Examination of Witnesses (Questions 180
- 199)
MONDAY 21 OCTOBER 2002
MR RICHARD
DOUGLAS, MR
ANDY MCKEON,
MR GILES
DENHAM, MS
MARGARET EDWARDS
AND MR
ANDREW FOSTER
180. Do you not feel that is a weakness of the
system if we are attempting to direct policy away from dependence
on care homes and nursing homes if we forget about people who
have resources who are not featured in the evaluation of each
local authority? If you are saying to my authority it has got
proportionately more people in care than anywhere else, I would
say these are all rich ladies from Harrogate who have come here
because they choose to come here because it is such a nice place.
It does not seem to add up to an analysis of the situation. What
steps have you taken to pull in that information and does the
Care Standards Commission have any role in assisting you with
that kind of material?
(Mr Denham) I think the Care Standards Commission
will certainly in time have comprehensive data on the care homes
it is registering and the number of places that are in those homes
for which they are registered. They have certainly got a requirement
to report annually to the Secretary of State on the state of the
care homes sector. I am not sure that we will expect them to tell
us who is resident as a so-called self-funder and certainly the
performance indicators that I have talked about are entirely based
on council supported residents, not on those who are paying for
their own care who will have made their own decisions about whether
they want to enter a care home or not.
Chairman
181. The other pattern you have picked out from
the SSAs is that unitary authorities tend to receive their SSAs
for social services via higher average amounts than other classes
of authority. Is that something you have tried to analyse in more
detail? Is that something you have tried to look at in the review
of the formula?
(Mr Denham) Councils make their own decisions
on what they spend so in a sense it is quite difficult for us
to know without talking to all of them individually about why
they have reached the decisions they have reached. The SSA formula
is a local allocation mechanism for a national sum of money. We
have looked at demand for social services as part of the Spending
Review certainly, and that is what in part led to the additional
resources that have been put in. But the distribution of those
resources has traditionally, as I say, been done on a formula
basis. We have certainly underpinned the system by looking again
at the formulas used to see whether they make sense, and that
is why there has been a period of consultation, to get people's
views on whether the formulas used do make the best sense.
182. So you do not know why whether it reflects
particular needs or costs in the unitaries as against other authorities?
(Mr Denham) Unitaries have a fairly widespread mix
of needs. They are not a uniform set of authorities. There would
be batches of them in particular positions but they range in terms
of levels of deprivation quite broadly, so it does not seem to
be, as far as I can see, just down to the simple point they are
all in a particular category.
183. It is interesting that a pattern has come
out and it might be something about fixed costs or something in
the way they are run.
(Mr Denham) I guess so. People will no doubt make
their views known. As with the NHS we get a pretty wide range
of views.
184. Moving on to maternity services, if I may.
Within the general expenditure data you gave us maternity services
used about five per cent of NHS funds. Does that include the spend
on litigation?
(Mr Douglas) No.
185. It does not, so there is litigation on
top.
(Mr Douglas) Litigation is within the "other"
spend figure. It is not allocated across any of the services.
186. Remind me how much is "other".
Would it increase it significantly by five or six per cent?
(Mr Douglas) I am not sure how much of it. The "other"
figure at 2000/01 prices is about 12 per cent.
187. It would be interesting to know that because
I imagine a large part of it is maternity related. If it is easy
to do, not if it is a lot of work —
(Mr Douglas) We will see if we can pull out the maternity
element litigation figures.
188. Obviously one of the other things you point
out in your report is that the Department is collecting some of
the maternity data and we recognise that major progress has been
made with timeliness. In terms of getting the data from units
which are not submitting what is called "maternity tail"
data, what is happening on that? What is happening on collecting
data from the private sector and improving collection of data
from outside hospital, particularly home births, which is a key
issue?
(Mr Denham) I do not think we have an answer, can
we give you a note on that?
189. Okay. Information Strategy on children
is included in maternity services within it, will that look at
this issue of data collection and deliveries in England linking
those with the relevant data about mothers and babies?
(Mr Denham) It will certainly look at information
needs. At this stage I cannot say how far that has got nor can
I pre-empt what proposals it will come up with. The selection
of complete maternity data is a big issue. As you can see from
the figures the percentage collection is not complete and it does
not represent a collection of all births because it does not include
home births, as far as I can see, or births GPs are responsible
for, except where in hospital. The most helpful thing is if we
cover what state the maternity module of the NHS has reached in
terms of information.
190. We would like an update on where you are
getting to in terms of the maternity data project, which was supposed
to be complete by April 2003, that would be useful for us. One
other question within it, there is a huge variation in terms of
deliveries, if we look across the regions in the south west 42
per cent of mothers are giving birth in a consultant ward and
that goes up in the north west to 86 per cent, the northwest are
not getting as much choice as against the south west. What is
you comment on that?
(Mr Denham) It could suggest a number of things, it
may suggest the reverse.
191. I doubt it.
(Mr Denham) The issue that I know is being looked
at is NICE has taken on the issue around caesareans, as opposed
to asking about where deliveries take place because at the moment
we do not have data. Home birth is a classic example, we do not
have data as far as I know.
192. You mention caesareans there and NICE is
going to come up with guidelines on it as you say. What will happen
in terms of delivering that across the country, if we look across
the south west we see Truro had 15 per cent caesarean deliveries
compared with my local hospital, the Princess Margaret in Swindon,
which had 28 per cent.
(Mr Denham) At the moment we do not know what the
optimum level is.
193. Most people would seriously question 28
per cent.
(Mr Denham) Without knowing the locality and without
knowing what types of mothers—
194. We are not that strange in Swindon.
(Mr Denham) It could be where else they are coming
from.
195. What management action is being taken?
(Mr Denham) The management action being taken is around
NICE.
196. It will not change things very quickly
on the ground, will it?
(Mr Denham) I think it will probably have more impact
than anything else at the moment.
197. There are already guidelines set out. People
referring to the World Health Organisation saying caesareans 10
per cent, we accept it is a bit more than that now, but 28 per
cent is not—
(Mr Denham) Without knowing the breakdown—
Chairman
198. Do you have any knowledge—looking
at these percentages it interested me as well—the extent
to which certain areas may have mothers-to-be who would more often
choose to have a caesarean?
(Mr Denham) There are three categories
mothers will fall into, emergencies, elective caesareans are caesareans
where the clinical view is that somebody needs one, maternal choice,
which is the type you are referring to, we believe to be small,
but I do not think we have separate figures.
(Ms Edwards) I am not aware of the figures but it
does vary quite dramatically. There are parts of the population
where that is an issue.
199. I am conscious of what is happening in
America and the extent to which they are having caesareans there.
When you look at these figures do you have any opinion as to the
proportion of the 28 per cent you are talking about, would they
be choice?
(Ms Edwards) We do not have that centrally. Locally
having run a hospital with a very low rate and one with a very
high rate we did have that information locally. I imagine that
information is kept locally.
Julia Drown: That is fine. Thank you
Chairman: Mr Burnham, with the most recent experience
on the Committee.
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