Health Bill [HL]

That is an extremely good question. Perhaps people coming from, say, the Middle East to Great Ormond Street Hospital would want to come to a very specialist service, which probably would not exist in a lot of other countries. It is not something that I am planning in my trust. Obviously, the Foundation Trust Network has looked into the possibilities and has established that this would be feasible from its point of view. A further example is a completely different foundation trust, which wants to deliver a model of care to NHS patients that is not currently available under the NHS; namely, cancer care. It can achieve this only by increasing substantially its private income in that area, which it cannot do because it would take them over the private patient cap. In a completely different example, another trust wants a private company to provide equipment for laser dermatology for private and NHS patients. The equipment is very expensive and is not available under the NHS. That foundation trust knows that its NHS patients would benefit if only it could get hold of that equipment. Those are just a few examples of the arguments coming forward to the Foundation Trust Network from trusts around the country. The fourth general problem reported to the Foundation Trust Network is that the cap means that NHS foundation trusts are precluded from supporting and delivering some of the Government’s policies. I shall give a couple of examples. Mental health trusts are precluded from contracting with private insurance companies to deliver services for employees they cover, and also from delivering the return-to-work activity, which I happen to know a little about. I suppose that we probably could not do that work; it is no problem for us, but it might be a problem for patients. Another area is the top-up issue; again, it is rather controversial, but there we go. NHS patients will not be free to choose a foundation trust to receive their top-up treatment if that treatment would take the foundation trust above its cap. This is particularly likely to be a problem in cancer care, where the treatments are very expensive and some of them have not been approved by NICE, and also in dementia care where, again, expensive treatments have not necessarily been approved by NICE. There is a barrier faced by some leading NHS providers against becoming foundation trusts, because of the extent of their private patient work. For example, Great Ormond Street has highly specialised care for tiny groups of children. To provide that care, it brings a couple of children over from some other countries so that they can sustain their highly specialist units within the hospital. However, it is in trouble in terms of becoming a foundation trust; it is not a foundation trust, ironically. A very different issue, which happens to be important to me, is that some foundation trusts—I do not know how many—use NHS resources to help them provide private patient services. These trusts are below the PPI cap and, therefore, as foundation trusts, no one can actually do anything about this, as I understand it—or are not doing anything about it, anyway. I would want to see a change in the law so that a foundation trust cannot use NHS resources to support its private patient work. Rather, to the contrary, if it is to do private patient work, it must demonstrate that that is beneficial to NHS patients and of no detriment to others. The new clause does not indicate whether the level of private patient services should be higher or lower. I happen to have a personal view on that, but the amendment does not indicate it. If we can achieve agreement about the principles for the purposes of the Bill, I know that the Government will want to go in for a major consultation exercise about how the detail of this should be sorted out, ideally in regulations. This is not a simple matter. It is quite controversial, but if we could get the principles right, we could have something far better than what we have at the moment; certainly, what we have is pretty inadequate. I propose two further safeguards in addition to the three principles that I mentioned at the beginning, which are important for me. One is a restricted rate of change in the percentage of private patient work over a period of time. You should not be able to leap to some huge private patient involvement, partly because that would threaten the public service ethos of the trust. Secondly, private patient work would not create an unacceptable divergence from existing services. Will the Minister confirm her agreement with the following four propositions? They are, first, that proper control of the extent of private patient services within all health trusts is desirable—that should not be too difficult; secondly, that the current framework for controlling the extent of private patient services is unfair and needs reform; thirdly, that reform should be done in a way that ensures that private patient work enhances and avoids detriment to services to NHS patients; and, fourthly, that the system should have an equal impact upon all trusts, whether NHS or foundation. In conclusion, I suggest that getting the treatment of private patient income right could greatly help the NHS to weather the storm of public service restrictions in the years ahead. In crafting a solution, however, the essential nature and integrity of the resources of the NHS must be safeguarded.