
But PFI need not be unproductive or chaotic; it can, if properly used, offer the NHS an important way of building hospitals. That is why the Government gave their manifesto commitment to overcome the problems that have plagued PFI in health at a national level. However, to achieve this we need to make changes. For
To complement this work, my honourable friend in another place the Minister of State, Mr. Alan Milburn, has announced an overall review of the workings of PFI in health. In the Department of Health we are committed to end the delays, sort out the confusion and develop new forms of public/private partnership that will work and protect the interests of the NHS. Noble Lords will be extremely concerned to learn that Mr. Milburn has discovered that to date £30 million has been spent by individual NHS trusts on legal and financial advice and other consultancy fees--without a single major contract being secured. In future much of the necessary expert advice will come from within the NHS. This should be quicker and save the money which has previously been spent on expensive consultants' fees.
Naturally, my honourable friend will be listening to the views of those closely involved with the PFI from both the public and the private sectors. The objective will be to identify how to make the best use of skills and expertise from both sectors.
The legislation before your Lordships today will remove the most significant obstacle in the way of the major pathfinding schemes. There is no lack of general support or interest from the financial community for PFI in health. Leading financiers who met the Secretary of State soon after his appointment expressed their willingness to provide the backing for PFI contracts in the NHS. But the banks are concerned that there may be some doubt about whether NHS trusts can legally enter into PFI contracts. The Department of Health's own legal advice is clear: the National Health Service and Community Care Act 1990, which sets out trust powers, gives those trusts the power to enter into PFI contracts. However, it is true that PFI is not explicitly named on the face of the Act, and the banks remain concerned that they may not be able to recover their money if, at some point in the future, PFI contracts are found to be ultra vires the trust.
The banks have been chastened by their problems in other sectors and are unwilling to take what they perceive to be an excessive and unnecessary risk without further legislative cover. The possibility of a statutory instrument has already been explored with them, but it is clear that this would not resolve their concerns.
In the circumstances, primary legislation is necessary, and the Bill before your Lordships removes any doubt about the power of an NHS trust to enter into contracts under the private finance initiative. The banks concerned have seen and agreed the wording of the Bill and have
In retrospect it might have been much more sensible--and probably much more productive--if this issue had been resolved at the same time as the National Health Service (Residual Liabilities) Bill which was considered in your Lordships' House about a year ago. However, the new Ministers at the Department of Health have been assured by officials there that this particular stumbling block was only recently identified as a serious issue. Perhaps the expensive consultants missed an obvious trick. However, we are where we are, and this short Bill is now necessary to get things moving on hospital building.
Clause 1 of the Bill provides that the powers of an NHS trust include power to enter into agreements which are certified by the Secretary of State as externally financed development agreements, and specifies the circumstances in which the Secretary of State may give a certificate to that effect.
It will be apparent from the brevity of the Bill we are considering today that this is a straightforward and uncomplicated piece of legislation. It fulfils a manifesto commitment and its purpose is transparent: to remove any doubt about the power of an NHS trust to enter into contracts under the private finance initiative.
This Government are determined to get hospitals built rather than simply to talk about getting them built. I remind your Lordships that no hospitals planned under existing PFI schemes have yet reached financial close, let alone been built. By enacting this legislation we will then be able to start constructing the new facilities which the NHS so badly needs, and make clear our commitment to nurture and strengthen the health service.
Baroness Cumberlege: My Lords, although the Minister and I had a short skirmish at Question Time, this is my first formal opportunity to welcome her to the Dispatch Box. I do so with great pleasure--not only as one of the Government's Ministers for Health but also as the Deputy Leader of this House.
I know that the Minister and her colleagues do not have a great deal of patience with the hereditary principle, and this is certainly not the moment to enter that debate. However, I cannot help thinking that her most distinguished father must have passed on some very useful and relevant genes. That was evident when the noble Baroness, as deputy leader, with great mastery, summed up the fifth day of the debate on the Queen's Speech.
I congratulate the noble Baroness and her colleagues on choosing as their first piece of legislation this Bill--which I am informed is word for word the Bill drafted by the previous government, in fact lifted straight from the "must do" pile of our administration.
It is none the worse for that, but it does place me in a dilemma, for although I am well aware that the role of the Opposition is to oppose, with this particular Bill I am in wholehearted support. However, it is the support of members of the Government that concerns me, since in the past they vigorously opposed the private finance initiative.
My noble friends and I, particularly my noble friend Lady Anelay of St Johns who will sum up for these Benches--and I take the opportunity of also welcoming her to the Front Bench--will wish to probe the intentions of the Government. And we have good reason, for only on 2nd April, two months ago, Mr. Chris Smith, in his statement following publication of the Conservative manifesto, said:
When I became chairman of the Brighton health authority, 80 per cent. of the floor area of our 16 hospitals had been built in the last century. It was an issue I was determined to tackle. I failed. My successor failed; as did the one after that, and the one after that. The task is now in the capable hands of the noble Baroness, Lady Emerton, who as an advocate of the PFI has the very real possibility of achieving at the Royal Sussex County Hospital buildings suitable for modern medicine and fit for the next century. I wish her every success in her endeavours.
Brighton's history is not unique. All over the land promising young consultants were appointed in the knowledge that a new hospital was about to be built and yet have been lucky to see the foundation stone laid before their retirement party. The frustration has been considerable, and has often soured local relationships as people felt betrayed or did not understand the internecine intricacies of the Treasury mind. Fifteen years ago rigidity and red tape were the rule book.
The private finance initiative--our initiative--allows the NHS to by-pass these Treasury constraints and to harness the expertise of the private sector in the design, construction, maintenance and provision of buildings in order to deliver better quality patient care and better value for money.
Larger schemes are now starting to reach contract signature: the Norfolk and Norwich new hospital project, with a capital value of £194 million, was signed in November 1996, although it has yet to reach financial close.
A further 150 schemes with a total capital value of about £2.1 billion are testing private finance options. They include 22 schemes worth over £10 million each that have got as far as appointing a preferred bidder. Their combined capital value has been some £1.7 billion.
But despite these considerable successes, it would be disingenuous of me to admit that there have not been some complications. On 21st May last year, when I introduced the Second Reading of the NHS (Residual Liabilities) Bill, I stated that any residual liabilities would be transferred to the Secretary of State. Although that has been the custom and practice throughout the life of the NHS, contractors were still unsure and wanted the Government, through legislation, to remove any element of doubt.
This we sought to do, albeit both we (the Government of the day) and the then Opposition thought it to be unnecessary--a point very forcefully put by the noble Baroness, Lady Jay, during the debate. But that was before the banks became concerned. Their concern was generated by the activities of some councils. It will not surprise the House to know that these were Labour councils such as Hammersmith and Fulham. Those councils sought, with public money, to gamble on the money markets. The banks caught a cold and were justifiably wary that they should not catch another. Hence the necessity for this further piece of legislation. Bearing in mind that we now have a new Labour Government, I have some sympathy for the banks' concerns.
