Examination of Witnesses (Questions 151-159)|
JOHNSON MP, MS
10 FEBRUARY 2005
Q151 Chairman: Good morning. Can I welcome
our next group of witnesses. Minister, I particularly welcome
you. We are most grateful for your attendance today. As you are
aware, this session in a sense is partly a follow-up to our sexual
health inquiry and also looking at the HIV/AIDS issue and the
charging regime. Can I ask each of you briefly to introduce yourselves
to the Committee please.
Miss Johnson: I am Melanie Johnson
and I am the Minister for Public Health.
Ms Ryan: I am Elizabeth Ryan and
I lead on charging for overseas visitors within the Department.
Mr Dessent: I am Geoff Dessent,
the Deputy Head of Sexual Health and Substance Misuse in the Department
Q152 Chairman: We are very grateful for
your co-operation in the inquiry. Can I say, first of all, that
I think it is important to place on record that we appreciate
the steps that were taken by the Department in response to our
Sexual Health Report. We picked up a number of areas where the
Government have acted and we generally appreciate the fact that
what we suggested has been listened to. Having said that, one
of the areas that we talked about, as you are aware, Minister,
was the 48-hour access and that was an area where the Government
has indicated that steps have been taken to try and ensure that
people do have that access at a reasonably quick period from when
they know they have got a problem. The evidence that we have got
is that that is not actually working. The evidence that we have
got from the witnesses that we have had in this short inquiry
is that the picture that we got 18 months ago is now considerably
worse. I think you will have seen the evidence that the demands
upon the service are such that in a sense this 48-hour access
is meaningless. How do you see it working and do you feel that
there is a need to take further steps to address the problems
that are being picked up?
Miss Johnson: Did you say at the
end of that that you thought the 48-hour target was meaningless?
I am just checking that I heard you.
Q153 Chairman: I do not think it is meaningless.
I think the picture that we are getting is that it is not working
because the GUM centres are basically so overwhelmed that they
cannot meet that target. Let me just give you an example. Last
week I had a meeting with a sexual health project in west Yorkshire,
called Yorkshire Mesmac and they particularly help gay and bisexual
men. They were talking in particular about the 48-hour target
and they were saying that it is meaningless. They said, "For
example, at least one clinic in west Yorkshire `guarantees' an
appointment within 48 hours. However, this is achieved by not
answering the telephone once all the following two days' appointments
are full", and this is from Tom Doyle the Director of Mesmac.
They are genuinely worried that people continue to be turned away
when they are attempting to access services, knowing that they
have got a particular problem.
Miss Johnson: Well, you have highlighted
one apparent problem there which I am not aware of and I will
certainly look into that. What I say overall is that obviously
the 48-hour target is very far from meaningless. One of the ways
in which we have driven improvement across the Health Service
much more widely is by the judicious use of targets in key areas
where we need to drive up performance, and all the evidence is
that actually that has brought about a remarkable improvement,
along with the investment and the reform, in the standards of
service, the access times and so forth, so improving the quality
of services to patients. I am sure that that will apply with the
48-hour target. The 48-hour target is for 2008 and we realise,
because we started from a low base and there is a problem which
we have acknowledged and your report has highlighted of sexual
health, that investment is only recently going in to sexual health,
so that is a target for 2008 which we are working towards. We
have got for the first time, as a result of the survey which we
have undertaken on that, a good understanding of what the current
waits have been. We will get updated information based on the
recent survey on that. I believe that that shows a small improvement
is likely to be taking place in fact in the waiting times, but
we will have to see how that looks and what direction that is
going in, but overall £130 million extra has just gone out
only yesterday to primary care trusts as part of their funding
through the announcement the Secretary of State made in the House
yesterday and that money is specifically designed to do things
like improve access and GUM facilities and is going to PCTs for
that purpose. Now, I know, before you raised the question with
me, that there is always a question raised about whether this
money goes on and is used for the purpose for which it is meant,
but for the first time ever we are actually making sure that the
local delivery plans, the LDPs, for the PCTs have to include a
reference to what they are doing on sexual health and they will
be assessed against that and it will have to reflect the local
needs and local demands. I am sure for one thing that your example
earlier on is something that is going to be of interest to the
commissioners of services in the area of the clinic that you mentioned.
