Examination of Witnesses (Questions 300-319)
8 DECEMBER 2004
RT HON
JOHN REID
MP, MR RICHARD
DOUGLAS AND
MR JOHN
BACON
Q300 Dr Taylor: From the patients' point
of view, one of the vital things to protect their interests and
give the best service is the formally constituted Advisory Appointments
Committee for Consultants. Foundation Trusts no longer have to
have that sort of method of appointment. Have you any information
about any that are disregarding it, or are Foundation Trusts so
far still using that efficient way of selecting the right person?
Dr Reid: To the best of my knowledge,
although this is not a legal requirement, the conventions continue.
Mr Bacon: To add, we know that
the new Foundation Trust Network, which is a grouping of the Foundation
Trusts, is actively in discussion with the Academy and the Royal
Colleges about that process. There is not currently a formal agreement,
but they are very sympathetic to the interests of the Royal Colleges,
and, whilst we do not intend, and indeed they do not intend, to
make it compulsory, there are very constructive discussions underway
at the moment.
Dr Reid: And the convention is
continuing, as far as I am aware at the moment.
Q301 Dr Taylor: It is the sort of thing
we could ask you about in the future if they are sticking to it?
Mr Bacon: I think you can expect
to see some relatively formal position established between the
network, but, of course, that is not our business.
Dr Reid: Yes, that is the second,
the sting in the tail, where you can ask in future, but we are
not going to be in a position with the transfer where we are as
accountable to you as we were with those which are not NHS foundation
trusts.
Q302 Dr Taylor: However, the Royal Colleges
could?
Dr Reid: However—it is a
big however—the NHS trusts are in a particular way more
answerable to Parliament, in a sense, through the regulators and
the foundation trusts and other mechanisms than they are to me.
So there is a burden placed upon them, from memory, which says
they have to give you the sorts of answers as MPs that previously
I would have had to give you, but they have to give you the rights.
It is the same standard. There is a legal burden placed on them.
Chairman: I am going to shift to social
services for a few minutes. If we have time we will come back
to a number of other health related issues.
Q303 Mr Burns: Before I go on to my next
question , I wonder if I could ask you about another area of health
service spending, and that is that your Parliamentary Under- Secretary
earlier this year announced that he anticipated it was going to
cost your Department about £180 million as a result of the
ombudsman's decision with regard to those people it is thought
were wrongly charged for continuing care?
Dr Reid: Yes.
Q304 Mr Burns: And that there have been
a series of reviews. Your Parliamentary Under Secretary came before
us in the early summer, where he admitted that he was embarrassed
at the progress of the SHAs in reviewing the cases and determining
whether people had been wrongly or inappropriately charged and
issuing recompense. He also said a little later, I think rather
unwisely, that by 31 July this year all the cases that have been
made to SHAs up to 31 March would be completed and determined,
and, of course, he published in a written ministerial statement
on 16 September his responses to what had been going on where
it became quite clear that his target of 100% completion by 31
July had not happened and it was only 86.1%. Now we have a problem,
because as of 2 December the Minister says in written answers
that he has no additional statistical information beyond that
information that he gave on 16 September, which refers back to
31 July. It comes as a bit of a surprise, given how closely the
Minister has been monitoring this situation, that since 31 July
up until now the Department has no additional statistical information.
As you are the Secretary of State, I was wondering whether you
would be able to tell me why all of a sudden you have no statistical
information, whereas up until 31 July you had very detailed statistical
information?
Mr Bacon: I do not have numbers
with me, I am afraid, but, as a consequence of the answer, my
Director in the Department is now tracking this down and I am
quite happy let you have the latest position.
Q305 Mr Burns: That is extremely helpful.
I am genuinely extremely grateful. Will that be before Christmas?
Mr Bacon: I can let you have the
last set of data. We obviously do not collect this every day.
Q306 Mr Burns: No; I understand that?
Dr Reid: So I can clarify, the
last point is not March. I am just making sure that when he said
he will give you the data up to the last point it was collected,
it was not the March data he was talking about, it is much later
than that.
Q307 Mr Burns: Presumably beyond 31 July?
Mr Bacon: The answer is that he
has asked me and my colleagues to ensure this exercise is completed
with haste.
Q308 Mr Burns: I think the deputy has
been saying that all summer. He told us that it would be 100%
by 31 July, but it was only 86%; but I am grateful to you, Mr
Bacon, because if you read the Daily Telegraph and Alison
Steed's columns, you will notice that a week last Saturday the
Parliamentary Under Secretary said that you were no longer going
to issue this information. So for you to now be issuing it is
a bonus, for which both I and Alison Steed will be very grateful.