Anthony Hilton, the City editor of the Evening Standard, on 14th May drew our attention to the fact that here is a new Government on their best behaviour, yet willing to invent spurious reasons to impose a retrospective windfall tax on companies which have acted in good faith and within the law. It hardly bodes well for a committed and reliable partnership between the Government and the private sector; and this before the rigours of governing have been felt, and before the trade unions, always strong in the NHS, have reasserted their power. In three or five years' time things could look very different. So what guarantees can the Minister give to PFI partners that there will be no dawn raids on their assets, and no retrospective legislation or confiscation of their investment--for I am sure the experience of the past three weeks will not provide much comfort?
Perhaps the Minister could tell us who is right: a health Minister tackling the day-to-day realities of trying to run the NHS or the Prime Minister trying to win an election campaign. Bearing in mind this contradiction among Ministers, it is imperative that the Bill should clarify matters, but it does not. Clause 1(5) states:
Another area subject to procrastination and delay is the future of London's healthcare, for the Labour Government are undertaking yet another review. London's history is littered with countless reviews of its hospital services. The policy document, Making London Better, set out clearly the future healthcare needs of Londoners, the specialty services required, the issues surrounding world-class research and the paucity of primary care. In her speech on 13th December 1993 the noble Baroness introduced an Unstarred Question debate. She said:
Finally, we heard the Prime Minister say during the visit of the President of the United States that this Government are practical, not ideological. That is to be the new way. But to be practical, people who are ill are not really concerned about who built the hospital, who washes the sheets or even who pays the clinical staff, so long as doctors, nurses and all other staff are efficient, skilled and caring.
We were harassed, when in government, by the totally untrue assertion that we were privatising the NHS--which we were not. The new Secretary of State for Social Security, when she was health spokesman, said that the PFI was an initiative for privatising the health service. It is not. It is a means of improving the NHS, which was and still is our sole aim.
But if the Government (as the Labour Opposition) thought that the PFI was a means to privatise and that they were and are the only defenders of the NHS, we are right to ask: "What is this Government's purpose for the PFI? What is their philosophy?". There seems to have been no thought put into the direction of policies. The Minister owes us an explanation. Surely the NHS is founded on a great ideal. Its philosophy is an ideology. It is absurd to think that the NHS can be wholly pragmatic. At its core is a belief that the health service should be free at the time of need and that its sole criterion should be need. These principles cannot be abandoned--dismissed as mere practicalities. The NHS is motivated by idealism. Without it, it will surely perish. Perhaps in her summing up the noble Baroness could address this most important of all issues, because it is a fundamental matter, relevant not just to today's debate but to the long-term future of the NHS--for we all know that without a vision, the people perish. Pragmatism is simply not enough.
Baroness Robson of Kiddington: My Lords, I join in the congratulations to the noble Baroness, Lady Jay, on her arrival at the Dispatch Box. I have known her for a number of years and I am aware of the amount of time she has devoted to the health service. We could not have a better representative in her place. It is also a quite unusual experience for me to hear the Minister's immediate predecessor and the new Minister in this House in such perfect agreement about two Bills. I realise that the Bill before us today was produced and ready to go on the statute book had not the election interrupted the procedure.
However, I wish to question why it has been necessary, within the period of one year, to have two Bills. I understand why the first was introduced. It was because there was no assurance to any contractor about the residual liabilities that would arise if a trust collapsed. The reason for the present Bill is largely that one could envisage a position where a trust became no longer financially viable. If the Secretary of State closed it down, he would have to pay back the liabilities to the constructing company or the consortium running the hospital. So one could envisage that the bankers would be worried that the Secretary of State would not close
The first Bill went part of the way. But the need for the two Bills in such a short time gives rise to a certain amount of scepticism about the viability of the PFI as it relates to the provision of hospital buildings. The question arises of whether the scheme was properly thought out before it was introduced.
When the private finance initiative was first introduced in 1992, it was publicised as a source of additional finance for the NHS over and above publicly financed projects. However, in the 1995 Budget the previous Chancellor announced a planned reduction in NHS capital spending of 16.9 per cent. in 1996-97, 5.4 per cent. in 1997-98 and 6.9 per cent. in 1998-99. That made it clear that the PFI is no longer additional finance for the NHS; it is now a substitute for Treasury funding.
So far as I know, no one in this country has subscribed in a democratic way to the proposal that the PFI should replace Treasury funding in the NHS. There may be a case to be made that the PFI would be cheaper and more efficient for the NHS, but, in my view, the case has not as yet been proved.
What worries us is that it is clear that the PFI saves the Treasury money on capital projects in the first instance. But it saddles the NHS with revenue expenditure over a period of 25 to 30 years. That is a long time in the life of a hospital and in the health service. In the end, the burden falls on the taxpayer. It may reduce the PSBR but it will certainly increase taxes in the long run. I ask the Government whether they will increase the revenue allocation to the trusts by the amount that they will have to pay, year in year out, as a rent for the building they occupy. There is also the danger that the length of the contract is likely to create rigidity in a service that we all know to be in need of flexibility as further advances are made in the delivery of health care. We therefore look forward with great interest to the publication of the Malcolm Bates report on 13th June.
Another concern under the Bill is the question of accountability, when most services, including cleaning and catering, are run by the developer and the clinical services are provided by nurses and doctors. For many years now the NHS has employed outside contractors to provide some of those services but there was never any doubt that ultimate responsibility rested with the trust or the district hospital which were accountable for all the services they provided, whether contracted for or provided by themselves. Where does accountability rest under the PFI scheme? Is the housekeeper accountable to the consortium and the clinical staff accountable to the NHS trust? It does not take a lot of imagination to see that such a system could be open to great friction. We should like an assurance from the Government that the ultimate responsibility and accountability still rests with the hospital trust.
For those reasons we suggest that the Bill should be time limited while further research is undertaken and some experience gained in the working of the new system. The title preferably should be changed to the National Health Service (Private Finance) (Temporary Provisions) Bill.
Lord Marsh: My Lords, the noble Baroness, Lady Cumberlege, expressed surprise that this Bill should come from the Labour Party. I suspect that it will be a bigger surprise to some members of the Labour Party. Some of the more hysterical comments heard recently--in the past 24 hours those on Camelot, for example--do not help in terms of getting confidence when trying to deal with the private sector. All I can hope is that the conversion to entrepreneurial capitalism--that is basically what it is--will spread. I am sure that it will. I look forward to hearing the speech of the noble Lord, Lord Monkswell, supporting it.
