Examination of Witnesses (Questions 200-217)
WEDNESDAY 4 APRIL 2001
SIR JOHN BOURN, KCB, MR GLENN HULL, MR NIGEL CRISP AND SIR BRIAN FENDER
200. That is fine.
(Mr Crisp) As I have said to three of your colleagues.
201. We are told if we look at page 3 that under-estimates by the NHS trusts led to insufficient numbers of training places. Are you saying that all that gap in that six-year period was due to the trusts? Was it part of the decentralisation? Did you not as a Department monitor this? Did you not as a Department give guidance on training?
(Mr Crisp) The position was that it was a mix of central and local and the assumptions that were made for workforce planning in the early 1990s were that we would require fewer nurses at the end of the 1990s and those assumptions were clearly wrong.
202. Yes, but who was wrong, the Department or the trusts? Were the trusts acting on advice given by the Department or was the Department acting on figures given by the trusts?
(Mr Crisp) It was a mixture. It was a decentralised system whereby there was a degree of autonomy for trusts and others within the system but the general assumptions that were around at that time and the policy that was around at that time was that we were expecting to see a reduction over time in the need for hospital beds and a whole set of programmes around care in the community and so on, and there were assumptions made.
203. What I would like you to do is submit a document explaining the thinking at that time and how the statistical projections were arrived at. If you would be so kind as to give us a document explaining how we got into that situation. Further down in box B
(Mr Crisp) Which one?
204. The one I just turned you to, box B on page 3, we were talking about that when I moved to NHS trusts. When you look at that on page 3 about a third of the way down it says: "There are wide variations in student attrition between institutions"which has been addressed by various people"and limited understanding as to the reasons for variation." If then you go to the next paragraph: "The NHS does not have the information to understand or compare institutions' costing policies." That is another gap, is it not? Does one not get the impression from what went on in that shortfall in training over that six-year period and from the fact that you only have a limited understanding of the reasons for people leaving training courses and from the fact that you have no information to compare institutions' costing policies that the Department over the years has not been on top of the job?
(Sir Brian Fender) Can I deal with the question of attrition again. I referred earlier on to the big factors which affected it. We have done a study in 1996you will be pleased to know, it was quite a long time agoto look at some of the reasons why students dropped out of their courses. An important factor was they did not find the course the right course for them.
205. We know that but you signed up to what is said here which is the current situation, not 1996. There are wide variations in student attrition and there is limited understanding as to the reasons behind it. That is in 2001 and you have signed up to it, so I do not want to know about 1996. You still do not know it, do you? You are no wiser than you were in 1996?
(Sir Brian Fender) I am saying we know something about the reasons why students drop out of courses. It is basically because they did not find the courses right for them, they did not have enough information, they might not have been properly prepared for the experience. We know generally the reasons. We do not know whether there are some particular circumstances in institutions which influence that attrition.
206. Let's go to figure 5 on page 25. This is attrition rates for nursing diploma contracts. If you look at the best, the attrition rate for the number of students leaving during the course is nine per cent, which is one in ten. If you look at the worst, the number leaving is 38 per cent, which is four in ten. If we concentrate on the bad because we want to know why things are so bad, what analysis have you done, Sir Brian, our has your organisation done, to analyse why that lower quartile, those eight colleges, are so bad compared with the best?
(Sir Brian Fender) First of all, as I said earlier, I think that the National Audit Office have done a good job in picking up this data, but one year can be misleading. There is a clear indication that the reference year was an unusual year. The examples that have been looked at are now showing very considerably reduced rates.
207. Why did you not give the latest figures to the NAO?
(Sir Brian Fender) I do not know in a sense when the data was available.
208. I find it grossly inadequate that we are having to look at a table which is four and a half years out of date. You are now saying we have a different set of figures.
(Sir Brian Fender) They are not
209. Tell us the different figures.
(Sir Brian Fender) You have to wait a period of time for students to complete. The data reported here is whether students qualify. What we have been looking at is the year on year transfer which gives us an indication about whether these attrition rates are falling, and the answer I can give you is that they are much reduced for the high examples that are given here.
210. So taking you back to the worst eight, the last quartile
(Sir Brian Fender) Yes, I am still with you.
211. Have you particularly monitored those over this time and been to those to find out precisely why they are so much worse?
(Sir Brian Fender) As I tried to explain before, nursing is only one subject within our whole remit and the National Audit Office report has focused attention on that. We have got a group which is looking at the factors which affect
212. If it is outside your remit, what about the Department?
(Sir Brian Fender) It is not outside my remit. It is a question of having the information which will allow you to issue good practice. In fact, there is are studies going on both in our sector and for the Department more specifically which will give an indication of good practice and what can be done about improving completion rates which we will publish and disseminate more widely.
213. These figures are already four years out-of-date and yet they seem to come as a great surprise to you.
(Sir Brian Fender) I do not think they are four years out-of-date. The reference year the National Audit Office used was 1997 and we would only have known if nurses were going to complete and if they were qualifiers in 1999-00.
214. Okay. If we turn then to the costing side on page 31, the South Eastern table in number 9 and the price per student nurse, the South East, as one might expect, is significantly higher than Trent or the West Midlands or the South West or Eastern Region but there is also an incredible disparity between it and the London region. I would have expected the table to look the other way round and London to look worse than the South East. I would have understood that. Why is the South East so markedly out of line with all the other regions?
(Sir Brian Fender) Some of the institutions that I am looking at which are in the upper quartile, if we are looking at the same table, the actual institutions which I have got listed here, do include universities from London.
Mr Williams: But we have got a London region and a South Eastern region. Which one is which? Are you saying the London colleges are in the South East and not in the London region?
Chairman: We are going to have to go and vote, I am afraid. You can consider the question and answer it when we return.
The Committee suspended from 6.42 pm to 6.48 pm for a Division in the House
Chairman: Gentlemen, I am sorry for the delay. Mr Williams?
215. You have probably had time to look at it again.
(Sir Brian Fender) We have and we were grateful for the opportunity.
216. So long as we get the answer. My basic question was simply why is it that the South East is not only out of line with other parts of the country, as one might well understand, but out of line with London? I suspect there is some degree of confusion which you can clear up.
(Sir Brian Fender) I hope so but you will be a bit surprised at the answer. The answer is that five of those bars in the South East are one institution, Greenwich, and the reason is that some of these costs have been consolidated, in other words the whole programme has been priced and in other cases individual parts of the programme have been priced and are recorded in this bar chart, so the South East turns out in the bars that you have been looking at to be Greenwich. There are reasons why the Greenwich figure is higher, and I can give you them if you wish, but essentially capital charges were negotiated into the contract and there was a contractual requirement not to make transferred staff redundant. You might be pleased to know that the contract was reduced in value in 1999-00 by a factor of two million, so it would no longer be abnormally high.
Mr Williams: Thank you, Chairman.
217. Thank you very much. Can I ask you still to have a look at that after the meeting and see if you need to come back to us because even given your five there are still three more that are above the highest London region number.
(Sir Brian Fender) I am happy to give you a note on that.
Chairman: Thank you for that. You have got a number of other notes of which you will be notified. It just remains for me to say to you thank you very much gentlemen. It is a very important issue.
15 Note: See Evidence, Appendix 2, page 23 (PAC 152). Back