6. QUESTIONS
ON THE
DEPARTMENTAL ANNUAL
REPORT
6.1.1 In respect of SR2002, target 1,
why do are figures provided for the number of patients waiting
more than four months when the target is to reduce the maximum
wait for an out-patient appointment to three months? Figures on
the Treasury web-site indicate that in March 2004, 43,800 people
had been waiting more than three months (13 weeks) for an out-patient
appointment. Are these figures correct?
6.1.2 In respect of SR2002, target 1,
was the (interim) NHS Implementation Plan target of reducing the
maximum in-patient waiting time to nine months by the end of March
2004 actually met?
6.1.3 Given that it is now more than
a year into the timeframe of SR2002 targets, has the Department
finally established a target date and baseline for the one hour
A&E waiting time target (SR2002 target 2)?
6.1.4 Was the interim March 2004 milestone
in respect of bookings of outpatients' appointments met (SR2002,
target 4)?
6.1.5 When will the 2004 patient survey
results be available (SR2002, target 5)?
6.1.6 The 2003 survey of emergency department
patients in acute trusts showed that 8% of patients thought the
emergency ward was "not very clean" or "not at
all clean" (twice that number in London hospitals) whilst
15% felt the toilets were "not very clean" or "not
at all clean". Are these figures the baseline in this area?
What are the target figures for the cleanliness and comfort theme'
of SR2002, target 5?
6.1.7 What are the reasons for the slower
than expected rate of progress in establishing Crisis Resolution
Teams (SR2002, target 7)? When does the Department expect that
the 2004 target of 335 teams will be achieved?
6.1.8 Could the Department actual figures
for the number of people aged 65+ who have been supported intensively
to remain at home (SR2002, target 8)? What is the reason for reporting
performance on this measure only in terms of the proportion of
elderly people supported to live in residential care?
6.1.9 Overall, there does not appear
to be any increase in the number of people aged 65 and over who
receive help to live at home ((Figure 7.9). Is it the Department's
intention to boost the provision of help for the elderly to live
at home more generally?
6.1.10 The number of elderly people supported
in residential care or nursing homes has only increased very marginally
in recent years (Figure 7.9), and reports indicate that up to
75,000 care home places have been lost over the past seven years.[1]
Is the Department planning to prioritise this area, and set
targets to increase the support for elderly people in residential
care as part of SR2004?
6.1.11 Could the Department supply annual
data on the national teenage pregnancy rate (pregnancies per 1,000
females aged 15-17) from 1998 to date (SR2002 target 9)? Was the
original (SR2000 target 2) 2004 milestone of a 15% reduction by
2004 met?
6.1.12 Has the interim target of a 55%
increase in the number of problem drug users participating in
treatment programmes by the end of 2003-04 been achieved (SR2002
target 10)?
6.1.13 What are the primary policy instruments
being used to reduce the class-based differentiation in infant
mortality and life-expectancy required by SR2002 target 11?
6.1.14 When evaluating progress on the
value-for-money target across the NHS and Personal Social Services
(SR2002 target 12), how do you adjust the unit cost for "quality"?
6.1.15 Why were the efficiency targets
for social services not met in 2001-02 and 2002-03 and what is
the Department doing to ensure they are met in future? Page 106
of the Annual Report says that efficiency measures for 2003-04
to 2005-06 will be in two parts both with targets of one percent
annual improvement. The targets for 2001-02 and 2002-03 were 3%
and 2.5% respectively, why have the efficiency targets been reduced
for later years?
6.1.16 Could the Department supply monthly
data on the proportion of out-patients' appointments and in-patients'
elective admissions respectively that have been pre-booked since
January 2003? (SR2000, target 3)
6.1.17 Is it the Department's intention
that all hospitals should eventually have ward-housekeepers? If
yes, what is the target date? If no, why not (SR2000, target 5)?
6.1.18 If the current rate of annual
progress were maintained, at what point in time will at least
95% of hospitals offer patients "good quality" food
(SR2000, target 5)?
6.1.19 The Department has indicated that
the rate of emergency re-admissions for patients of all ages declined
very slightly in 2003 ((SR2000, target 6). Was this decline statistically
significant? Could the Department provide data for the first quarter
of 2004? Could the Department provide quarterly data for the numbers
and proportions of emergency re-admissions among patients aged
over 75?
6.1.20 Does the Department expect to
reduce the "coefficient of variation", measuring "the
dispersion of costs between NHS trusts" to zero (SR2000,
target 10)? What is the target timeframe for this?
