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Baroness Robson of Kiddington: My Lords, perhaps I may intervene. I do not believe I ever said that I had doubts about the Bill being necessary. I said it was a pity that we had to have two Bills and that they could not have been taken at the same time. The legislation could have been thought out a little more carefully.
Baroness Jay of Paddington: My Lords, in that case the noble Baroness and I are entirely at one. As I am sure she will recall, in my opening remarks I said that I, too, thought it might have been more sensible for the Bills to have proceeded together. I was a little concerned that she felt this was too heavy-handed a way to approach the problem. I understand now that that was not her concern. However, I am nonetheless grateful to the noble Earl, Lord Home, for making the points he did from a specifically banking perspective. I am particularly grateful that he offered further help in regard to working with the Department of Health to bring these projects to fruition more quickly. I am sure that is an approach which my honourable friends who are concerned with some of the individual projects will want to take up.
The noble Lord, Lord Addington, raised specific points about the development in Norwich. I understand his concerns about local public consultation. I will raise those points with my ministerial colleagues. I can only say to him, and indeed to my noble friend Lord Rea, who raised similar concerns, that I am genuinely surprised if their suggestion is that the general response to any new hospital development in any community would be unenthusiastic. However, I know that there
have been particular problems in Norwich--although I also understand that the local community health councils have endorsed the proposals as they stand. As I say, I will take up the specific concerns of the noble Lord, Lord Addington.
Lord Addington: My Lords, I understand that there may be some areas of agreement; however, there is certainly great public concern about the way this matter was handled and the way in which, in this particular case, account was not taken of the wider issues involved and not merely the site. That is the main point of concern.
Baroness Jay of Paddington: My Lords, I am grateful to the noble Lord for making the point even clearer, and I shall take it up again with my colleagues at the Department of Health.
Another point was raised by the noble Viscount, Lord Ullswater, who feared that the Bill would not cover the situation where private contractors found themselves paying from their own resources rather than receiving a loan. I am advised that, although that is the correct reading of Clause 1(3), Clause 1(6) provides that nothing in the Bill affects the validity of an agreement between a trust and a private contractor which does not have a certificate. The validity of the small scheme which does not qualify for a certificate is therefore unaffected. Apparently there is clear legal advice that trusts are able to enter into contracts without a certificate and the certificate process provides concrete reassurance to the banks which are funding the larger schemes. If there is anything further on the point which the noble Viscount would like to raise I shall be delighted to write to him.
Other more general points raised concerned the general scepticism--as I think I can call it--of noble Lords opposite about the overall confidence of the financial community in the new Government's determination to develop public/private partnership schemes and our real conversion to and interest in that as a profitable way forward for the National Health Service. The points were raised by several speakers, including the noble Baronesses, Lady Cumberlege, Lady Robson and Lady Anelay, as well as the noble Lord, Lord Jenkin of Roding. I can only remind your Lordships of the commitments that were given in the Government's business manifesto in the election to which I referred. I remind the House of the 12-point plan on the PFI and the specific understandings between the new Secretary of State and the banks about the schemes that we have discussed and the general enthusiasm of the private sector for the reappraisal by my noble friend the Paymaster General of the whole area of policy which has been widely considered. As I told your Lordships, it will be readily available and, as the noble Lord, Lord Ezra, suggested, it will be the subject of a more general debate at that time.
The whole question of clinical services is very tricky. It was raised by the noble Baroness, Lady Cumberlege, and others. I wish to take this opportunity to reaffirm the Government's clear commitment that we shall not allow clinical services to be included in the private
finance initiative or in the public/private partnerships as they develop. Under the previous administration, there was some discretion as to whether core clinical services could be included in PFI. Under this administration, there is none. Core clinical services are excluded. However, we acknowledge that there is an on-going debate about some of the definitions of clinical support services. It is undoubtedly a grey area, and several noble Lords raised the question of pathology and radiology, as well as other so-called support services. We have given a clear undertaking to look at the detail. It is part of the investigation by my honourable friend Mr. Milburn into the issue of PFI and health services, but we have never been in any doubt about the principle.I say with the greatest respect to the noble Baroness, Lady Cumberlege, that I was intrigued by the number of questions on the issue which she raised with me this afternoon. I thought she raised appropriate questions about the definitions of clinical support services and I was intrigued because they were familiar to me. I asked many of the same questions myself a year ago when we debated the National Health Service (Residual Liabilities) Bill. The difference is that we are now determined to sort the problem out. My honourable friend Mr. Milburn is urgently considering those questions in his general review and I am confident that he will throw constructive light on the problematic area. We shall then be able to reach workable and acceptable clarity on the issue.
