Examination of Witnesses (Questions 1020
WEDNESDAY 9 JANUARY 2002
MP, MR ANDY
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
(Mr Milburn) Largely because the private patient units
and the pay beds in the NHSI think there are around 3,000
of them or something of that ordergenerate 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.
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"?
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
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
(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
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
1028. He came before the Committee.
(Mr Milburn) In that case have him back, I am sure
he would be delighted to come.
(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
(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 agenciesthere will always be some reliance to cover
for sickness and absences and so on and so forthI 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
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 onif the Committee has not got it
I am very happy for the Committee to have it, it is a perfectly
public documentis 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?