Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 160 - 179)



  160. I find it surprising you answer that. Surely we can find out when a person was referred, that is recorded within primary care, and we know when a person is treated. Why can we not calculate the period of time between the two?
  (Ms Edwards) It is actually quite difficult because we have to identify what they were referred for, so it is not a simple case of looking at one hospital computer system and finding that referral, one patient may have been referred for a range of things and you have to track that right through the system and we cannot do that at the moment. By 2008 the NHS plan commitment was total waiting times and waiting for any single procedure regardless of whether that was traditionally in outpatients or inpatients or a whole range of treatments. It is something that we have to move towards. At the moment we do not have the data. We know that we have made improvements in outpatient waiting times and we know about improvements in inpatient day care waiting times, we do not know about the rest of the experience of patients at the moment.

Mr Burns

  161. On the question of outpatient waiting times you publish quarterly the numbers of patients waiting 13 weeks plus for an outpatient appointment, why do you not publish, you may not collect it, from week 1 to week 12?

  (Ms Edwards) We do not collect the data.

  162. Why not?
  (Ms Edwards) We think it is about reducing the burden on the NHS and that is how we ask them to break data down. Last year we were not collecting the number of 21 week plus, we were only collecting the number of 26 week plus, so we do not have anything to compare this year's 21 week plus with because we only started it, that is a new target for this year.

  163. What is significant about the 13 week benchmark?
  (Ms Edwards) 13 weeks, as with a lot of the access targets, was derived from the NHS plan and that involved a lot of consultation.

  164. The 13 week benchmark was used long before the NHS plan. Why 13 weeks? Why not 12 weeks or 14 weeks, why 13?
  (Mr Douglas) It is a quarter of the year.

  165. Right. I am just surprised that given inpatient waiting list figures are kept from day 1 up to beyond twelve months that successive governments have not kept the figures from day 1 for outpatients, which also begs the question, why are they only published quarterly, not monthly like inpatient figures?
  (Ms Edwards) Traditionally they have been produced quarterly. Quarterly gives us a better indication of trends over time.


  166. Can I come back to your answer on the issue of difficulties in actually calculating the full period of wait. I understood the point you were making, I can appreciate the point you were making, do you have any evidence in terms of the referrals by GPs to hospitals where the proportion of referrals would require treatment by more than one consultant? That may be an unfair question to put to you, have you a broad idea, I will not quote you in terms of an exact figure. Do you have a broad idea? If this is a problem what proportion would present that problem?

  (Ms Edwards) I am trying to remember, we do have a number. I know that the number of consultant-to-consultant referrals has increased dramatically over time, much, much higher than the number of GP referrals. We believe that increasingly in specialisation a patient will be cross referred to a specialist within that particular department.

  Chairman: Could you get back to us on that information?

Julia Drown

  167. On social services you give us the SSAs for local authorities—I know that is out for consultation at the moment—the current differences are very dramatic, for example for elderly people where I live in Swindon you get £228 per over 65 per person and that goes up £512 in Hackney and for those in residential care they get £378 compared to £1,093 in Hackney. Is there a recommendation that the differences are too large or where is your thinking going in terms of your view?

  (Mr Denham) The differences are simply related to the formula used and that takes account of a range of things, including local costs and also particularly an assessment of levels of need, because for residential care most people are subject to a residential means test. If you have a particularly deprived population where almost everyone who lives in the borough is going to be going into residential care and getting help from social services clearly then their assessment of the need for resource for that group will be much greater that if you are talking about a part of the country where we have over half of the population in residential care who are funding their own care. That is the reasoning.

  168. What is the proportion across the whole country, it is high anyway, is it not?
  (Mr Denham) From social services it is pretty high, it is six or seven out of 10 people.

  169. By the time you allow for differences it would not effect that difference of three times as much in one area.
  (Mr Denham) It could. Six or seven out of 10 is the national average but there some very wide variations. It is a formula based calculation.

  170. You have not thought that the differentials might not narrow, they just might be different.
  (Mr Denham) They might narrow for a range of reasons. The consultation has just closed I think.

  171. 30th September.
  (Mr Denham) If the area cost adjustment changes that will certainly change what happens to individual councils. If you would like a note on the formulas that were consulted on, we can provide this. One thing we have done is move towards a single, older people's formula bringing together residential and home care.

  172. Within that you are consulting whether the elderly population of Swindon town should just be the elderly population of a particular authority or the elderly population plus any member of the elderly population who live else where but are supported by that particular authority. Surely that has to justified? How could that not be justified, because you will get all sorts of authorities who have people living else where, and the idea that that should not count as part of the population is peculiar?
  (Mr Denham) It is normally based on the resident population.

  173. I do not know what the normal thing is. I know what you are consulting on, should it include both people living in the population or outside or just people living in the population? It seems a strange thing and it seems unfair to exclude people that just live over the boundary.
  (Mr Denham) As you say, it is a question for consultation. People will argue both ways.

  174. What would be the justification for arguing the other way?
  (Mr Denham) I guess people will argue about who is responsible, the so-called ordinary residence test, when somebody moves around the country at what point another council becomes responsible for their care. That has a certain amount of case law behind it. I do not have the details to hand, if you would like a note I am sure we can provide one.

  175. That would be useful. The only population question is the one supported by those people, if you are supported by somebody else, a particular authority then naturally there is not a question over who is supporting them.


  176. This was an issue I recall cropping up when the 1993 care changes came in. There was concern that authorities were receiving resources for people who were institutionally cared for in their own areas, when many of them came from other areas completely, but because the money went to those areas or institutions those attempting to keep people out of institutions were penalised.

  (Mr Denham) I think your answer is very helpful. Over time should you be looking at the population as people move round or should you start from the point where we still have a number of people? We have the preserved rights residents who are placed out of the area from which they are originally moved, which has now become the responsibility of the council in whose area they are living in a home. There are some issues. We will give you a note on the issues.

  177. Can I pick up on this. I am very interested in the way in which there are significant differences between areas in terms of the numbers of people who end up in care nursing homes in the country. Presumably you have some information on where those people are and where they come from—this is the point that Julia was making—looking at the way in which you can analyse the proportionate populations as to the number of people who end up in hospital. My area has more people kept in hospitals who should not be in hospital than some areas. Do you also have the ability from the information you acquire from local authorities to come up with recommendations that certain areas appear to place more people in permanent care settings than others? I know it is difficult because of this broader costing issue that Julia has raised.
  (Mr Denham) What we do—and I think it is one of the performance indicators and published as part of the framework set which will be out in the next month or two—is a population-based estimate of the number of people placed in a residential setting or given intensive support at home, for example. So that is available.

  178. That is a management tool in terms of how you set objectives for each local authority. When there is a review one assumes you look at that?
  (Mr Denham) They are part of the performance indicator set used in terms of inspection of old people's services. It is certainly used in making assessments around star ratings, for example.

  179. Presumably you feel these figures are reasonably refined and accurate bearing in mind obviously there will be people who will privately place themselves. Do you have the ability to obtain the figures in relation to, in my area, Harrogate, where people tend to be a little better off, where they may have arrived from another area to Harrogate? Would you know about these people if there is no local authority support for their placement?
  (Mr Denham) If there is no local authority support, the answer is no we do not tend to. We know a bit more about some of the people in nursing homes now because the NHS is involved. The only information we have on so-called self-funders would be research surveys, which are quite small surveys on the whole and not that recent. We do not have annual data.

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