Main direction of Committee's
work
2. Since May 1997 the Committee has carried out 13
inquiries. These are listed in below.[8]
In addition, it publishes an annual memorandum on Public Expenditure
on Health and Personal Social Services.
Session 1997-98
First Report:Tobacco Advertising
and the Proposed EC Directive
Second Report:Children Looked After by Local Authorities*
Third Report:The Welfare of Former British Child Migrants*
Session 1998-99
First Report:The Relationship between Health and Social
Services*
Second Report:Primary Care Groups
Third Report:Future NHS Staffing Requirements*
Fourth Report:The Long Term Care of the Elderly
Fifth Report:Regulation of Private and Other Independent
Healthcare*
Sixth Report:Procedures related to Adverse Clinical Incidents
and Outcomes in Medical Care*
Session 1999-2000
First Report:The Cost and Availability of Generic Drugs
to the NHS
Second Report:The Tobacco Industry and the Health Risks
of Smoking*
Third Report: Consultants' Contracts
Fourth Report:Provision of NHS Mental Health Services*
*indicates substantial inquiry
3. Our inquiries vary in both length and complexity,
ranging from in-depth examinations of a particular issue to one-off
sessions on key policy developments. Since May 1997, we have carried
out eight substantial inquiries. An analysis of each of these
is provided below.
4. The report on Children Looked After by Local
Authorities provided a wide-ranging analysis of problems faced
by some of the most vulnerable members of society; it aimed to
complement the report People Like Us[9]
drawn up by Sir William Utting, into the safeguards for children
living away from home. It came up with some 93 recommendations
to Government, the great majority of which the Government accepted.
As is the case with most recommendations from select committees,
it is difficult to 'prove' conclusively a chain of causality between
Committee recommendation and Government action. Nonetheless, a
reading of the Department's own analysis of action taken indicates
that the Government has now taken a range of measures which accord
with the tenor of our report. A new framework has been developed
to assess children in need; extra resources have been provided
for foster parents; foster care and children's homes are now subject
to new regulatory frameworks, vetting procedures, codes of practice
and national training standards; and new mechanisms have been
established to co-ordinate policy and legislation in this area.
The Government has taken some measures to increase the quality
of educational provision available for these children and to tailor
their health provision to make it sensitive to their age. The
Government did not accept our recommendation that there should
be a separate Children's Right Commissioner for England.
5. The Report on The Welfare of Former British
Child Migrants drew attention to an international scandal
that had for too long remained hidden. The Government accepted
our recommendation that a central information index should be
established to allow child migrants to trace their roots. The
Government also acted on our recommendation to establish a travel
support fund, which supports first time reunions between former
child migrants and their immediate relatives. It has, as we recommended,
increased funding to support the Child Migrants Trust in respect
of the invaluable work it carries out in terms of tracing families
and offering counselling. Finally, a Child Migrants information
website was set up on 1 March 1999 in response to our recommendation
that information should be made more readily available to former
child migrants.
6. The problems that users and their carers sometimes
encounter with the provision of health and social services led
us to examine The Relationship between Health and Social Services.
The Committee found that many of these problems arise, or are
exacerbated by, separate NHS and social services provision; barriers
between the organisations frustrate the goal of "seamless"
service provision and the division often appears confusing to
the users of the services. We consider that the problems of collaboration
between health and social services will not be properly resolved
until there is an integrated health and social care system. We
welcome the moves the Government has made to strengthen joint
working between the NHS and local government and will watch the
development of Care Trusts with interest.
7. The Report on Future NHS Staffing Requirements
called for a review of planning procedures, which subsequently
occurred, and for at least another 1,000 medical students to be
trained each year. The Government has announced over 1100 new
medical places. It remains to us unclear whether the Government's
measures to address shortages in nursing, professions allied to
medicine, pharmacists and scientists will be sufficient to avert
a potential major shortfall in the future. The Committee's recommendation
that the Department should move to a single pay spine for all
NHS staff was not accepted, though some reforms to the pay spines
have been implemented.
8. A particularly difficult and sensitive report
was our inquiry into Procedures related to Adverse Clinical
Incidents. We heard from many patients, and their relatives
and carers, who had suffered dreadfully following adverse clinical
incidents or poor performance by doctors and nurses. Too often,
they had found it hard to get an explanation of the incident from
health providers; they felt the NHS closed ranks. The complexity
and lack of apparent independence of the NHS complaints procedure
were highlighted as key problems. We look forward to the outcome
of the Government's review of the NHS complaints procedure. We
are pleased that the Government has accepted the need for patients'
advocates. However, we are concerned that the reforms proposed
in the NHS Plan do not meet our recommendations on the need for
such mechanisms to be independent of local health authorities
and trusts.
9. For the first time the Committee examined the
operation of the private and independent healthcare sector in
its report The Regulation of Private and other Independent
Healthcare. This is a complex area, and the Committee's report
was widely praised as offering an objective and thorough blueprint
for future regulation. The Government accepted the key recommendation
of this report, namely the creation of an independent regulator
for healthcare outside the NHS, with the creation of the National
Care Standards Commission. Although a number of less important
recommendations were not accepted, we believe that this area of
policy was fundamentally influenced by our report.