Mr Bacon: If this Committee is
requesting it, we can give you the best information that we can
have.
Dr Reid: But we will do that against
a background where we are trying not to burden the NHS with constant
demands from the Centre for Information, not least because we
are encouraged by other parties.
Chairman: We are very impressed to see
the reduction in costs, Secretary of State?
Q309 Mr Burns: I understand that, Secretary
of State, but presumably it is no burden for you to produce statistics
frequently on what you consider good news stories, but we would
hate you to take the view that anything that is not good news
is a burden to produce statistically?
Dr Reid: No, we publish a whole
range of statistics. For instance, we would hardly call MRSA a
good news story, but we insist on publishing the statistics for
that. But you are absolutely right, I think we all agree that
where it is possible we should try and minimise the collection
of statistics and the extent of decrees from the centre which
burden the front-line. I do not think it is a party political
point. I think all of us want that, but it is not always easy.
Q310 Mr Burns: Let us not go into discussion
about the statistics. I take your point broadly. Last year when
you came to us you were very keen to point out the average 6%
increase in PSS funding up to 2006, but the planned increases
for the following two years announced in the Spending Review are
less than a quarter of this. I was wondering if you could tell
us why there is such a poor settlement for those two years after
what were significant increases, and do you think that reflects
the poor performance of social services or the poor value for
money?
Dr Reid: No, I think it reflects
the fact that government has to make hard choices. The general
expenditure over the three years, including the 6% in the first
of the three years, is about 2.7% per annum, it averages out at,
which implies that it is less than that for years two and three.
It comes after reasonable settlements and a particularly good
one in year one, but there is a limit to the amount of government
expenditure and we have to make very hard choices about this and
the decision was that we would continue until 2008 to put that
investment into the National Health Service. Of course it has
been accompanied by a lot of other initiatives to try and increase
quality, to drive up efficiency, and so on and so forth, but I
will not pretend to you that it is possible across government
to have 6% expenditure. It is not. It is 2.7% over the three years,
which is commensurate in adult social services with what other
public sector investment is.
Q311 Mr Burns: I assume you are aware
of the findings of CSCI, that they have found that there are a
small, but to their minds significant, number of people who have
been inappropriately discharged as a result of the introduction
of the delayed discharged legislation. I was wondering what you
as a department were planning to do to address their findings
and if you accept their findings?
Dr Reid: We accept that in any
human system there will be human failings. I think you would accept
that the extent of inconvenience to individuals, to patients,
caused by the other side of the coin, which was delayed discharges,
being forced to sit in hospital when you wanted to come out of
hospital, the hospital clinically regarded you as somebody who
should leave, but being stuck there, a huge amount of inconvenience.
I think it was of the order of 7,000 to 8,000 bed days at any
given time, which is the equivalent of probably 16 general hospitals,
was being caused by that. So it was grossly inefficient, it was
grossly inconvenient and distressing from the point of view of
the patient. We have reduced that hugely in the past 18 months
to two years. A lot of people have benefited, but, in so doing,
there will be individual cases where people have been inappropriately
discharged, there probably were even before we had the delayed
discharge reduction as well. We are doing what we can to try and
make sure that that does not happen. I do not know if you want
to say something more specific. John, do you want to add to that?
Mr Bacon: I think probably the
reverse is true, that the probability is that we are able to take
much more care about discharge because we do not have the massive
number of people sitting in hospital beds inappropriately. So
I would suspect, although I have no individual evidence, that
the 60% reduction we have achieved through our initiative in the
delayed discharges over the last two or three years has improved
the experience for individuals and enabled us to take much more
care about the handling of individual discharges, but, as the
Secretary of State said, the volume of activity that a service
of our size does will be, sadly, in individual cases rare but
individual cases where we do not get it quite right.
Q312 Mr Burns: As a matter of interest,
what has happened to your figures for the over 70s for emergency
readmission to hospital in 28 days of discharge?
Mr Bacon: Sadly, I do not carry
that in my head.
Dr Reid: Can we write to you?
Q313 Mr Burns: You will write to us with
those figures?
Dr Reid: Yes, if the Committee
requires figures, we will provide them for the Committee.
Q314 Mr Burns: That is very helpful too,
Secretary of State, because, of course, you will know that ministers
have stopped collecting those statistics and publishing them to
MPs?
