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Private Sector (NHS)

I entirely agree. It is an area that I shall explore later. Trying to pin down exactly what the costs are is difficult as they are shrouded in mystery somewhere in the Department of Health. Following Mr. Saxby's letter, I asked a series of written questions to try to get the facts about this contract. I was keen to find out what the Department of Health's view of the contract was and, in particular, I wanted to know whether the contract represented value for money. Contrary to press reports in The Sunday Telegraph of 27 March this year, I have not been gagged, and over the past six months I have asked more than 100 written questions to try to get to the bottom of this matter. I have not been reassured by the answers that I have received. Overall I have a number of concerns about the replies from the Minister and his predecessor, the Chancellor of the Duchy of Lancaster, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), and even the reply to my oral question to the Secretary of State herself a few weeks ago. I hope that by answering some of my questions, which the Department seems reluctant to answer in writing, the Minister can free up some of my time and ensure that I do not have to table five questions a day to the Department. I suggest that any right hon. or hon. Member who wants to get to the bottom of an issue should keep asking parliamentary questions, because the way in which they are answered raises even more concerns. I have used this process to glean as much information as I can, and the information that I am about to give is the Department of Health's own—it is not my opinion. If the Department wants to deny the facts, it can happily look through my hundred-odd written questions. My first concern is that, in commissioning a private firm to run the scanning service, the Department has made no assessment of existing capacity in the NHS—this is where things gets a little boring, so I hope that everybody will stick with me. On 5 October, in answer to a written question, the Minister said that what he described as "an unparalleled expansion in most diagnostic services" was the result of "plans . . . based on understanding and meeting local needs for diagnostic services, which have been developed through working closely with local health communities to understand their needs for extra capacity."—[Official Report, 5 October 2005; Vol. 436, c. 2831W.] 19 Oct 2005 : Column 273WH I wonder how that answer squares with the facts at the University hospital of North Durham, whose scanner is only five years old and is used for only 50 per cent. of the time that it could be. In other answers, the Minister refers to the capacity planning exercise that took place in 2004 with the strategic health authorities. Apparently, it concluded that MRI scanning services needed to increase by 100 per cent. over the next three years. Unfortunately, the Minister and the Department do not refer in their answers to any assessment of existing capacity—they talk only about expanding capacity. Furthermore, I spoke to my local strategic authority, which confirmed that no such planning exercise had been undertaken. Like the University hospital of North Durham, it has simply been told by the Department that it has to use a centrally procured contract with Alliance Medical and that that is the way to get the waiting list down in Durham. That can lead to only one conclusion: the commissioning of Alliance Medical to provide scanning services was done on the basis of political dogma, not evidence. According to the dogma, if waiting lists are long, the NHS must be too inefficient to sort out the problems and a private firm should be given the money to tackle them instead. However, the failure to examine existing capacity has led to a problem, because, in north Durham, an NHS-provided scanner is sitting there unused. The other problem is how we test whether the contract is good value for money. The Minister was unable to tell me the average cost of a scan on the NHS and, in a written answer on 22 June, declined for reasons of commercial sensitivity to tell me the average cost of a scan provided by Alliance Medical. In the same answer, however, he stated: "The contract was secured at excellent value being approximately half the national health service equivalent cost for the total patient episode."—[Official Report, 22 June 2005; Vol. 435, c. 1091W.] I therefore have a simple question: could the Minister define what he meant by value for money? I would be grateful it he could tell us today how he arrived at the statement that he gave. I say that especially because, having read various medical journals over the summer, including the magazine of the Society and College of Radiographers—that is how sad I am—I saw that the managing director of Alliance Medical had said: "At the time the contract was awarded, there was an NHS reference price of around £330 per scan." If he can announce that in a national publication, why can the Minister not give the information to me, as an elected Member of Parliament? It also appears that the Department of Health does not have much information about the impact that Alliance Medical has had on the scanning waiting lists. In a written answer on 21 July to a question asking how much Alliance Medical has reduced waiting times in the Durham and Darlington trust area, I was told that the information is not held centrally. That was a surprise to me, because I read an article in The Guardian by my right hon. Friend the Secretary of State for Health that stated that waiting times for scans, in Barnsley of all places, had been reduced substantially. 