Examination of witnesses (Questions 1
- 19)
THURSDAY 17 FEBRUARY 2000
MR STUART
GRAY, MR
EDDIE KINSELLA,
MR NEIL
LARGE, MR
ANDREW PIKE,
DR SHEILA
PESKETT, MR
NIGEL BEVERLEY
and DR PAUL
ZOLLINGER-READ
Chairman
1. Can I welcome colleagues and particularly
our witnesses. On behalf of the Committee thank you for your willingness
to participate in this inquiry. Perhaps I could ask you to introduce
yourselves to the Committee?
(Mr Gray) I am Stuart Gray, the Chief Executive of
the Countess of Chester Hospital in Cheshire.
(Mr Large) I am Neil Large. I am the Deputy Chief
Executive of South Cheshire Health Authority.
(Mr Kinsella) Eddie Kinsella, Chief Executive, South
Cheshire Health Authority.
(Mr Pike) Andrew Pike, newly appointed Chief Executive
of the Mid Essex Hospital Trust.
(Dr Peskett) Sheila Peskett, Medical Director of Mid
Essex Hospital NHS Trust.
(Mr Beverley) I am Nigel Beverley, Chief Executive
of North Essex Health Authority.
(Dr Zollinger-Read) Paul Zollinger-Read. I am a GP,
and I am also Chair of the Braintree PCG, and I am Vice Chair
of the Eastern Regional ? Task Force.
2. We have asked you here because you have had
what might be termed contrasting fortunes in recent times and
we would like to explore some of the reasons for this and look
at what lessons we may learn from your experiences. Perhaps I
could ask the two Chief Executives of the Health Authorities to
begin briefly by giving the Committee a sketchy outline of the
structure of local provision. I do not have knowledge of either
area particularly well. I am interested to learn if you have a
single acute trust separate provision for the community. Is there
a second community trust for example? Is the main provision in
your area based on a single DGH or what? I would be interested
in a brief description of the relationship with primary care,
how far advanced your primary care groups are, the populations
covered and so on, whether you have any intermediate care provision
within your areas, and in particular some comments on your relationship
locally with the local authority social services, and which type
of authority that service is provided by.
(Mr Kinsella) First of all, South Cheshire is a misnomer.
The health authority covers the whole of the county of Cheshire.
It is the largest health authority in the north west region. It
is within the top 20 across the NHS. It covers a population of
670,000-plus people. We have six NHS Trusts that vary considerably.
We have two acute trusts, one integrated trust, we have two community
trusts, and we also have a mental health and community trust which
straddles our boundary with Mr Hesford's constituency in Wirral.
We also have a very large number of independent sector beds. There
are something like 4,200 beds in the independent sector scattered
(and they vary considerably) over something like 120-plus facilities.
3. Are we talking here about hospital beds?
(Mr Kinsella) We are talking about private nursing
homes, private hospitals, a mixture in the independent sector.
4. Can you break those down roughly percentage-wise
into hospital, care and nursing homes?
(Mr Kinsella) The vast majority would be nursing homes.
There are a small number of independent private hospitals as well.
There is a considerable difference in terms of the communities
across the county and also the historical arrangements and the
social circumstances prevailing within those communities, so there
is no one easy answer and provision across the county will vary
from year to year and indeed in this winter has varied significantly.
Although, as you would expect, a great deal of preparation went
into planning for winter, there are some things that took us by
surprise. For example, last year we had greater admissions of
children. This year we had made provision for that but there were
actually fewer children's admissions, so we had to adjust accordingly.
A great deal of preparation has gone in across Cheshire, not just
in this year. We started our preparations some two and a half
years ago when the first allocations of additional monies were
made by government, and we evaluated, with the help of Liverpool
University, how we had collaborated with all partners, not just
the trusts but local authorities as well. Coming back to your
question, we deal with seven local authorities, six district councils
and one county council. Relationships with all of those partners
are excellent, particularly around social services.
5. How many of those authorities are providing
social services?
(Mr Kinsella) It is Cheshire County Council.
6. That is just the one county?
(Mr Kinsella) Indeed.
7. But the other councils presumably provide
housing services?
(Mr Kinsella) Indeed.
8. So you have all those different elements
providing the housing side of what might be termed the continuum
of care?
(Mr Kinsella) Absolutely right, Chairman. We have
very good relationships and that has been a contributory factor
to the way in which we have been able to handle the winter pressures.
