Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 695 - 699)




  695. Good morning. May I welcome you to this morning's session of the Committee and welcome our witnesses? We are very grateful for your co-operation with our inquiry and your presence here today. May I ask you each to introduce yourself briefly to the Committee, starting with you Mr Goldstone?

  (Mr Goldstone) David Goldstone. I am Chief Executive of Partnerships for Health which is a company which has been set up to implement NHS LIFT.

  (Dr Stanton) I am Tony Stanton. I Chair the Practice Premises Sub-Committee of the BMA's General Practitioners' Committee.
  (Dr Fradd) Simon Fradd. I am joint Deputy Chairman of the GPs' Committee of the British Medical Association.
  (Dr Dixon) Michael Dixon. I am a GP and Chair of NHS Alliance which in this forum really represents the local people, professionals and primary care managers trying to run primary care trusts.

  696. May we begin, before we go on to look at the capital aspects of our concerns, by asking one or two points about commissioning of health care by PCTs within the private sector? One of the issues which I have a concern about at the moment is that there is very limited information as to the extent of activity in respect of this area. I do not know whether our colleagues from the BMA or you Dr Dixon, have any ideas on what the levels of activity are relating to local arrangements under the concordat with the private sector.
  (Dr Fradd) The problem we have is the shortage of resources within primary care trusts. As things stand at present, any commissioning of services within the private sector is at the cost of the NHS.

  697. Can you explain what you mean by that?
  (Dr Fradd) If you only have a fixed quantum of money, not sufficient to purchase services within the secondary sector within the NHS and you move resources elsewhere, then obviously there is less for your local NHS trust to be resourced with. In most areas the level of activity is still very small because those decisions have to be made and there are demands within the secondary sector which are almost impossible to meet. We have things like the cancer targets and we find that routine elective surgery is coming almost to a halt in many parts of the country. Having said that, we have no objection to the concept of using all the spare capacity there is, both within this country and with certain protections within Europe, but separate resources for that must be identified, otherwise all you do is shift the waiting list onto the NHS and remove some of it within the private sector.

  698. Are you saying that among your members the possible impact on the local secondary or tertiary sector is a real issue of concern at the present time? That is an issue which your members are presumably raising with you.
  (Dr Fradd) Yes, but having said that we are actually in favour of using any spare capacity. If we build an NHS, which we hope is going to happen, to a capacity which will meet the then current levels of demand, there will be no perceived improvement in the service if we continue to have one million people on the waiting list. Therefore we need to seek other ways of dealing with the backlog. We are not proposing that we build an NHS with vast spare capacity in order to remove backlog.

  699. When you talk about spare capacity, there are different meanings to that term. One of the issues this Committee has looked at in the past in respect of mental health is the extent to which we purchase from the private sector within mental health. One of our areas of concern was that the extent to which we do use the private sector in mental health may in some respects retard the appropriate development of better facilities in the NHS. Is that an issue which is of concern?
  (Dr Fradd) We should like to see a system where this was temporary. When I use the word "temporary" I am not talking about a few months, I am talking about many years until we can build the capacity within the NHS. The commitment really is to an NHS which is able to provide services as agreed will be provided by that services to the best possible standard. All we are looking for is breathing space in order to build capacity. That brings me back to my point of the need for a separate tranche of funding so that the development of the NHS can continue.

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