Examination of Witnesses (Questions 220-239)
TUESDAY 11 FEBRUARY 2003
MR DOUGLAS
PATTISSON, MS
KAREN BELL,
MR MALCOLM
STAMP AND
MR CHRIS
BANKS
220. It is the governing arrangements rather
than the financial changes? (Mr Pattisson) The governing
arrangements are very powerful in putting patients in charge on
a seat round the table in their local surgery.
Chairman
221. Presumably you would agree that, regardless
of foundation status, doing that process of engaging with patients,
bringing in a different form of governance and accountability
assists you with your current no star status? (Mr Pattisson)
We are working very hard to involve patients in what we are doing
in our hospital, for example, with our planning and diagnostic
and treatment centre. We have several patients involved in working
with us on the plans, thinking through the designs, how it is
going to work. We are very well connected with our community health
council. We link very strongly with the primary care trust and
the 90-odd GPs working alongside the primary care trust.
222. To be specific, if this Committee was to
argue that we believe the governance arrangements and the board
of governors' proposals for foundation trusts ought to be extended
to organisations such as your own, to your own trust, regardless
of foundation status, you would welcome that? (Mr Pattisson)
I would very much welcome that.
Dr Taylor
223. One very good thing we heard last week
from the north east and again from you is that it is networking
rather than competition. The other good thing was this: we have
seen that primary care trust chief executives and acute trust
chief executives sitting side by side are obviously used to talking.
Are you confident that you will be able to influence what the
trusts do? Karen, what measures do you need to see in place to
strengthen your input in controlling what they do? (Ms
Bell) I am confident partly because we communicate more now
than we have ever done and our professional executive committee
have more confidence in GPs' ability to influence acute trusts,
but particularly because of the clinical networks and in some
cases one clinical department crosses the two hospitals in the
future, it would be very important to make sure that our PCT is
represented on the board of governors. That is just one means
of having influence. We also have very close partnerships with
the county council through the strategic partnerships. The fact
that local authorities will be represented will be another way
in which we can exert influence because, for example, with our
own local council, we have a shared director of public health
post.
224. Mr Stamp, PCTs will not ensure that you
keep up your five star research work. Who will ensure that you
as a foundation trust will keep going with that? (Mr Stamp)
We have a lot of interested constituents to make sure that we
keep up with that. The guidance quite clearly marks out that there
will be a requirement that, where there is recognised research,
NHS teaching commitment etc., that will be protected within the
contractual arrangements that we make with PCTs, with workforce
development confederations and I guess with the further empowerment
of strategic health authorities we will see an increased role
there. We were concerned prior to the publication of the guidance
but once the guidance came out we were less concerned.
Andy Burnham
225. Can I take you on to the issue of competition
for staff and pay structures for staff. I am conscious we have
not heard from Mr Banks, perhaps I will start by addressing this
question to you, if that is okay? We have heard concerns from
certain quarters that may be divisive in terms of conditions for
staff and, let us say, that foundation trusts may more aggressively
poach better staff and offer them better terms and conditions.
Do you see that as being a danger? (Mr Banks) In the
discussions we have had so far our early conclusion was that we
did not want to start destabilising the market. It comes back
to this ethos of collaboration, I can take you back a bit further,
if you look at Hinchingbrooke, that is sandwiched between us and
Addenbrookes with a population of about 150,000, it is not in
either of our interests to destabilise that function.
226. Is there a lot of competition at the moment
between the three trusts, possibly competition is the wrong word,
presumably there is a limited pool of staff you can draw from? (Mr
Banks) You have to look at the geography, we are 20 odd miles
north of the Hinchingbrooke and about 20 miles north of Cambridge,
although people can travel there is a limit to it so most of the
people that work in our hospital live in and round the Peterborough
area.
227. Would you be concerned about the scenario
if Addenbrookes were to get foundation status, where they were
able to offer improved terms and conditions on top of the basic
changes that are coming in? Would you be concerned about a scenario
like that where it possibly would give incentives, the playing
field would not be even any more? (Mr Banks) To some
extent there is a degree of flexibility in the system anyway.
I think if you look nationally we know in the south east the pay
is different from else where. There are, in our view, a number
of different ways of attracting staff to Peterborough. Peterborough
has a lower cost of living than Cambridge, there is a different
environment, there is a different group of people coming to us.
Also, and I hope we are conveying it today, there is a kind of
maturity round the system we are working in, in that we are speaking
to each other, and I think it is unlikely we will be trying to
diverge.