19 Oct 2005 : Column 274WH It transpires—I have being digging—that the figures in the article were, to quote from another written answer, "based on reliable information provided by Alliance Medical Ltd." —[Official Report, 21 July 2005; Vol. 436, c. 2178W.] I am disappointed that such reliable evidence was not available for my area, either through the Department of Health or Alliance Medical. I shall turn briefly to the performance of Alliance Medical. I was unable to determine how it was performing in meeting the obligations of the contract. I was told in a written answer on 5 July that the contract "is monitored weekly, quarterly and annually".—[Official Report, 5 July 2005; Vol. 436, c. 342W.] I was then told on 21 July that the annual review was taking place in July and that if a decision could be published consistent with commercial confidentiality, that would take place later. I am still waiting for that report to be published. The House will also be interested to know that an article in the Health Service Journal in August spoke of how 70,000 scans had not been carried out by Alliance Medical, meaning that only 62,000 had been carried out. Alliance Medical has been operating at less than half its capacity under its contract with the Department of Health. On more than one occasion I have had cause to wonder whether the Department of Health is in possession of the facts. The conclusion that I have come to is that it is clearly not. In an oral answer to a question that I asked in the House on 12 July, my right hon. Friend the Secretary of State made great play of the Government's desire to reduce waiting times. She said: "We need both to reduce the unacceptable waiting times for scans and to meet our target of a maximum of 18 weeks from GP referral to hospital treatment by 2008."—[Official Report, 12 July 2005; Vol. 436, c. 685.] However, when I asked how many trusts were meeting the target of no more than 18 weeks' wait from GP referral, the Under-Secretary of State for Health, the hon. Member for Birmingham, Hodge Hill (Mr. Byrne), replied: "We do not currently collect information on the length of time from GP referral to start of treatment".—[Official Report, 5 October 2005; Vol. 436, c. 2843.] How can we make statements about the efficiency of a contract if the Department is not collecting the information? I have lost count of the number of replies that I have had from the Department of Health—all hon. Members will have experienced this—telling me that the information is not held centrally. How can we then monitor the contract with Alliance Medical? In these days of data sharing and communication between trusts, surely the Department of Health should be able to provide such basic information. There is the issue of how the contract is undermining the NHS. Although it is obvious that the NHS is undermined when money that could have been used to reduce NHS waiting times goes to a private sector company, I am also concerned that the NHS is being undermined in two other ways. In signing up to the contract, Alliance Medical had to agree not to employ staff who had not worked in the NHS over the previous 19 Oct 2005 : Column 275WH six months. I believe that that is right. However, I am not convinced that any systems prevent that from happening. In answer to another written question about the way in which the additionality clause is enforced, I was told that staffing is a matter for Alliance Medical. I am concerned that we are relying on the good will of the contractor not to breach the terms of the agreement. It would also appear from another answer that no monitoring system is in place to check whether staff are being poached from the NHS. Even if we assume, however, that staff are not being poached, we should bear in mind something that the Royal College of Nursing has pointed out—that the independent sector treatment centres are not obliged to follow the "Agenda for Change" agreement. I am concerned that the centres are mechanisms for delivering reform in the NHS through a two-tier work force, despite the many assurances from Government that that would not happen. The operation of the Alliance Medical contract has been a salutary lesson in how not to use the private sector in the health service. None of the three criteria that I set out for assessing the viability of private firms' provision of NHS services has been fulfilled. Did the contract remain true to the founding principles of the NHS? No. People in my constituency were forced to travel 30 miles out of their way to get treatment that could have been provided locally, with the result that the service has not been open to all. It has been open only to those who could get in a car to get there. Did the arrangement give value for money? It seems, from the replies that I have and the sketchy financial information that is retained in the Department of Health, that that is very unlikely. I have yet to see a scrap of evidence that the suggestion was good value for money. It is even clearer that in some respects the contract is not being adhered to. Finally, are NHS services being complemented, rather than undermined? Again, I doubt that. Procedures to prevent poaching seem to be non-existent, and while a private firm is paid to provide scans, a pretty good NHS scanner that is less than five years old sits idle in the University hospital of north Durham. I have said that I am not opposed to the use of the private sector in the NHS, but it should be employed only where it adds value in patient choice or in the service. Clearly, the contract is leading not to more efficiency, but to more inefficiency. Mike Sobanja, the chief executive of Alliance Medical, made a comment that seems to me to sum up what is wrong with the national top-down approach. He said: "It seems to me a little sad that the centre is not able to create contracts that are really needed by the NHS." If what I have described is a demonstration of efficiency in the way the NHS will use scanner services, it shows that those losing out are not only taxpayers but my constituents. I hope that I shall receive some answers to the points that I have raised—and that they may be more effective than the hundred-odd written questions that I have tabled.