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Private Sector (NHS)

I, too, begin by congratulating the hon. Member for North Durham (Mr. Jones) on a superbly begun debate. The very large attendance at a debate in which not everybody knew that they would be able to speak is indicative of the importance of the subject. That is one reason why the Government should have initiated the debate—at far greater length, and in Government time. Another is that, as has been said, a major reform of the primary care trust system was slipped out at the end of July when we had all left for the summer recess, and that has not been debated properly in the House. A great deal of rapid change is taking place in the heath service, and it is our job to scrutinise it. The Government should facilitate that process, rather than relying on the issues being brought before the House by energetic Back Benchers such as the hon. Gentleman, who has done us a great service. I start where the hon. Member for North Durham started—by saying that we are not saying today, "Private bad, public good." Rather, we are concerned that there are those who might say the contrary, "Public bad, private good," and that the pendulum has swung too far. I agree with the hon. Member for Stourbridge (Lynda Waltho) that we should have no problem with the idea that some high quality health care should and 19 Oct 2005 : Column 287WH can be delivered by people who are not direct employees of the NHS. I had already written "hospices" on my notes before she spoke. She also mentioned counselling, and many of us encounter people who receive good quality care in private nursing homes. If it were so important to us that staff be strictly employees of the NHS, not many of us would ever visit a GP or a dentist. It is not simply a matter of being employed by the NHS. If the private sector is to have a part to play in the NHS, it must pass a number of tests, several of which have been mentioned. We have ended up with about six. I shall clarify the key tests. We must start with accountability. For me and for many of my constituents—I am sure that it is the same for many hon. Members—accountability in the NHS seems to be diminishing. We are told that we cannot find out about so much of what goes on because it is commercially confidential, and that we cannot challenge decisions. If we ask in the House about certain decisions, we are told that they have been made by the trust. If we ask the trust, we cannot get rid of its management. Where is the accountability? If the private sector were more extensively involved, what would that mean for accountability? My hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) made a powerful point when he referred to the contracting out of commissioning in Oxfordshire. As the hon. Member for Banbury (Tony Baldry) rightly said, what would that mean for accountability? This week, Nigel Edwards of the NHS Confederation argued that the NHS not doing health commissioning was a little like British Airways saying that its core business is air miles and that the running of planes was too difficult for it. Why does the NHS exist, if not to determine dramatically the provision of health services? If we are to go down that route, why have an NHS at all? We have not received an answer to that question. If the private sector is to be involved in the NHS, it must be competitive on the basis of costs. However, as we have heard, it has been given a favourable deal on cost in too many cases. It has been given guaranteed business. There is an irony in the way in which the Government use the rhetoric of the market and drive up standards by fierce competition, but then mollycoddle the private sector with guaranteed contracts and prices. How does the giving of subsidies to generate a market constitute fair competition and a level playing field? Hon. Members must make no mistake. That is what is happening. The Government are determined that there shall be a market; unaided, the private sector will not enter it. It has to have its hand held. The Government's determination to form a market is creating unfairness. The hon. Member for Banbury and others asked how we specify a contract. That is essential. If the contract were not specified correctly, the private sector provider would cherry-pick and choose the cheapest cases. As the hon. Member for Warrington, North (Helen Jones) said, private sector providers will not undertake training unless they were required to do so under the contract. Sometimes the answer can be, "Well, we can deal with that. We shall draw up better contacts", but the world moves on. Life changes. In effect, a contract can be rewritten if it was in respect of an organisation in the public sector. It can be asked to do something different, because the world is different. However, if a contract 19 Oct 2005 : Column 288WH was drawn up five or 10 years ago, it would be difficult and expensive to change. Will the private sector be as responsive as the public sector when the world changes? I fear not. What about quality? Clearly, if the private sector is to provide NHS services, the quality must be as good. There is no reason to suppose a priori that it will not be, but there might be a danger of it not being as good. The hon. Member for Wyre Forest (Dr. Taylor) referred to accreditation. NHS provider services and NHS employees go through a process of accreditation. However, when services are contracted out—possibly using overseas staff—can we be confident that all the medical staff involved will be of the same quality? So far, I do not think so. What about scanners? Over the summer, I visited several hospital trusts. I heard about a mobile scanner unit in a car park that had two problems: first, people had to go up three steps to get into the unit. People who were sick could not access it. Secondly, because it was a mobile scanner, it was not as big as the regular scanner and, thus, tall people could not access it. Essentially, it was a scanner for short, healthy people. I have nothing against short, healthy people per se, but I do not think that they are a priority of the NHS. Alliance Medical has a contract, yet the Government have been so determined to avoid embarrassment that they said to the NHS, "If you use an Alliance Medical scan, you can have it for free. We shall not compel you to use the scan. You can choose someone else. If you want to pay the price, that's fine, but the service will be free from Alliance Medical." I wonder which company would be chosen in those circumstances. Is that good value for money for the taxpayer? We must bear in mind that getting the private sector in the NHS on a subsidised basis will generate a market, and that means gainers and losers. The losers might be in the NHS, if that is not properly protected. As the hon. Member for North Durham said, what will be the impact of such issues on the core NHS, the NHS ethos and on the universal public service that we want? We do not know what the transition mechanisms are. The NHS needs keyhole surgery, but it is getting amputation. One department will close and then another; the unit cost to the rest of the hospital will be too high, so it will not be able to compete and it will go. Is that the transition mechanism? What will happen? We have not been told. As has been said, this process is driven by dogma. The funny thing is that one might have imagined from the title of our debate that the dogma would come from the person who sought it, but it has not, because the hon. Member for North Durham has said that he is willing to consider private sector involvement. The dogma is coming from the Government, who are in a desperate rush to get the market in because the Prime Minister wants a legacy before he retires.