Last week the Minister objected to my description of this as tuck shop economics. Ken Grant, the manager of the City and Hackney health authority, who has done more than anyone else to generate income, expressed it in more blunt language than I dare use. He said:
In terms of what the NHS needs, the money we are raising is peanuts. It's just that at the moment peanuts are bloody useful
After three years the peanuts will amount to £70 million in a full year. To put that in perspective, it is less than half the £168 million by which the Government have underfunded nurses' pay in the past year alone. It is sheer effrontery for a Government who cheated the health authorities on that scale now to claim the credit for allowing them to raise half that money in the market. The basic reason why we are suspicious of clause 4 is that, eventually, the pressures on hospitals to make profit will make the patient pay. Nearly two thirds of clause 4 is about charging patients.
It might be salutary to recall at this point the crushing failure of the Government's previous intervention on charging patients, which encouraged hospitals to expand pay beds by one quarter over six years. Unfortunately for them, those six years turned out to be the same period in which the number of patients wanting pay beds fell by one third. The legacy of that colossal misreading of the market is a mountain of bad debt. Health authorities are writing off £500,000 in bad debt from private patients who slipped to the front of the queue into pay beds and failed to pay for them.
Despite that lesson of history, the Government now want to encourage health authorities to invest still more money in that loss leader. I have evidence of what the Minister has in mind. I understand that on Wednesday, or later in the week, at a press conference he intends to reveal a deal which the Government have struck with Bioplan Holdings to develop private day units in NHS hospitals. One of those is the Hope hospital in Salford, where Bioplan is to build a 12-bed new day centre unit. Another is the Churchill hospital in Oxford, where Bioplan is to equip an existing Health Service day surgery unit and provide 15 private beds. Those are the first two out of six such deals around the country. Each of them will have the capacity to carry out 10,000 operations.
That reflects the trend in America for fast in and out day surgery as the basis of private care—the "Kwik-Fit" approach to surgery. It breaks new ground in reducing health care to a market commodity. It will mean that NHS hospitals and private hospitals will occupy the same sites — in the case of the Churchill hospital, the same building. They will share common staff. It is not even clear whether consultants will operate in their own time or in the time paid for by the district health authority. They will share common laboratory staff—at any rate until such time as the Government privatise the laboratories.
The absurdity of the position is that the district health authorities will provide the sites, lend the staff, run the back-up services and must then pay Bioplan for the treatment of the patients. Of course, the deal has been stitched up behind closed doors, which is the very antithesis of market forces. There was no open tender here.
It is a flagrant case of favouritism — and what a favourite to have chosen. Bioplan shares its directors with the British subsidiary of the Hospital Corporation of America. The vice-president of that corporation has observed with engaging frankness:
We try to maintain a low profile when we enter a country because we don't want it to appear that — here is a big American company to take over the health care system.
With equal candour, two years ago the founder and controlling shareholder of Bioplan stated his health care philosophy at a Financial Times conference. He said:
I don't apologise for being commercial—the bottom line to me means profit.
How fitting that this Government should choose such a company as a partner. How perfectly that demonstrates where we are going with clause 4 and the joint priorities of that company and the Government.
Meanwhile, back in the state sector, every day we see more clearly the reality of the Government's commitment to the NHS. In Birmingham the reality of health care under the Government is a charity appeal for £500,000 to cover a corridor from the operating theatre so that ill babies need not be wheeled through the mud. In Leeds the reality is parents clubbing together to fund a registrar's post in a children's cancer ward.
At the weekend it was the turn of the royal colleges to issue an unprecedented joint statement. I have not been charged with the health portfolio for as long as the Minister has, but even if I had the years of experience that he has I hope that I would not presume to tell the presidents of the three senior royal colleges that they had not grasped the complexity of the issue. The three presidents said:
In spite of the efforts of doctors, nurses and other hospital staff, patient care is deteriorating. Acute hospital services have almost reached breaking point.
That statement is a damning indictment of the state of our hospitals this year. The statement demands a response from the Government that matches the magnitude of the crisis that it depicts. That response will require vision and clear-headed choices between priorities. It will require a readiness to square up to providing the resources to do the job adequately. Instead, the House is offered this tawdry Bill about putting petrol pumps in hospital forecourts and charging the elderly to have their eyes examined.
The measures are objectionable enough in themselves. The Bill that contains them is doubly objectionable because it is a pathetic and fatuous irrelevance to the real crisis in the Health Service. We will vote against it tonight with contempt.