Examination of Witnesses (Questions 160-179)|
JOHNSON MP, MS
10 FEBRUARY 2005
Q160 Chairman: Do you think there are
any lessons which can be learned from the AIDS campaign in the
1980s and 1990s? One of the areas that we recognised was a problem
was that in the 1980s and 1990s the public were much more aware
of what AIDS could mean and many of us knew people who had died
of it, let's be blunt about it, and the AIDS campaign at the time,
the education campaign, was pretty explicit.
Miss Johnson: Yes, I remember
it. I am old enough to remember it!
Q161 Chairman: Yes, I know how old you
are! It was your birthday, I saw it in the paper and it mentioned
your age! What I wondered was whether we have learnt any lessons
from that and will we recognise the need to be pretty blunt and
pretty explicit and to talk in terms that kids understand as part
of this campaign?
Miss Johnson: I think one of the
things that we have done historically is to target the 18-to-24
age group. I think that everybody accepts that we need to target
a wider age group really and I think that one of the features
of the HIV campaign, the tombstones campaign, was actually that
everybody became aware of it and I think there may be a need to
make sure that everybody is much more aware rather than us only
targeting the most at risk in the population. I think we also
need to do more about actually working with young people before
they get into that age range so that they are aware of the risks
too. In a sense, although obviously we would not want to return
to those days in any way, it was easier to scare people about
HIV when in this country people were dying of it regularly and
although people still sadly die of it, in a lot of cases their
lives are very considerably extended and, who knows, even indefinitely,
as it were, by the complex drug treatments that are now available.
I think we have to reckon that it is going to be a little bit
more difficult to worry people on that score, but we are already
running sexually transmitted infection campaigns which are aimed
to frighten and make people aware and to lodge it in their memories,
to use good handles for doing so and to make sure that they really
do register in the minds of those that we are targeting at the
present time, and we need to make sure that we extend that effectively
to a wider group, I think.
Q162 John Austin: The Chair mentioned
earlier the study you have commissioned from the Medical Foundation
for AIDS and Sexual Health, which is something which we would
welcome, but I know that that is a two-year study.
Miss Johnson: Yes.
Q163 John Austin: But the first phase
is complete and you have the results.
Miss Johnson: I have not personally
had them to me with advice from officials as yet, so we are very
happy to share them with you in due course.
Q164 John Austin: The results of that
study do give the most accurate, up-to-date snapshot of how GUM
services are functioning.
Miss Johnson: Yes.
Q165 John Austin: That information is
available. You may not yet have seen it, but it is in your Department.
Miss Johnson: Yes, I am sure that
it will be with me soon.
Q166 John Austin: Your officials may
not have had a chance to interpret the findings, but the findings
Miss Johnson: But that is the
case, that normally there is a process of digestion really in
any government department when it goes through looking at things.
I think what we have got is
Q167 John Austin: But would not the most
up-to-date information available be very useful to the Health
Select Committee in conducting an inquiry into the state of the
sexual health services in the country?
Miss Johnson: I do not know without
looking at the information. I am not sure that the picture is
going to markedly change. I think we have all got the broad idea
about what the picture is and I am sure you are very well aware
of what the picture is actually, so I do not think that this is
an area where there are likely to be dramatic changes one way
or the other. I think what the MedFASH survey is is an ongoing
audit of individual services, as I understand it, and actually
what we will do at the end of that is we will get an overview
at the end of two years about what the picture is out in the field.
Obviously I believe that the teams are communicating back, as
they are out there doing the audit work, the results of their
work, as it were, back to the places that they are looking at.
I understand that that is going on, but I am not familiar with
the detail of it. I do not know whether Geoff would like to comment
on the process of the review.
Q168 John Austin: Perhaps he might be
able to tell us when the Department received the data and how
long it will take to interpret the findings.
Mr Dessent: We received the data
quite recently and, as the Minister said, what we would normally
do is look at that in the context of all the other information
we have got and then put it to the Minister so that we can decide
how best that informs the study and indeed as to whether there
is a case to release stuff earlier rather than later in terms
of informing where we are.
Q169 John Austin: How recently is recently?
Mr Dessent: Well, I was only aware
of it a few days ago.
Q170 John Austin: Perhaps we might find
out later how long you have had it.
Miss Johnson: I think that was
a few days, but we can give you a precise date.
Q171 John Austin: It still does strike
me that it is rather curious that there is this air of secrecy
about the raw data which, if one values the work of Parliament
and scrutiny, the Health Select Committee and its report, it would
seem sensible for the Committee to have the most up-to-date information,
would it not?
Miss Johnson: It is normal practice
in fact. Firstly, this is a rolling snapshot, so there are some
questions about getting to the end of the business of taking those
snapshots anyway and having the whole film, as it were, and that
is one issue. The other issue is that it is a series of snapshots.
I think it was only as a result of something said to the Committee
that we really became aware that there were things emerging from
the findings, so actually you knew about some of that, as it were,
or were told about some of that before we were. We were the commissioner
of the data, but actually the data has only just come to us on
the back, I think, of what had occurred at a previous hearing
or what was said to you in some way or another by way of briefing,
and I am not quite sure which it was here, so it is not any attempt
to keep anything secret whatsoever. As I say, I doubt very much
if it will fundamentally alter the problem that we are facing.
