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Independent Sector Treatment Centres

I stand by what we said in the report, and would therefore concur with my hon. Friend. Later, I will briefly mention the Government’s response, which touched on the Healthcare Commission. One of the most contentious parts of the ISTC programme was the use of take or pay contracts. They meant that the NHS had to pay independent providers for a set volume of work, whether or not it was carried out. The Government defended those contracts by saying that they were necessary to encourage the private sector to participate in the programme, although they also caused considerable disquiet among NHS providers. On the day we went down to the constituency of my hon. Friend the Member for Dartford, we visited a day treatment centre. It was early afternoon when we arrived and the centre was very quiet, running at about 50 per cent. of its capacity. Many reasons were given—most of them anecdotal—for why that centre and others were not as active as they should be. One reason was that the referral patterns were not as active as they should be, because some people did not want to refer. I came across anecdotal evidence for that when I visited the ISTC in my area, in north Derbyshire, a couple of miles from my constituency. The guy who was the NHS-ISTC link there told me that the biggest problem was getting health professionals with contracts with the NHS to refer people there. I met two constituents when I was there, completely unplanned, and asked them, ““How did you know?”” ““Word of mouth from people who’ve been in as patients,”” they said. ““So it wasn’t your doctor, then?”” I asked. ““No, it wasn’t,”” they replied, although they were quite happy with the treatment that they were receiving. That was a big issue for the Committee, although I do not know how big an issue it is today. We concluded that although the decision to create the ISTC programme had not necessarily been a bad one and had brought several benefits, it had not been supported by evidence and was—to quote the phrase used in the report—a leap in the dark. I have heard that phrase on many occasions in the media since, but I have to tell my hon. Friend the Minister that that was the case. We often smile about the decision making—or the lack of it—in the NHS without good evidence, but it was clear that the original decision was driven by other things, not by any evidence at the time. The Government response, which was published in October 2006, accepted some of the Committee’s criticisms and said that there would be a series of improvements. One of those, which my hon. Friend the Member for Pendle (Mr. Prentice) has mentioned, was that the Healthcare Commission was asked to carry out a detailed comparison of the standards of care in ISTCs and those in the NHS. However, it is now many months down the road and we are still not there yet. That is disappointing. However, sooner than rush, and jump to conclusions, which people have been doing for a number of years—albeit anecdotal, rather than real conclusions—I hope that when that piece of work comes out, we will be able to go into what has been happening in detail and see what the real comparisons are. Phase 2 of the ISTC programme would make provision for the training of doctors and other clinical staff a contractual requirement, which, in a sense, was a weakness. We could have had the additionality rule, whereby phase 1s were able to set up, but without poaching people from the NHS. It was right to ensure that phase 1s did not do that, because it would have weakened the NHS. On the other hand, there was a question whether we could have had surgeons in there, training. The volume of elective surgery done in ISTCs, undisturbed by anything else in the establishment—there are no A and E departments to disturb the elective surgery list—creates the ideal opportunity to obtain experience. My hon. Friend the Member for Dartford described it as an ideal time for young surgeons to practise on people. I would not have put it quite like that, but training with such a volume of surgery, on lists that are not complicated, would be much more predictable than training in a district general hospital as an A and E tag-on, which might also disturb the list of the day. I hope that my hon. Friend the Minister will talk about phases 2s and whether that training is now taking place. New ISTCs would also be better integrated with the local NHS, by requiring integration to be part of the planning process and allowing NHS staff to work in ISTCs during their non-contracted hours. Again, we felt that that would be a step towards breaking down the barrier that had been set up by the additionality rule, under which a person could not work in the NHS and also cross over to work in an ISTC. Does my hon. Friend the Minister have any experience of that to share with us? The Government committed to spending £550 million a year on the ISTC programme. We were uncomfortable with that pledge because without doing the real work, one could not say whether that was driven by clinical need. As we said in the report:"““The decision to maintain the commitment to spend £550 million per year despite changing circumstances has not been explained, and seems to sit uncomfortably with the Secretary of State’s admission that ‘in other [areas] it has become clear that the level of capacity required by the local NHS does not justify new ISTC schemes’.””" At the time of the inquiry, for the first time that I had known, all the national health service institutions in my own area of south Yorkshire were united in their opposition to phase 2 in the area, so it did not go ahead. However, the Secretary of State told us that the money would still be spent. It was extraordinary for the Government to say that although they would not be going ahead with certain parts of phase 2, they would still spend the same amount of money that they were going to spend anyway. I do not know whether that has changed in the many months that separate us from the evidence that we took at that time. I am looking forward to hearing my hon. Friend the Minister explain the Government’s current plans and whether the commitment to £550 million still stands even though a substantial number of phase 2s have not taken place. Obviously, the collection of data must also be significantly improved. I hope that the Healthcare Commission’s report will show how well things are going, although I am not sure when we will get it. My hon. Friend the Member for Pendle said that we would get it in—