Supplementary memorandum submitted by
the Department of Health
INPATIENT AND OUTPATIENT WAITING IN THE NHS
Question 30: How many National Health Service
beds are used for private care?
NHS elective beds are only available for use by NHS
patients. Private patients in NHS hospitals can only use beds
designated as private beds. Of course, if a patient admitted privately
suddenly required unforeseen intensive care this would happen
Private beds are not covered by the Department's
annual beds census. However, Hospital Episode Statistics (HES)
identify 104,000 private patients admitted to NHS hospitals in
Question 112: Why is there such an extraordinary
capacity variation in acute facilities between different health
There are a number of factors which can, at any one
point, impact on the available capacity in an acute trust to deal
with elective inpatient waiting list work. In most instances elective
work requires a mix of theatre time, beds and staff, both clinical
and ancillary. The non-availability of these elements can impact
on the treatment of patients from the waiting list.
Emergency pressures, for example, can reduce the
amount of available beds for elective patients. Similarly, delayed
transfers of care can have the same effect. Chapter 4 in the NHS
Plan acknowledged this issue, and outlined plans for 5,000 extra
intermediate care beds. Equally as important as having beds available
for post operative care is the availability of operative theatre
capacity. The Modernisation Agency is currently leading a Theatre
Project to optimise the use of these resources. Obviously without
sufficient staff neither beds nor theatre time can be fully utilised.
The NHS Plan Chapter 5 highlighted our plans to increase the overall
numbers of both doctors and nurses.
At any one point the interaction of these factors
will vary from locality to locality leading to different levels
of available capacity.
Question 113: Why does Wakefield Health Authority
do worse than adjacent health authorities in terms of inpatients
and outpatients waiting longer than 6 months?
We recognise that there are currently wide variations
in levels of performance across the country, and the below health
authorities, as at December 2001 reflect this:
|Outpatient over 13 week waiters||1,804
|Outpatient over 26 week waiters||258
|Inpatient over 12 month waiters||175
|Inpatient over 15 month waiters||5
|However, both Wakefield HA and Pinderfields & Pontefract Hospitals NHS Trust have a good record of achieving local waiting list and waiting time targets in recent years. At the end of December 2001, Wakefield HA was very close to having achieved the 15 month maximum waiting time target and the 175 patients waiting over 12 months represent less than 3 per cent of the waiting list. This compares with 80 over 15 month waiters and 341 over 12 month waiters a year earlier. Wakefield HA, the Trust and the two local Primary Care Trusts are working together closely to ensure patients receive treatment even more quickly in the future. Current initiatives include putting on extra operating theatre sessions, and offering patients the choice to be treated at other hospitals such as Barnsley District General Hospital and by the independent sector.
I set out at the hearing some of the initiatives we are using to address such variations, including the programme of work to implement best practice being taken forward by the Modernisation Agency. We are aiming to reduce the maximum waiting in successive years so that by 2005 no one waits over three months for an outpatient appointment or six months for an inpatient admission. These targets recognise the importance that patients place on waiting time.
Question 167: What powers do you have to dismiss a chief
executive or chairman of a trust?
Section 13 of the Health and Social Care Act 2001 enables the
Secretary of State to make an intervention if he is satisfied
that an NHS body "is not performing one or more of its functions
adequately, or at all, or that there are significant failings
in the way the trust is being run". Intervention orders are
required to be placed before parliament and would give specific
directions that were relevant to the use of the power in the particular
case. The Secretary of State's powers include the removal of any
board member from the board of the trust. The Chief Executive's
employment is a matter for the employing trust.
Question 181: Can you provide a breakdown, by specialty,
of the consultants that considered 80 per cent of referrals were
The table below provides the specialty breakdown requested:
|Specialty||Number of consultants
|Question 182:What are the patterns for out of area treatment?
There are a number of means through which patients can be treated outside their normal locality.
The out of area treatment (OAT) arrangements were introduced on 1 April 1999 as part of a package of new commissioning arrangements that saw all patient care arranged under service agreements. OATs are used where pre-arranged service agreements are not practical, primarily emergency treatments required while away from homefor example treatment required while on holiday. Under the OAT arrangements each NHS trust has a main commissioner health authority. The main commissioner is funded for OATs through a non-recurrent adjustment to allocations. This is based on past referral levels. The adjustments are:
an addition to the resource limit of the health
authority which is the main commissioner for the NHS trust; and
a deduction to the resource limit of the health
authority responsible for the patient.
For elective care the local health authority should commission
care from each NHS Trust that provides care for its responsible
population. Local GPs should be consulted and where possible the
agreements should reflect their referral preferences.
These arrangements try to strike a balance between coherent planning
for service development, and responsiveness to individual needs.
Question 194: What percentage of consultants are full time?
The following table details the number of consultants in the NHS
and the percentage of the total number of consultants who are
Consultants in the NHS, 30 September each year
|| Full time||Maximum part time
||Whole time equivalent for part time staff
||Percentage of consultants who are full time
Source: Department of Health medical workforce census
Department of Health