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Private Sector (NHS)

I shall make some progress because I want to ensure that I give the Minister plenty of time. If there is time at the end of my speech, however, I will take the hon. Gentleman's intervention. The Government are wedding themselves to a particular approach and are reluctant to relinquish control from the centre. That is why the NHS has not made the progress that it should have done in recent years. It would be churlish not to accept that some progress has been made, but despite a 70 per cent. real-terms increase in funding, average waiting times have lengthened by five days—that is the Department of Health figure—and the number of hospital treatments has risen by only 5 per cent., despite the hard work of NHS staff. The Conservative approach to the private sector is in complete contrast to the Government's, and I know that it will not find wide acceptance in this place. Under our right to choose policy, the decision to involve the private sector would ultimately be made not by the Government or the primary care trust, but by patients and GPs. Our right to choose policies would allow any patient to go to any hospital, free of charge, that can perform the operation at the NHS cost. Such a policy would iron out the great variations that exist in the provision of NHS health care at present. One example of that was brought out last year by the Dr. Foster medical research company which showed that patients had to wait 390 days for a hip replacement at Norwich university hospital yet at Basildon and Thurrock university hospitals trust, which is only 90 miles away, the wait was less than half that at 182 days. By empowering patients in this way, resources will find their way to where they are most needed. Such a policy would also allow patients to go to private hospitals if they met NHS costs and standards. This policy would send out a clear signal to the private sector to increase capacity. For too long the private sector has been used by the NHS simply as an "overspill" facility. This does not encourage long-term sustained investment. That needs to change. On the continent, the private sector plays a much greater role in the provision of health care than it does here, but nobody grumbles about it because there are very few waiting lists. The patient benefits. Stockholm in Sweden is a good example of what happens when a genuine choice programme is introduced. In the early 1990s, centrally allocated budgets were put to one side and payment by activity was introduced, enabling patients to take their budget to any hospital that could provide their care for that price. What was seen over a relatively short period was a major mushrooming in the number of care providers coming into the market and competing for patients. With more than 200 new care providers set up since 1992, there are very few queues in Stockholm to this day. I take this opportunity to raise briefly with the Minister two other important issues that have been alluded to by other hon. Members. The first is the document "Commissioning a Patient-led NHS", which proposes a shift in role for PCTs from providing to purchasing. That announcement has created great uncertainty and confusion among NHS staff. Many hon. Members have referred to the lack of consultation on this issue. Many staff are unsure as to what will happen to them. In my constituency they are unsure whether they are to become independent providers 19 Oct 2005 : Column 291WH themselves, work for a private or voluntary company, or join foundation hospitals and sell their services back to the PCT. Will the Minister provide clarification by saying what proportion of health professionals will cease to be employed directly by the trusts? What exactly will happen to community nurses? Will they be required to join private companies? Will chiropodists be expected to set up private practices like dentists? Will the NHS staff no longer employed directly by trusts still benefit from the pay and conditions of "Agenda for Change"? Will the Minister take this opportunity to explain why such a major proposal affecting so many staff, and which includes both PCT reconfiguration and the outsourcing of provider functions, was launched by a simple letter from Sir Nigel Crisp to local trusts? Surely a more detailed paper produced by Ministers was warranted when we are considering such an important issue. Mention should also be made at this point of the 17.5 million people who suffer from long-term medical conditions. The Government's approach of block booking reflects their thinking as it does when it comes to targets in that it is focused almost exclusively on the acute sector. Once again, those suffering from long-term medical conditions are being neglected because of the Government's focus on what they perceive to be politically sensitive medical conditions. That has to be wrong. What will the Government do to put this bias right within the health care system? I have one other question for the Minister. Social care is being neglected in areas such as rehabilitation services for the visually impaired, where local authorities are struggling to meet their responsibilities. According to the Guide Dogs for the Blind Association, 20 per cent. of local authorities are not providing any services at all. There is much scope for outsourcing some of the responsibility to charities and the private sector. Greater use of direct payments will help that, and I hope that the Minister will ensure that such a system will eventually realise its full potential for all concerned. In conclusion, there is a fundamental contradiction at the heart of the Government's thinking. On the one hand, they are moving closer to our view that patients should be given genuine choice. However, on the other—perhaps because of dogma, as has been mentioned—they are clinging on to their old policy of centrally deciding where the extra capacity should be placed. That muddled of thinking is causing confusion, not least among NHS staff, and, most importantly, it will not service the patient well. I therefore ask the Minister to directly address the questions he has been asked.