Examination of Witnesses (Questions 180
- 199)
MONDAY 19 NOVEMBER 2001
MR NIGEL
CRISP AND
MR DAVID
FILLINGHAM
180. So that I am not going off in a tangent
here, I want to be absolutely clear, have you chased down those
figures and those cases and found that they do, in fact, refer
to those particular specialties, so that you can now say to this
Committee with confidence, "the reason for that is that they
happen to be orthopaedic and trauma".
(Mr Crisp) We do know what the specialities are but
we have not asked those individual consultants, neither has the
National Audit Office asked those individual consultants, why
they think that is, or what sort are inappropriate referrals.
It would be interesting to see whether the GPs in those cases
also thought they were inappropriate referrals. We have not done
that with these 40 people.
181. That is something where I think it would
be helpful if the Committee could have further information from
you?
(Mr Crisp) If we know who these 40 people are, and
I do not know whether we do or not.[5]
(Sir John Bourn) I will certainly make
the information we have available.
182. Thank you. Could we also have a note about
what Mr Trickett was asking about on extra contractual referrals,
out of area treatments, as you now call it, and the pattern and
the penalties that are applied for out of area treatments?
(Mr Crisp) The pattern for out of area treatment is
the levels and specialties, and so on, and then the question of
whether there are any penalties, you mean penalties on GPs?[6]
183. Yes, such as were discussed earlier. Under
the 42nd hearing of the Committee in paragraph six, this is when
we are talking about the referrals which could be allocated equally
across all consultants it says, "existing guidance requires
that patients are told in their appointment letters that shorter
waiting times may be available with alternative consultants and/or
providers", this is largely what my colleague Mr Steinberg
had been approaching with you at the beginning. Now what I would
be grateful for from you, given that was being said in 1994 is,
how is that guidance monitored and how is it enforced, because
it certainly sounds from Mr Steinberg's experience that it is
not?
(Mr Crisp) I think you are referring to the fact that
in 1994 we were running a different system in the Health Service
which tends to get called by the name of the internal market and
that that was guidance that was appropriate to 1994. I suspect,
although I would be happy to check, that that guidance does not
still continue.
184. That guidance does not apply now?
(Mr Crisp) I would need to look at the details of
it but the way you have described it sounds to me as though—[7]
185. I understand that things change, often
for the better. What I would simply ask you is that given the
experience that Mr Steinberg has outlined do you not think it
would be appropriate to provide patients with that information,
that they might be able to get a shorter waiting time if they
went to a different consultant?
(Mr Crisp) There are two elements there, the first
bit of it is, do we provide people with information on the internet
or, indeed, elsewhere about waiting times throughout the country.
That is something that I think we will certainly be looking at
in advance of being able to do it in 2005. The second point is,
do patients have a choice based on that information. The second
point, as I have said our current Secretary of State says that
he wishes to see how we can improve choice within the service,
so let us look at it, but let us look at it in a way that does
not have some of the counter-consequences and problems associated
with it which may have been when it was last done.
186. I will take that as we will look at it.
Thank you very much. It has been quite a political afternoon in
many of the questions that we have had, particularly on paragraph
2.22, I only want to touch on the waiting list waiting time matter
briefly, it is to ask you this, we have heard a great deal about
the distortion of clinical priority because of political priorities
effectively and that had we not concentrated on waiting lists,
and you said well, of course, we are now concentrating on waiting
times.
(Mr Crisp) Yes.
187. Why should it be any less likely that by
concentrating on waiting times there should be in any given circumstances
less likelihood of a distortion of clinical priority?
(Mr Crisp) I think the answer—
188. I do not want you to rehearse the answer
that you gave earlier. I understand fully about there is no need
to distort clinical priority, I understand that argument, and
it can be achieved in other ways. What I am putting to you is
this, in exactly the same way that the waiting list and the desire
to cut waiting list could have distorted clinical priorities so,
surely, any political priority such as cutting waiting times can
do exactly the same?
(Mr Crisp) I think it is very important to make another
distinction and to move away from politics here and to patients
and professionalism, if we actually look at the area where we
are being specific about waiting times, broadly at the moment
within cancer they are broadly coming out of the cancer plan and
also the coronary heart disease plan, which has been built up
from the expertise around the country and not from political routes.
The things that you will see in the NHS plan about the requirements
to get from urgent referral to completion of treatment within
two months of surgery is a clinical priority, a different priority,
rather than a political one. I think there is a strong driver
there to say that that is how we are building up those standards.
I think that will help in the context you are talking about because
we will be starting with the most serious conditions anyway, like
cancer and coronary heart disease.
189. Would you accept—I have five more
questions in the two minutes left to me—that any prioritisation
of waiting times could also, in a situation where somebody is
coming up against the maximum allowable under the rubric, bring
about a situation where there was distortion of clinical—?
(Mr Crisp) I think when we are talking about the levels
we are talking about it is clearly a hypothetical point, a hypothetical
possibility that that will happen, but the most important thing
is that people need to have planned what is going to happen to
the patient at the point of entry to the system. If they have
done that, it may go wrong during the course of it in which case
you readjust, if they plan at the beginning that should not happen.
190. Three very easy ones, a fully integrated
booking system by 2005, is that going to happen?
(Mr Crisp) I hear a nod to my left.
191. The second easy question, cancellations
rebooked within 28 days or paid for privately by 2005, is that
going to happen?
(Mr Crisp) That is next year.
192. Goodness me! The third easy question, the
maximum in patient waiting of six months by 2005, is that going
to happen?
(Mr Crisp) We certainly intend it to.
193. If they do not will you be resigning from
your job?
(Mr Crisp) Thank you for that question, I think that
is a policy question.
Chairman: You have been done very well, Mr Crisp.
The last questioner is an easy one, Mr Alan Williams.
Mr Williams
194. Mr Crisp, I want to follow up where Gerry
Steinberg started on the consultants. You gave him a figure of
17,000 to 20,000 consultants. How many of those are full-time?
(Mr Crisp) There are over 20,000, I got that wrong.
I will give you a note on your point, I am afraid I do not know.[8]
195. Not even a ballpark figure, a rough estimate?
(Mr Crisp) I would be guessing. It very much varies
by speciality.
196. The full-time are allowed to do private
work up to 10 per cent of their salary?
(Mr Crisp) That is correct.
197. How much can part-timers do? Mr Steinberg
asked that but you did not give an answer.
(Mr Crisp) Sorry, if I did not. There is no technical
limit, however, they have to agree what sessions they are doing
with the NHS provider, and they have to stick to those sessions.
Therefore the practical limit is what else they can do outside
those sessions.
198. So there is no limit at all on what the
part-timers can do and, unfortunately, you do not know what proportion
are part-time. My understanding is in many cases it is difficult
to get consultants who are willing to be full-time; they want
to be part-time.
(Mr Crisp) Well—
199. I do not need an answer to that because
it was not really a question, it was a statement. How do you monitor
the 10 per cent?
(Mr Crisp) It is monitored by trusts.
5 Ev 25, Appendix 1. Back
6
Ev 25, Appendix 1. Back
7
Note by witness: EL(94)90-Waiting Time Policy-was cancelled
on 30 November 1995. Back
8
Ev 25, Appendix 1. Back
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