Examination of Witnesses (Questions 980
WEDNESDAY 9 JANUARY 2002
MP, MR ANDY
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
(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,
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
(Mr Milburn) Not that I know of.
Mr Burns: Not that you know of.
Jim Dowd: That is what he said.
(Mr Milburn) That is what I say, yes.
993. Secretary of State, we understand what
(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.
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