Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 151-159)


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 of Health.

  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 you about?

  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 had commissioned.

  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 to generate?

  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.

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