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FIRST REPORT
The Health Committee has agreed to the
following Report:
THE WORK OF THE HEALTH COMMITTEE, 2002
Introduction
1. During the year 2002 the Health Committee has
examined some of the key policy areas within the Department of
Health. Our inquiry into The Role of the Private Sector in the
NHS allowed us to explore the funding arrangements for the major
capital programmes within the Department of Health; our inquiry
into the National Institute for Clinical Excellence (NICE) addressed
a key component of the Government's quality agenda; and our most
recent completed inquiry, into Delayed Discharges, offered a systematic
analysis of the issue.[1]
2. The Government has responded positively to many
of our recommendations and we believe our work has made
a valid contribution to the policy debate. In addressing the core
tasks set for select committees as the Liaison Committee demands,
we would suggest that the sheer scale and diversity of the Department
of Health make any comprehensive analysis of the range of activities
it supports impossible. Rather, the Health Committee can only
undertake a limited range of inquiries in areas we believe to
be of key importance or urgency.
3. We made a number of domestic visits in the reporting
period. We looked at the impact of the Private Finance Initiative
design at two sites; we visited a range of trusts to see how they
were coping with the impact of delayed discharge; we also visited
a number of providers of genitourinary medicine services in the
context of our sexual health inquiry.
4. As part of our Delayed Discharges inquiry we undertook
a visit to Vancouver and Boston. This allowed us to examine other
systems for the management of hospital capacity and care outside
of hospital. It also allowed us to see some of the potential for
telecare solutions to the management of acute and chronic conditions
outside institutional settings.
Inquiries carried out into: (a)
Government Policy proposals and implementation of legislation
and major policy initiatives
5. The breadth of areas covered by the Department
of Health means that the Committee can only look selectively at
major policy proposals. All three major inquiries completed in
the year 2002 related in some measure to major policy proposals:
the inquiry into The Role of the Private Sector in the NHS examined
policy proposals set out in The NHS Plan[2]
and substantiated in the Concordat between the Department of Health
and The Independent Healthcare Association, signed in October
2000; the inquiry into The National Institute for Clinical Excellence
made clear in its terms of reference that it would consider the
progress NICE had made in achieving the key goals envisaged for
it in the consultation document A First Class Service.[3]
The inquiry into Delayed Discharges also examined a policy proposal
set out in The NHS Plan, "to end widespread bed blocking
by 2004".[4] The Committee
not only looked at the current situation but also assessed the
likely impact of proposals for cross-charging of local authorities
for delayed discharge, proposals now embodied in the Community
Care (Delayed Discharges etc.) Bill. Finally, in June 2002, the
Committee asked the Secretary of State to give evidence on the
Department of Health's action plan, Delivering the NHS Plan.
This allowed us to explore progress that had been made towards
targets set out in the Plan. Our current inquiry into sexual health
examines the effectiveness of measures contained in the Government's
consultation document on the sexual health strategy.[5]
(B) AREAS SEEN BY THE COMMITTEE AS
REQUIRING EXAMINATION BECAUSE OF DEFICIENCIES
6. We undertook an inquiry into The Role of the Private
Sector in the NHS in the knowledge that there had been enormous
controversy and debate over the merits and cost-effectiveness
of the Private Finance Initiative and related areas. The inquiry
sought to discriminate between the polemical evidence advanced
by both sides of the debate in order to reach a balanced judgement
on the policy. Perhaps the key deficiency identified by the Committee
related to the lack of accessibility and clarity in the data used
to support PFI business cases.
7. The inquiry into The National Institute for Clinical
Excellence attempted to establish whether NICE was producing clear
and credible guidance, had ended confusion by providing a single
national focus, whether its guidance was "locally owned and
appropriately acted upon and whether NICE was actively promoting
interventions with good evidence of clinical and cost-effectiveness.
The Committee also examined suggestions that NICE was perpetuating
health inequalities in those areas not covered by its studies
and that its recommendations had not been universally implemented.
In its response to our recommendations the Government broadly
accepted our analysis of the problems and NICE has now adopted
a number of measures in response to our findings.
