To ask Her Majesty’s Government what assessment they have made of the effect of NHS Foundation Trusts offering private healthcare services on waiting times for NHS patients.

My Lords, since the founding of the NHS in 1948, NHS hospitals have been able to generate small amounts of additional income by treating both international and British private patients. Since 2010, this has remained well below 1% of hospitals’ total income. Any surplus created is used to improve the services that NHS patients receive.

I am grateful to the noble Lord for his Answer. I declare an interest: I am an ordinary user of the NHS. I do not have any private medical care, nor do I make any private payments. Is it not true that there are now over 4 million people on queues waiting for treatment in the NHS? Did he see the article in The Times last Thursday headed “Patients pay £1bn to jump NHS queues”? Chelsea and Westminster Hospital recently offered me insurance, terming it the best of both worlds. How many trusts offer opportunities for people to go private, and what is the effect on ordinary users of the NHS? Surely with the shortage of resources, it can mean only that they will wait longer than at present.

I am not familiar with the type of insurance the noble Lord is talking about, but would be delighted to see what he has been offered. The 2012 Act obliges income from non-NHS activities to be tied to a foundation trust’s principal purpose, which is,

“the provision of goods and services for the purposes of the health service of England”,

and that is the standard by which it should be held. He is right that waiting lists have been growing. The NHS is doing more than ever—2 million more operations in 2017-18 than in 2010—but we realise that we need to do more, which is why the Prime Minister made the historic commitment to increase funding in the NHS by £20 billion in real terms in five years’ time.

My Lords, is it not the case that people who can afford to see a consultant can jump the queue? In a civilised society, is that not wrong?

The noble Lord well knows that we live in a society which has a mixture of public and private provision. That is true of every public service in most countries of the developed world. The critical point is that we need to invest in our National Health Service, and that is something the Prime Minister is determined to do.

Has the time not come for a further review of the previous policy when the Right Honourable Member for Rushcliffe, as Secretary of State, allowed for a tax reduction or costs to be set against tax for those who take themselves off the NHS list for a particular ailment, thereby freeing up the NHS to carry on the work it should be doing and does so well?

I am grateful to my noble friend for the suggestion. I do not think that now is the time for such a use of public resources, but it is notable that over three-quarters of subscriptions for private medical insurance are paid for by companies as a benefit that they provide to their staff. That is an enlightened approach to looking after the welfare of staff that we want to encourage.

My Lords, the Minister has not answered the Question put by my noble friend, which was about the effect of this on waiting lists. Using the private sector to relieve waiting lists, particularly during the winter crisis, which hospital trusts were told they could do, suggests that the understaffing and underresourcing of the NHS is the problem. Who pays for that private sector use? Is it trusts or NHS England? Is the cost of the use of private hospitals set against the cost of providing enough funding to ensure that hospitals and primary care are fully staffed and resourced?

With respect to the noble Baroness, I think I did answer the noble Lord’s Question because there are two different issues. One is the offering of private healthcare services and the second is the use of private providers to carry out NHS-funded provision—something that has been going on in the NHS for a long time and was accelerated under the last Labour Government. Of course, if private or independent providers are used to reduce waiting lists under the NHS, the NHS pays and the patient does not pay anything.

My Lords, there is also a problem with the pipeline. Hospital beds are not clearing as patients recovering from surgery wait to get home or to less intensive settings. Had the Government’s green paper been published when it was due two years ago, NHS treatment might be available for those requiring surgery, so how long after its publication does the Minister expect the ideas in it to be fully implemented, so helping this situation to go away?

Is the noble Baroness talking about delayed transfers of care? Of course, it is a major issue. We know that there needs to be better integration between health and social care. The better care fund provides that. We have seen some improvement in delayed transfers of care and the Government made an investment for further beds to come on stream this winter, to ensure that there are more beds for people and that we discharge people faster from them.