NHS: Private Sector Involvement (Hansard, 2 July 2001)

§ Lord Clement-Jones
asked Her Majesty's Government:
What evaluation of past, and expected future, benefits of private sector involvement in the National Health Service they intend to conduct.

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the Government's policy is that where evaluations demonstrate value for money for the NHS and the taxpayer, the private sector will be involved through, first, the provision of facilities and certain support services to the NHS through the private finance initiative and other forms of public/private partnerships; and, secondly, the concordat with the voluntary and independent sectors under which NHS patients will receive clinical treatment free of charge, where appropriate in terms of cost and quality.

§ Lord Clement-Jones
My Lords, I thank the Minister for that reply. What evaluation is taking place? What services are proposed? The general secretary of the TGWU recently described the Government's policies as a cocktail of policy confusion. The IPPR has cast considerable doubt on the value of PFI for the NHS. The Minister is responsible for performance and quality in the NHS. Clinical doctors are required to evaluate their actions in terms of evidence-based medicine. If the Government do not have a proper system of evaluation, are there not double standards?

§ Lord Hunt of Kings Heath
My Lords, of course we have a proper system of evaluation. Every PFI scheme has to demonstrate that it is providing value for money. That is underpinned by the work of the National Audit Office.
On the general issue, it is clear that core clinical services will be provided and will be mainstream NHS services. However, in some instances the expertise of private partners can help the NHS to deliver expanded and improved services. That is the context in which we are taking the policy forward.

§ The Earl of Onslow
My Lords, will the Minister ensure that public/private partnerships remove some of the more ridiculous examples of restrictive practices in the NHS? Spanish nurses, who are sometimes employed in this country, have different skills from English nurses—and in some cases greater skills; for example, their Spanish qualification allows them to administer intravenous drips, but that is not the case in England. Furthermore, when English nurses in English hospitals qualify to do that locally, they have to get approval from London, even though they have been given approval by the local doctor in the hospital concerned.

§ Lord Hunt of Kings Heath
My Lords, foreign nurses would be employed directly by the National Health Service, because they would be part of the core services that we offer. The recruitment of nurses from Spain and other countries has been very successful and has gone down very well with patients. The protocols under which those nurses operate must be agreed by the National Health Service as a whole, underpinned by clinical governance within every NHS organisation. I certainly accept that we need to do all that we can to encourage nurses to take on a greater clinical responsibility if they have been trained to do so.

§ Lord Davies of Coity
My Lords, is my noble friend aware that the right honourable Neil Kinnock is reported today as saying that the Government are moving dangerously towards a privatised National Health Service? Perhaps the Minister would like to comment on Mr Kinnock's suggestion that we should consider ring-fencing certain taxation for the National Health Service.

§ Lord Hunt of Kings Heath
My Lords, I reiterate that the NHS will continue to be a core service that is publicly financed and in which the core clinical services will be provided by directly employed NHS doctors and nurses. There is no suggestion that we are going down the route of which my noble friend is fearful. We are seeking to use the expertise of the private sector when appropriate, but at no risk to the core values of our beloved National Health Service.

§ Baroness Gardner of Parkes
My Lords, what is the position of dentistry, which the Minister does not mention as a core service? Why is there no core National Health Service treatment available to patients in London and in most of the high-cost cities?

§ Lord Hunt of Kings Heath
My Lords, the noble Baroness will know that the Government published a strategy on dentistry 12 months ago, which is designed as a foundation for ensuring that NHS patients who require NHS dentistry receive it. At the moment, many dentists provide NHS services and private dental care. We are seeking to encourage greater provision of NHS services. We are in fruitful discussions with the British Dental Association. I am sure that the opening up of dental access centres and commitment payments to "incentivise" dentists will enable us to provide those services to the public when they require them.

§ Lord Barnett
My Lords, will my noble friend return to the issue of core values and value for money? Is the involvement of the private sector a short-term policy? If there were a comparison in the longer term with the ability of the public sector to provide those services, would it still be considered value for money?

§ Lord Hunt of Kings Heath
My Lords, we clearly need to take a long-term view when comparing a publicly financed NHS project and a private finance project. The history of the NHS developing its own capital programme is full of stop/start projects because of the vagaries of public finance, with the second and third phases of many hospitals never being built. Where a private finance initiative scheme is shown to be value for money, we can ensure that it will be completed on time and that there will not be the traditional delays. I am satisfied that we are promoting effective public/private partnerships in which the patient gains.

§ Lord Avebury
My Lords, does the Minister agree that the issue is not purely financial and that to leave it entirely to the National Audit Office to advise on the evaluation of such projects is not satisfactory, because there is a political dimension? Will the Government involve wide sections of public opinion outside the National Health Service in the evaluation, including the trade unions?

§ Lord Hunt of Kings Heath
My Lords, we are in the process of developing the largest capital building programme that this country has ever known, with 100 new hospitals. Private finance is one of the ways in which we are going to deliver that. Of course we want dialogue with the public and the staff. We constantly have such dialogue and we shall continue to do so. However, I think that the public would sign up to the proposals if they realised that they could deliver 100 new hospitals.

Lord Bruce of Donington
My Lords, is the Minister aware that it is highly necessary in the national interest that the Government's intentions on the issue should be as detailed as possible and available to the public as quickly as possible? There should be a full debate in Parliament about exactly what is involved in the generalities of definition that the Government have so far given.

§ Lord Hunt of Kings Heath
My Lords, I shall be happy to debate the issues with my noble friend if he cares to table an Unstarred Question at some stage. The Government's intent is clear. We have said that the NHS will continue to provide core services. We shall use the private sector where it has expertise to enable us to develop and expand services more quickly than we can at present.