Q154 Chairman: One of the problems I
was going to ask you in terms of the delivery plan is that I think
we gained a feeling when we looked at sexual health that the SHAs,
in the healthcare commissioning, needed to play a much stronger
role in ensuring that these plans mean something and that the
resourcing that has been made available, and we will probably
talk about, in particular the resourcing of primary care, actually
goes to where it is supposed to go. Can I come back to your point
that you seemed to be surprised at the evidence that we have received.
You were referring to your MedFASH review presumably, were you,
the information in that review, which we have corresponded to
Miss Johnson: Well, there was
no data on waiting times at GUMs, as I know you are aware, and
for the first time last year we actually commissioned a survey
of those waiting times, I think in May of last year.
Q155 Chairman: Is this separate from
the MedFASH review?
Miss Johnson: Yes. The MedFASH
review is also being conducted, an overall audit separately, which
is another source of information about performance and provision
which we will obviously be using to inform for the future, but
that is not yet completed and we do not have that information.
Q156 Chairman: But have you seen the
evidence that we got from the Health Protection Agency and the
British Association for Sexual Health and HIV which shows that
only one-third of patients are being seen by the GUM within 48
hours of trying to access that? Are you aware of that information?
Miss Johnson: The HPA published
the information, but it was actually information which the Department
Q157 Chairman: So you are aware of that?
Miss Johnson: Yes, certainly and
that is the baseline that we have got. We know that there is a
lot of improvement to be made on that. We fully acknowledge it
and that is why we have made record levels of investment. Altogether,
£300 million has been identified for the purposes of campaigning
or improving sexual health, so actually in terms of information
and provision, we are accepting that a lot needs to be done and
that is what we have done through the White Paper, the investment
to follow that and the investment that went out to PCTs to start
making the improvements on the back of that.
Chairman: One of the things that you
are doing in sexual health is an education campaign and obviously
we all want to see that. I have a vivid memory of going to Manchester
to the GUM clinic there in the Royal Infirmary and being shocked
by some of the issues that they raised with us, so shocked that
we left Dr Taylor behind in the ladies section of the GUM clinic
and we found out when we got to Bolton that he was not on the
bus! It was a terrible situation!
Q158 Dr Taylor: It is a myth!
Miss Johnson: I think these things
should be fully written up!
Q159 Chairman: Anyway, one of the issues
that I remember from Manchester was that we had the public health
people and the GUM specialists together in the GUM clinic and
we were talking about the issue of education and screening in
particular. The public health people were raising the importance
of doing this and the GUM people were kind of putting their hands
up, saying, "No, for goodness sake, don't do that because
we won't be able to handle the amount of work we'll get arising
from this campaign and this screening". That does seem to
be an issue. Professor Kinghorn, who came before us in the previous
session, I am sure you will know of his work, said that an education
campaign, if it did not go hand in hand with capacity increases,
would drive already overstretched services to a state of collapse.
Could you outline the planned timing of the campaign and how you
are taking account of that anxiety that the campaign needs to
be linked into being able to deal with the demand you are going
Miss Johnson: Well, that is an
absolutely accurate analysis, that we need to be careful about
that. Obviously the investment is now going out and to some degree
there are issues around facilities, although we have also made
investment already, some additional investment on the capital
side of things, so there is some additional historical capital
investment gone in. On the service side, we obviously need the
service to be able to respond. We are thinking at the moment about
the design of the campaign and we are in the early stages of doing
that. One of the things we need to do is to raise awareness of
the risk and a part of that is preventative. It does not necessarily
have to lead only to people thinking, "Ah, I might have a
sexually transmitted infection. I had better go and get checked
out or screened", so there is an element, a very big element
probably actually, particularly as for each new age group coming
through, the sort of 19 to 25-ish greatest period of being at
risk, as it were, there is a particular need to educate them,
so we have got to get the balance right, you are absolutely right,
between educating and information and using that as a preventative
tool and simply stoking up demand, some of which may be the worried
well as well, so we need to get that balance right and that is
what we are thinking about in terms of the campaign which we will
be running later on this year.