Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 980 - 999)



  980. Let us go on to another thing. You have ruled out charges for food in any shape or form in our hospitals. Let us go to another one. Would you rule out charging for the actual bed in a hospital, not the treatment, the bed? Would you rule that out?
  (Mr Milburn) No.

  981. You will not rule that out?
  (Mr Milburn) Sorry?

  982. You will not rule out charging for the actual bed in a hospital?
  (Mr Milburn) I do not thing we should charge for a bed. However, as you know, the National Health Service, and I think it might have been the previous party when they were in government who introduced this policy, introduced a policy of amenity beds in hospitals and certainly we have cases, for example in maternity services, where if people want access to a single room as distinct from, say, a four bedded bay or an eight bedded bay, providing that room is not occupied already according to clinical need, a patient is being treated, then if they want that they should be able to have it. We have not changed that policy.

  983. I am not talking about amenity beds. What I am talking about is will you consider charging for non amenity beds?
  (Mr Milburn) No.

  984. Not at all?
  (Mr Milburn) Absolutely not. Let me tell you why.

  985. I think we can take your no.
  (Mr Milburn) No, no, no, I think it is quite important because otherwise unless there is a clear differentiation between the reasons why we should not charge for those sorts of things and the reasons why we might contemplate charging for other sorts of things people will be unclear.

  986. What are the "other sorts of things"?
  (Mr Milburn) Well, for example, in the NHS plan we have said that if people want to have a telephone at their bedside or a television at their bedside then they can have that if they want to pay for it. Remember there is already a telephone at the end of the ward and very often in the ward itself. There is certainly a television both in the ward generally and very often in the amenity room at the end of the ward. If people want the further convenience of having a bedside television or telephone then I see absolutely no reason why an NHS patient should not pay for that. Just as, as I understand it, since the inception of the National Health Service in 1948, if people have wanted a newspaper, the National Health Service has not paid for it, the patient has paid for it. Suddenly I can think of, as technology advances, for example if people go into hospital and they take their laptop with them, because they want to get access to something on the internet or whatever, I do not see why the National Health Service should have to pay for that, that seems to me to be perfectly reasonable that the patient should pay for that. However, the differentiation is this, that in the end people do not actually need to have access to the internet when they are in hospital, they do need a bed and they do need good food and, therefore, it seems to me they should be provided for free as part of the service that the National Health Service provides, not just to some patients but to every patient.

  987. Are there any other areas where you might consider charging patients? For example, for them to have a greater choice of the services of a doctor or a consultant?
  (Mr Milburn) No.

  988. Not at all?
  (Mr Milburn) No.

  989. Not at all?
  (Mr Milburn) No, because I think that basically when people are treated in the National Health Service, and incidentally when I say the National Health Service I mean both NHS hospitals and private sector hospitals which are treating NHS patients, they should be treated according to the right principles, which is according to their need and not their ability to pay. I thought that at least until very recently had been a matter of broad consensus in British politics.

  990. Right. Yes. Any other areas of charging that you envisage or are considering? Are you discussing with any organisation or anyone other areas of potential charges?
  (Mr Milburn) Not even The Independent on Sunday, no.

  991. Right. Fine. Let me ask you somewhere nearer to home. Are you having any discussions with the Number 10 Policy Unit on charging in any shape or form in the health service or are any of your special advisers doing so or any of your junior ministers?
  (Mr Milburn) Not that I know of.

  Mr Burns: Not that you know of.

  Jim Dowd: That is what he said.

Mr Burns

  992. Right.
  (Mr Milburn) That is what I say, yes.

  993. Secretary of State, we understand what you said —
  (Mr Milburn) I do not listen in to all their telephone calls. I do not know whether that was practice when you were a minister or not, Simon, but we try to avoid that sort of Stalinist approach in the New Labour National Health Service.

Andy Burnham

  994. Secretary of State, an issue arose from the additional memorandum which the Department sent to the Committee following your earlier appearance. In particular there is an issue about how the Concordat is working in practice and on the ground. We asked a question about the funding that had been allocated to the Concordat, £20 million, how that had been distributed and whether it was according to available capacity or according to need and length of waiting list. Reading the figures that your Department prepared for us, I note that the North West had the fewest number of cases, 444 cases, and this compares fairly unfavourably, to my view, with the South East 3,294, South West 1,624.
  (Mr Milburn) Yes.

  995. I think it is fair to say from the figures you have given that the Concordat seems to be benefiting some parts of the country more than others and I would go on to say the South more than the North.
  (Mr Milburn) Yes.

  996. I am not against the principle, I think patients do not care where they are treated, they want their treatment as soon as possible and as quickly as possible.
  (Mr Milburn) Sure.

