HL Deb 16 September 2003 vol 652 cc765-8

3.7 p.m.

Earl Howe asked Her Majesty's Government:

Whether their plans for diagnostic and treatment centres represent good value for money.

Baroness Andrews

My Lords, the NHS is bringing on-stream diagnostic and treatment centres throughout the country. Some of those will be run by NHS providers and others by independent sector providers under contract to the NHS. The cost of treatment in the new centres will be based on the standard tariff, which is being introduced progressively. Where we are initially paying slightly more to the independent sector than reference costs, that is to cover the start-up costs so that the new facilities open as quickly as possible to treat more patients and reduce waiting lists.

Earl Howe

My Lords, is not the additional hospital capacity being purchased at an unacceptable price, not just financially, but also in terms of the future stability and effectiveness of the NHS? How can the Government justify the migration of staff from the NHS that looks likely to occur? How can they justify paying an overall price to the independent DTCs that is a good deal higher than the cost incurred in an NHS hospital?

Baroness Andrews

My Lords, as I have explained, the price paid will be exactly the same as that paid to all NHS providers. There is no dual or preferential tariff. The noble Earl said that it was an unacceptable price, but it is unacceptable that so many people are waiting so long on waiting lists. This is a radical response to that. We are investing in independent and NHS treatment centres. Out of the independent sector arrangements we will get 135,000 extra operations and 115,000 operations transferred from the NHS to create even more capacity.

On staffing, no contract will be allowed unless it provides for stability and security of staffing across the NHS area to which it applies.

Lord Clement-Jones

My Lords, the Minister mentioned a tariff, but the private sector will receive a market forces premium on top of the NHS equivalent tariff. How can that represent value for money? Moreover, the DTCs will be entitled to take 70 per cent of their staff on secondment from the NHS? Again, how can that be good for the NHS or represent value for money?

Baroness Andrews

My Lords, as I said, the tariff will be the same whether they are NHS or private providers. The additional costs will be essentially for start up—we have done this already for NHS providers in some cases. It covers the mobilisation of additional staff, extra equipment so that staff can start as soon as possible, and refurbishment of the plant. It is a necessity that we are prepared to provide. I am not clear where the noble Lord's figure of 70 per cent comes from. It would certainly not be typical, although it might be at the extreme end of the spectrum of the number of NHS staff who might be involved. The indications are that many of the providers will bring whole teams with them to provide the extra service.

The Earl of Onslow

My Lords, does the Minister recognise that the Government are departing from being the monolithic state provider of health? Is it not a good idea to provide healthcare from wherever it is best provided as opposed from only one source—the NHS? That is almost a damascene conversion that we on the free market, liberal part of the political spectrum should welcome and encourage.

Baroness Andrews

My Lords, I suspect that I am taking my life in my hands to agree in part with the noble Earl. I refer to the NHS plan 2000, which made it clear that we would be using private capacity to meet the real challenges within the NHS and the need to reduce waiting times. We are pleased to be able to do that, because of the extra capacity that we are delivering. However, I reiterate that these are NHS patients within the NHS framework. They will not pay for their treatment. They are provided for because they are in need and there is no compromise to the fundamental NHS principle of treatment that is free at the point of need.

Lord Hunt of Kings Heath

My Lords, does my noble friend agree that, in accepting that there can be upfront costs for new entrants into the provision of NHS care in the private sector, it could also apply to the voluntary sector? If we are to encourage more voluntary sector organisations to provide services to the NHS in the future, does she agree that we must provide stability and some financial incentive to enable them to set up the infrastructure to enable them to provide such additional services?

Baroness Andrews

Yes, my Lords. The noble Lord has enormous experience in both the statutory and voluntary sectors. He makes a very rational case and I would say "yes" in principle.

Baroness O'Cathain

My Lords, have the Government assessed the long-term effect on doctors' training if they do not have the opportunity to witness and, indeed, to perform eye cataract and hip replacement operations?

Baroness Andrews

My Lords, that is a good question. The DTCs, as we call them, are in areas that have extremely long waiting lists and need urgent action. We are examining the impact on doctors' training. However, we envisage that doctors will be able to do some relevant training in the DTCs. There will be no loss of accreditational training facilities within the hospitals, but the doctors will have the opportunity to learn from very new and exciting techniques. There will be no loss and there may be added value to training.

The Lord Bishop of Hereford

My Lords, will the Minister explain again why this additional investment, expenditure, recruitment, training and provision cannot be made within the NHS more efficiently, economically, simply and quickly?

Baroness Andrews

Yes, my Lords. We have gone down this road because, when the strategic health authorities examined the capacity of the NHS to deliver shorter waiting times by the target that we have set ourselves of six months by 2005, many of them realised that that could not be achieved within the NHS. Rather than give up and leave people waiting in pain, the decision was taken to try to expand capacity. That can only he to the benefit of NHS patients and the NHS.

We would all want to see capacity freed up within the NHS. Hospitals may be able to take other elective surgery in place of the high-volume work that they were doing or reform their A&E departments. We have no doubt that there will be additional value for the NHS.

The Countess of Mar

My Lords, where are these people to come from? Surely, doctors and nurses are all trained in this country, within the NHS. Does she envisage the DTCs bringing doctors and nurses from countries other than the United Kingdom—in other words, poaching?

Also, does the Minister envisage the closure of the DTCs when the waiting lists have been mopped up?

Baroness Andrews

My Lords, some of the teams will indeed come from overseas and will bring whole teams of clinicians with them. Others are from the UK and will bring their own staff. Some will use some NHS staff in strict agreement with the local PCTs and in circumstances that reflect local conditions, circumstances and need.

On the question of closure, we see the proposal not as a short-term fix but as a long-term investment—a new way of working for the NHS to deal with high-volume, complex and very painful conditions, which have condemned people for far too long to waiting lists of a year or more.

Baroness Sharples

My Lords, have countries such as South Africa complained about this new proposal? I understand that many expert people are needed there who will now be coming to this country.

Baroness Andrews

My Lords, I am happy to give the noble Baroness, Lady Sharples, an assurance on that. I understand that we have asked the South African teams to ensure that they have the support and clearance of their Government to bring their teams over here. They see this opportunity as an investment, because the staff coming will be largely on short-term contracts. There will be investment in training and experience for staff who will return to their country of origin, so we can make an investment in that way. Also, because the people coming want to make a success of the proposal in the long term, we envisage a permanent relationship that will work harmoniously for the country of origin and the local providers.

Lord Hayhoe

My Lords, will the Minister reassure us about the patients treated in these centres? I accept what she said about the speed of dealing with painful conditions, but operations can sometimes go wrong and one needs the back-up facilities of major hospitals, intensive care and the like if such were to happen. What arrangements are being made to deal with that aspect of the matter?

Baroness Andrews

My Lords, on the broader question, the independent sector treatment centres will be registered with the National Care Standards Commission and, as from next year, with new CHAI, the regulatory body. They are staffed by highly-trained doctors. These are world-class organisations. All surgeons working in the centres will be registered with the GMC. Many of the centres will be physically based within the NHS and will have a close relationship. Obviously, we want to see the closest possible partnership between the NHS as a whole and the new centres.

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