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Independent Sector Treatment Centres

I am not sure whether Angus Wallace, professor of orthopaedic surgery at Nottingham university medical school, gave evidence to the Committee, but he has said that"““the number of patients we are seeing with problems resulting from poor surgery—incorrectly inserted prostheses, technical errors and infected joint replacements—is too great.””" He also said that many overseas surgeons"““have been asked to carry out joint replacement operations that they have never seen or done before.””" Many of the centres have contracts to buy just one type of artificial joint, but sometimes it is one that the surgeon has no experience of using. Professor Wallace continued:"““It is quite clear that this has occurred with inadequate training of both the surgeons and the operating theatre staff and as a consequence there have been several serious errors—joint replacements put in without bone cement when bone cement was essential for that joint replacement, the use of the incorrect size heads…for a hip joint replacements, etc.””" Professor Wallace is not in the business of systematically analysing all the cases that have been done in ISTCs. He cannot do that, because he does not have the resources—nor does the British Orthopaedic Association—but he is reporting what he is finding on the ground. I am no orthopaedic surgeon, but I have hung off the end of a retractor in an orthopaedic operating theatre, as the hon. Member for Dartford will have done, and even with our rudimentary knowledge of orthopaedics—I speak for myself,not the hon. Gentleman—we know that that is disastrous. There are many sorts of hip replacement. They are not all the same, and fitting a Charnley or an Exeter requires surgeons to have done a course for them and the team to be familiar with the kit. Professor Wallace’s comments have the feeling of truth to me, and I entirely accept them—[Interruption.] The right hon. Gentleman says from a sedentary position that there is no evidence. The evidence is what I want the Department of Health to acquire. That is what it should have done, then the Minister could have provided the evidence and said whether it refuted any allegations that there are problems with ISTCs. We cannot ignore such remarks from the front line, and if we do, we do so at our great peril and with complacency, which is not what our constituents expect—mine certainly do not expect that of me. Although the Liberal Democrats’ absence has freed up a bit of time for us, the hour is late and I am sure we all want to get away in good time. My hon. Friend the Member for Southend, West (Mr. Amess) made an important point about language proficiency. The international English language testing system does not apply to European economic area doctors, but does to those from outside the EEA. The Committee rightly pointed out that that is inconsistent. It is not acceptable for Ministers to say that it is up to the employing trust to ensure that people are proficient in the English language. The issue is safety-critical, and if we do not require proficiency to be demonstrated by Polish surgeons, but require that from surgeons from India or Pakistan, who in my experience have excellent English of course, what on earth is the point of having the test at all? Last month, the Prime Minister delivered what we assume will be his last major speech on health care to the King’s Fund. The fund’s chief executive pointed out that the success of the reforms will be measured by their sustainability. The Prime Minister did not disagree, and I should be interested to know whether the Minister agrees or disagrees with that assertion. For example, how sustainable does he believe independent sector treatment centres will be, particularly phase 2? The Committee heard that of the 31 schemes proposed under phase 2, seven will not go ahead. I should be interested to know from the Minister why that is, and why the strategic health authorities that are responsible for the seven schemes will, nevertheless, be obliged to make independent provision by other means? We seem to be going back to Sir Nigel Crisp’s assertion at the beginning of last year that 10 per cent. of deliverables should be forthcoming from the independent sector. As I have made clear, I have no problem with involving any provider if it is beneficial to NHS patients, but it is strange that we should insist on private provision, and particularly a certain proportion of service delivery being provided from the independent sector. Why have primary care trusts been bullied into accepting independent sector treatment centres when the Department of Health makes so much about local decision making. The Committee heard about Mrs. Jane Hanna’s remarks. She was the non-executive director of South West Oxfordshire primary care trust and talked of policy"““imposed through private, informal methods which included threats and bullying.””" That seems odd, and to fly in the face of local decision making and accountability. The Government’s response does not rule out take or pay, and I should be grateful if the Minister would say what he would rule in and what is to replace take or pay, or how take or pay might be modified in phase 2 to make it more acceptable. One thing is for sure—take or pay has resulted in a huge waste under phase 1. Page 13 of the Government’s response says:"““we do not expect to pay the same premium as in wave 1.””" I should be grateful if the Minister would say how much of a premium he expects to pay in phase 2. We need to know the status of phase 2 ISTCs. Had the Liberal Democrats been here, they would have pointed out that the hon. Member for Yeovil (Mr. Laws) asked about ISTCs on 24 April. It was a good question, which resulted in the Minister placing in the Library a list of ISTCs on which decisions are outstanding. I have a copy of the list in front of me, but it needs updating, because the Nuffield group’s project for the west midlands has apparently been cancelled. The Nuffield group has pulled out, citing costs and delays, although we understand today that the BUPA contract for the north-west has been signed off. I should be grateful if the Minister could say why there appears to be such a delay in signing off the various contracts in the document that he placed in the Library. Has there been or is there likely to be a last-minute rush to sign contracts, given today’s momentous events? I am not talking about the Bank of England raising interest rates. How far is the Treasury driving the situation, and can the delay be attributed to the Chancellor’s attitude to the NHS or desire to placate the service? Finally, I should like to know the cost of cancelling any projects listed in the document that the Minister placed in the Library on 24 April. Has he, or have any of his officials, been asked to prepare an account of them? I hope that he will be able to answer that question. He can be assured that if he does not answer it directly, I shall press him further.