  997. Can you give me some assurances that the funding will benefit all parts of the country more as it progresses?

  (Mr Milburn) I think what is important is that I would be personally pretty disappointed if the National Health Service in all parts of the country simply used the small chunk of money that we are making available specifically for extra private sector activity as the sole pot of cash available for purchasing that activity. Okay. We put £40 million out, which you remember I announced at the last Committee, but I would be surprised if the National Health Service does not spend more than that but that really is a matter for the National Health Service on the ground. As I said at the last Committee, what I really want to see, but I want to encourage this rather than, if you like, force it to happen, is I want the local health service in different parts of the country to decide on the nature of the relationship that it wants to have with the local private sector in those parts of the country. Now, as you know, the way we allocated the money was largely according to the pressures in the system actually rather than according to the sustainability of the relationships between the NHS and the private sector. I think as most Members of the Committee would recognise, indeed Simon has been making this point continually, the pressures in the service tend to be different in certain parts of the South for perfectly understandable labour market reasons than from parts of the North. I do not say there are not pressures in the service all round, there are, but where you have got bigger staff shortages for labour market reasons, full employment, etc, higher housing costs, then it is clear that those are the parts of the country where we need to take account of those factors and try to get some resource.

  998. Can I follow on and say that it does seem that it is the availability of capacity which does seem to be driving the development of the Concordat from the figures that you have given. To me that would suggest that over time you might begin to see more regional disparities within the waiting lists because the South East and the South West clearly have more private capacity available to them. If so, am I right to be slightly concerned about that? Is there a case for giving people in the North West and and the North East a chance to travel to receive treatment?
  (Mr Milburn) I am all for giving people in the North East as many possibilities, options and choices as possible. I think the broad point that you make about the geographical spread of private sector capacity being differentiated is obviously right, and the further south you travel the more private sector capacity there is. It is a simple fact of life. Whether that will remain the case in perpetuity is, frankly, doubtful. You took evidence, I notice, from Mr Auld from the General Health Care Group who I think was making a generous offer to the Committee, as indeed he made a generous offer in a recent speech, which is that he would seek to build through his group a new diagnostic and treatment centre in a part of the country where waiting times and waiting lists were long and where private sector capacity, potentially, was few and far between. So I think what you will see is that you will get some new entrants to the market. I think there will be new entrants to the market, whether from this country or from abroad. You may well see the regional spread of the private sector capacity beginning to change and if, for example, there is a shortage of private sector capacity in the North West (and I do not know if there is or not) then that potentially could be plugged over time as the private sector capacity in this country grows as a consequence of more contracting with the National Health Service. That is one option, first of all. The second option, which you know we are making some progress on, is that we want to get to a position over the next few years where rather than patients being stuck in a ghetto of having to wait a long time for the hospital operation because the waiting times at their local hospital are very long, that increasingly they should be able to exercise choice and, as you know, later this year we are going to begin the roll out of that new initiative which will involve patients who have been waiting for heart surgery for more than six months being offered a choice of either sticking with their local hospital, in which case they may well have to wait a little bit longer or, alternatively, travelling and being treated potentially in a private sector hospital or, alternatively, in an NHS hospital, or maybe even for a few travel abroad, if it is appropriate for them to do so, and in that way try to get waiting times down for those particular patients and hopefully in the process save some lives. We are beginning it with heart surgery because we think that is probably the most serious clinical condition and although waiting times are falling overall people are still waiting too long. In time we want to develop that principle of the patient being able to choose the hospital rather than the local hospital just inevitably choosing the patient as something which runs right through the National Health Service. The answer to your question is that we need to get capacity in the right places both for the National Health Service and private sector capacity, and we want to open up more options around choice.

  999. Just one final point which is linked to the variable capacity and that is the cost per case differential which emerges I think from the figures you have provided to us. It seems to suggest that the cost of an episode in the North West costs £2,000 on average and costs the North and Yorkshire £3,000. Is there a concern that what the NHS is paying for episodes is varying quite markedly?
  (Mr Milburn) I think I said at the Committee last time in answer to questions from Julia Drown that I am concerned about the fact that there is diffentiation in the prices that the National Health Service is getting from the private sector, and I think there are some real issues that we have got to bottom there because with all of this stuff, frankly, there is no blank cheque. We have always made it clear that a growing relationship with the private sector depends upon patients being assured of the highest clinical standards and taxpayers being assured of good value for money. What the figures throw up in pretty sharp relief is that there are differential prices being negotiated in different parts of the country and indeed, I suspect, within the same parts of the country. Some hospitals will be negotiating better deals than others. As I said at the Committee last time, the way through that is not to abandon the whole thing (actually I want to expand the whole thing in order that we can get more people treated on the National Health Service) but the way through it is to try to bring some standardisation to the process. As you know, we want to have a framework within which these individual deals can be located. As it happens, we are getting some good prices in some parts of the country where there has been a real tough negotiation.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 15 May 2002