National Health Service (Travelling Expenses and Remission of Charges) Amendment (No. 3) Regulations 2001

[back to previous text]

Dr. Harris: The Minister said that the price of the contracts negotiated with the hospital in Lille applies to that provider and that it was not his policy to release information that would help those of us who seek to scrutinise the Government--perhaps even some Labour Members--so that we know whether value for money was obtained. Why not?

Mr. Hutton: As I have made clear, to release information about a specific provider would breach the terms of commercial confidentiality under which the contracts were negotiated. I hope that there will be a time when we can provide more specific information that would help the hon. Gentleman, and indeed my hon. Friends, in their job of scrutinising the Government. Let us be clear: the hon. Gentleman does not have a monopoly on that function, although he is right to present himself as discharging that unique constitutional function all on his own.

It is a concern for all Members of Parliament to ensure that we obtain value for money. That is the responsibility of the primary care trusts participating in the three pilot schemes, as it will be for all primary care trusts that send patients abroad under the provisions. That is why the tendering exercise for longer term provision that will follow the conclusion of the three pilot schemes will provide a yardstick and benchmark, and, I hope, the information that the hon. Gentleman and others want.

This is an important issue. Members on both sides want to be sure about the costs and the value for money aspect. I do not dispute that. I simply point out to the hon. Gentleman that all primary care trusts must publish accounts. Those accounts will contain information. They will be subject to the full, normal—

Column Number: 15

and, I believe, effective—process of scrutiny and auditing by the National Audit Office, the Audit Commission and other bodies. He can rest assured that arrangements are in place to ensure that his concerns are properly and fully addressed.

Dr. Harris: The contract is commercially confidential, but did the Minister share my concern that the chief executive of the primary care group in the Isle of Wight said that the prices negotiated with Lille were significantly less and therefore much greater value for money than the presumably extortionate prices being charged to NHS commissioners by the private sector in the UK? Did that give him cause to worry about how much money was being spent by the NHS in the private sector in the UK?

Mr. Hutton: As I understand it, the prices are comparable to purchasing in the UK private health care sector. The hon. Gentleman's wider argument about the use of the private sector probably takes us slightly beyond the scope and the range of the regulations, although it is a perfectly fair and reasonable point for him to raise and he has done so on a number of occasions. The same discipline about value for money and accountability applies not just to these arrangements, but to the use of all public money in the NHS. We have to be sure that the arrangements that the NHS makes with local private and independent sector providers represent good value for money. We are ensuring that NHS patients are treated in those private facilities and that they receive health care that is free at the point of use. Until now, only patients who could afford to go to those health care facilities had access to them.

This is a wider debate about the relationship between the NHS and the private sector. Our view is simple and clear: if we can help patients to receive their NHS treatment more quickly by utilising spare capacity in the private sector, we should do so. Like many other hon. Members, I would find it difficult to look my constituents in the face and tell them that, for ideological reasons, they will have to wait longer to be treated in the NHS even though they could be treated more quickly in the private sector. I am not prepared to do that. I am not prepared to make any of my constituents wait in pain when an easier solution is available.

This has been a wide-ranging debate. My hon. Friends and I are still none the wiser about whether the Conservatives or the Liberal Democrats oppose the changes. However, it is clear that we have a legal obligation to amend the existing framework of NHS legislation. Failure to do so would put us at risk of not complying with our treaty of Rome obligations. This is the right thing to do not only on legal grounds, but to ensure that patients who want to exercise their freedom of choice are treated in exactly the same way as they would be treated if their NHS treatment were provided here in the UK. That is what the regulations do. I hope that my hon. Friends will support them.

<<16>>5.17 pm

Dr. Harris: I am grateful to the Minister for his reply. I do not always say that about him, as he can be quite grumpy sometimes. Some hon. Members might have thought him grumpy this afternoon, but that was moderate for him. Much of what he said was reasonable. He gave us an exposition of the EU law and the legal cases, for which I am grateful. However, he seemed to argue that praying against regulations and asking the Minister to come before a Committee automatically means that one opposes them, does not see the need for them, or is an anti-European ideologue. None of that applies. It should be possible for us to bring him here to justify and explain the framework, timetable and details of the regulations without being portrayed as opposed to what they seek to achieve.

