Select Committee on Health Minutes of Evidence


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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