Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 40 - 59)



  40. Is it possible for the Committee to look at the responses you receive at some point?
  (Ms Edwards) I should think so.

  41. In terms of the point raised earlier on, I certainly had local consultants and managers saying to me that they would have preferred to have been given the freedom to spend this money within the NHS rather than commit it specifically to the private sector. Was that a factor that was looked at within your survey? Would they be able to respond to that point in some way within the questionnaire?
  (Ms Edwards) We did not specifically ask that question. The guidance has always been that they should provide the best value for money. The clear guidance we have given from the Department is to get best value for money from the private sector, as I said earlier, we need to stop some of the spot purchasing going on at the end of the year and spread it. The additional funding put out last year specifically for purchasing in the private sector was at the end of the year and it was recognised because of that there was likely to be some considerable pressure. There was already pressure within the NHS on electives and each economy was asked to look at the situation in their area and they took quite different approaches. What we did get back from the survey showed that there was quite a lot of diversity in approach.

  42. Who suggested that a 50 per cent response was not good enough to publish?
  (Ms Edwards) That was done within the Department in discussions with senior officials.

  43. Have you got a minimum figure for returns on the next one you are doing?
  (Ms Edwards) We have not agreed. We have got a—

  44. What would you reasonably expect? 65 per cent? 60 per cent? Where are we?
  (Mr Douglas) I would hope if we are collecting it on the basis that we want this information ourselves that we would get a significantly higher response than 50 per cent. I will assume that we will get a response sufficient to publish.

  45. Okay, but we are not sure what that figure will be?
  (Mr Douglas) No, but it will be big enough because we will make sure.

Andy Burnham

  46. To push you a little bit further on that, are you surveying PCTs and trusts as part of this survey?
  (Ms Edwards) We have been surveying all NHS chief executives on a commissioning basis.

  47. You indicated last year that costs came out slightly above the NHS reference costs. Was that an average cost?
  (Ms Edwards) The NHS reference was an average cost.

  48. You took an average of the price paid?
  (Ms Edwards) That is right. If you take a cataract, the average costs from the survey were slightly higher than the average NHS cost for the cataract.

  49. As part of our evidence, as I seem to remember, there is a very, very wide variation indeed between some parts of the country and others as to the cost being charged. Can you give us an idea for any one procedure the range in cost that was picked up by this survey?
  (Ms Edwards) I do not have the range with me. The ranges varied geographically and they varied as to time of year and even within very tight localities there were significant variations, but I do not have the actual range with me.

  50. Just from memory, I seem to remember going from thousands of pounds to hundreds of pounds for some of them, big gaps in the costs.
  (Ms Edwards) One of the difficulties we face is comparing like with like and, for example, if you take a procedure like a hip replacement, what is purchased in one area may include recuperation, rehabilitation and physiotherapy but not in another area. We are trying to refine that so we can compare like with like. Some of the figures in the past have included basic work, diagnostics, and others have not, etcetera.

  51. I understand that but is there a concern that given the volatility of the prices that the NHS has been quoted that policies are a year on and yet we are nowhere clearer on knowing what the true value for money is?
  (Ms Edwards) One of the reasons for wanting to get the survey right and share the information with the NHS is to give the NHS benchmarks about what is reasonable to pay. By providing the NHS with information about what is the standard price for a cataract, we should reduce some of these variations by creating those sort of benchmarks.

  52. Is there any evidence in the absence of that that some health bodies have stopped using them for the private sector?
  (Ms Edwards) I have got no evidence of that at all.

  53. In your view is this variation mainly determined by available capacity so that in parts of the country where private sector capacity is more plentiful that is, crudely, where prices tend to be lower, and it is parts of the country where it is not in such great supply where prices are far higher?
  (Ms Edwards) That is one of the major factors when you are talking about providers being able to provide it at relatively marginal rates or having to increase staff to cover the provision. That is one of the reasons we have moved away from the idea of a nationally negotiated contract to allow individual economies to negotiate within the Concordat framework.

  54. In the absence of a reliable survey, you obviously nevertheless gleaned information from last year's patchy survey which has given you some early thoughts. On the basis of that, have you issued any interim guidance to PCTs or to trusts about use of the private sector in, say, particular parts of the country where the costs seem to be far higher than other parts of the country?
  (Ms Edwards) No, not on the back of anything to do with the survey. As I say, we have given limited information on the survey out to the NHS. What we have done is through a process of capacity planning where we are asking each economy to identify their capacity requirements for the next three years, we have asked them as part of that to look at what is available in the private sector and make sure they are making maximum and efficient use of that within their capacity plans, so as part of separate guidance we have been talking to them about making sure they use all the available resources. As I mentioned earlier, within that, in advance, we have given some clear advice that they would get better value for money from the private sector if they entered into medium-term deals rather than negotiating at the end of the year.

Dr Taylor

  55. Moving on to question 1.4.1, the question was how much has the NHS spent on health care provided outside the UK, to how many patients, and what treatments in each year. I was rather disappointed to find from the answers below that the quality of the information available on these is really very poor. Point 5 says: "No precise information is available on the types of treatment covered." Obviously in the one trial that in the South East England has taken place at a £1.1 million cost with 190 patients, I understand, that is considerably more than it would have been within the NHS reference costs. Is that right? Have you any plans to improve the amount of information available, because lots people are actually asking me under E112 when they are waiting for a long time for a cardiac coronary artery bypass how they get it and when they can get it abroad? So it is a fearfully important part to look at and you do not appear to have that much information on it at the moment.
  (Ms Edwards) I think we need to distinguish between the patients who are treated under the more traditional arrangements of E111 and E112 and the work that we are doing to purchase explicitly services like cardiac surgery from abroad.

  56. So that will not be E112?
  (Ms Edwards) No, it is through a separate mechanism.

  57. Do PCTs know about this?
  (Ms Edwards) Yes. What we referred to as our first pilot last year, which was a small-scale pilot where 190 patients were treated through a separate mechanism, unlike with the E112 and E111 arrangements, we paid direct and entered into a planned agreement using NHS funding.

  58. Right, so what is the likely funding under this special agreement for 2002-03?
  (Ms Edwards) We do not have a figure at the present time partly because we encouraged individual commissioners to enter these agreements so we do not have the total. In terms of patient numbers we are looking at very small thousands, 2,000 to 3,000 patients, which are the sorts of numbers we are anticipating going abroad. In addition, there will be some cardiac surgery patients. So not large numbers but significant in terms of the patients treated because these tend to be orthopaedic and cardiac patients.

  59. If we have this questionnaire again next year will you be able to tell us more about the 111s and the 112s?
  (Ms Edwards) I do not know if we will be providing any more detail. Certainly on the ones purchased through the health agreement we will have all that sort of information in detail.

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