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Independent Sector Treatment Centres

I have not asked Capio that question, and it has not volunteered the answer, but my right hon. Friend makes an important point. I remember, 12 or 14 years ago, when I was a member of the Select Committee on Health, picking up in the United States a publication called the Washington health Checkbook—which is a pun in American, because they do not know how to spell the type of cheque that one writes to one’s bank. It compared performance, hospital by hospital and consultant by consultant, of hospitals in Washington DC, northern Virginia and Maryland. It included interesting information about post-operative infection rates and re-admissions—or perhaps it was mortality—30 and 90 days after discharge. It also included information about which consultants and hospitals were chosen by health professionals seeking treatment. That may be an important indicator of informed opinion about the quality of the care likely to be received from a hospital or consultant. I should welcome publication of such information in the UK. The Capio centre in York has attracted mixed reactions locally. One constituent came to my surgery to complain that he was offered treatment there—at a private centre rather than an NHS trust. Concern has been expressed to me by the local medical committee and by consultants at York hospital that the centre is failing to treat as many patients as it is contracted to treat. The point was reinforced by a letter that a constituent who is a retired nurse sent to me recently. She said:"““I have recently been fortunate enough to have a hip replacement operation at the new NHS Treatment Centre at Clifton Park where I received excellent care.””" Later in the letter, however, she says:"““I was an in-patient for four days and was one of only three patients being treated, leaving 22 empty beds””." Such concerns prompted me to table some written questions to the Department of Health. To establish the context, perhaps I should say that North Yorkshire and York primary care trust has one of the worst, if not the worst, deficit of any PCT in the country, at about £30 million. The York Hospitals NHS Foundation Trust has been commissioned in the current year, 2007-08, to treat fewer patients than it did in 2006-07, as part of the PCT’s effort to reduce the deficit. As a consequence of that reduced level of commissioning, the hospital is reducing staff by not filling vacant posts, and it is closing beds. Some of those beds are being closed because of a substantial increase in the capacity of the day surgery unit at York hospital, but I suspect that some are also being closed because 25 additional beds have been provided for elective surgery at the Clifton Capio centre. The question that comes to my mind is whether the provision of the Capio centre is a good use of resources by the local PCT. That is what prompted my questions. I tabled three questions on 11 January, and they were answered a couple of weeks later on 25 January. I asked, first,"““how many procedures for NHS patients will be (a) paid for and (b) provided by the York Capio Centre in 2006-07””." Secondly, I asked"““what the (a) national reference cost, (b) average cost per case at the York Capio Centre and (c) average cost per case at York NHS Trust was for each procedure provided for NHS patients at the York Capio Centre in the most recent year for which figures are available””" and, thirdly,"““what the total NHS expenditure on the York Capio Centre will be in 2006-07.””" I quote part of Minister of State’s answer, the rest of which describes the nature of the centre. He said:"““It is not possible to provide the data in the format requested. Reference costs data are collected from NHS trusts and primary care trusts. Reference cost data will cover procedures that are carried out by the trust and those that are contracted out, which will include to an independent sector treatment centre. However, information on the payments for services and operational costs of Capio UK is commercially sensitive.””—[Official Report, 25 January 2007; Vol. 455, c. 2052-3W.]" If the Government have entered into contracts with those independent treatment centres on a basis that, for commercial reasons, will not allow information to be made available about the treatment of NHS patients in privately-run NHS units, but allows information about NHS hospitals to be made available to Members of Parliament and the public, there is a serious problem with the accountability of the national health service to Parliament and the public. I thought about that for some time and on 2 March I wrote to Sir John Bourn, the Comptroller and Auditor General, to explain that I was dissatisfied with the Department’s failure to answer my questions about NHS treatment paid for with NHS cash for NHS patients in my constituency. Among other things I said:"““One of my responsibilities as a Member of Parliament is to scrutinise the Executive to find out whether its services provide good value for taxpayers’ money. It severely undermines my ability to do so when a Minister declines to provide information about the volume of NHS activity and costs of providing this at an NHS treatment centre in my constituency.””" I went to see my hon. Friend the Minister, to express my concern. He thought about the issue and said that he would re-examine it, and encouraged me to put down a pursuant question, which I did on 12 March. I heard nothing for a little while, and on 17 April Sir John Bourn wrote a holding reply. He said:"““We are investigating this matter with the Department of Health and the North Yorkshire PCT and will write to you with a substantive reply as soon as possible.””" A few days later I received an answer from the Minister, who said:"““The Clifton National Health Service Treatment Centre is expected to deliver approximately 10,000 procedures over the five year contract period. At the end of January 1,817 procedures had been delivered for NHS patients.””—[Official Report, 24 April 2007; Vol. 459, c. 1055W.]" I still did not have enough information to make an informed judgment about whether the Capio centre carries out as many treatments as it was commissioned to carry out and is being paid to carry out by the local PCT—which is, of course, in deficit. Nor did the reply allow me to make any assessment of whether the cost of providing those treatments in the independent treatment centre is more or less, per case, than the cost of treating patients in the local NHS hospital. When a local primary care trust is deeply in deficit and cutting services to patients because of a shortage of money, it matters enormously to me, as the Member of Parliament, and to people locally, to know that their money is being well spent. That is why comparative information is so important. I tabled further questions to my hon. Friend quite recently to ask for that comparative information. He has not yet replied, and I hope that before he does so he will feed in his reflections on the debate and be able to provide me and Parliament with the information that we need to make comparisons. I congratulate the Select Committee on the report that it has produced. It examined wide policy issues and raised important questions, and I wish briefly to reflect on how some of its points affect the situation in York. The Committee raised the issue of capacity, stating that it is not clear whether the independent treatment centres have actually increased capacity. What has happened in York adds doubt and underlines the importance of drilling down to find out whether we are increasing capacity by encouraging the private sector to build new units. Yes, we have 25 additional beds for elective surgery at the independent treatment centre, but we are losing beds at York hospital. I do not know whether we are increasing capacity overall, but we do know that the most important determinant of capacity for elective surgery in York is the financial standing of the North Yorkshire and York PCT. Providing extra beds does not increase the amount of money available to pay for treatment. I hope that the Select Committee will consider the issue further. The Committee makes the point that we do not really know anything about clinical quality in the independent treatment centres compared with that in NHS hospitals. I do not wish to prejudge the issue; the information that I have had about the quality of care at the Capio centre in York is extremely good, but I should like an evidence-based, rather than anecdotal, assessment of the relative quality of care. Finally, the Government response to the Committee points out that the utilisation rates of independent units is high, at 84 per cent. That suggests that my constituent’s experience that 21 out of 24 beds were vacant is very much the exception rather than the rule, and I am pleased to hear that. I am not sure whether 84 per cent. is a high utilisation rate compared with the use of beds in NHS hospitals in the areas in which the private treatment units are competing, but again I hope that the Select Committee will examine that. I have detained the House far too long. I am grateful for its indulgence—I have an independent unit in my constituency and it has posed important questions. I see the Capio centre as part of the solution to provide more treatment to more patients more quickly in York, but plenty of questions need to be answered. They are primarily about the quality of care; the relative cost-effectiveness of the independent centre and the service provided by the same doctors at the York Hospitals NHS Foundation Trust, and whether the creation of the independent centre has increased capacity and therefore the number of patients being treated in York.