Examination of Witnesses (Questions 200
- 219)
MONDAY 19 NOVEMBER 2001
MR NIGEL
CRISP AND
MR DAVID
FILLINGHAM
200. How?
(Mr Crisp) Specifically by the mechanism that is in
place, which is that there should be a review with each consultant
each year on the basis of what their job programme is, and as
part of that they should be looking at what they are doing in
the private sector, and they need to make a return on it.
201. But the 10 per cent is not a matter of
the number of contracts, it is the amount of money. Who monitors
the 10 per cent is 10 per cent of salary?
(Mr Crisp) Trust chief executives.
202. And you do not know on what basis?
(Mr Crisp) I was explaining on what basis, which is
that there is an annual meeting.
203. If, for example, of the 20,000 all were
full-time, we would be needing to employ an extra 2,000 consultants
just to make up the 10 per cent they are doing outside the Health
Service?
(Mr Crisp) If we want to talk about consultants' workload
there are a number of other figures you want, such as how many
hours consultants are working for the NHS.
204. It is almost impossible to get that from
the chief executives. I have been trying with mine in Wales for
some time to get the figures, and they refuse to give them.
(Mr Crisp) There are a lot of studies which show by
and large the vast majority of consultants, part-time or full-time
in this country, work longer than the hours for which they are
contracted and do more work than the hours for which they are
contracted, and their 10 per cent private work is Saturdays or
Sundays or whatever.
205. When one of my colleagues asked about operating
theatres and the 8.30 to 5.30 timescale, you said that operating
theatres were not the bottleneck.
(Mr Crisp) Yes, generally.
206. So what is the bottleneck?
(Mr Crisp) Staff.
207. Consultants and other staff?
(Mr Crisp) Nurses more than doctors.
208. So if the doctors who are working part-time
elsewhere were not, we would be able to make more use of the theatres
which are already there and are under-utilised?
(Mr Crisp) That is certainly potentially true, but
the bottleneck is not actually consultants, the bottleneck generally
is the ancillary staff and nurses who actually provide those services
rather than doctors. You will no doubt also have come across doctors
who say they would like to operate more but they cannot get the
facilities, by which they normally mean staff.
209. Do you have any measure of the physical
surplus capacity which is in there? Working 8.30 to 5.30 means
there is a less than 50 per cent usage of the hardware facility.
(Mr Crisp) Of some of the hardware facility.
210. So one could use that much more intensively.
(Mr Crisp) But it is only a bit of the system, because
by and large you need beds to put the patients into afterwards—not
always, there are day surgery units which operate on longer hours,
day surgery units which operate 6 in the morning until 10 at night
to take advantage of that. We have more theatre space but we do
not necessarily have the beds and the staff to go with it.
211. You were rather dismissive when one of
my colleagues—Geraint I think—raised the issue of
bed blocking. You said that a whole series of interventions are
needed but you did not seem to regard it as a matter of some significance,
whereas most of us in our own constituencies probably think it
is a matter of some significance.
(Mr Crisp) My tone of voice obviously came over wrongly.
I think the two biggest issues we are facing are bed blocking
and staffing, the two issues we are talking about, and that is
why, during the course of this year, we have invested an additional
£300 million in bed blocking and that has not effectively
happened for anything else. It is because chief executives from
Croydon and elsewhere have pointed out to us this is the most
significant problem they have, or one of the two.
212. Alan Langlands pointed this out some years
ago at a hearing here. He made the point, which is a valid one,
which is a point for politicians, not for you, that while you
have the division between social services with responsibility
for post-hospital care and the hospitals who are left saddled
with the people who are not accommodated by social services, you
are never going to be able to use the facilities efficiently.
So how would the 300 million resolve it?
(Mr Crisp) That was the point of the fact that this
money has come to social services on the understanding that they
spend it alongside health and that they use the Health Act flexibilities
to do that, which are about joint budgets, joint management and
so on, which is a move towards systems integration if not actually
merger of the organisations. It is precisely for that reason.
213. The other major problem in terms of surplus
capacity which several of my colleagues have touched on, Mr Trickett
in particular, is the health authorities' blindness across the
borders and their inability to look beyond their own borders to
use what is clear surplus capacity perhaps a few miles from where
they are working.
(Mr Crisp) Your colleagues have shown the problems
at particular boundaries. Next year, we will have primary care
trusts, which will be in general smaller than the current health
authorities, making these decisions closer to their patients perhaps.
They will therefore be able to make the sort of decisions we are
talking about so in an area like Mr Trickett's health authority
they could use the other hospitals rather than the one they usually
refer to.
214. Is there any reason to think that a multitude
of small authorities will be more efficient in their use of facilities
than a relatively small number of large authorities, which should
be able to find out where the surplus capacity is?
(Mr Crisp) The point which I think you and colleagues
have been making is that health authorities may be a bit distant
and bureaucratic and look at things on a planned basis. Primary
care trusts are going to be very interesting, new organisations
with a chair, a chief executive and lead doctor, and I expect
on the basis of that they will be making decisions in a rather
different way and more locally.
215. But if you are having a diffusion of decision-making,
you also need a diffusion of information to people.
(Mr Crisp) I agree.
216. Our experience in this Committee has been
rather sad as far as IT is concerned in the Health Service. We
had the disaster with Wessex and then we had the NHS Hospital
Information Service which lost £60-odd million. Have we made
any worthwhile progress in the extension of the use of IT within
the Health Service?
(Mr Crisp) This Committee is managing to range over
most of the current issues in the Health Service. There is a lot
of work which has gone on in putting in infrastructure over the
last two years which is starting to bear fruit. For simply getting
information to GPs about inpatient and outpatient waiting times,
faxes will do and those arrangements are in place. They should
have that information anyway.
217. You say, "faxes will do", I suppose
it seems rather bureaucratic when you can just get information
on the screen. With dozens of doctors in any one hospital area
making arrangements in any one day it would obviously be far better
if there were an IT solution rather than a fax solution?
(Mr Crisp) I misunderstood you, I thought you were
asking the hospitals to give the GPs information, I am saying
that they already have that, they can get that through whatever
route is appropriate. If you are talking about an electronic booking
system then there are clear plans to introduce that by 2005, and
I think we just said we are on time to do that. That will allow
people to book through their GPs.
218. Now we are back on sensitive ground, you
have plans to do that, we have been through other plans, do your
plans have a grandiose software or hardware project at the heart
of them or is there something less sophisticated?
(Mr Fillingham) We certainly need to invest in information
technology in order to deliver electronic systems. We do not envisage
grandiose national schemes to do that. Some local organisations
have their technology in place, King's Hospital in London have
24 general practices already linked-in electronically, three quarters
of all their appointments are booked electronically. What used
to take three weeks takes a matter of minutes. We need to get
the rest of the NHS up to that kind of level and standard. We
are learning some lessons from IT development, the intention is
very clear, national specifications, clear project management
to make sure benefits are delivered, systems that fit well with
what we already have in existence and which deliver the end result
overall.
219. With the PFI hospitals do you work on the
planning possible throughput as far as the use of their theatres
are concerned? Do you work on the same assumption in terms of
utilisation of the physical resources of their operating theatres
as you apply to existing hospitals?
(Mr Crisp) It varies. And as I said, for some theatres
we do use them more extensively than 8.30 to 5.30 for day procedures
and there are some that work on Saturdays. By and large, planning
has been done on the basis of what we do now, plus an estimate
of some improvement.
| 
