Examination of Witnesses (Questions 160
- 179)
MONDAY 21 OCTOBER 2002
MR RICHARD
DOUGLAS, MR
ANDY MCKEON,
MR GILES
DENHAM, MS
MARGARET EDWARDS
AND MR
ANDREW FOSTER
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.
Chairman
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.
Chairman
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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