§ Mr. Michael Brown (Brigg and Scunthorpe)I am grateful for the opportunity to raise the subject of the greater involvement of private enterprise in the National Health Service, especially in hospitals. On my last Adjournment debate about the complex Boothferry bridge proposals, I had to detain the House for nearly an hour. I am pleased to say that I have a simple argument to advance this evening, one that I am sure will find favour with my hon. Friend the Under-Secretary of State for Health and Social Security.
I am grateful to my hon. Friend for being prepared to respond to the subject at such short notice. I know that it is dear to his heart, as it is to his colleagues at the Department of Health and Social Security. They have tried to tell the health authorities that it is possible for them to involve private enterprise in the provision of many ancillary services. I am glad that the Government have decided to issue general directives and general encouragement in support of my contention that this proposal will ensure that hospital ancillary services are provided much more efficiently than at present.
I am aware, as are all hon. Members and the general public, that there is a great shortage of funds available to the National Health Service. No one wishes to see the NHS starved of funds. Every hon. Member must try to ensure that the NHS can provide the sort of medical care, aftercare and trained doctors that are needed. However, at present there is a shortage of money for every aspect of the services provided by the Government. We must recognise the situation, not as we would wish it, but as it is. The Health Service is in the same position as every other Government-provided service—it is short of money. That is the base from which I start.
I feel that we are not getting the value for money from the National Health Service system that we could get if we contracted out to private enterprise some of the cleansing and laundry services that are now done in house. We all remember the winter of discontent about three years ago, when NUPE stopped a number of hospitals from doing their normal work because its members refused to clean hospitals. It is terrible that that monopoly union and COHSE should be able to hold a hospital to ransom and compel it to close its doors to new patients, or impose demands upon nursing and medical staff that are unreasonable.
I know from the experience of the United States that there are companies in Britain that can provide a better standard of cleansing service at a lower price than the service that is now provided. What does that mean? I am not suggesting that the savings that could be achieved by using private enterprise should lead to the Health Service being deprived of the funds that are now made available to it. I am saying that the savings made could be released for other purposes.
We constantly read stories in the newspapers about local health authorities that have to close down wards and to close kidney units, for example, because of a shortage of money. A classic example was brought to our notice last week when the attention of the Prime Minister and of the House was drawn to the lack of funds for the bone marrow unit at Westminster hospital.
527 We should encourage local authorities to take to heart and implement the guidance of Ministers at the Department of Health and Social Security. I know that the Government are anxious that they should do so. If that is done, we can release funds from the cleansing services, which is work that private enterprise could probably do more efficiently at a cheaper price. The money that would be saved could be redirected, for example, to kidney units and to the Westminster bone marrow unit. I should like to know from Westminster hospital what steps it might take in the near future to involve private enterprise in the provision of some of its ancillary services.
At present there is a monopoly that is not giving value for money. It is run by two or three trade unions and it is powerful enough to cause hospitals to close. There is no moment when a hospital cannot be closed, but invariably closures are caused to take place in the winter when hospitals have more patients than at any other time. Recently a hospital in North Humberside was threatened with closure because a trade union that is involved in providing ancillary services decided that it would call a strike.
I am not suggesting that the involvement of private enterprise in the provision of ancillary services necessarily means that there will be no industrial disputes, but it means that in future a local health authority will be able to invite tenders from a number of cleansing firms which I know are experienced in the work that is involved. Firms in Britain that are performing this work are ready and waiting for local authorities to interpret the guidance that has been given by my right hon. and hon. Friends.
It is possible to involve the private sector to the long-term benefit of patients. There should not be a monopoly. A system that enables a number of firms to tender for a hospital contract gives the hospital the security of knowing that if the firm does not meet the contract it can be dismissed and another employed instead. No firm wants to lose a contract. It will be only too anxious to provide an efficient service, as it will want the contract renewed at the end of the period. There is a sanction that can be applied to answer that the firm provides a standard of care and cleansing. That does not apply to local authorities.
We have a unique opportunity. Next year we shall have the new DHAs running our hospitals. New chairmen have already been appointed, as have the members of the authorities. Some members have great experience of health authorities as they will have been members of the old authorities, but, whatever their experience, they will bring a breath of fresh air to the new authorities, which will enable them to reconsider how to run their hospitals.
With the new opportunity, and with guidance from the DHSS, the new DHAs have a chance of providing a new beginning for our NHS hospitals. It has nothing to do with private health care. The patient is still a NHS patient in a NHS hospital. I, like my right hon. and hon. Friends in the Department, an anxious to get better value for money. I do not have the figures, and I do not expect my hon. Friend to have them, as the debate has been called at short notice, but a massive amount of money in the NHS is not being used to pay and train doctors and nurses and for the units which we believe are essential, such as kidney and marrow transfer units. That is the sharp end of the service, where we should concentrate the money.
