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Independent Sector Treatment Centres

I congratulate my colleagues on producing yet another splendid report. However, I do not congratulate the Government on their response, which was late and less than robust in dealing with the 25 recommendations. The Minister was a splendid member of the Health Committee. He made a unique contribution to our report on obesity, so he knows only too well how important our work is and how worth while it is for the Government to read our report carefully and respond to it positively. To follow on from the Committee Chairman, the right hon. Member for Rother Valley (Mr. Barron), I should say that we heard some robust evidence. However, I can certainly recall one or two occasions when the evidence was less than robust and extremely disappointing. I completely absolve from that Mr. Bernard Ribeiro, the president of the Royal College of Surgeons, to whom the Committee Chairman has referred. When I was Member of Parliament for Basildon, Mr. Ribeiro led the local teaching faculty. His evidence was impressive. I shall not name the disappointing performers, but I say gently to the Minister that when people give evidence to the Health Committee, they should take that seriously and be properly prepared. To shrug their shoulders as if it is not their responsibility, when it jolly well is, is very disappointing. As we all know, the ISTCs were opened in 2003 under an agreement between the NHS and the private sector to carry out specific procedures to help with the NHS waiting list and mitigate the lack of capacity. I shall not make an intellectual contribution; I shall leave that to others. However, this occasion is useful because it gives the House an opportunity to have an intellectual debate about how the private and public sectors work together in practice. My hon. Friend the Member for Westbury (Dr. Murrison) has mentioned the absence of the third party, but the two main parties have a real interest in considering the twists and turns of the issue. I should not forget the hon. Member for Wyre Forest (Dr. Taylor), an independent Member of Parliament. When measuring the success of the ISTCs, it is important that we remember the objectives of involving the private sector in the health service, about which the Government now seem enthusiastic. One objective is to increase the elective capacity available to the NHS to reduce waiting lists and times. The Opposition have a real interest in how that happens in practice. Other objectives include reducing spot purchase prices in the private sector, increasing patient choice within the NHS—how that works out in practice has yet to be proved—and encouraging best practice and innovation. However, it is also important that we focus on the impact that ISTCs will have on local hospitals and the NHS in general. One or two of the Members in the Chamber who are not on the Health Committee will hope to catch your eye and reflect on how the issues work out in practice, Dr. McCrea. I have recently received representations from the hospital in my constituency about the commissioning of an ISTC in Essex; the contracts are expected to be finalised at any time. I say to the Minister that I genuinely welcome the involvement of the private sector in the health service, and I was encouraged by our Committee’s finding that the ISTCs have gone some way to meeting their objectives. However, although I agree with the principle of involving to some measure the private sector in the health service, I object to the centrist slant put on the implementation by the Government. I intend to list the concerns that have been raised about ISTCs and the fact that the Government’s response to the Health Committee document does not adequately address the matters at stake. I say again that there is no point in the Health Committee spending great time producing reports if the Government seem not to take the findings too seriously or are less than robust in their response. I am delighted that we have been given the opportunity to have a debate, and I welcome that. However, I hope that the debate will be ongoing and that the Government will take our recommendations a little more seriously. First, let me deal with waiting lists and times. Since the introduction of ISTCs, waiting lists have dropped. There is no doubt about that, so I congratulate the Government. However, it is disappointing that we are unsure about how far waiting lists have dropped. It is extraordinary, too. The NHS has changed in response to the ISTCs, or because of additional NHS funding, and the intense focus on waiting list targets over that period has had an adverse effect on clinical priorities. The Health Committee was surprised that no attempt was made to assess the effect that competition from ISTCs would have on the NHS. It is extraordinary that no such attempt was made. The absence of conclusive information has prevented the Health Committee from making observations in a number of areas. Did that merely happen, or have our objectives been obstructed in some way? I do not know, but that is certainly one of the main criticisms that I want to level at the Department. Secondly, let me deal with the aim to reduce spot purchase prices. I welcome the Health Committee’s conclusion that ISTCs have successfully reduced the purchase price as intended. We certainly welcome that. I was pleased to learn that as well as reducing the spot purchase prices in the private sector, ISTCs have a more general impact on charges in the private sector. That is excellent. The Health Committee was told by Robin Smith, chief executive of Mendip primary care trust, that fees for some operations had fallen by as much as 50 per cent. as a result of the ISTCs. That is splendid. The Committee also heard that the NHS is no longer as reliant on spot purchasing as it once was, and that is excellent news.