Examination of Witnesses (Questions 20
- 39)
MONDAY 21 OCTOBER 2002
MR RICHARD
DOUGLAS, MR
ANDY MCKEON,
MR GILES
DENHAM, MS
MARGARET EDWARDS
AND MR
ANDREW FOSTER
20. Thank you. That was useful because I was
not clear from the breakdown. By 2007/2008 will the United Kingdom
total health expenditure on current plans be higher than the unweighted
European average?
(Mr Douglas) Yes, it will be. On current plans we
will be 9.35/9.4 per cent. The current unweighted EU average is
8 per cent.
21. What is the projected?
(Mr Douglas) We do not have projections for the forward
EU average, we are assuming that it is not going to move significantly.
22. Why do we assume that if we are moving quickly
and they are not?
(Mr Douglas) In the evidence over the last 10 years
the average has not varied significantly, it has varied between
7.7 per cent and 8.2 per cent for the last 10 years.
23. Okay. By 2007/2008 how will the United Kingdom
compare to Europe in terms of the share of public sector contribution
to total health spending?
(Mr Douglas) Assuming that the share remains the same
in the EU countries, the EU share is currently 6 per cent of the
8 per cent and we will be 8.2 per cent of the 9.35 per cent.
24. What basis do you have for that? We know
there is a lot more that the Health Service has to pay for now
compared to a number of years ago?
(Mr Douglas) Assuming overall proportions stay the
same we have made the assumption that as there have not been significant
shifts over the past 10 there would not be over the next five
or six.
25. What has been the United Kingdom shift over
the last six years, has it been significant for the past 10 years?
(Mr Douglas) I am afraid I will have to see if I have
the figures. The United Kingdom was 6.5 per cent in 1991, rising
to 7.3 per cent in 2000.
26. Can you give me the European ones again
for 1991 and 2000?
(Mr Douglas) For 1991 the average was 7.7 per cent
and for 2000 it was 8.0 per cent and it peaked as a proportion
at 8.2 per cent in 1995/1996.
27. We obviously had a slightly better increase
and that may be due to government, it may not be, it may be because
of the increased demands. Could you provide evidence for the last
10 years of European spend so that the Committee can have a look
at it before we give it to the minister?
(Mr Douglas) We can give you a figure for the EU average
and every EU country we can provide you with that help.
28. Okay. Again looking at your response to
the comparative health spend, you have assumed that the share
of private spending will remain static, 1.15 per cent. I was fairly
convinced this had been rising over the past five years at least.
Can you tell me what premise that is based on, please?
(Mr Douglas) We used them on the latest data we derived
from the Office of National Statistics. I am not aware there has
been any significant rise, there might have been a small increase,
but I am not aware.
29. Can you check that? I think most people
would accept that the sign-up to private health care plans has
been fairly static and there has been a big increase in the number
of people paying for one-off operations.
(Mr Douglas) My understanding is that has not had
a significant impact as a proportion of GDP, but I will have to
check. It may well be that that has not shifted them significantly.
Dr Taylor
30. Can I confirm something on those figures,
it strikes me as very odd it remains at 1.15 per cent for the
next however many years, however it is when there is going to
be an increased use of the private sector by the NHS? Are those
figures hidden from the private sector?
(Mr Douglas) They are public sector funded, they are
within the public sector figure.
31. The amount spent in the private sector is
going to go up a vast amount and a lot of that is coming from
public funds.
(Mr Douglas) The amount spent in the private sector
will increase as we increase the plurality of providers. In terms
of NHS spending it will mean an NHS spending rise.
32. Can you give any assessment of the impact
of the European Working Time Directive on doctors availability?
(Mr Foster) We have been conducting a dialogue principally
with the Royal Colleges and also the BMA across the summer which
has concluded there is really a huge plurality of solutions to
complying with the Working Time Directive depending on the medical
speciality concerned, depending on the size of the hospital we
are talking about and the nearness to other hospitals. The approach
that we are taking offers effectively a menu of compliant solutions
to local health communities and to take next year as the planning
year to comply with that. Because of the plurality of solutions
it is difficult to give you an answer to your question at this
stage.
33. It will be looking at sharing expertise
and doctors rather than a wholesale closing.
(Mr Foster) The NHS is in expansive mode I do not
see any room for closing services but reorganising the way we
do things to make best use of our resources.
Chairman
34. Can we move on to the concordat. Your Department
undertook a survey about a year ago, as I recall, autumn of last
year, on how much acute care was being purchased by the NHS, what
specialties and what prices. Can you tell us the response to that
survey? Obviously our Committee when we look at the NHS in the
private sector it was interested in exactly how the concordat
would work in practice? A number of us had serious doubts about
it, as you are probably aware. A number of us were told in our
own areas that it was a preference for spending concordat money
within the NHS more effectively. What was the response rate to
that survey? What did the survey tell you about the purchase of
the acute care?
(Ms Edwards) We did commission a survey of all NHS
providers to identify what price they had been paying and what
use had been made of the private sector. Unfortunately the survey
was not well responded to, about half of all providers responded.
On that basis the decision was made that the evidence that we
got from the survey was not reliable enough to publish and we
have not published a survey. We have asked for it to be reworked
and we have gone back to the providers. We thought on the evidence
we did get it was too important an area not to pursue and we have
asked to redo the whole survey to get the information again.
35. What kind of conclusions do you draw from
that exercise? Is it normal for there to be such a limited response
to a fairly important questionnaire?
(Ms Edwards) It was first time we had done the survey
and we have shared the limited information we received back with
some of the chief executives and said, this is the information
we can provide you with and this can be used to encourage them
to cooperate with the survey in the future. We think this is really
helpful. It was not a good response and we were very disappointed.
36. Is it fair to ask, can you give us a rough
idea of what the 50 per cent said about what they were purchasing
and what their comments were. We do note the questions asked and
what the overall impression given was.
(Ms Edwards) One of the key comparisons with reference
costs response we got indicated on average the NHS was paying
slightly higher. One of the reasons for that is the NHS tends
to spot purchase within the private sector and they do not enter
into a planned basis at the beginning of the year. Particularly
towards the end of the year we see an increase in the amount of
contracting right towards the end of the year. We are encouraging
through the capacity planning work to contract on a much smoother
basis, on a planned basis and that is one of the reasons we have
been able to reduce the costs to get them matched with NHS reference
costs. It is difficult to compare it to such a small group of
patients and the case load is different and it has come out slightly
more expensive.
37. Did you come to the conclusion those managers
who were aggrieved about that point may have been more likely
to respond to the survey?
(Ms Edwards) I do not think we had any information
to say that one way or the other. With the 50 per cent response
rate on a relatively small activity it starts to get very difficult
to get reliable figures.
38. You are re-running this now?
(Ms Edwards) Yes.
39. When do you anticipate the results being
available?
(Ms Edwards) I do not have the date on me. We can
get that to you when we have that information.
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