10. Turning to the Committee's report on The Tobacco
Industry and the Health Risks of Smoking we can reflect on
an investigation which has made a significant contribution to
knowledge worldwide of this major public health epidemic. The
Committee used its powers to send for persons, papers and records
to uncover several thousand pages of documents from four of the
leading advertising agencies with contracts with the major UK
tobacco firms. The documents which were disclosed painted a disturbing
picture of the tobacco companies and their advertising agencies
cynically exploiting marketing techniques to depict smoking as
glamorous, thus attracting young people to smoke. The evidence
gleaned has received worldwide attention and has been received
both by the European Parliament and the World Health Organization.
The Committee welcomes the Government's decision to introduce
primary legislation to ban tobacco advertising: we remain unconvinced
that the exemption for Formula One motor racing is justified.
We welcome the fact that the Government agreed to our recommendation
that the Department of Trade and Industry should investigate allegations
relating to smuggling involving British American Tobacco. The
other central recommendation of the Committee was for the creation
of a tobacco regulatory authority. The Government has not, at
present, acted on this recommendation, a fact we very much regret.
We hope that such an authority could be instituted in a future
session of parliament, and that the Government will make an early
commitment to this effect.
11. Most recently we have completed a comprehensive
review of NHS Mental Health Services. The Committee supported
the philosophy underlying the recommendations of the Expert Committee
on the reform of the Mental Health Act 1983, in contrast to the
proposals set out in the Government's Green Paper. We were particularly
concerned that mental health services are not adequately meeting
the needs of ethnic minority patients. We are pleased that the
Government has accepted the need to take action on this and that
it will, amongst other initiatives, be charging the Mental Health
Taskforce to ensure that these concerns are taken on board. We
were disappointed that the Government has not accepted the need
for the replacement of the existing high security hospitals with
regionally based units.
12. We carried out five short inquiries, which examined
issues of immediate relevance to the Department. These were: Tobacco
Advertising and the Proposed EC Directive, Primary Care Groups,
the Long Term Care of the Elderly, the Cost and Availability of
Generic Drugs to the NHS and Consultants' Contracts. Whilst we
do not wish to comment in any detail on the impact of the recommendations
contained therein we would draw particular attention to the impact
of the report on generic drugs: we believe we drew attention to
massive increases in the prices of generic drugs and that this
in turn led directly to action on the part of Government to alter
the pricing mechanisms. We took this matter forward in a Westminster
Hall debate[10],
and were gratified to see that progress was already being made.
Resource Accounting and Budgeting
13. The Department's 'shadow' resource-based estimates,
and a background note, were circulated and approved by the Committee
in June this year. We review all Departmental expenditure in the
form of an annual lengthy and detailed public expenditure questionnaire
submitted to the Department each February. Oral evidence has been
taken in each session on the findings of the PEQ and a similar
process is likely to apply to the new form of accounts. At this
stage, however, the Committee thinks it is too soon to establish
the impact of RAB.
Other activities
14. In conjunction with the Agriculture Committee,
we took evidence from Sir John Krebs, the new chairman of the
Food Standards Agency. We also took evidence from Sir Michael
Rawlins when he was chairman-designate of the National Institute
for Clinical Excellence. This is the type of hearing is sometimes
described as "confirmatory". Whilst we find the use
of this term - which has a clear function in the US congressional
committee system whose powers are different to ours - to be misleading
we thought the exercise was helpful.
15. The Committee has undertaken numerous visits:
amongst those that stand out are the visits to two of the Special
Hospitals, Ashworth and Broadmoor in the context of our mental
health inquiry, visits which directly informed our recommendation
that these centres should close; the visit to Australian which
gave members of the Committee the most harrowing insights into
the conditions of former child migrants; the visit to Washington,
where we met some of the prime movers in the US litigation against
the tobacco companies; to Northern Ireland, where we saw for ourselves
the benefits of a unified system of health and personal social
services; and to various parts of England in the course of our
inquiry into adverse clinical incidents, where we met many victims
of such incidents who would not have felt able to come to London
to give us the benefit of their experience.
Relations with the Department
of Health
16. In general, we have satisfactory relations with
the Department. They have supplied thorough written evidence for
each inquiry, clearly stating the current policy position. Witnesses
have also mostly been available when requested and the Secretary
of State has always been willing to attend.
17. However, we have been disappointed with the timeliness
of Government responses to our reports. Seven responses were received
more than two months after our reports were published. In five
of these cases, the Committee's report was published before the
House rose for the summer and the Government's response was received
after the House returned. Of the other two, the Department failed
to keep us informed of progress of one of the responses, which
was only received after approaches by the Committee Clerk. We
would urge the Department to ensure that the work of the Committee
does not suffer from the late arrivals of responses and other
requested information. We also believe that the Department seeks
to influence public opinion relating to our inquiries by manipulating
the timing of announcements in policy areas which we are examining
in an attempt at "damage limitation".
8 These reports, together with House of Commons printed
paper numbers and ISBN references can be found at the Health Committee
website at www.parliament.uk/commons/selcom/hlthhome.htm Back
9
Sir William Utting et al, People Like Us: The Report of the
Review of the Safeguards for Children Living Away From Home,
The Stationery Office, 1997. Back
10
Official Report, 17.05.01, cols. 68-89 WH. Back