The noble Baroness, Lady Robson, unfortunately voiced doubt about the principles of the Bill. I certainly hope that it will not be a temporary Bill. I hope that it will grow wider in its application, because I believe that the principle is a very important one.
The NHS problem is part of one of the biggest and least publicised problems facing this country. There has been massively inadequate investment in public sector infrastructure, both in terms of capital and maintenance, over a century. One of the problems of parliamentary democracy is that the pressures of the "Today" programme and the inexorable approach of the next election are not conducive to systematic long-term investment programmes. All the pressure on government is to deal with matters of the moment, and in a democracy it is foolish to believe that a government can take a long-term view or stick to it if they do. Some of our most famous and prestigious hospitals are a classic example of the effects of that.
I remember when I first became chairman of the special trustees of Guy's Hospital and walked round that hospital. Parts of it were a slum; yet it was one of the great hospitals of the world. I remember visiting my mother in the Brook Hospital in Woolwich with a wife who had grown up in the Middle East and had never
This is a very good Bill indeed. I have heard it described by some people who are worried about the cost as "mortgaging the future". In my view that misses the whole point. There is nothing wrong with borrowing and repaying over a long period. There is an international market in sovereign debt using interesting financial instruments called Brady bonds which has already done more for the third world in terms of direct support than have all the resolutions of the UN put together. Over the years I have bought eight different houses. The first five of them were all financed by 25-year mortgages. Most people in this building would have done the same. It is a perfectly sensible thing to do. I believe that the Bill can make a significant contribution to more efficient and cost-effective investment within the National Health Service.
In support of that claim I should like to advance two main arguments. It is the result of a system (which has very good factors--I am totally in favour of parliamentary democracy for most of the time), not the result of lack of keenness on the part of Ministers, or that one political party wants a lousy national health service and one wants a very good national health service. No matter which party is in power, the government of the day inevitably will face problems with the public sector borrowing requirement every few years. Every time that happens, a Cabinet committee is formed and the Cabinet begins to discuss cutbacks. Prior to privatisation, under both governments--I served in the public sector under both governments--the first target was always the nationalised industry investment programmes. That was not because it was a sensible place to start but because it has the minimum short-term impact on the voters. It is politically much easier to cut investment and maintenance than to undertake almost any other fiscal measure in the hands of the government. In the longer term, the effect is always higher maintenance costs and in due course massively increased replacement costs. That is the problem in the National Health Service: the sheer scale of the investment required in bricks and mortar and the cost of maintaining it afterwards.
The involvement of private sector finance in a joint venture will not end that practice. All Chancellors will continue to look at the public sector to see where they can cut the investment programme because the punters will not notice it as they do other things. It will, however, make it much more difficult for governments to come in and take short-term measures. It was easy when there was a chairman of a nationalised industry--I speak from personal experience of this--to introduce what used to be known in the trade as the "lunch table directive". The Minister invited one to lunch and for the first time there was a decent bottle of wine available. He explained that it was all the chairman's responsibility, but then he would press enormous problems when he came to deal with the next thing you
My second argument is that civil servants and public executives are not the best people to run what are essentially large and complex commercial projects. I do not want to be misunderstood on this point. I have the highest regard for the intellectual ability of the vast bulk of civil servants. I was lucky enough to learn a great deal from a small number of extremely eminent and able civil servants. But the public and private sectors have different cultures; they attract different people. There is no regular movement between the public and private sectors either way because they call for different skills and experience.
I spent five years heading up a nationalised industry which consistently lost £0.5 billion per year, as it had done under virtually all my predecessors. I enjoyed the job immensely; slept soundly each night, and in due course received a knighthood for my achievements. When I moved into the private sector I found myself heading up two very different start-up situations--companies whose capital involved other people's money and all of it at risk. Fortunately, both of them eventually made it and became profitable. However, for the first two years I spent a lot of time in the wee small hours wondering whether we were in danger of trading while insolvent and whether we should pull the rug. That is the sort of pressure that concentrates the mind and which is absent from the public sector. That is not a criticism; it is just a big difference.
A year ago I resigned from the chairmanship of Guy's Special Trustees--not to be confused with the trust. I had a group of extremely able colleagues, professionally qualified, effectively managing a portfolio of about £150 million which Guy's had inherited over the years. We were asked if we would provide pump-priming finance for phase three of the rebuilding of Guy's. After much discussion we agreed to provide £25 million for a project with an agreed end price of £60 million.
I shall not go into all the details except to say that some of the professionals who were working for nothing for Guy's Special Trustees were far more frequently right than were the people who were managing the project. But what happened? I do not know what the figure is today; the noble Baroness may be able to tell us. But the last I heard was that it was not £60 million; it was £150 million, and still going north. That is a sad and complex story which, frankly, can only be described as a near total shambles.
I do not believe that the Bill will produce perfect project management in the National Health Service; there is imperfect project management in the private sector as well. But I have no doubt that the principles which underlie the Bill--the direct involvement of private sector management and private sector capital sharing the financial risk--would have made the Guy's phase three saga far less likely and probably would have prevented it because those financing the project would
Lord Winston: My Lords, first, I apologise for the second time in two weeks for having to leave early. I shall not be able to hear the Minister's summing-up at the end. Some time ago I agreed to give a lecture in Boston and must catch a plane from the airport tonight. Secondly, I must declare an interest in that I am a practising clinician at a London teaching hospital and have some limited personal knowledge of the PFI in that we are trying, and have been for some two years, to arrange a PFI for the transfer of Queen Charlotte's Hospital to a new building on the Hammersmith Hospital site. In a way that is a small project which is covered financially and will clearly give significant savings to the health service and improve delivery of services. Yet that PFI has so far taken two years to reach the present stage and is not yet agreed. Hopefully it will be.
Clearly one must support the Bill. It is an important initiative of the Government to push the PFI forward in this limited way. However, like a number of your Lordships I have always had strong reservations about the private finance initiative. While I totally respect the knowledge of the noble Baroness, Lady Cumberlege, in relation to genetics and agree with her comments on father and daughter, I remind her that in the debate on 21st May last year when the PFI was raised, she did not address any of the issues that I and a number of other noble Lords raised indicating anxieties about the PFI, which still stand.
Of course, our buildings are often in disarray. Perhaps I may distract your Lordships for a few seconds. I am reminded of the first time I went to the Hammersmith Hospital, which was then making its own radioisotopes for research. One of my colleagues was a senior consultant who was in the business of injecting a short-life isotope--it had a life of seven minutes--into a patient to image the parathyroid glands. That had to be done on the medical ward two floors up.