Dr Reid: Yes, but if the Committee
requests that, this is the Health Select Committee, this is the
vanguard of accountability, and if you want us to do something,
we will try and do it, because I know that you are aware of the
burdens that places on everybody.
Q315 John Austin: Can I go back to social
service funding and particularly staffing issues. Last year you
responded to my question by saying the difficulties in recruitment
and retention of staff was mammoth?
Dr Reid: Yes.
Q316 John Austin: I would like to know
what the Department has done to improve the situation since then
and what improvement there has been. Given the fact that the Spending
Review settlement is certainly a lot less generous than in the
past couple of years, whether that is going to help, and on the
question of vacancy rates, the national figures are for social
workers 10%, 19% for occupational therapists, 11% for care staff,
and, as a London MP, I know the figures are almost double that
in London. What is being done?
Dr Reid: You are absolutely right.
This is one of the big the problems in health. We have got radiographers,midwives
and radiologists where we have difficulty recruiting, and in social
services, adult social services. There are about a million people
working in adult social services, about 70% of them are in the
private sector, but in our sector, the directly local authority
sector, it is a particularly competitive market. There are two
differences in the groups, one is the carers, and so on, and one
is the social workers themselves, and I will not go over the particular
problems, but in the first group, the carers and so on, it tends
to be hugely competitive and low paid at the same time. It is
one of these cases where the natural instincts of those who study
markets are a bit confounded, because what can happen is you get
what is called a Bluewater effect where you get a lot of low paid
workers working in care homes, or whatever, and suddenly a new
employer comes who offers slightly higher and you get an en
mass movement from that. What are we doing? We have got a
national social work recruitment campaign which was launched as
far back as October 2001. We aim to increase the number of applicants
to social work courses by 5,000 by 2005-06. I do not know if John
has figures on how far we are meeting that target just now, but
it is quite an ambitious one. We have had some success in the
latest figures we have got available in the vacancy rates for
home care staff. The vacancy there in the latest figures I have
been given—I asked about these before the Committee—have
almost halved from around 10.8% in 2001 to around 5.8% at the
end of 2002, which I think are the latest figures that we have
got available here. There has also been a success in the turn
around in the steep reduction of applicants that we have seen
for social work courses. There had been a fairly steep reduction
in that. The numbers in the figures that are available for 2001
for the first year since the mid 1990s stopped that decline and
started to come up again. We have now got a new three-year degree
course for social work which replaces the diploma, which not only
ensures that the theory and the research are tied in with the
current practice, but also gives a degree of status, I think,
to social work that was not previously there. Finally, we have
introduced a bursary, a non means-tested bursary—it is about
£3,000 a year—for those who are not funded by their
own employer. I do not want to be over-optimistic about this,
because there are huge challenges. We can speculate as to the
reason, and obviously things like Victoria Climbié and
the press reports did not help, but we are beginning to turn some
of them around by the methods I have mentioned.
Q317 John Austin: Given all the pressures
on the social services and additionally the pressure to fill vacancies,
you have talked about the generous settlement there has been in
past years, but there is not a cost index for social service like
you produce for the NHS. Is there a reason for that? Would that
not give a more accurate picture as to how generous or not generous
the increases were?
Dr Reid: I do not know. Richard,
do we have a particular reason?
Mr Douglas: I would have to check
with colleagues. We do not publish a separate cost index, but
we do maintain records of what is happening on pay and prices
in social care activity; so, although there is not a separate
published costs index, we do have a track of what is happening
to pay rates, what is happening to price rates.
Chairman: I want to cover two other areas
before we conclude in time for Prime Minister's questions.
Q318 Dr Naysmith: One is the new national
tariff system which has been referred to a little earlier for
big changes that are coming into the National Health Service.
A lot of the things that are happening, John, are wonderful—I
am really with you on that—despite the fact that now and
again I ask corporate questions! Trusts, which are above average,
were meant to come down over four years to provide some average
costs, but they are still providing services at too high a cost.
What is going to happen to them?
Dr Reid: Ultimately they will
not thrive as other hospitals will thrive.
Q319 Dr Naysmith: So are we left to market
forces basically?
Dr Reid: No, not left to market
forces in the sense that there is a transfer of cash between an
individual to others, but it is left to patient choice. If you
are asking me is there a degree of risk in this to individual
institutions in, say, the Health Service which was not there in
the first 15 years, the answer "Yes".
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