Examination of Witnesses (Questions 200
MONDAY 21 OCTOBER 2002
200. Having now notched up two caesareans, have
you any reasons why the caesarean rate is increasing so dramatically
and if not are you commissioning any research into that?
(Ms Edwards) I do not think we have the
(Mr Denham) The one piece of work that is going on
is the NICE advice on what is actually the optimum level and that
will have to be done on the basis of the best evidence that they
can assemble, that is what their job is.
201. Have there been any corresponding decrease
in problem childbirths?
(Mr Denham) I do not think we have any research I
am aware of. What we will do now that we have this raft of questions
is to take them away.
Chairman: Do any of my colleges have any further
202. I think we have let them off lightly because
we have not got on to PFI. I have one question on PFI, it is really
a request for further information. I gather from table 546 j that
the PFI finance capital expended for 2002/2003 is expected to
be 783 million. I also gather that the repayments this year total
£315 million, that is obviously the unitary payment, which
includes services as well as interest and capital. If you reckon
in very rough figures that the figure for capital borrowed plus
interest is a bit less than half of the total that does work out
that one is paying something like 17 per cent of the 783. What
I would like is a forecast year-by-year for the next 30 years
of what we are going to be paying315 million this yearnot
including the service cost, just the interest and the capital
cost year-by-year for the next 30 years?
(Mr Douglas) Excluding the services element?
203. Yes, because the services element we would
have to be paying in any case.
(Mr Douglas) Okay.
Dr Taylor: Thank you.
204. Can I ask a couple on PFI. In Table 5.4.5
(a) you show increases to the capital costs of PFI schemes. In
Hull and East Yorks, for example, it says increased costs are
due to increases in the building price index. I want to know whether
it was considered to try and transfer that risk or whether those
sort of risks are transferred in any of the PFI projects.
(Mr Douglas) That has been the change
from the strategic outline case so we would not have transferred
the risk on that.
205. I see, so the increase is not from when
the project started?
(Mr Douglas) No, it is not from close.
Julia Drown: Would that be the same with the
one above, Pinderfields and Pontefract, where it is changes in
NHS Estates Departmental Cost Allowance
Chairman: Be careful on that one, Julia!
206. I am just interested.
(Mr Douglas) I am double checking on
the dates on the Pinderfields and Pontefract one. If there was
a change because we had changed the specifications, it clearly
would not be a risk we transferred to the private sector and a
departmental cost allowance for a better patient environment would
be one that we would impose on the private sector. So I would
need to check the dates at which they were done. The Hull and
East Yorks is specific about it being from the SOC and I would
have to double check the other one, but basically the principle
will be if it is a cost that we were responsible for then we would
bear it; if it is a risk the private sector should have managed,
they would bear it.
207. Can I just ask a brief question on the
Race Relations Act. Although you provide evidence of the work
that the Department has done to meet its requirements by 2002
to have a strategy in place, your answer on 3.11.2 seems to indicate
that the Department has taken no steps to ensure that every other
bit of the NHS has fulfilled its requirements. I know that responsibility
passed to the strategic health authorities but did the Department
not think that it had some responsibility to ensure that the NHS
complied with the Act?
(Mr McKeon) Yes, we have been assisting
through a variety of means set out in the previous question in
order to help compliance and we are now considering looking at
a survey of new organisations because there have been a lot of
new organisations in the NHS since 1 April, of which strategic
health authorities only came into being formally on 9 October,
so in the light of their new establishment now is the time to
start thinking about complying with the Race Relations Act and
ensuring that is followed through appropriately at that level
and down to trusts and PCTs.
Chairman: If there are no further questions,
can I thank our witnesses for a very helpful session. You have
promised to follow up on a number of points. You will be aware
that we have got the Secretary of State in a fortnight. It would
be helpful, for example on Sandra Gidley's question when she talked
about the survey which referred to the EU states' figures, if
it is possible to let us have that. We would be very grateful
because that clearly will be an issue we are likely to raise with
the Secretary of State. Otherwise, we are very grateful to you
for your help.