Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 1020 - 1039)



  1020. There are only a limited number of nurses available at the end of the time and if there is a massive expansion of the private sector in providing for NHS patients,, unless they come from abroad, they must be competing with the NHS.
  (Mr Milburn) Or they could come from nurses who have left the National Health Service. As it happens, we have recruited around 10,000 nurses back who have left. The private sector needs to be on its mettle too. The idea we have got this huge flow between the NHS as an organisation and the private sector is just wrong. The figures, which I will very happily share with the Committee, show that that is the case and actually the figures for the last year show that the flow of NHS nurses into non-NHS employment, including into private sector hospitals, has fallen rather than risen at a time when there is an expansion in the National Health Service contracting with the private sector.

  1021. If the NHS is short of capacity, why does it not stop the current practice of providing private care within the NHS and release that capacity for NHS care by NHS staff in NHS hospitals?
  (Mr Milburn) Largely because the private patient units and the pay beds in the NHS—I think there are around 3,000 of them or something of that order—generate 300 million quids' worth of income for local NHS trusts.

  1022. Taking into account the hidden subsidies?
  (Mr Milburn) That is the amount of income that they generate. If we were simply to remove those from the National Health Service, then somebody somewhere would have to find £300 million worth of income. If, for example, a local NHS trust said, "We have got a private patient unit and maybe it is not particularly well used because we cannot generate demand or whatever, and what we would like to do is to convert it into extra capacity purely for NHS patients", then that would be perfectly reasonable. I know of at least one case where that has happened in Warrington where the local private sector had a private orthopaedic unit on site at Warrington hospital called the Daresbury Unit. It effectively went bankrupt and the local (pretty enterprising) Chief Executive of the NHS trust bought it at a knock-down rate, similar to the way we bought the Heart Hospital in London last year. He has now left the trust and on gone on to another trust in Manchester, but he bought it and it is now providing orthopaedic surgery purely for NHS patients. I actually opened it as a NHS unit six or nine months ago. That is not a problem if that is what they want to do but the trust has got to balance its books, it has got to decide whether or not it is going to forego the income that is coming in as a consequence of having a private patient unit. If that is what it wants to do by turning the private patient unit over to treating more NHS patients, that is absolutely fine, and it is a matter for it and not really for me.

Mr Amess

  1023. I have to say that as the evidence session progresses I am getting more and more confused, but anyway! As you know, our Chairman hates the private sector. I am sure I am not being unfair. He hates everything to do with the private sector. I thought that view was shared by the Prime Minister because he told the House of Commons on 12 January in the year 2000: "We accept that there are fundamental capacity constraints in the National Health Service. We are working to tackle them. However, the way to tackle them is not what is being urged on us by the Opposition who say that private health care will take the strain; it simply will not." You yourself seem to hate the private sector because you told a group of NHS executives on 26 March 1998 that you would come down "like a ton of bricks on anyone who has anything to do with the private sector". So what on earth is this Concordat all about?
  (Mr Milburn) Does that sound like me, Mr Amess, "coming down like a ton of bricks"?

Mr Burns

  1024. You were old Labour.
  (Mr Milburn) I was what? I was old Labour? I do not know what the charge is, Chairman. I am now completely confused. I am sorry that Mr Amess is confused but that is a permanent state of affairs!

Mr Amess

  1025. Straightforwardly, all the language that the Government used was totally against the private sector. Now, all of a sudden, because the Government is in a mess on the Health Service, you are sending people abroad, you are using hospitals overseas, you are going to charge; in fact, you are privatising the service. We have been running now for 57 minutes with all this soft soap stuff as if it is all so nicely done and we are not privatising the service. Has the Government changed its view or not?
  (Mr Milburn) No and when the Prime Minister talked about the Opposition's policy, which is the question which you asked me, perhaps I can expand on that —

Mr Burns

  1026. You do not know the policy, it is not for you. We come to question you, not you us.

  (Mr Milburn) I got a question, in all fairness Chairman, not about your attitude but about our attitude about the Opposition's policy and I can expand at length on our views about the Opposition's policy, but just to keep it crisp, I think the differentiation is pretty straightforward. I think there are some in this country who say that the way forward for health care is that we should have more and more people paying for their care through private health care. I think that is profoundly wrong. I do not think that is the right way forward for Britain. In countries where that sort of approach applies you have more regressive health services, you have less fairness in the health service, and you have less trust in the health care system. The most notable example of that is probably the United States of America who manage to spend 14 per cent of GDP on their health care and yet have 40 or 50 million Americans who have no insurance whatsoever with all the consequences that that brings. On the one side there are those who say that what we should do is force more and more people to pay for their health care. Our position is that the best way of providing health care is through a National Health Service that treats people according to the scale of their need and not the size of their wallets. Where they are treated, where those principles and values are applied is a quite different matter and, as far as I am concerned, what we do want to see in this country is not the old definition of the National Health Service as some sort of monopoly provider of health care, but instead what we should have is a set of NHS values about need, not ability to pay, free services, comprehensive services, which will be provided in a variety of settings. Some will be public, some will be private, but in all cases the patient will be treated as an NHS patient for free according to clinical need, and that is the difference I think.

