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NHS: Finance

My Lords, I am grateful to my noble friend Lord Rea for introducing the debate today. It comes at a very opportunetime, following a week in which there havebeen demonstrations—including a march on Parliament—by a workforce that is notably non-militant. It is clear that staff in the NHS are deeply concerned about redundancies and future job prospects. They also attribute many of the problems they face to the piecemeal privatisation, as they see it, of the NHS. They believe that the redundancies are being caused because of the requirement that health trusts have immediately to clear deficits which have accumulated over a long period. For this they blame government policy with its commitment to creeping privatisation. They point to the impact of the private finance initiative. As well as guaranteed income streams and excessive annual returns, PFI consortia are allowed to keep 70 per cent of windfall gains made from refinancing debt and 100 per cent from trading their PFI gains on the secondary market. It is alleged that, across all sectors, PFI companies will make £148 billion over the next 25years. It is surely unacceptable that private industry should be making these profits at a time when NHS staff are facing redundancies because of trust deficits. Then there are the independent sector treatment centres, to which my noble friend has already referred. These are stand alone private sector clinics specialising in a limited range of simple treatments. They are contracted to carry out procedures at a fixed price, which is paid whether or not the operations are actually carried out. They were supposed to provide extra capacity but they are in fact in competition with the NHS in many areas. I am informed that, on an average, they cost 11 per cent more than the NHS for each of their procedures. Attempts are also apparently being made to outsource to the private sector the commissioning function of the primary care trusts. Private companies would thus gain control over which treatments patients receive and who provides them. The Government apparently now wish to introduce the private sector into running GP practices. The Department of Health has taken control of the procurement of GP services in a number of areas. In these circumstances, it is not surprising that staff feel that their problems and difficulties are attributable to the privatisation which the Government have undertaken. The union Unison says that it has never been opposed to reform but believes that what is happening is not in the long-term interests of the NHS or its patients. Staff who have recently undertaken training are now unable to find jobs. As has already been indicated, there have been redundancies and further redundancies are expected. As a Londoner who is also an NHS patient, I find this absolutely astonishing. The hospital where I am a regular patient always seems to me to be absolutely inundated with work. The staff are very good, but look overstretched to me. Yet I understand that there are to be redundancies. During a recent interview, the Health Secretary said that innovations and improved technology meant that it would not be necessary for people to spend so long in hospital, so fewer beds would be needed. We have heard some reference to that this afternoon. In any event, it is said that people prefer to be cared for at home, rather than in hospital. That is fine, as long as support services are available. However, I fear that very vulnerable people, particularly the elderly, will suffer as a result of such a policy. The appropriate services are simply not there. I recall only too well my own recent experience. I had a rather difficult operation on my knee which had not gone too well—indeed, it is still not very good, but that is another story. I had been told by the consultant that I would need to spend at least a week in hospital after the operation. To my surprise, the ward manager came to see me a couple of days after the operation and told me that I was going out the next day. I complained that I was in some pain, I could not walk and I lived alone. How was I going to manage, I asked? ““Oh””, she said, ““haven’t you any relatives?””. ““None that lives near””, I said. She eventually said that I could have another day so that I could get in touch with my sister who lived in Wiltshire. My sister and brother-in-law came up from Wiltshire to London to collect me, take me back to Wiltshire and there arranged for me to have follow-on therapy at Melksham Community Hospital. The hospital in London simply did not have room for me; it needed the bed. I was able to make alternative arrangements, but we have an increasing population of ageing people, many of them women living on their own. Families cannot always help. Support services are very poor in most areas. The notion that they can simply be discharged from hospital very soon after surgery into care services is likely to leave many old people in some difficulty and distress. Or else it means imposing more burdens on families, and carers already save the NHS a great deal of money. I believe that the concerns of staff in the NHS should be given greater credence. The vision of an NHS largely provided by an assorted set of private care companies does not give a great deal of confidence. Much money has indeed been spent by the Government on the NHS, and for that the Government are obviously to be commended. But while I—and, I am sure, most people—would be happy to see this money spent on ensuring that the staff are better paid, we are less happy about it forming the basis for huge profits for PFI companies and the private sector. Again, I thank my noble friend Lord Rea for giving me the opportunity to speak this afternoon on what I think is a growing problem.