528 When there is an industrial dispute, it grieves me to know that nurses who are badly paid have to do duties which they should not have to do. If a private firm cannot deliver the goods, the health authority can dismiss it and re-employ another. I hope that my right hon. Friend will translate the statements that he and his colleagues have made into action when the new DHAs come into being next year.
Finally, I point out that the NHS is sitting on a great deal of land surplus to its requirements. If it could sell it, more money could go to the sharp end of the service to pay doctors and nurses what they justly deserve.
§ 9.4 pm
§ The Under-Secretary of State for Health and Social Security (Mr. Geofrey Finsberg)I am grateful to my hon. Friend the Member for Brigg and Scunthorpe (Mr. Brown) and indeed to my hon. Friend the Member for Uxbridge (Mr. Shersby). It seems that only Conservative Members are sufficiently interested in their constituents' problems to stay and take the opportunity available to raise these important matters. It is also pleasant to have the chance to answer a debate without warning, without preparation and without briefing. One has the opportunity to respond in a way that is perhaps unusual for a Minister and which I frankly welcome.
What my hon. Friend has said is basically correct. We wish to make the maximum amount of money available for the benefit of the patient. That is what hospitals are for—medical care.
It is common sense to look to private enterprise in matters of the kind to which my hon. Friend referred, such as catering and cleaning. There is the example of the substantial amount of money that private enterprise is saving ratepayers in Southend on refuse collection.
In the meetings that I have already had with the private sector on this, it has been made clear that private firms are not seeking any advantage. They are merely asking for the opportunity to quote on a fair basis. If the health authorities' costings for work currently carried out on an in-house basis include all the items that a private contractor must bear as overheads and are still cheaper, private contractors can have no objection to that. They are worried that in many cases they do not have the opportunity to quote and sometimes wonder whether all the overheads have been included to make a fair comparison. There should be little argument among people of common sense but that my hon. Friend's suggestion has much merit. I certainly assure him that the Department is well aware of the potential benefits available to the National Health Service in considering these matters for privatisation.
My hon. Friend was perfectly right in saying that much needs to be done, but one thing is too often overlooked, perhaps because, being good news, it is no news and whereas sensational stories hit the headlines, good news seldom does. Nevertheless, it is a fact which I shall continue to repeat that spending on the National Health Service is now 5 per cent. greater in real terms than it was when the Government came to power in 1979. I am sick and tired of hearing Opposition Members talk about cuts being made in the National Health Service. There are now more nurses, more doctors and more midwives in the Health Service than when we came to office. I hope that 529 there will now be an end to the scare stories put around by the Opposition that we are cutting the National Health Service.
My hon. Friend is right to point out that the National Health Service has a substantial amount of unused and underused land. We have asked area health authorities and regional health authorities to examine their land holdings to see what can be done to release any land not required for National Health Service purposes. We do not want them to sit on land like broody hens. That does no good. Moreover, it is worth recalling that if land is sold the capital receipt does not go back to the Treasury but is available as extra capital expenditure for the National Health Service. That, again, is often overlooked by the Opposition and is perhaps not always at the forefront of the minds of some people in the National Health Service in deciding whether to hold on to land.
I hope that when the new district health authorities take over in April they will address themselves to two specific tasks, in addition to all the other equally important things that they have to do. I hope that they will accept that the basis of what my hon. Friend has said, and what my hon. Friend the Minister for Health has been saying for a long time, is that it is incumbent upon health authorities to put their limited resources to the best possible use. The best possible way of making certain that they are getting value for money is to see whether jobs such as catering and cleaning are being done efficiently, effectively and as 530 cheaply as possible. It is unreasonable to expect the public to believe that those jobs are best done in house unless they can see it. I think that it was the late President Truman who said
I am from Missouri. Prove it".That is what my hon. Friend is saying. Prove that doing the jobs in house is better and then no one will argue.I hope that the health authorities will also consider what land they can release, so that it can be put to productive use in other ways and so that the capital receipts can be added to their expenditure in whatever way they may choose in their region or district. We have said that if the land is made available by, at present, areas, and in future by the districts, the bulk of the money should be capable of being spent in the district or the area and should not necessarily be swallowed up by the region. The important consideration is that it is extra money for the National Health Service.
I appreciate the interest that my hon. Friend has shown in the subject by raising it tonight. I hope that he will feel that I have given him some encouragement. "Some' is a modest word. I assure him firmly that this is an issue that will not be forgotten at 9.12 tonight. We shall continue to bring it to the attention of those who are at the sharp end of the National Health Service—those who run the districts and regions.
§ Question put and agreed to.
§ Adjourned accordingly at eleven minutes past Nine o'clock.