Mr. Hutton: Does the hon. Gentleman support or oppose the regulations?

Dr. Harris: If the Minister is patient he will find out, because I believe that it is your habit, Mr. Winterton, to call a vote, or at least to seek some agreement on whether we have considered the regulations. Indeed, I might tell the Minister sooner than that if he is desperate to know. Even if we opposed the regulations, he might still have enough votes to get them through. Charitably, he conceded our point about the delay in introducing the regulations after the European Court of Justice ruling, which was about five months. Obviously, his Department faces many demands, but taking the recess into account meant that less time was available for examining the regulations, which is regrettable.

The policy framework of the regulations is important. The Liberal Democrats accept the need for the regulations, and will not oppose them today, but we do not necessarily support the Government's intention to spend considerable NHS funds on ensuring that people take advantage of these opportunities. The Minister did not deal with my point that, before the Government make a virtue of our citizens' rights to seek treatment abroad and scale up treatment of many individual cases, they should establish whether the money might be better invested on expanding or releasing NHS capacity.

I raised the matter of delayed discharges earlier and the House of Commons Library confirmed that about 1,200 operations could have been performed if the beds subject to delayed discharge in the three health authorities were free for operations. I suspect that only a fraction of the money spent on those operations would be enough to free up beds by providing additional capacity in social care.

Mr. Hutton: The hon. Gentleman knows that we have made £300 million available to tackle delayed discharge, but he does not understand the legal significance of the two European Court judgments. He cannot say that he does not oppose the regulations and then say that the NHS should not fund any of the treatments. Some patients are entitled to choose

Column Number: 17

treatment abroad. In this country, that is dealt with under the national health service. There is no choice in the matter.

Dr. Harris: I do not argue with patients having the entitlement to seek treatment abroad under the NHS if the criteria set out in European law are met. I support that. What is questionable is a decision taken by commissioners—under Government pressure and aided by a Department of Health unit called ''treatments abroad'' or ''patients abroad''—to spend tens or even hundreds of millions of pounds promoting the initiative when that funding could treat more people more quickly if it were invested in releasing capacity. Until we see the figures on how much the Government are allowing the NHS to spend on treatment abroad, we will not know exactly by how much they have failed to increase capacity. The individual contract information is a secret, so it is difficult to make a judgment.

The Minister said that the scheme was not a strategy for reducing waiting times or a solution to the problem of long waiting times. As he put it, it was simply a fact of life. I am with him as far as that goes, because the

Column Number: 18

European Court has ruled that patients are allowed treatment abroad under certain circumstances. My doubts are about the scheme promoted by the Minister or his spin doctors: the newspapers are full of headlines about the reduction of waiting times by Government schemes to send patients abroad and I do not believe that he has no control over what appears in the media.

The Minister must address questions about value for money. I am pleased that he accepted that it was an important issue. My concerns relate to that rather than to the details of the regulations. We shall not oppose them, but we hope that we have done a service in drawing the Government's attention to issues surrounding value for money. They must be tackled when the data become available.

Question put and agreed to.


    That the Committee has considered the National Health Service (Travelling Expenses and Remission of Charges) Amendment (No. 3) Regulations 2001.

        Committee rose at twenty-four minutes past Five o'clock.

Column Number: 19

        Winterton, Mr. Nicholas (


        Cousins, Mr.

        Dalyell, Mr.

        Davies, Geraint

        Fitzpatrick, Jim

        Gidley, Sandra

        Harris, Dr. Evan

        Hutton, Mr.

Column Number: 20

        Keen, Alan

        Loughton, Tim

        Mackinlay, Andrew

        Mactaggart, Fiona

        Palmer, Dr.

        Tyrie, Mr.

        Ward, Ms

        Wiggin, Mr.

        Wilshire, Mr.

        The following also attended, pursuant to Standing Order No. 118(2):

        Russell, Christine (City of Chester)

Previous Contents

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

©Parliamentary copyright 2002
Prepared 5 February 2002