Pathology and Radiology Services (Hansard, 16 July 1997)

§ Lord Walton of Detchant
asked Her Majesty's Government:
Whether they will reaffirm the long-accepted definition of pathology and radiology as clinical services in the NHS and that these will not be included under the private finance initiative.

§ The Minister of State, Department of Health (Baroness Jay of Paddington)
My Lords, I am happy to reaffirm that the Government have given an undertaking that pathology and radiology services should not be included in private finance initiative schemes. Work is now being undertaken to draw up a definitive list of those activities which will be considered clinical and excluded from PFI projects. That will he completed by the end of the year. Interested parties will be consulted and the Government have given a commitment that the interests of employees will be properly taken into account.

§ Lord Walton of Detchant
My Lords, I thank the Minister for that reassuring Answer. It is important to have her reaffirmation of these specialties as clinical disciplines, as they have been since the establishment of the NHS, more particularly as pathologists, immunologists, microbiologists and others and interventional radiologists are increasingly involved in the personal care of patients.
However, does she accept that a distinction must be drawn between the services to be provided in a clinical setting by such specialists and the infrastructure in which and with which those services can be provided? I accept, as she said, that the clinical services will not be included in the private finance initiative, but does she agree that it would be appropriate for the infrastructure in the form of buildings and highly expensive equipment from time to time to be provided through such an initiative?

§ Baroness Jay of Paddington
My Lords, that is precisely the basis on which the Government are proceeding with the private finance initiative within the health service. We are happy to see the design and building of particular installations funded under the initiative, but we are not happy to include clinical services.

§ Lord Glenarthur
My Lords, will the noble Baroness answer the second point which the noble Lord, Lord Walton, mentioned? It was whether equipment as opposed to the infrastructural elements can be included under the PFI.

§ Baroness Jay of Paddington
My Lords, that depends entirely on the degree to which those pieces of equipment are integral to the clinical services. That is precisely the kind of detailed question at which we shall he looking when we consider the detail of potential PFI contracts and whether services need to be excluded from individual schemes.

§ Baroness Robson of Kiddington
My Lords, does the Minister agree that it is a pity that the Bill was rushed through the House before anyone had considered the meaning of the main services as they appeared in it? The noble Baroness agreed that pathology and radiology should be excluded in response to an amendment which I tabled. What will happen when the list is drawn up? 1004 Are we to have an additional Bill? What assurances shall we have that the provision will he as sure as though it were on the face of the Bill?

§ Baroness Jay of Paddington
My Lords, the noble Baroness rightly recalls the amendment which she and her colleagues on the Liberal Democrat Benches proposed. It was the basis on which I agreed that pathology and the other services should be excluded from the private finance initiative.
The Bill was rushed through this House and another place, as she described it—I would say that it was taken with due speed—simply because the Government were anxious to achieve the primary purpose of the Bill, which was that the original 14 new hospitals should be built. We believe that the importance of giving 14 communities the opportunity to have new hospitals which have been denied to them for several years has been the most important objective of the Bill, and that has been achieved. We shall certainly not have another Bill to include the matters relating to clinical services, but they will be considered as a list of exclusions when individual contracts are considered.

§ Lord McColl of Dulwich
My Lords, does the Minister regret that for years the Labour Party condemned the PFI as privatisation by the back door? Are the Labour Party happier now that they have admitted that the PFI is the best way to build hospitals? Is the Minister happy with NHS trusts using the private sector to provide haemodialysis, routine operations, pathology and radiological services, and will the Minister encourage that?

§ Baroness Jay of Paddington
My Lords, I am not entirely clear about the overall philosophy behind the noble Lord's question. If he is asking whether the Government accept the role of public/private partnerships within the health service, that is certainly the case. I can quote to him from Hansard my contributions on previous Bills on this subject. I believe that he was personally involved in the residual liabilities Bill, which we discussed when the principle was supported from my position, which was then where he is sitting.
As I mentioned in answer to previous questions today, individual specialties will be considered when individual contracts are examined. Obviously, as would be the understanding with any new government we shall not overturn any commercial contracts which have previously been negotiated.

§ Lord Winston
My Lords, those on this side of the House will be grateful for my noble friend's reassurance about clinical services. Does she agree that there are certain circumstances in which clinical services might appropriately be part of a private finance initiative? I am thinking, for example, of private practice within the health service, which could be of great benefit to the health service, and often may be better practice within 1005 the health service—within the public sector—where there can be maximum benefit both to the public sector and to the patients concerned.

§ Baroness Jay of Paddington
My Lords, I am afraid that I cannot accept the principle that clinical services are in general better served in any way other than under the NHS arrangements. However, I look forward to my noble friend's contribution to the discussion on the details of the PFI arrangements under individual contracts as this process continues.