Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 160-179)


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 are there.

  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 for?

  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.

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