The isotope was made in the cyclotron building, dropped out of the window into a waiting fishing net below and handed to a cyclist who cycled across a courtyard, handed it to a PhD student who climbed a stepladder over a wall and dropped it into another net. It was then wound up by a fishing rod to the second floor where it was injected into the patient with at least four minutes to spare. I understand that the isotope worked very well and the patient survived, obviously with a little less radioactivity because of the time it took to deliver the drug. Hospital buildings are higgledy-piggledy, and that will always be in the nature of health service buildings.
The fundamental problem with the PFI is that it is a form of hire purchase agreement. Whether or not we like it, it is a way of avoiding the public sector borrowing requirement. Who can borrow cheaper than a government? Clearly, when a private financier is involved there must be some form of profit. The anxiety
I agree with the noble Lord, Lord Marsh, that there is nothing wrong with a mortgage. However, one must shop around to make sure that one obtains the cheapest possible terms for the mortgage. That encourages delay once one enters the private sector and that is a problem.
I agree with the noble Baroness, Lady Robson, who made some important points. One of the issues I should like to pick up is the length of contracts. We must recognise that health service needs change increasingly rapidly because of the nature of technology. It is important that contracts are not put in place which, over a period of 20 to 30 years, become obsolete and end up being a millstone around the neck of a hospital, a trust or a health authority.
There is also a clear risk of fragmentation because of the financiers' need for profitability. Although that issue does not need to be directly addressed in the Bill, nonetheless I hope we look at it when we consider the issue of the provision of services--that they are maintained on the basis of need--when we come to the Committee stage of the Bill. With the PFI it is important that there should be careful planning to ensure evenness of distribution of health service resources.
I was amused by the remark of the noble Baroness, Lady Cumberlege, about the heritage. It seems to me that the heritage is not about the past but about the future. It is about planning for Britain's future. If there were ever a case for the PFI it would surely be more appropriate in some ways for the national heritage than for the National Health Service.
There is great concern among many academics about academic medicine. As your Lordships will know, and as has been pointed out repeatedly, the universities are in very cruel straits indeed because of the difficulty of raising money for important capital projects such as laboratories. Those services are hand-in-hand with the health service. They provide 10 per cent. of our medicine in hospitals. It is vital that in the future that aspect is protected within the PFI. I agree with the noble Baroness, Lady Robson, about lines 20 to 25 of the Bill with regard to the provision of services. What is meant by a "clinical service"? Are pathology services clinical? Of course they must be because they look after patients. So are radiology services and operating theatres. However, there is a risk that unless we look at this point very carefully they could be privatised in the wrong kind of way. That has to be taken account of at the Committee stage of the Bill.
It is sensible of the Government to move forward in this limited way. I am grateful to hear that they are to make progress because at the present time it is urgent that we get on with outstanding projects as this issue is causing a great deal of concern among clinicians and all support services throughout the country.
Lord Jenkin of Roding: My Lords, I am left in some doubt as to the degree of support of the noble Lord, Lord Winston, for the Bill. He has declared himself enthusiastic that the Minister and the Government have brought it forward but most of his speech seemed to damn it with less than faint praise. We shall watch with interest the amendments which he and his noble friends move at the Committee stage.
The noble Baroness, Lady Jay, gave an altogether too down-beat account of the progress of the PFI to date. I hope to be able to offer some comment as to why I think it would have been totally unrealistic to imagine that in the course of two or three years a large number of fully fledged schemes would have come on stream. It is not that kind of operation. Like the noble Lord, Lord Winston, I must declare an interest as the chairman of a National Health Service trust. It has undertaken one or two very limited PFI schemes but was frustrated in one rather larger scheme because it was impossible to get both sides to agree the terms.
I can deal with the Bill very briefly. It has a very limited purpose which was outlined to the House by the noble Baroness. If one takes Clauses 1(1) and 1(2) together, one has the whole purpose of the Bill, which is to ensure that the Government can certify an externally financed development agreement. Indeed, an externally financed development agreement becomes one only when it has been certified by the Government. It is rather like that splendid little clerihew quoted by Sir Robert Megarry in his wonderful book Miscellany-at-Law, in which he lampooned modern legislation:
I wish to make three short points about the PFI and its relevance to the Bill. The noble Lord, Lord Marsh, referred to the cultural difference between the public and private sector. I should like to develop that argument a little further. My second point is that the Government have a need, having regard to almost everything that has been said by the Labour Party about the PFI over the past four years, to set out to build the confidence of the private sector that they now mean what they say. Thirdly, I wish to refer briefly to the problems which my noble friend mentioned arising from the London NHS review.
First, on the clash of cultures, I do not think it is even now appreciated how profound are the differences in the cultures of the National Health Service and of the private sector. That became apparent to me many years ago when I was Secretary of State and led delegations of health industry businessmen to foreign markets in order to try to boost the sales of British products in those markets. I found that many of the industrialists who were selling abroad did almost no business with the National Health Service and that, correspondingly, many of the firms which had got themselves well dug
I have seen exactly the same phenomenon in the field of urban regeneration. Over the years a succession of initiatives by governments to try to build partnerships, often with considerable success, have had to overcome these huge cultural differences between the public and the private sector. If one looks at the considerable successes of City Challenge, one had different financial regimes between local authorities and private developers, different decision-making processes within the two different organisations and different timescales within which they operated. One saw the steep learning curves that were necessary. That is the point about PFI here. The noble Baroness, Lady Jay, totally ignored that in her opening remarks apropos the criticisms of the lack of progress with PFI.
People have had this steep learning curve. That has nowhere been better stated than in a paper that was read to the Royal Society of Arts last January by John Owens, a very distinguished chief executive of the Royal Infirmary of Edinburgh NHS Trust. Referring to the clash of cultures--I am happy to adopt the phrase of the noble Lord, Lord Marsh--he said:
If the noble Baroness has not already done so, I recommend that she reads Mr. Owens' paper because I believe that it is an extremely valuable critique and comment on the way that PFI has been working. However, there is a more recent article by a private sector lawyer seconded to the Government's PFI initiative, Mr. David Anderson, who is with Nabarro Nathanson. This article has only just been published. He said,
I can deal with my second point much more briefly. Labour's recognition of the merits of PFI, like so much else in the policy of New Labour, is a very recent and a very abrupt change of stance. Nonetheless, I suppose that it is welcome for all that. My noble friend mentioned one recent criticism. Two years ago the party opposite wrote,
Finally, perhaps I may say a word about the London review. As of today, we know astonishingly little about what is in the Government's mind on this matter. Trusts and health authorities in London are being led to believe that it is not going to be another Tomlinson; that it will need to be a fairly speedy review; that the review will be a selective process, although it is totally unclear as to what is going to be selected. Many aspects of the NHS in London will not be covered by the review. I understand that the noble Baroness's honourable friend, Mr. Alan Milburn, is going to be in charge and that he is going to be advised by an advisory panel, but who are they to be? We simply do not know.
