Examination of witnesses (Questions 740
- 745)
WEDNESDAY 6 MAY 1998
RT HON
FRANK DOBSON
MP, MR PAUL
BOATENG MP SIR
HERBERT LAMING,
MR ALAN
LANGLANDS AND
DR SHEILA
ADAM
740. I have one of those perhaps little big
questions which refers back to democracy and accountability. Helplessness
is a characteristic felt by people who feel a lack of any democracy,
any accountability. It is my experience that one of the things
inducing the most frustration and feeling of helplessness is the
power of GPs to remove a patient from their practice list without
giving even an explanation. Have you put your mind on this particular
aspect, democracy within the power relationship?
(Mr Dobson) Well, in a sense there is an unequal power
relationship for all of us when we go to see a doctor because
the doctor knows, generally speaking, rather more about our condition
and such like than we do and usually speaks with more authority
about how he might help us or she might help us to put ourselves
right or what-have-you, so I think there is nothing we can do
about that relationship other than expect, as is happening more
and more, that the doctors will involve people more and more in
their own care because all the evidence is that that helps you
get better, generally speaking, generally speaking.
741. But what about the removal from the practice
list without an explanation?
(Mr Dobson) The situation is as it is and we are looking
at all sorts of things in the Health Service and I really do not
want to make any comment about it at the moment, if you do not
mind.
Mr Walter
742. I just wanted on this question of equity
and inequality just to bring us back to the social services relationship
and pose the question that surely the greatest inequality is the
fact that the social services budget is determined by SSAs and
regional cost adjustments and all those sorts of things and in
my own constituency, which is in Dorset, it is part of the South
West and just literally over the border people might even be treated
in Hampshire which has a different costing regime. Whilst you
talk about local discretion, surely that local discretion is to
some extent determined by the money which the local authority
has available, so if you are planning a national strategy with
health and social services interacting, the inequality is created
by the social services budget of a local authority.
(Mr Dobson) Well, it is in some cases, but of course
that budget is not necessarily determined by central government
and, as I was saying, say, on children's services, I think the
average authority that has responsibility for social services,
and certainly Dorset and Hampshire do, they are spending the best
part of 23 per cent over and above what the Government standard
spending assessment suggests that they should be doing. I do not
know whether that applies to Dorset and Hampshire of course, and
they may be higher or lower than the average, but there clearly
is a relationship with the resources and what may be available,
but, as Paul pointed out, this is not necessarily the case in
terms of the standard of services provided and there are variations.
As I have said, there are variations and inequalities in the standards
of services provided by the National Health Service, but they
pale into insignificance compared to the differences between standards
of performance by local authorities in relation to social services.
Sir Herbert helped initiate, as you know, the joint investigations
between the Social Services Inspectorate and the Audit Commission
of local authority social services departments which have, I think,
been useful and salutary without being particularly unpleasant
at least for most of the authorities who have been looked at up
to now, but they are intended, as I say, to look at things from
the point of view of, broadly speaking, a national sort of standard
and say, "How are these various social services departments
performing in relation to how they ought to be performing?"
I think that will raise standards and bring about a greater uniformity
of standards as well, but by raising the worst not reducing the
best. I think we have a long way to go there. This is no criticism
of people working in social services generally speaking but I
think the Government has never made particularly clear what it
expected social services departments to do. It has done it in
certain particular spheres via particular Acts of Parliament,
but generally speaking it has not really said, "This is what
we think social services departments ought to be doing" or
what their standard of performance ought to be. Generally speaking,
social services, I do not think, has got the ministerial attention
it deserves. If it does not embarrass Paul, I might say that when
we took over he was given a choice of what job he did, and he
chose to do social services and mental health, and I rather suspect
he may be the first minister with responsibility for social services
and mental health whose first choice it was. I think the difference
is beginning to show because of his real commitment to it. Also
the work which has been done by Sir Herbert and his colleagues
and, for that matter, the work which has been done by Alan Langlands
and the NHS Executive in relation to improving the whole relationship
with social services. I think there is movement now which should
bring about a greater equality and quality of services.
Mr Gunnell
743. A minor point and a technical question—
(Mr Dobson) It will be unanswerable, almost certainly!
744. One of the things which did strike me in
this visit we paid was that we came to an area where they had
lost co-terminosity. They had previously had it but they had lost
it, because of the emphasis on district councils in the area and
the loss of Dorset as an authority. We heard from the practitioners
that really the loss of co-terminosity was a bad thing and made
life more difficult, and the primary care teams we talked to also
took that view. If we are going to have pooled budgets, are you
not going to have to have co-terminosity or re-introduce it where
it has been lost? Can pooled budgets work unless you have co-terminous
authorities?
(Mr Dobson) In an ideal world it would be nice if
every single boundary in this country was co-terminous but that
is not the world we live in. There was a massive desire on the
part of people in many towns and cities throughout the country
to return to what I used to describe as independence, and the
previous Government went some way along those lines. I think we
just have to live with it. We have the local government boundaries,
Parliament has agreed them, and I do not think we can now start
saying, "We had better botch round the health boundaries
to fit." Again, as I say, in an ideal world co-terminosity
would be great, but we do not live in an ideal world and what
I do not want to see is people coming up with, "We have not
got co-terminous boundaries" as another excuse for not doing
their job properly. If people are aware they are not co-terminous
and that they have to deal with two groups, the ones who want
to do it, can do it. I said at a conference the other day, there
are two approaches to boundaries, there are those people who want
to cross them and those who want to patrol them. I am out to eliminate
the border patrols!
Chairman
745. On that note I think we can conclude. Can
I thank the Secretary of State and all the witnesses for coming
along for this very lengthy session. We are particularly very
grateful to you, for your willingness to come again, in fact you
have virtually joined the Committee because you were here twice
before the recess, and we do appreciate the time you have spent
with us. Can I finally thank Sir Herbert, because I believe it
may be his last appearance before our Committee. I have known
him many years and I have met him on this Committee on many occasions
going back a long, long while. We do appreciate the work you have
done and your willingness to come along and share your expertise.
I hope the conclusions of this inquiry will be of some use to
the Government and we wish you well in your retirement.
(Sir Herbert Laming) Thank you very much.
(Mr Dobson) Can I say that the witnesses, at least
four of them, entirely endorse what you have just said!
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