6.1.21 The measures used to determine
progress on each of the (CSR98) PSA targets 1, 2, and 5 have been
adjusted as a result of data from the 2001 Census. In all three
cases, this has apparently led to the figures changing in an undesirable
direction. Please provide a full time-series of the revised data
on all three targets.
6.1.22 Is the Department on course to
meet the 2005 milestones for the Our Healthier Nation targets
included in SR2002 targets 6 and 7?
6.1.23 Progress on (CSR98) PSA target
3 (reduction in the rate of deaths from accidents) has slipped
so that the most recent figure stands at a higher level than the
1995-97 baseline figure. Could the Department provide a breakdown
of fatalities across different types of accidents, and an outline
of the measures taken to bring you back on course for achieving
this target?
6.1.24 The Department claims to have
"nearly met" (CSR98) PSA target 7, waiting time to see
cancer specialists, on the basis of July-September 2003 figures.
In last year's report, you quoted March 2002 figures. Could the
Department provide monthly data for this measure covering the
past two years so that in order to gauge the trend as well as
seasonal variations?
6.1.25 The Departmental report states
that the Department "narrowly missed" meeting (CSR98)
PSA target 21 concerning the emergency psychiatric re-admission
rate. However, you did in fact miss it by 20%. Would the Department
normally consider missing a target by 20% a narrow miss? Is the
improvement of 1.6 percentage points statistically significant?
6.1.26 Also with regard to (CSR98) PSA
target 21, the Department states that the introduction of new
service models are expected to result in a decline in emergency
psychiatric re-admission rates after 2002-03. Could the Department
provide us with data to show whether this expectation has been
fulfilled?
6.1.27 Why has there been no progress
on achieving (CSR98) PSA target 32 on reducing sickness absence
among NHS staff? And what steps is the Department taking to achieve
this target?
6.1.28 Following the NAO and Public Accounts
Committee report in 2003, has the Department now developed a complete
method of investigating the extent and causes of long-term discharge
delays for elderly patients? Does your strategy for dealing with
this problem extend beyond the Delayed Discharges Grant (Annex
D, para. 6)?
6.1.29 How many foreign nurses have been
recruited directly by the NHS in each year since 1997? How many
foreign nurses have transferred from the UK private sector into
NHS posts in each year since 1997? How many have been recruited
from Commonwealth countries? What proportion of all nursing staff
recruited since 1997 has come from Commonwealth and third world
countries respectively?
6.1.30 What is the overall cost of the
development and implementation of the Departmental change programme?
6.1.31 Have external management consultants
been employed in the process to restructure the Department? If
so, how much has been spent on such consultancy services?
6.1.32 Will staff be made redundant as
part of the Change Programme in the Department? If so, what are
the total costs of redundancies?
6.1.33 The Departmental report states
that the Department will be reduced in size by 38% as a result
of the Change Programme (para. 1.33), and that this programme
will be complete by the end of 2004 (para 8.4). However, it goes
on to state that these changes have not yet been fully incorporated
into departmental budgets. Has the Department now got revised
forecasts available for the net departmental administration costs
and paybill costs for 2004-05 and 2005-06?
6.1.34 The Departmental report states
that the Department will employ a lighter touch on performance
management in future (para. 1.35), and that, following the Change
Programme, the 28 Strategic Health Authorities will operate as
local headquarters of the NHS. Does that mean that RHAs will take
on a greater role in performance management? What will be the
procedures with regard to "arm's length" organisations
perceived as failing?
6.1.35 Could the Department supply annual
data on the amount of money paid out in compensation and legal
fees respectively (through the NHS Litigation Authority and otherwise)
in cases of medical negligence over the past five years?
6.1.36 What is the total annual administration
costs (rather than just wage costs, as quoted in Annex C) of the
National Treatment Agency?
6.1.37 Could the Department explain why
the aggregate deficit of NHS Trusts increased by £54 million
between 2001-02 and 2003-04?
6.1.38 Could the Department provide a
list of the 50 NHS Trusts with a deficit in 2003-04 and the 22
PCTs that overspent in 2002-03, in both cases detailing the amount
of deficit/overspending involved?
6.1.39 The 2002-03 Resource Accounts
show provisions for clinical negligence increasing again to £5.9
billion. What are you doing to reduce claims for clinical negligence
and is there any evidence that these measures are having any impact
on such claims?
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