The relevance of that to this Bill is that the Government face a special challenge in London. It will be difficult both to conduct a review, presumably of decisions which have already been made or which are in the pipeline, and at the same time to keep the private sector PFI parties to the various negotiations going on all over London on board during the review process. I beg the Government to understand that that will be quite a difficult thing to do. If they are committed to a review, I suppose they must have one. But it could result in some very valuable potential PFI projects being abandoned as the private sector looks to less uncertain corners of the country in which to make its contributions.
All that is in addition to the more general obstacles to which I have already referred--the cultural change and so on--and I urge the Government to recognise the need for some solid assurances. Perhaps I may not inappropriately point out that every time Ministers are criticised from behind about a matter such as PFI, that undermines the credibility of what is being said from the Front Bench. No doubt the party opposite is well aware of that.
Over the years the NHS has survived only at the cost of under-investing both in new facilities and in maintenance. There can be few trusts--certainly mine would not be one of them--which do not face a huge backlog of maintenance. Though new investment in recent years has risen sharply--and this is a point which it is fair to make because it is now running at over 60 per cent. higher in real terms than when I first became Secretary of State for Health 18 years ago--there is still a long way to go before we have a properly housed and equipped National Health Service.
That the PFI is now seen by all parties as the best way forward is solid gain, and in its small way this Bill is a welcome reflection of that fact. But recognising and enthusiastically embracing this new culture will be an essential ingredient if PFI is to yield the level of new investment which is needed. I hope that we shall see in future a little more of that than we have seen today.
Lord Addington: My Lords, I speak on this Bill on the grounds that one of the projects concerned is the removal of the Norfolk and Norwich Hospital from its current site in the middle of Norwich to a greenfield site at Colney. That goes against what was said by the Minister of State in the Minister's department in another place when he referred to a project in Swindon. In referring to the health service and the project in general he used these words:
Tonight, at 7.30 p.m., at a meeting of Norwich City Council a motion will be tabled which condemns the siting of the new hospital. It will be backed by the controlling Labour group on the council, with the full backing of the Liberal Democrat opposition. There are no Tory members on the council. The motion is:
At one point a petition containing 18,000 names was raised in a few days. That is approximately 10 per cent. of the population of Norwich. That petition was presented to the local health authority. In those circumstances something must have gone very seriously wrong. Going back over 10 years, the conclusion in effect--and it has been mentioned by many people in this debate already--is that it takes a long time to get new capital projects built. Indeed, the noble Lord, Lord Marsh, struck that nail squarely on the head by saying that no one liked shelling out for such projects. Over 10
After a series of changes, in 1992 it was agreed that everything should be moved without public debate and a public review process. It was agreed that there should be a new, extremely large hospital on a greenfield site outside the city centre. However, the site and the hospital have now "shrunk", and dramatically so. Not only are we to lose two hospitals in Norwich--the West Norwich and the Norfolk & Norwich--but they are to be replaced by a hospital with about 200 fewer beds.
There has not been any public consultation. Whenever changes have been made, it has been on the authority of a public inquiry which said that there should be a split site. The current site of the Norfolk & Norwich is slap in the centre of the city. Indeed, it is just under half a mile from the main bus station in Norwich. Anyone who looks at a map of Norfolk will see that Norwich appears to be at the centre of a spider's web of roads. Norwich has very good public access and very good public transport. It is said that one of the reasons for siting the hospital outside the city is that that will allow far better car parking facilities.
Salt has been rubbed into the wound of public disquiet in the area because it has recently been proposed that a new centre on the existing site could be developed at considerably lower cost--at anything up to £100 million less--and that underground parking could be provided. The Member of Parliament for Norwich, South (Charles Clark), pursued the issue throughout the election campaign and was finally told that the compensation that would be required (given the existing legal commitments with regard to the site) would be so great that it might outweigh even those savings. I have been confirmed in my original opinion that this Bill merely removes the last legal objection to acquiring the finance and the vires.
People are very bitter. I have run through the argument to try to amplify the fact that the people of the area do not feel that they have been consulted. There is tremendous resentment in the area. It has been estimated that about one-third of the population of the county lives within a 10-mile radius of the city centre. It has been estimated that nine out of 10 people now have a hospital within easy reach. However, the proposal is for a greenfield site that will require new roads and new building. That will take economic activity away from the city centre, which at the moment is scarred by unused potential building plots.
Surely the Government should take advantage of this opportunity to state whether they intend to establish a process whereby any major change to a PFI project must be subject to at least some form of public debate. Without that, there will be a series of disgruntled people, feeling that they have been badly treated and who are often ignorant of the decisions that were taken. Regardless of the medical benefits, what has happened in this case has left a very bad taste in the mouths of the people of the city of Norwich. They feel that local opinion and local democracy have been totally ignored.
Viscount Ullswater: My Lords, I understand from the major contractors who are involved in leading PFI health projects that the Bill is to be welcomed. It sets out to achieve the objective of clarifying the power of NHS trusts to enter into contracts for major projects which are externally financed by the banks or other funding institutions which will not be providing services themselves. The power to enter into PFI contracts was missing from the legislation setting up the NHS trusts and has been of concern both to them and to the providers of the finance for some time.
Perhaps I may refer to the contract which has already been brought to your Lordships' attention and which is perhaps one of the biggest. My noble friend Lady Cumberlege mentioned the building of the £194 million Norfolk & Norwich hospital in the county in which I live. That project has not reached financial close and has not been started. The noble Lord, Lord Addington, clearly demonstrated some of the problems that arise when one is unable to go ahead with such capital projects when they are first agreed. When such projects do not proceed, local people often decide that the location is not right and we then encounter all the problems that the noble Lord outlined.
Public sector capital funds are always scarce and have to be rationed across the whole range of government departments--so much so that long-awaited and long-promised new developments, despite the massive hospital building programmes of the 1980s and 1990s to date, are still in the Treasury queue. The noble Lord, Lord Marsh, correctly commented on the length of the queue of public sector projects in the generality and on the size of the problem for the NHS in particular. However, the PFI allows the NHS to bypass or to jump the Treasury queue as long as the project is financially viable and has a private sector partner.
The Government have announced that they intend to conduct a speedy review of all PFI across government, to be conducted by the Paymaster General. I am pleased that they are prepared to put this sensible piece of legislation before Parliament even before the review has been completed. The speed with which this Bill has arrived makes me believe that it was unfinished business from the previous Administration. Indeed, we have had confirmation of that from my noble friend Lady Cumberlege. There is no harm in that. The new Administration have made favourable noises about public/private sector partnerships, and if the review is to identify obstacles in the way of the PFI and ways in which the process might be streamlined, I welcome it.
