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Independent Sector Treatment Centres

The hon. Gentleman has helpfully fired a missile right at the point that I was trying to make. The Minister will have heard the point, and I hope that he will address it when he responds. The hon. Gentleman should be reassured that during our inquiry those points were made in public, and it is right that the Minister should deal with the fairness of the ““competition element””. Assessing the extent to which ISTCs have facilitated patient choice, a central objective of the programme, is not straightforward. ISTCs enable some patients to received treatment earlier than they might through the NHS, and they are also given a choice of location at which to be treated. The Committee reported:"““ISTCs have for the present increased choice, offering more locations and earlier treatments.””" However, those choices are limited. For example, if the existence of ISTCs in the long run leads to the closure of NHS facilities, as we heard, patients will once again have limited choice. More worrying is that patients cannot make informed choices on where they receive treatment. We were given evidence to that effect in one sitting. There is a gulf in the information that relates to the clinical quality of treatments in ISTCs. The lack of centrally held information, such as that on complication rates and other measures of clinical quality, seems to have prevented patients and the Health Committee from drawing conclusions about the standard of care offered by ISTCs. We pressed the witnesses on that point, and we got nowhere. I was pleased to learn that the Department of Health recognises the need for information on clinical quality to be available to patients, and that it is looking at ways in which it can meet that challenge. I look forward to seeing how far the Department manages to meet its objective to publish"““robust measures of clinical quality in the July publication Health Reform in England—Update and Commissioning Framework””" when that document is published. I am also keen to learn of the progress of the information taskforce, which was set up with the aim of developing and overseeing a work programme to identify indicators of clinical outcome relevant to patient choice. I am not looking for a conspiracy, but that is all likely to happen when we adjourn for the summer recess and we will not be able to hold the Executive to account until the autumn. However, I want to flag up to the Minister that we are aware of those dates, which are important in the context of the report. Central to the aims of the programme is that ISTCs encourage best practice and innovation. The Health Committee found that:"““ISTCs have embodied good practice and introduced innovative techniques””," although it also reflected:"““ISTCs are not necessarily more efficient than NHS Treatment Centres””." Furthermore, it reported:"““The Department claims that ISTCs drive the adoption of good practice and innovation in the NHS, but we received no convincing evidence which proved that NHS facilities were adopting in any systematic way techniques pioneered in ISTCs.””" We received no evidence at all about that. I appreciate the Government’s response that ISTCs are in their early stages and cannot be expected to be more efficient than NHS treatment centres. The Committee accepts that. I agree with the Department of Health that ISTCs offer an excellent opportunity to draw together best practice from a wide variety of sources, in particular when the NHS and ISTCs are more integrated. On the subject of best practice, I was particularly alarmed by the questions that were raised about the quality of staff employed in ISTCs. It has been argued that ISTCs are too reliant on overseas staff, and we heard evidence about that. As a result of the European legislation, the regulation of foreign-trained European economic area clinicians, who make up the majority of doctors in ISTCs, is not as rigorous as it should be. The evidence showed the problems that patients encounter with foreign doctors, which include language barriers since language tests cannot be imposed on doctors from the EEA. It is fundamental, in a situation that can be frightening and stressful for many, that patients can communicate effectively with the staff who will care for them. The Health Committee recommended that ISTC clinical appointments for overseas doctors should incorporate a standardised, independent assessment system based on competency. What thought has the Minister given to that critical recommendation? It does not seem to have been properly addressed in the Government’s response. Finally, I want to mention my local hospital in Southend. One of the most important aspects of the ISTC programme is its impact on the NHS. Again, it is most frustrating that no attempt has been made systematically to assess and quantify the possible effects. John Gilham, chief executive of Southend university hospital—he is an old boy of the school that I attended, St. Bonaventure’s grammar school, and so the House will understand that I hold him in high esteem—has brought some concerns to my attention about value for money. Mr. Gilham is concerned that as the ISTCs increase their overall capacity in Essex, possibly above initial assumptions, and if other trusts actively compete along with Southend hospital for service choice, there is a greater probability that ISTC capacity will be underutilised. He has pointed out that underutilisation of capacity in the ISTCs will be underwritten—I think that that may have been the concern of the hon. Member for Pendle (Mr. Prentice). That would result in underwritten payments being made to the ISTC for no activity, with a financial cost throughout the country. On the other hand, if the ISTC was successful in attracting activity, Southend and other acute trusts in Essex would need to reduce capacity further, with a consequent loss of income. That would increase the proportionate costs of existing overheads, which does not seem particularly fair. In some cases, hospitals will be limited in their ability to reduce overheads, which would in turn limit the opportunities for investment in improving core local health care facilities. Southend university hospital does a splendid job, and it too is concerned about which specialities the ISTC would take responsibility for. The hospital could be required to provide more by way of emergency services than by way of a balanced mix of elective and emergency services, and that could have adverse affects on hospital funding. Local residents would be concerned about that. I understand that, in worst-case scenarios, local hospitals could even be forced to close. In February, Southend university hospital estimated that the financial impact of an Essex ISTC would be something in the region of £7 million, which is a huge figure. The ISTC programme has repercussions for a number of local hospitals, and I have outlined pressing financial concerns regarding the costs of the programme for local hospitals and for the nation as a whole. Lack of information has marred the success of the ISTC programme, particularly with regard to patient choice. I was disappointed that the Department of Health seems to have hindered the Health Committee's inquiries by misrepresenting situations, withholding information and producing confusing figures. The Health Committee is non-partisan, but it is perhaps slightly easier for me to be robust on that point. I am particularly concerned that the Department is withholding information regarding the significant effects that ISTCs could have on the finances of NHS hospitals. Why is the Department concealing such information, when hospital closures could result? Although I am confident that there is a bright future for private sector involvement in health care, I am currently frustrated that we cannot see the tangible benefits of the programme.