228. That does come out. Mr Pattison, it might
be more of a concern to you where staff may feel they get more
if they work in a different trust, it is not an exciting place
to work when it has this label on it. Is that a concern of yours
when you look at your neighbours that might go down the foundation
route? (Mr Pattison) Every hospital has something to
offer, some people like working in large teaching environments,
others like working in a small district hospitals, it is horses
for courses really. Inevitably there is some competition for staff,
to use your word. We employ one million people across the country
in the NHS, so one in 50 people work in the NHS, and people do
have choices.
229. Is it a common part of the health ecology
that people start in your trust, develop skills and then move
on, is there that kind of hierarchy? (Mr Pattison)
It depends on people's training. People train in different hospitals
and then decide when they want a promotion to go to a different
hospital for different experience. I think there is a maturity
within the system. We do think very carefully before varying our
wage rates, we have some flexibilities at the moment, to make
sure that we are not going to cause difficulties in other places.
It serves all of us to behave in that way, otherwise you get leap-frogging.
230. Do you genuinely think your colleagues
are not going to put you in that difficulty? Do you hope you can
work out a situation where they are collaborative? (Mr
Pattison) I have real confidence in that. Our human resource
departments talk to each other, they look at jobs that are advertised,
for example we have had an issue around what we pay our medical
secretaries, who are a very scarce and very important group of
people, and we checked very carefully with Peterborough, Papworth
and Addenbrookes to make sure what the rates of pay were and we
would not be causing any difficulties in the community.
Andy Burnham: Can I ask one final point, what
people associated with, and I do not necessarily think they are
that comparable, with trust status was an explosion of executive
pay within the Health Service. I would just like to ask you about
that given we have four chief executives in front of us.
Chairman: This is a bonus question.
Andy Burnham
231. I gather there are some figures out today
that show that chief executives pay is rising between 9% and 15%
in the Health Service, do you think with more freedoms to attract
the best managers to the best trusts that there may be a more
competitive market at the top end of the management trust? If
so, might that then undermine public confidence in the foundation
trusts concept? Clearly there is pretty strong wage inflation
amongst senior management, might this accelerate it? (Mr
Stamp) What I would say is that I do not see that moving to
foundation trust status or moving from one star to three star
or no star is any reason for a boom in executive pay at all.
232. Why do you think it is increasing so quickly? (Mr
Stamp) I have not seen the figures. I am staggered by what
you said, 9% to 15%. I would like to see the source of them. It
does not feel like that where I come from.
233. I think they are right. (Mr Stamp)
I have not seen the figures, I am sorry, I honestly have not.
I do not know the source of them.
Julia Drown
234. Just going back to Andy's original point,
the evidence we had from Hinchingbrooke said that you believe
in terms of work force issues there would quickly become an imbalance
as some NHS organisations have greater agreements than others.
You have been talking to the Committee about those feelings, that
you will be able to co-operate and that it will all be all right,
do you stand by that evidence? You are implying that one lot of
the NHS organisations should not have greater freedoms than others
and I wonder if Mr Banks or Mr Stamp might agree with that? (Mr
Pattison) The point I made in the evidence was there would
become an imbalance if one NHS trust started to upset the labour
market and paid significant rates above.
235. Do you think that some NHS organisations
should have greater freedoms than others or not? (Mr Pattison)
Freedoms come with responsibilities. My impression is that the
responsibilities that are taken locally are very well understood
and well communicated and there would not be an issue of locality
where I come from. I could not comment on other localities. (Ms
Bell) I was just going to say that the agenda for change is
not just about pay, it is about transformation.
236. This is beyond agenda for change. (Ms
Bell) I understand that. The foundation trusts are going to
have the option of being early implementors around the agenda
for change.
237. I would like to restrict my questions to
the freedom beyond agenda for change. (Ms Bell) I am
not sure what you are talking about then, sorry.
238. It has been suggested that the Government
would give additional freedoms beyond those in the agenda for
change to trusts. (Mr Banks) There is an economic argument
here as well, we are going to get paid the national price rate
per operation and that is going to cap the amount we can earn.
There is a limit to the amount of income we can get in.
239. It depends if you are under or below that
tariff to start with. (Mr Banks) Sure, but that is
happening irrespective of whether there is a limit or not. There
is a limit to what one can do anyway. I think, hopefully, we will
demonstrate that we are not engaged on that sort of pathway.
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