The Bill will cover major projects which are externally financed. However, I am advised that it will not cover a deal where the private sector contractor is financing the project from its own resources. Many of the smaller PFI projects which have already been let involve the building contractor or service provider funding the project on the strength of its own balance sheet. The Secretary of State would not be able to
Lord Dean of Beswick: My Lords, I rise to support the Bill. Other noble Lords have already explained it and what it entails. I thought the Opposition spokesman, as we must now call the noble Baroness, Lady Cumberlege, a little uncharitable in going wide of the Bill and attacking people who are not in the Chamber to defend themselves. She said that one of the main reasons why the Bill had had to be brought forward was the behaviour of some Labour local authorities. That would be the case--wouldn't it?--because there are not many Conservative local authorities left to misbehave although some have done so in the past. I believe that the noble Baroness actually used the word "confiscation"--she certainly implied it--with regard to what local authorities might do with their money.
To put the record straight, the biggest act of financial brigandage this century was perpetrated by the Conservative Government under the leadership of the noble Baroness, Lady Thatcher, and her Chancellor of the Exchequer, the noble Lord, Lord Lawson. Quite cheekily, they purloined £3 to £4 billion of water assets from local authorities without any compensation. I did not hear any shouts from noble Lords opposite in defence of local taxpayers to whom that money belonged. I believe it is on record that one Member of this House on the other side who said that the money ought to go back to the local authorities was the former Secretary of State for the Environment whose memorial service is sadly being held tomorrow. I refer to Lord Rippon who at the time was Geoffrey Rippon. In the other place the action of the Thatcher Government was deplored by the former Prime Minister, Mr. Edward Heath. He also said that the money should be returned. It was only £3 to £4 billion. I believe that the noble Baroness should be careful in speaking about financial probity. That was a disgraceful act on the part of any democratic government.
An enormous sum of money has been squandered because this Bill has been delayed for 12 months. However, I welcome it because of what it will do for the building industry as well as the health service. Members from all sides of the House have asked why more money is not spent on the infrastructure and why capital receipts from council housing have not been released. The new Government will do it. I hope that no Member on the Benches opposite will ask why it was not done when the previous Government were in power. The implication is that when noble Lords on these Benches were in opposition they held up schemes. That is absolute nonsense.
I differ from those who say that any new hospital that is built, including services, should be totally privatised. I put this view as a layman. I do not believe that it is my party's view. I do not want to see a situation where treatment following clinical diagnosis is withheld on the basis of a view put forward by a financial adviser to a trust who sits in an office. One often came across this in local government. I believe that in Manchester I gained some distinction for running a good ship. If one had let the city treasurer run Manchester there would not have been much advancement because, like most economists and accountants, he always found a case for not spending extra money. If one wants to progress one must spend a lot of money. There is need for enormous sums of money--I do not know where they will come from--to put right the infrastructure of the health service. I believe that we are starting on the right track.
When one talks of wasted money or money that has gone west one thinks of what has been lost in computer scandals, what has been lost in the West Midlands as a result of something similar and the final report issued only a few weeks ago on overspending in the former Yorkshire Regional Health Authority which went quite beyond the needs of the National Health Service. Quite a chunk of that money was paid over by officers of the regional health authority to take account of the negative equity in the sales of their houses when they moved. They were taking money from the health service in Yorkshire to pay for more expensive houses elsewhere. That was being done for consultants. The sum involved was three quarters of a million pounds. I raised the matter in this Chamber some time ago. I asked why all this money had gone west in the health service. As far as I am aware, no appointed members responsible for that policy--I am not referring to officers--ever
I understand that £2.1 billion of work will be put in hand. I hope that that occurs as quickly as possible without the building industry overheating for the reasons that I have given. The buildings are needed for patients and the buildings will provide work. I hope that because of the sums of money involved strict financial control over these contracts will be maintained. One knows that in very high value contracts the figures to be paid on completion are out of all proportion to those envisaged when the contracts are let. I hope that that facet will be looked at carefully. Having said that, like other noble Lords I welcome the Bill and look forward to the Committee stage when Members of your Lordships' House may agree variations, but the sooner the measure goes through the better.
The Earl of Home: My Lords, I first declare an interest. I work in Deutsche Morgan Grenfell, a bank that advises various consortia involved in projects that may go ahead as a result of this proposed legislation. It was one of the banks that expressed the gravest reservations about the vires of the National Health Service trusts to enter into these contracts.
Like my noble friend Lady Cumberlege I am grateful to the noble Baroness, Lady Jay of Paddington, for introducing this Bill so early in the Session. It will enable several highly desirable projects to proceed through the PFI. Likewise, I am pleased that there is an all-party approach to the principles of the Bill which I hope will lead to its speedy enactment.
I was interested to hear the Minister say that she had supported PFI for some time. When the noble Lord, Lord Eatwell, was Front Bench spokesman for the party opposite he referred to the PFI as "probably fictitious investment". I trust that, so far as the Government are concerned, that somewhat flippant attitude to what is a serious topic is now firmly buried and consigned to the pages of Hansard and of history. Without being over dramatic, the projects which will benefit from the enactment of the Bill will
Although PFI is thought to be a complicated subject, its basic principles are perfectly straightforward. They are all about who should take what risk and, having established that, who is empowered to take that risk. It is perfectly fair for investors, banks and financial institutions to seek clarification on who is empowered to sign what. Indeed, it should be helpful for the Government to know who is responsible for what element of each project. In the same way as government must safeguard public funds, we in the private sector and in the bank must safeguard our depositors' funds and not put them and shareholders' money at undue risk. I am very pleased that the principles of the Bill provide a needed clarification to enable the trusts to sign these contracts.
The Bill is a good start. It will enable a significant sum of money to be raised. But I believe that a lot more could be done. It is not appropriate today to debate the wider aspects of PFI when the vires of local authorities to enter into transactions will have to be addressed. That must be the topic of further legislation, for their powers have already been challenged in the courts. However, I hope that that problem will be addressed by Mr. Malcolm Bates in his study and we all look forward to its results.
I further hope that it will recognise that many factors are common to all these projects. In the past, there has been a tendency to reinvent the wheel with each new set of advisers, investors, lawyers, bankers and government officials. As has been pointed out, that has been an expensive exercise, but each new project creates new case history. As my noble friend Lord Jenkin of Roding pointed out, it has enabled practitioners to move further up the learning curve. Nevertheless, large amounts of money have been set aside and there is impatience among sponsors and investors, as well as within government, to get on with it.