I think we all understand very well what the problem is that we
are facing and what the main things are that we need to be doing
to address it and that is why we have got the course of action
that we announced in the White Paper and why we are pursuing that
through the funding announcements of yesterday and the problem
is very well known.
Q172 John Austin: But the information
contained in there, which is somewhere within the Department,
will at least be able to tell us whether services are about the
same, improving or deteriorating.
Miss Johnson: Well, the 48-hour
target monitoring is also being conducted every six months, so
we will get a second read-out on that shortly too and we will
certainly be publishing that.
Q173 Dr Taylor: Minister, can I go back
to the funding issue to try and sort of tease out some of the
details. In your very helpful paper, you have summarised the money
that comes from the White Paper, which is the £50 million
over three years for the sexual health campaign, the £130
million which you have already mentioned, £80 million to
help with the Chlamydia work and £40 million to help with
the contraceptive work, so that is the £300 million.
Miss Johnson: Yes.
Q174 Dr Taylor: Yesterday the Secretary
of State announced the amounts going to primary care trusts and
in round figures, from memory, because I have not brought the
paper with me, if a primary care trust was getting, say, about
£120 million and an average rate of increase is about 10
per cent on last year so that means the increase is £12 million,
is that £300 million or a PCT's share of that £300 million
part of that total increase or is it on top of it?
Miss Johnson: I think it is part
of that total sum of money, although the percentage you are quoting
I think is a one-year percentage because I think the 10 per cent
or thereabouts is the average for 06/07 and the following year
has a similar additional percentage increase on the budgets as
well, so they will vary between sort of 8 and 13/14 per cent on
each of those years, roughly speaking.
Q175 Dr Taylor: So working on very rough
round figures, if a PCT that has got an increase of 10 per cent
in fact has got an increase of about £12 million, that is
to cover absolutely everything in its local delivery plan?
Miss Johnson: That is correct.
Q176 Dr Taylor: Is there any compulsion
on what is in the local delivery plan?
Miss Johnson: Yes, that is what
I was saying earlier on in relation to what the Chairman was asking
me, that is to say, that the local delivery plan has to include
coverage of how they are going to meet the sexual health needs
of their population and they will be assessed on their performance
against that and their delivery of that as part of the delivery
plan, as part of the performance management that is undertaken
and as part of the Healthcare Commission work on monitoring them,
so for the first time ever in fact there will be a demand that
they deliver, as it were, in outline on sexual health. Obviously
the exact nature of what goes in there needs to reflect local
needs and local circumstances and that is entirely in line with
our policy, that you need to get it local and the decision-making
local. Then on top of that there will be the normal performance
management of that and account taken of the delivery of it by
the Healthcare Commission.
Q177 Dr Taylor: So even though there
is not an NSF or particular NICE guidance on this, there has been
compulsion on them to put this in their local delivery plan?
Miss Johnson: Yes, it is a strategy,
and I know we have had this discussion many times, but the strategy
is not very much different from actually having an NSF.
Q178 Dr Taylor: You have already touched
on the fact that we have doubts. If the money is given direct
to GUM clinics, it gets there, but if it is given to PCTs, it
tends to sort of leak out. Are you really quite confident that
this method will spot that it really is going to what it is meant
Miss Johnson: Yes, because we
have never had this degree of performance management on sexual
health provision before and, coupled with the monitoring that
we are doing now six-monthly on the 48-hour target, the extra
investment that is available which was not available for them
before, both the overall quantum of investment where the envelope
is much bigger and much more generous on top of historical generosity,
as it were, and they have already got a lot of investment gone
in historically, they have got a very large extra increase which
has just been announced for 06/07 and 07/08 and, within that,
there is specific money which we are expecting them to deploy
for this purpose and on which their performance will be monitored
if they do not deliver it. I think also, as it happens, that the
public anxiety around this subject, the attention that the Select
Committee has given it, the House has given it, we, as ministers,
the Department are giving it and the Government is giving it is
sending a very strong message in any case to commissioners that
this is more important than they may have thought it was historically
and that will be reflected in changed behaviour on its own, but,
on top of that, there will be these much more formal and much
more fierce, if you like forms of monitoring and performance management.
Q179 Dr Taylor: I am absolutely sure
we all welcome this huge amount of money going in, but has there
been any estimate of the cost of local delivery plans in total?
Again I am speaking sort of locally. I know that local PCTs have
debts and overspends amounting to several million which will mop
up the first bit of their extra money. Is there any assessment
of what a typical PCT's local delivery plan would cost if they
funded everything in it?
Miss Johnson: Obviously we have
sent out money, having had some look at the centre at what that
money is going to be spent on and how reasonable that is, what
the pressures are, salary increases and other structural changes
which may lead to them needing more money for things, so we have
looked at all of those demands and, within that, the plans have
been formulated and the money has been allocated. The money, as
you know, is also for the first time much more closely correlated
actually to the needs in a given area, so there has been a much
greater focus on getting more money to those areas with the greatest
need and some of those needs will be reflected across the board
and will impinge on sexual health needs too because some of the
areas with the greatest deprivation are probably some of those
areas with the greatest sexual health needs as well. Manchester,
for example, with £113 million extra going into it has got,
we know, a number of needs on this front and it has a number of
other health needs, so we have got all of that background to this.
You asked me something else as well, I think.