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NHS: Finance

My Lords, it is extraordinarily difficult for me to be sandwiched between two great people from St Thomas's. My only activity relating to that great hospital opposite is that, for 10 years, I was a director at a construction company who built the new children's wing. Also, St Thomas's—or Guy's and St Thomas's—were appointed by the Government as lead commissioner to evaluate international hospitals that might be suitable for treating British patients. I found that an extremely interesting scenario. Today, I want to try to evaluate what we mean by private sector. I start with the simplistic terms that we are all private people who are members of the general public who voted at an election and, in general, believe that there are certain essential services—we can call them public utilities—which should be provided by the state in the most appropriate manner. The greatest of those by far is health. I stand fair and square behind the principle that healthcare in this country should be free at the point of delivery. The question is: who pays for the infrastructure, who pays for the services and who pays for the support? Have the Government effectively mortgaged their souls and bodies for the future? The word mortgage means death grasp or death wish. I am concerned about that as an ex-banker because I never support any word that begins with ““p””, or ““PFI””. To respond to some of the questions raised by the noble Lord, Lord Rea, the PFI structure was set up with the best of intentions. Before, there was very little public expenditure on new buildings. Frankly, I preferred the original Ministry of Public Building and Works; I have always preferred public procurement for public buildings. Today, however, we have £2.5 billion of expenditure under the first PFI stage, and expenditure under the next two PFI stages will come to about£12 billion. That is an enormous amount of money. The structures that were set up for this were set up in good faith because they estimated that there would be an adequate cash flow into these hospitals to meet the costs and to provide a margin for development and maintenance. Unfortunately, however, there is a shortage in that cash flow because there is a shortage of patients. There is a shortage of patients because there is a shortage of finance to finance the operations of the patients. An extremely serious situation is developing. Added to that is an amazing factor; we do not need as many hospital beds as we thought we did. I have spoken in your Lordships’ House about the strange comparison with international figures. We have a million people working in a health service with 200,000 beds, the French have 500,000 people in a health service with 400,000 beds, and the Germans have 650,000 people in a health service with 500,000 beds. Do we have too many people? If we do, do we have too few facilities? The Government’s 2005 plans to reduce waiting times were that every patient should have four tofive choices of hospital for operations. They also declared that, by 2008, the waiting time would be only 19 weeks and that everyone would have freedom of choice. That meant freedom of choice everywhere. Will the Minister say whether that means that, under EU regulations, it is now possible for a patient who cannot get an operation in the United Kingdom to seek an operation in the EU and be funded by the United Kingdom? There is another worry. We had a great health service, and we have great people, but this division between the private and public sectors is strange. Every consultant whom I know, and I know a fair number, works both privately and publicly. He works in National Health Service hospitals or in private hospitals, but he spends a large amount of his time dealing with bureaucracy or on teaching and training, and the waiting lists seem to be getting longer. I made a few inquiries, and found that it is true that the waiting time to see a GP is now probably two weeks instead of four. The moment you see a GP and ask for a referral to a consultant, you are given the option to choose four hospitals, two of which may be near to you and two that may be specialist, but by the time you get through on the telephone, you find that there is no hope of ending up with an appointment. It generally takes between 45 and 47 days to get an appointment but, having got that appointment, you may need a scan or other equipment which leads to a longer delay before you get on to the official waiting list. According to the last waiting list figures given to me by the Government—the best way in which to get figures from the Government is to go to the House of Lords Library; it is much quicker—the waiting time for a knee operation is 39 weeks once you are on the waiting list, and 20 or 25 weeks for other things. I believe that these are the longest waiting lists in the world. At the other end of the scale, the hospitals do not have enough patients. They are also restricted from taking international patients. I am not suggesting that international patients should replace British ones, but if sufficient funds are not being made available to the primary care trusts so that they cannot pay for their patients to be treated in the United Kingdom, we should be looking for extra business. If we have mortgaged ourselves and our bodies for the future, we should at least be looking for the revenues that can make our hospitals economic and viable. We should also recognise the sudden change in the state of our health. We are healthier and healthier all the time. For the older age group, repairs are often more the key. The move seems to be more towards treatment like the maintenance of an old car. You go in and out of a workshop within a very short period. Likewise, you would not go into a full hospital but into what some people are now calling a patients’ hotel, in which the costs would be like that of a two to three-star hotel—about £70 a night at most, or perhaps £50—because it does not need carpets or curtains. It has oxygen cylinders, and it is linked to what could be called a maintenance factory. These changes are taking place. I have spoken to friends in the health service who have indicated that possibly we have too many of the wrong sorts of beds. What do we do about it? Certainly, we must look at the new techniques available in the world. The United Kingdom is fairly far advanced in activities that not only save lives but may also save problems. For example, the British urological society has found, in conjunction with the Egyptians and based on ancient mummy technology, the ability to create a bladder from your gut. Doctors and surgeons are being trained so that people will not need the ““bag”” anymore. There is remote treatment for colon cancer, whereby a blown up picture of all the pixels in your body is hung on the wall and, instead of cutting out good tissue, just bad tissue is picked out. I gather that the machines and equipment are available in the United Kingdom, but that people are unable to use them. Not far from Hammersmith and Fulham, where I sometimes am in London, is the Chelsea and Westminster Hospital, which is good, and Queen Charlotte’s Hospital. There are problems with Charing Cross Hospital, which is an elderly building and probably needs £100 million spent on it to refurbish it. In the London area, the Ravenscourt Park Hospital, which was the ancient Royal Masonic Hospital, is one of the best hospitals for hips and knees. It has some 200 beds, but only 40 are occupied because it has a shortage of patients. I cannot work out why, when we spend all this money on hospitals and new systems, we do not have the cash flow to permit those hospitals to achieve the objectives that were laid down for them—perhaps many of them were too optimistic. Without that cash flow, we will have a crisis and without the ability to fund the patients who need treatment, we will have a major problem for patients themselves. This problem will not go away. However, if the private and public sectors were to sit together, they could possibly get rid of the PFI concept that I do not like and arrive at something which we might declare to be a really true partnership.