Examination of Witnesses (Questions 695
- 699)
THURSDAY 29 NOVEMBER 2001
DR MICHAEL
DIXON, DR
SIMON FRADD,
DR TONY
STANTON, OBE, AND
MR DAVID
GOLDSTONE
Chairman
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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