Health and Social Care Bill

My Lords, I agreed with everything that the noble Lord, Lord Walton of Detchant, said. His historical perspective reflects my own experience, both as a young trainee working at the Middlesex Hospital, where we had a separate private wing, and then post the decision made by Mrs Barbara Castle when the private wings lost their beds. The net result was that, when I became a consultant in 1979, there were very few private beds in my own hospital. I was a maximum part-time consultant as well. We saw a proliferation of new private hospitals in Brentwood—the Nuffield—Chelmsford and Southend; the whole area sprouted new private hospitals. I would see my private patients at the beginning of the day and then again at night while fulfilling my NHS commitment, which I am quite happy to say I did. I could travel 100 miles in a day seeing private patients, whereas previously those patients were in the same hospital. The junior doctors knew where the consultants were and if there was a problem on the ward they could consult them and bring them back. There is another dimension to moving private beds out of the NHS, which is that I used to be able to take my trainees with me to the private hospital to assist me with my operations. That was a level of learning that they would often not have the opportunity to access, particularly if it was related to overseas patients with conditions that they had not previously seen. It was a learning opportunity which is now more or less lost. Junior trainees are very rarely able to escort their consultants to work in the private sector. As to the private cap, it will not surprise your Lordships that two big hospitals in London, the Royal Marsden and Great Ormond Street, have a massive number of private patients who seek treatment from those hospitals because they are the best in the world. A cap in that situation is against the best interests of those hospitals. Robert Naylor, the chief executive of UCLH, has been quoted as saying that it is entirely transparent where the money from private patients treated in the NHS goes: back into supporting services within the NHS. Maintaining the cap on private earnings in the NHS will damage the NHS. Patients who come in to have their treatment privately in the NHS are treated by consultants who treat both NHS and private patients. There is no difference between the two. To deny those hospitals the opportunity of attracting patients from overseas and the benefits going back to the NHS would be a disservice. I have looked at this amendment and, clearly, the intention is to ensure equality of care. I was watching the monitor upstairs in my office and heard the introduction to this debate. I am sorry that I was not here. The meaning behind the amendment is right. There should be equality. I am not sure whether it can be achieved in the way that has been described. The noble Lord was quite right in saying that the clinical treatment—this is not about food, beds or those sorts of facilities—that is provided should be the same. As a working consultant until just three years ago I would say this. We used to have a system in the NHS whereby we had block booking for outpatient appointments. Four patients would be booked at 9 am, another four patients at 9.05 am, another four patients at 9.10 am and so it went on until all the patients were booked in until 11 am. Clearly, they did not have two minutes each. Patients were left sitting in the clinics waiting and waiting and waiting until they could be seen. I decided after some time that that was not acceptable and made the point of giving my NHS patients appointments in exactly the same way as my private patients. They all had 15 minutes each. It was exactly the same as in the private sector. Some private patients might just have a mole so it might take me only five or 10 minutes to make a diagnosis. For someone with bowel cancer it could take 30 minutes. That way, you can manage your practice. There is a requirement for individual consultants to be conscious of the fact that they must deliver the same standard of care irrespective of how that patient finances their treatment.