It should be possible to work out which problems are common to which projects, be they roads, prisons or hospitals--and I have been involved in all of them--and then to develop an umbrella template which would cover most of the answers to those problems which are currently addressed on an individual basis. Under that umbrella template, a further template could then be added to cover hospital schemes, for there are many similar characteristics to any new build hospitals. I am well aware that good work has already been done on that by the Private Finance Unit in the NHS. It has identified possible standard terms for certain commercial and financial agreements.
However, under my proposal, a second template could then be developed to include parts of hospital schemes. There is, for a financier, almost as much work in bringing to fruition a £1 million scheme as in undertaking one worth £100 million. It is simply
There is another way. One could find a sufficient number of common factors for the smaller schemes, which could then be lumped together to make a large package in a manner similar to the general purpose lines of credit, which are made available under the Export Credit Guarantee Department. They could still adhere to the European rules on competitive procurement. Likewise, a more detailed template to cover the smaller schemes could be formulated. Healthcare is not just about building shiny new large hospitals. Small facilities are particularly important, especially in rural areas. While each individual small scheme may not seem particularly large in terms of money, the totality adds up to a great deal. In order to allay any fears that the British Medical Association may have on this topic, I emphasise that I am not here talking about the privatisation of clinical services, nor indeed the extension of PFI into clinical services. I am here simply talking about the capital cost of bricks and mortar related to the smaller schemes.
While a general review of PFI is desirable, a short time has been given to Mr. Bates to conclude it. It cannot cover the common ingredients of the schemes to which I refer. If PFI is to be used to good effect for healthcare, more detailed discussion is needed between government and the practitioners if we are to turn theory into good practice. I know that the banking and the legal industries are keen to make PFI work and, as practitioners, we are more than willing to sit with those from the Treasury and whomever the noble Baroness, Lady Jay, wishes to nominate from the Department of Health to work out the details of the templates to which I have referred. I believe that it would be time well spent now and that it would save a lot more time and frustration in the future.
Baroness Seccombe: My Lords, I wish to begin by declaring an interest, though not a financial one. I am deputy chairman of Nuffield Hospitals. We have 34 acute hospitals countrywide caring for people in the private sector. Recently we completed agreement with the Royal Surrey Hospital Trust for the construction of a new Nuffield Hospital in Guildford. The contract contains initiatives for a new and exciting co-operation between the trust and Nuffield Hospitals.
Looking back on my childhood, I remember hospitals as dark, miserable and rather frightening buildings. Of course, once inside, the devotion, dedication and loving care shone through, even though I must admit that there was a stricter regime in those days. Tidiness of bed-making seemed to be high on the list of priorities. Most of the buildings were relics
Those were the hospitals which the NHS inherited. During the past 50 years, enormous sums have been spent on rebuilding and refurbishing. Indeed, the past 10 years have seen the completion of more than 750 schemes, each costing more than £1 million. But there has to be a balance as regards how funds are spent. Money put into buildings cannot be used for other worthy causes and priorities have to be set out. However, I believe that for patients it must be so much more agreeable to enter a hospital which is light and welcoming. It must also be of great benefit to all those who work in hospitals to have better amenities. I am sure that, for example, they will welcome not having draughty corridors or having to take patients into the open air on the way to and from surgery.
It is even more important that hospitals become centres of excellence, with the latest hi-tech equipment necessary for today's treatments. We all know of towns where the debate on the longed-for new hospital has ranged from excited expectation to mere despair, as the project queued for Treasury agreement. The private finance initiative was begun by the previous government to alleviate the problem. It applies only to buildings and non-core services, with the NHS retaining the freehold of the building. Of course, it provides an opportunity for the private sector to apply flair and expertise in the design and construction of the buildings required by a trust for its particular needs. Many schemes are in the pipeline--71 have been approved, bringing in private capital of more than £600 million, including last year an injection of capital for major schemes at Leeds, Amersham and, indeed, the hospital in Norwich about which we have heard this afternoon.
However, the whole initiative has not progressed as quickly as was envisaged. It is a new process which brings together private capital and NHS trusts. But doubts were raised as to the underlying powers of the trusts to enter into those financial arrangements. I believe that no one expected such doubts to emerge and I am sure that they were not intended. Therefore, it was natural that action should be taken and the previous Government promised legislation to ease the situation. Therefore, I am delighted to welcome this Bill and also, of course, the Government's conversion to the principle of PFI.
The Bill recognises the contribution that can be made by the private sector to the development of facilities for the NHS. I was interested to note from the briefing that I received from the BMA that it has withdrawn its main reservation, as it accepts,
I hope that this important, short Bill will have a speedy passage on to the statute book. It will enable and encourage the conclusion of many projects. That can only be of benefit to local communities and, indeed, the economy of the country as a whole. I look forward to hearing from my noble friend Lady Anelay of St. Johns as she takes up her new place on the
Lord Rea: My Lords, I thank my noble friend for explaining so clearly the purpose of this short Bill. I hope that she is right to predict that the log-jam or gridlock as regards some PFI projects will now break up and that some of them will start to get going.
In some parts of the country, there will be great relief if that occurs. However, some projects will not receive the whole-hearted support which perhaps the Minister would wish from the populations concerned. In that regard, I refer to the remarks made by the noble Lord, Lord Addington, about Norwich and I am thinking also of the next phase of development at Barnet General Hospital. That will allow the further dismantling of Edgware General Hospital, which is a hospital well situated in the midst of a population which contains many under-privileged people. If the development goes ahead, those people will have to travel much further for their acute and emergency services. Similarly in Norwich, as the noble Lord, Lord Addington, said, by moving out of the city the hospital will be more difficult to reach for the 40 per cent. of the citizens of Norwich who have no car. The new car park will be of little use to those people.
However, it seems that both projects are so far along the road of planning that it will be very difficult to reverse them now. Nevertheless, I feel that the anxieties of the populations concerned, who will be deprived of their local hospitals, must be addressed. I know that Norwich City Council and the citizens of Edgware would certainly be grateful for this.
As most noble Lords have said, this debate allows us to consider whether the whole PFI initiative is necessary or wise. The Government are in favour, as am I, of good forms of public/private partnership in the financing of a variety of enterprises, not only in the NHS but in many other fields--universities, roads and rail schemes, although that is not so much the case now that the railways are privatised--but there is still some call for public finance in that area.
The main reason for the need for those public/private partnerships is to avoid increasing the public sector borrowing requirement. But as several noble Lords said in the debate which took place about a year ago on the residual liabilities private finance initiative legislation, it may not always be the most appropriate method of private finance for the NHS. That is not only because the support services provided by the consortium or firm concerned will then be out of National Health Service control but there is also that grey area which the noble Baroness, Lady Cumberlege, mentioned where those support services impinge on clinical services so that one is not quite sure where the divide comes.