9. How many PCGs have you?
(Mr Kinsella) We have six. Another factor is that
primary care generally across Cheshire is very good comparatively,
both in terms of the standard of primary care (there are very
few single-handed practices—and I am not implying anything
about single-handed practices) and there has also been a great
deal of development generally even before PCGs were created. Our
PCGs have also made great progress in our opinion in terms of
the government's agenda, so they were heavily involved in the
planning for winter. In terms of our overall arrangements, we
had a steering group which was multi-disciplinary and covered
all the partners, and which I personally chaired, but underneath
that steering group, because of the sheer scale of the county,
we had three operational winter groups and they were chaired by
the PCGs with other partners involved.
10. Do you have anything that might be termed
intermediate care within the NHS? There is a debate about what
that might mean, but the beds inquiry which came out last week
referred to this issue, and the Secretary of State talked about
it. If you are in here long enough, as I have been, I spent a
lot of my time early on fighting to defend intermediate care which
was being closed down and now they are bringing it back in again,
so it is interesting to see it go full circle. Do you have anything
that might be defined as intermediate care currently within your
health authority area?
(Mr Kinsella) We do not have a distinct entity that
we could point to as that facility, but we have variations on
that theme in terms of innovative arrangements in terms of hospital
at home, multidisciplinary rehabilitation and so on. That is the
type of thing that came out of the evaluation of beds before.
A great deal of innovative work has been done by the trusts, and
also by primary care. We would like to build up on that. The joint
investment plans this year are very much focused on that type
of thing. You know better than I, Chairman, that there is a great
deal of debate about what is actually meant by intermediate care.
Chairman: I appreciate that.
Dr Brand
11. Do you have community hospitals or cottage
hospitals?
(Mr Kinsella) Yes, we do have a small number across
the county but they vary in their size and function.
Chairman
12. But some might now be termed intermediate
care?
(Mr Kinsella) Indeed, and, as you would expect, our
PCGs are looking very closely at how they may be used in the future.
13. Mr Beverley, may I put the same point to
you?
(Mr Beverley) North Essex is one of the largest health
authorities in the country, just under a million population in
a very large geographical area. One significant aspect of the
population is that we have the largest proportion of over-65s
of any health authority in the United Kingdom, so it is a significant
elderly issue. Because of the size of the patch it is complex
in terms of provision. There are eight NHS trusts, including a
county-wide ambulance trust. Within North Essex there are three
main centres of population: Colchester, Chelmsford and Harlow,
and there are three separate acute trusts in those three towns.
In terms of community service provision it is a mixed pattern.
We have some specialist community providers. One of the NHS trusts
is an integrated acute and community service provider. We have
a two-tier pattern of local government with the county council
providing social services, and district and borough councils.
14. So it is a similar situation to South Cheshire?
(Mr Beverley) A very similar situation to South Cheshire.
15. How many housing authorities would you be
dealing with?
(Mr Beverley) Eight. We have eight primary care groups
and two of those have just been approved to become primary care
trusts.
16. Do the PCGs parallel the boundaries of the
local authorities?
(Mr Beverley) All bar one where there is one PCG which
covers Maldon District Council and half of Chelmsford, but the
rest of them completely parallel the district councils. We have
two of those PCGs becoming primary care trusts in April, so we
are seeing relatively rapid development of primary care groups
and care trusts in North Essex which the health authority strongly
supports, mainly because we see that as being one of the keys
to what was behind your question about the integration of management
of services across social care, housing, health, etc. As a result
of that we are going to see (and it is already happening) a major
reconfiguration of NHS trusts. As far as the winter is concerned,
because of the complexity of that provision we spend a lot of
time and have invested a lot of effort in planning for the winter.
Mr Burns
17. Can I ask the two trusts what their current
in-patient waiting lists are?
(Dr Zollinger-Read) Shall I give you a history from
the beginning of March 1997?
18. No. It will become apparent.
(Dr Zollinger-Read) The end of January position in
Mid Essex hospitals was 10,234 patients waiting. That is an increase
of 383 on the December position. In December it was 9,851 and
that was an increase of 368 on the previous position.
(Mr Gray) The figure for the Countess of Chester Hospital
at the end of December was just under 7,000.
19. What were the similar figures on the 31
March 1997?
(Mr Gray) The comparable figure for that period was
about 7,700.
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