Select Committee on Health Minutes of Evidence

Supplementary memorandum by the Association of Community Health Councils for England and Wales (PS 2A)


  1.  Under current conditions, the Concordat is necessary because the NHS in England (especially in London and the South East) does not have the capacity to meet the ambitious targets for waiting lists and times in the NHS Plan in the short term. The use of private sector hospitals in England can help to fill the gap. However, it may not be sufficient on its own to do this safely—or even at all.

  2.  One acute trust (St. Georges's Healthcare NHS Trust) managed to have 350 elective in-patients treated successfully under the Concordat, enabling twice as many admissions through its hardpressed Accident and Emergency Department that winter (2000-01). To achieve this, a rigorous procedure was applied:

    —  The case mix of those selected took into account clinical appropriateness as well as waiting list factors.

    —  There was a clear procedure for dealing with clinical complications.

    —  Responsibility for the scheme lay with the Director of Operations of St. George's.

  It was a successful scheme; there have been no complaints thus far—rather compliments and letters of appreciation from patients.

  3.  Last winter (2000-01) commissioning under the Concordat was restricted to NHS Trusts. This summer the Department of Health announced that Primary Care Trusts (PCTs) would be allowed to commission under it in future. There are issues about the ability of PCTs to commission acute services knowledgeably. There is also a probity issue given the government regime as it has developed in PCTs.

  4.  Monitoring under the Concordat could be improved by extending the visiting rights of Community Health Councils (CHCs) in England by secondary legislation to all relevant independent and voluntary providers of health care. This could be done in the current session of Parliament. This would be without prejudice to the eventual creation of Patients' Forums relating to NHS Trusts and PCTs with similar powers by statute. It could be improved also by increasing, or at least maintaining, the minimum frequency of visits to independent and voluntary hospitals by the inspectors, who will be reporting to the Care Standards Commission from 1 April 2002. There may be a particular problem this winter (2001-2) as existing registration and inspection staff prepare to transfer from Health Authorities. In these circumstances, early action to extend CHC visiting rights (and support the increase in activity and responsibility appropriately) would be particularly important.

November 2001

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