It has been said that the PFI is mortgaging our future. The noble Lord, Lord Marsh, and other noble Lords have justified that and have said that that is not a bad thing. Like many of us, the noble Lord, Lord Marsh, has bought several houses on a mortgage. In this House there may be some who are lucky enough to have a tied cottage or a stately home. I wish that I was one of those because I certainly have bought more than one house on a mortgage. But it is a perfectly acceptable way to raise money, provided that the asset will be realisable at the end.
It has been said by a number of people, and in particular by my noble friend Lord Winston, that in the provision of health services things change very rapidly. It may be that a hospital which is built now will be redundant in 10 years' time. However, I suggest that architects may wish to think very seriously about that. They have thought a lot about making hospitals flexible according to their different kinds of clinical use. I suggest that they may have to think about building hospitals in such a way that they could be converted easily into something totally different--for residential or commercial use or as community centres and so on. But it seems to me that, regarding solid bricks and mortar investments, we could borrow money more cheaply on the international market as a government than can be raised through the private sector.
As for the costs of servicing the hospital and the facilities, they will still have to be met every year whether the enterprise is publicly or privately financed. If the project is privately run, then a profit must be made out of taxpayers' money. I just wonder whether that is what the Government really want to see. In many cases, where services have been contracted out by existing hospital trusts, the result has not always been a happy one. The use of a "flexible", often part-time, low-paid workforce has often led to a lowering of standards. I suggest that when a minimum wage is introduced the charges for such services will probably rise, so that the competitive advantage of commercially contracted out support services may well become less.
I agree that the Bill is necessary for the current projects that are waiting impatiently for the starting gun. However, I hope that the operation of the PFI in these projects will be carefully evaluated and that in future the PFI will only be used where a clear
Baroness Eccles of Moulton: My Lords, I should like to start by adding my congratulations to those already offered to the noble Baroness, Lady Jay. Our paths have crossed, shall I say, in the health service on a number of occasions and I have the greatest admiration for her knowledge and ability. I should first add my name to the list of those speakers who have also declared an interest, in that I am chairman of a west London health authority. A number of PFI schemes are under way or already completed in that part of the city.
It might be helpful if I say a few words about some of the background to capital investment in the health service. Within the public sector, the NHS has historically had a narrow and restricted approach to capital investment. Local government and the university sector have had greater freedoms to use private sector money and have had the associated powers to borrow. The approach of the health service has been more cautious. This can be extended to its overall financial management where over the years it has had a good record of living within its allocated funding without accumulating debt.
However, as a result of that traditional, rather unimaginative approach to capital investment, neither the costs of capital nor the potential to create funds for new buildings through the sale of surplus land holdings were sufficiently taken into account. A notable exception to this approach has been in general practice. Traditionally, GPs, as independent contractors, have had a well-established pattern of using private sector funds for capital investment in GP premises development. Further, over the past 20 years or so, the closure of the large, long-stay institutions for elderly people and people with learning disabilities, as well as for psychiatric patients, has depended heavily on non-NHS funding to provide capital for high quality, small residential units, offering standards of privacy and a quality of life which are often far better than those previously offered in the NHS. Moreover, for frail elderly people the enormous growth in the independent nursing home sector is another example of the NHS utilising third-party capital funds. There are also numerous partnerships with housing associations and other non-profit-making groups where their ability to access capital has enabled them to work in partnership with the health service, thus providing truly excellent facilities for some of the most vulnerable groups in our society.
We are all aware that the purpose of the PFI when applied to the health service is to inject additional capital money into the NHS to tackle the considerable backlog of out-of-date unsuitable buildings and equipment. However, experience gained while working up the schemes--in other words, the learning curve, which has already been referred to by my noble friend Lord Jenkin--has inevitably revealed some problems
One of the obstacles that has emerged has been dealt with by this Bill; another is the matter of risk, which was mentioned by my noble friend Lord Home in the context of banking. In order for the capital sums involved to be excluded from the public sector borrowing requirement calculations, the private sector was required to assume a substantial proportion of the risk involved. If the private sector funders were to take such large risks they would have had to charge premiums so high that any potential benefit would have been negated.
The residual liabilities Act, to which reference has already been made, was passed last summer and goes some way to reduce the commercial risk as it allows the Secretary of State to deal with insolvent trusts. However, if reasonable rates of return on the capital employed are to be achieved, the sharing of risk between the health service and the consortium providing the project must be sensibly applied.
Another problem, but one which, if properly organised, could also be a virtue, is the management of facilities. The issue has already been extensively dealt with by the noble Baroness, Lady Robson, but I have a slightly different slant to put on the subject.
The large PFI schemes tend to be bid for by consortia. These can be made up of a number of companies supplying different services. Part of the deal is that members of the consortium take over the provision of some or most of the non-clinical support services such as catering, domestic services, estate management, car parking, and many others, on a long-term basis. It is important to note that this provides part of the return on the investment and is part of the process of transferring risk.
The virtue can be in services more effectively and efficiently provided. However, the problem can be that the management of the trust concerned has lost direct control of those services and has closely and continually to monitor their quality. It means that there is a different management role, with managers becoming performance approvers rather than service managers--a skill that needs to be learnt.
When the PFI was first introduced into the NHS--and this is another aspect of the learning curve--there were doubts about whether people at local level would have the maturity to balance the risks and benefits of large capital projects in both financial and non-financial terms, and so a complicated, highly centralised and lengthy process had to be embarked upon. That has contributed to the length of time it is taking to sign off the contracts for the big schemes. It would be a help if some of the preliminary procedures could be streamlined. That would save both time and some of the excessive costs which fall both on the lead parties in the consortia and the trusts. That point has already been made, but I should like to emphasise that a great deal of learning has had to be done as the PFI has taken a grip in the health service.
The health service cannot operate efficiently without adequate sources of capital funding. One source is recycling--for example, through the sale of land no longer needed by the health service--but this will never provide enough and sources of new capital will always be needed. The PFI is becoming established as one of those sources and through the benefit of experience it must be made to work properly.
The very short Bill before us--indeed, I do not believe that I have ever seen a shorter one--will remove an obstacle which has emerged as work on large PFI schemes has continued. I hope that the Bill will progress through all its stages as speedily as possible and be on the statute book very soon.
Lord Monkswell: My Lords, I rise to speak in the gap but I do so in response to the noble Lord, Lord Marsh, who referred to me as speaking later in the debate and as obviously being in support of the Government. Therefore, I felt that if I did not speak it would be seen as an indication that I do not support the Government. Perhaps I may confirm to the House that I do support the Government. I congratulate my noble friend the Minister on the very effective way that she explained the purpose of the legislation which is aimed at clearing up a mess left by the previous Government. In saying that I must point out that the reason we are so desperately in need of infrastructure investment in the National Health Service is because of the paucity of that investment during the past 18 years of the previous Administration.
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