Speeches by Fenton-Glynn.

“One big concern is that some trusts pay more than £2 billion a year on old PPP contracts. We have gone back and capped the returns paid for defence contracts, and we have gone back and capped returns in education now. Where would your investors stand if we were to look at capping the returns in healthcare?”

“Moving on, the 10-year health plan has 70 new build health centres and 50 refurbishments by 2030. It might need a new model of private finance. You suggested that that is the most likely way that we get investment into healthcare. What should we learn from previous PPP models for future contracts?”

“One of the issues that evidence to our Committee has shown is that they do not have as much flexibility as you need for providers. Lord Darzi’s review said that some LIFT deals have left GPs being “locked into” arrangements where they have limited control over space they occupy. Does this suggest that the model is not …”

“What would be the key things that you would suggest that they look to change about our existing models?”

“Lord Hutton, do you believe that the Local Improvement Finance Trust, or LIFT, schemes address some of the concerns that were raised by previous PPP projects?”

“The NHS does, but do you think that the providers have a responsibility to make sure that the buildings they have provided are being used?”

“One issue is that the model that we have at the moment means that we end up doing much larger consultations than they do in most contracts for public-private partnerships, with much larger documentation and clearer outcomes, but healthcare is inherently a system that—whether it is because of demography, pandemics or te…”

“You say that you are not concerned about the lack of competition. Assura PLC, which previously owned Todmorden health centre, was recently taken over by Primary Health Properties. That was waved through by the Competition and Markets Authority. It now has a portfolio of over 1,000 properties. Out of the £12 billion tot…”

“Okay. Just moving on with that, how do we learn the lessons for future schemes? Do you think that there is more of a possibility of adapting the current contracts to ensure that we use these buildings properly?”

“I am going to give you a practical example. In my constituency, Todmorden health centre was built under the Local Improvement Finance Trust scheme by Assura PLC. It was built to accommodate five different health services. It has a large amount of space that is now vacant because the private company that provided the wa…”

“I did not look for this. It happened in my constituency. The only example I have seen of a LIFT building is one where the GPs are not able to provide the service that people locally need. Now they have moved a lot of the services elsewhere because it is less costly because of the private providers.”

“Okay.”

“Do you think that the lack of competition in private financing for healthcare infrastructure is an issue?”

“I appreciate that the easy get-out is that it is up to Ministers to decide, but my issue is whether they are going into a market where there is enough competition. Would you and the organisations that you represent support a move to outcomes-based payments in PPP contracts, in not just the buildings, but the broader he…”

“It is a criticism that comes up in a lot of the evidence that was submitted to our inquiry, and it is a criticism that I have seen at first hand. It seems odd to say that you do not think it is a criticism if that is something that has both come out in the evidence and been shown in my local example.”

“Do you think that asset owners and investors accept responsibility for ensuring that the health buildings are used for the service that they are meant for, or is that the responsibility of people who draw up the contracts in the first place?”

“One of the main recommendations in last year’s NAO report, which is almost as good reading as Barry’s report, is that forward planning for infrastructure needs to be credible and consistent. Do you feel that the health system’s current plans are clearer for investors in the market?”

“Those seem to have now consolidated a bit.”

“Okay. You talked about Ministers. You were a Minister for many years and signed off PFI projects. Do you ever worry that there is a conflict that you are now representing the industry that you signed off contracts into?”

“Your coalition represents what you are referring to as the responsible pharmacists, which I assume means that they follow both the letter and the spirit of the various regulators’ guidance. Is that right?”