8. The inquiry into Delayed Discharges covered an
area where the Government has itself identified deficiency. At
the time we took evidence, some 6% of all acute beds in the NHS
were occupied by delayed discharges.[6]
We are disappointed that the Government has not taken note of
our concerns and acted upon our recommendations regarding the
risks of cross-charging mechanisms to deal with delayed discharges.
9. The Committee's current subject of inquiry, sexual
health, is an area seen as requiring examination because of deficiencies:
the stark increases in sexually transmitted infections and HIV,
the very high rates of teenage pregnancy, together with the considerable
pressures which specialist clinics reported in dealing with these
numbers, necessitated an urgent and wide-ranging study. To date
the Committee has taken evidence on seven occasions, and undertaken
a series of visits within England, the Netherlands and Sweden
to establish the true extent of the problem and possible solutions.
(c) Departmental actions
10. Our inquiry into The Role of the Private Sector
in the NHS caused us to look not simply at the future implications
of the large wave of PFI initiatives currently in train, but also
at the impact of the first schemes and the measures the Government
had taken to ensure value for money and quality of delivery.
11. The general review of Departmental activity that
comes under the Public Expenditure Questionnaire allowed us to
question the Secretary of State on a number of individual areas
of departmental activity.
12. Our inquiry into NICE did not limit its focus
to the activity of the institute alone: we sought to explore the
relationship between NICE and the Government to establish where
responsibility lay for different areas of NICE activity, and what
the Government could do to improve the operation of what is a
fairly young institution.
(d) Associated public bodies
13. We undertook an inquiry into the Role and Functioning
of the NHS Appointments Commission, which was established on 1
April 2001 as a Special Health Authority. A single evidence
session was held and no report was issued, but we felt that it
was useful for us to establish how the Commission operated.
14. The Committee undertook a much more substantial
inquiry into the operation of another associated public body in
its inquiry into The National Institute of Clinical Excellence.
We also considered the role of the Commission for Health
Improvement in relation to monitoring the implementation of NICE
guidance.
15. As part of our current inquiry into sexual health
we have taken evidence on two occasions from the Public Health
Laboratory Service, and have also heard from the Health Development
Agency.
16. In most of our inquiries we take evidence from
NHS trusts and health authorities, and this evidence was particularly
pertinent to our inquiry into The Role of the NHS in the Private
Sector where we wanted to establish the degree of scrutiny applied
to individual contracts negotiated under the Private Finance Initiative.
(e) Major appointments
17. The Committee took evidence from Sir William
Wells a year after he was appointed Chair of the NHS Appointments
Committee.[7]
Extent to which systematic structure is in place
for meeting the indicative tasks listed, and response of department
18. All major Department of Health policy initiatives
are notified to the Committee by Departmental Press Notices. Key
policy documents are routinely issued by the Department through
Press Notices. Liaison between the Parliamentary Clerks and Committee
staff is good.
19. Given the breadth of areas covered by a single
committee it is not possible for us routinely to scrutinize each
major policy initiative. We try to cover those topics which seem
to us most urgent. The Committee has covered many of the proposals
outlined in The NHS Plan and proposes to look at other
major developments as and when the need arises: for example, we
will undertake an inquiry into Foundation Trusts early next year,
even before the first trusts have been established.
1 Health Committee, First Report of Session 2000-01,
The Role of the Private Sector in the NHS, HC 308; Second
Report of Session 2001-02, National Institute for Clinical
Excellence, HC 515; Third Report of Session 2001-02, Delayed
Discharges, HC 617. Back
2
Department of Health, The NHS Plan - A Plan for Investment,
A Plan for Reform, Cm 4818, 2001 Back
3
Health Committee, Second Report of Session 2001-02, National
Institute for Clinical Excellence, HC 515, para 5; Department
of Health, A First Class Service: Quality in the New NHS
- A Consultation Paper, 1988 Back
4
The NHS Plan, p 102 Back
5
Department of Health, Better Prevention, Better Services, Better
Sexual Health: The National Strategy for Sexual Health and HIV,
2001. Back
6
HC (2001-02), para 24 Back
7
Health Committee, Minutes of Evidence 15 May 2002, Role and
Functioning of the NHS Appointments Commission, HC (2001-02)
833-i. Back
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