Baroness Cumberlege: My Lords, perhaps the Minister would give way. I am grateful to her for being so clear in describing some of the issues raised this afternoon and for giving clear answers. However, when we were tackling them, as the noble Baroness said, when it came to radiology, pathology and some of the support services we were clear that if the local people wanted them to be part of the scheme we would seriously consider it and probably accede to it. From what the noble Baroness said this afternoon, I understand that her Government are far more ambivalent about it. I am still not sure whether radiology and pathology are part of the PFI schemes. She described them as "a grey area". When shall we know the results? People who work in the services find the uncertainty hard to cope with. With us, there was a clear line; but from what the noble Baroness said this afternoon, I think it is a fudge.
Baroness Jay of Paddington: My Lords, I have genuinely described it as a grey area because that is what I see it as being at the moment. I understand the noble Baroness's concern about a speedy resolution of the question; but without being disrespectful I can only say that it is somewhat surprising that the same questions should be asked by her this afternoon as I myself asked from her position last year. Very little conclusive work seems to have been done by the experts in the field to guide the new Government. That is precisely why my honourable friend Mr. Milburn is conducting his urgent review. I can be sure that it will throw a constructive light on the matter and we shall then be able to reach workable solutions. That is taking
place within the first month of the Government taking office, and to press us at this point for clarity on something which has been confused for such a long time is perhaps a little inappropriate.
Baroness Cumberlege: My Lords, I am sorry to come back again. I agree that the position is confused, but when we were in power it was clear what our line was. It depended on the will of the local people working in the service. I understand that that is not the case now with the new administration and that the matter has been thrown back into the pot. As I said, it is a fudge.
Baroness Jay of Paddington: My Lords, this is the third time that I say it but obviously with no great clarity: for us it is still a grey area. If the noble Baroness suggests that under the past government there was great clarity, all I can say is what I said in response to the noble Baroness, Lady Anelay of St. Johns. I do not wish to quote extensively from debates we had on the subject almost a year ago, but with precisely the same questions--and that is why I raised the point then with the noble Baroness, Lady Cumberlege--the same answers were given as I have given this afternoon. The clarity may have been in her mind, but it was not clear in the policy laid down. If the noble Baroness disagrees, perhaps we may return to the point later. I apologise if she feels that mine is a wrong interpretation, I do not wish to use extensive quotations from the Official Report.
Perhaps I may return to another issue raised by the noble Baroness, Lady Cumberlege, and the noble Lord, Lord Jenkin of Roding. Both were concerned about the equally difficult issue of health services in London, which is just as problematic as the area of clinical support services. With respect to both speakers, although the PFI clearly has implications for the future of services everywhere in the country, questions on London are not the subject of the Bill today. When the details of the review process for the London situation are announced by the Government I look forward to discussing the points raised by the noble Lord, Lord Jenkin, about membership of the review body and so on.
The noble Lord, Lord Ezra, rightly drew attention to the authoritative report of the Treasury committee in another place last year. He was right to be concerned about the prioritisation of projects under the PFI. The Government are concerned to pursue the issue on the basis of a strategic approach. We agree that that is necessary, particularly as a way of avoiding the types of consultancy costs to which the noble Lord referred, as I did in my opening remarks. My honourable friend Mr. Milburn wishes to deal with much of the work in the NHS now and we shall want to look at the useful suggestion of the noble Lord, Lord Ezra, of placing some of the issues within the context of the regional structure of the NHS.
Overall, I wish to reassure him that the NHS projects which are considered within the PFI will go ahead only if they demonstrate value for money, are affordable by the NHS and are explicitly supported by the relevant health authorities because they meet identified health
needs. The private sector will not dictate the capital programme of the NHS, although I hope that it will be a partner in our strategic approach.In conclusion, I apologise if I have not dealt with all the points that noble Lords raised. If there are substantive points, I shall write to them. I am confident that the co-operative spirit which greeted the Bill in your Lordships' House will be matched by practical support from the financial community. I hope and expect that what the noble Lords, Lord Marsh and Lord Jenkin of Roding, described as "a clash of cultures" will be replaced by productive joint enterprise. The NHS then can become a signpost toward successful public/private partnerships in the future. I believe that the Bill will begin that process.
On Question, Bill read a second time, and committed to a Committee of the Whole House.
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