  1027. There has been no change between Frank Dobson's policy and your policy?
  (Mr Milburn) I cannot speak for previous Secretaries of State.

  1028. He came before the Committee.
  (Mr Milburn) In that case have him back, I am sure he would be delighted to come.

  1029. Right.
  (Mr Milburn) You know, after all you invite me every few weeks, I do not see why you should not have Frank, I am sure he would be delighted.

  1030. Are you aware that following your remarks to this Committee on 17th October about private agencies supplying staff, a number of private health care providers were horrified by your statement. This is what you told the Committee "The National Health Service has private agencies over a barrel". That is what you said. You will be aware your ministers are getting letters at this moment from these private agencies contacting local Members of Parliament because the statement you made said that "The National Health Service has private agencies over a barrel". Now, given the problems that we have in recruiting and retaining staff in the National Health Service at the moment, do you not think that your remark about the private agencies was inappropriate?
  (Mr Milburn) No. I think what I was saying was that I think this Committee, of which you are a Member, has expressed concern about the issue of agency nurse costs in the past, as I recall it, because agency nurse costs were rising rather than falling. I do not know whether you signed up to that report or not, Mr Amess. The point I was making was this. At the moment the National Health Service treats the relationship as if the private nursing agencies have the National Health Service over a barrel. What I am saying is that it is very important for the National Health Service to remember that it is the monopoly purchaser and the monopoly provider here and as in London now, where for the first time you have got NHS trusts co-operating with each other rather than competing against each other to get the services of nurses from private sector agencies, we are beginning to get better prices as a consequence. The simple point I was making was that given the constraints in the labour market and the fact that in some parts of the country, more in the South than the North, there has probably been over-reliance on private sector nursing agencies—there will always be some reliance to cover for sickness and absences and so on and so forth—I do not think we really want to be in a position where NHS wards, to the tune of a third of the staff are coming in and going out again, night after night, different staff treating exactly the same patients, then the NHS should get its act together. Actually I think the NHS is getting its act together by working together and also through the new NHS professionals organisation which is, if you like, an in-house NHS agency, ensuring that NHS nurses can be located on a temporary basis in different places according to their own circumstances.

  1031. My final point is about the private sector in achieving GDP targets. Is it true that you were given a contract—
  (Mr Milburn) According to what?

  1032. The private sector in achieving GDP targets?
  (Mr Milburn) What is that?

  1033. GDP, gross domestic product.
  (Mr Milburn) I thought you said GTDP.

  1034. No. Is it true you were given a contract by the Number 10 Policy Unit to achieve 50 targets?
  (Mr Milburn) We have a delivery contract with Number 10 and the Cabinet Office. The number of targets in it frankly I cannot remember.

  1035. You see to me, and you are saying it is true, that is a complete contradiction to the five key priorities in the NHS own winter planning document.
  (Mr Milburn) There are certain priorities for winter because winter is a particular time of year. The key document that you should focus on—if the Committee has not got it I am very happy for the Committee to have it, it is a perfectly public document—is the National Priorities Guidance that we issue once a year which sets out what the priorities should be for the National Health Service. The priorities, certainly as we see them, for the forthcoming year, for 2002-03, the financial year, are pretty straight forward. The National Health Service should concentrate on improving emergency services to patients, because emergency patients should always come first. Secondly, getting the waiting times down for treatments because that is the biggest concern, I think, that both staff and the public have about the National Health Service today. Thirdly, we have certain clinical priorities that I think the Committee agrees with around cancer, coronary heart disease, mental health and care of the elderly, and those three areas should be the things that people get on with and deliver some improvements in services on. If you have not seen that I am very happy for you to do so.

  1036. What percentage of gross domestic product does the Government believe the target to be?
  (Mr Milburn) Which target?

  1037. Of health?
  (Mr Milburn) How much we are spending now or how much we will spend in the future?

  1038. What is the target in the future?
  (Mr Milburn) Are you talking about the EU GDP target?

  1039. No, the Government's, what is the percentage?
  (Mr Milburn) Which target are you talking about?

  Mr Amess: The Government's target.

  Dr Naysmith: What is it to be spent on?

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