Examination of Witnesses (Questions 320-331)
8 DECEMBER 2004
RT HON
JOHN REID
MP, MR RICHARD
DOUGLAS AND
MR JOHN
BACON
Q320 Dr Naysmith: You envisage some services
that are provided by some hospitals closing because they are too
expensive?
Dr Reid: Not because they are
too expensive, but because if they are able to provide the quality
of care that patients deserve they will prosper. If they are not
able to do that and to give patients what patients nowadays should
be getting, they will not prosper and patients will go elsewhere.
Let us start from a very simple starting point at which I think
everyone round this Committee will not be surprised. Most patients
want the best service in the world on their door step, locally
with immediate access. That is the ideal. If a local hospital,
through the capacity of the NHS right throughout the system provides
a better and better service locally, which they should be able
to do for good management, good leadership, good clinical judgments,
and the amount of money they are putting into good practice, then
they have no reason to fear because patients would prefer to go
locally. If, however, the service is of such a third-rate quality
that the only way they can survive is by the last 50 years of
saying, "No, take what you get", those days are gone.
Q321 Dr Taylor: Again from the patients'
point of view, one of the potentially very valuable developments
is the formation of patient forums.
Dr Reid: Yes.
Q322 Dr Taylor: Lots of us are very concerned
about the abolition of the CPPIH and the fact that as yet you
have not been able to give us costings for the replacement arrangements
or, indeed, any details of the replacement arrangements. Have
you any figures for that yet?
Dr Reid: I do not know if we have
got figures for it here. What I can say is that the patient forums
have been established. I do not have my notes in front of me.
The patients forums from memory have been established everywhere
now.
Q323 Dr Taylor: Yes, and in some places
they are working very well, but the worry is that they are not
all working well.
Dr Reid: In some they are working
well, in other places they are not working so well. You are absolutely
right. The functions of the central patients' forum lead-up, if
you like, will not disappear; they have been incorporated elsewhere.
We have got them up and we have got them established; we want
to make sure that the money we are putting into this goes to the
front-line patients' forum, not to some central bureaucracy, which
is one of the reasons that now we have established them we have
assimilated that in elsewhere. With regards to the specific question,
John, do you have it there?
Q324 Dr Taylor: There must be some sort
of central bureaucracy in order to run them and support them.
That is the feeling?
Mr Bacon: I think when I appeared
before this Committee earlier I offered you a table of the run
down costs of the CHCs and the build up costs of PCHIH.
Q325 Dr Taylor: Yes, we have had those.
Dr Reid: Hopefully we have supplied
those.
Q326 Dr Taylor: Yes, we have got them.
Dr Reid: The commitment we have
made is that we will continue to spend at the same level on the
overall activity around patient involvement as we work through
the CHIPH process. What we will do is redistribute the resources
in a way which we think provides a better service to patients
and enables them to be more involved in the process. I think,
as I explained to you before, there will be some central resource
in the Appointments Commission to manage the appointment process,
we will be continuing the process of having organisations manage
the infrastructure support for patient forums, and that will continue,
and the patient forums themselves are discussing what form of
over-arching structure they would like to see to help them do
their jobs.
Dr Reid: On the expenditure can
I make the point, because I have found these figures, which I
thought I had here, this year we spent about £33 million
on the patient forums, but £13 million of that, as far as
I can see, went to the central body. That seemed to us an imbalance
there where almost half of it was going in the central box. Now
that it has been established we want to try and make sure that
more and more of that goes to the front-line of patient forums;
but there will be an infrastructure still there.
Q327 Dr Taylor: Patient forums themselves
are being involved in those discussions about their support for
the future?
Mr Bacon: Yes, we are consulting
with them currently on the appointment processes. It looks very
sensible to ask our Appointments Commission who do and all other
non-executive appointments to take that function over, but specifically
we are asking them what sort of over-arching networking structure
they would like to do in order to support them in their activities.
Q328 Chairman: Can I say on the abolition
of CHCs, we have talked a lot today about many positive things,
and I think the Government generally have made incredible progress
on health policy. I think we would all accept that cross-party.
Having followed the abolition of CHCs rather closely, and worked
out that the full costs of abolition and replacement is £115
million, according to the figures that we have been given, I do
not think that the abolition of CHCs has been the Department's
finest hour. Obviously this was a decision taken long before you
were in post and I would not expect you to comment on your predecessor's
role in this, but is there a mechanism whereby you review the
way in which a policy of this nature evolves? Having been critical
of CHCs—and our Committee was occasionally critical of the
same in the year before me—I think what we have now is a
very confusing set of bodies that most people have not got a clue
about, and that worries me. Do we ever learn any lessons on an
expensive change of this nature? Do we look back and say we could
have done it differently perhaps and learn lessons for the future?
Dr Reid: Let me say, I have always
worked by the old adage that you do not reinforce failure. If
something that you change turns out to be a failure, you do not
just throw more money, and so on, at it. You have got to be prepared
to review it; that is as a general statement. If you ask me about
this, I know, Chairman, you took a deep interest in it, your Committee
did and individuals did, but I was not that closely involved and
I do not have a feel. I will be quite truthful with you, I have
a brief which tells me and I ask the questions and patient forums
provide a better service because there is one for each NHS Trust
and PCT. Unlike community health councils, patient forums cover
the full range of NHS services and so on, there are forums of
inspection and GP services, so I can tell you the information,
but I cannot genuinely claim to you that I was so absorbed in
this that at that time before I became Secretary of State I had
a feel about it. If you are saying to me, "Go away and have
a feel about it", I am not going to promise you that we are
going to change something back again because change is another
thing that people in the NHS do not want thrown upon them, but
if you want us to look at this more closely—
Chairman: All I want is an assurance
that some lessons might be learned because in the time I have
been Chairmaning this Committee, I think it is an episode that
frankly has been a shambles from start to finish, putting it bluntly,
and I hope you have learnt some lessons from it.
Q329 John Austin: My area is not untypical
in that the whole patients forum has resigned en bloc because
they say they cannot do their job and they have no support, whereas
the CHC had a full-time secretariat and staff and had that sort
of support. All that the CHC's response was to the last resignation
of the patients forum was, "They cannot do their job",
just to let them go and say, "Recruit another set",
so the support for forums does need to be looked at.
Dr Reid: I am not promising to
change anything, but I will promise you that I will do what you
ask me, I will ask ourselves what lessons we can identify and
where we think we have failed in a sense as well as succeed through
the patients forums so that the next time I come, rather than
just having four optimistic points to make to you, if we feel
there have been failings or teething problems of a major nature,
I will be able to identify them as well.
Q330 Dr Naysmith: On that point as well,
I get sent the minutes of seven different patients forums operating
different bits of health in my area and people who are interested
in health used to get all that information from one community
health council or maybe two, as I do cross two boundaries. That
kind of thing makes it incredibly difficult to keep in touch with
what is going on, so all of the trusts they are sending to which
people from my constituency go to for different things and different
services. What I really wanted to ask was the very final question,
I think, which is that in all this rearrangement and so on that
is going on, there is a bit of an amalgamation of bodies where
you have now got two totally different functions under one heading
and the one that I am particularly worried about or interested
in is NICE. NICE is world famous now and it is really an organisation
that has been fantastically successful and I certainly do not
want NICE's work to be interfered with, but I kind of suspect
that the Health Development Agency's public health work will be
of a sort of lower order of priority in the new arrangement and
that applies to a couple of other things too.
Dr Reid: Well, you could look
at this two ways. First of all, this is what I think you would
be wanting us to do and it is a pity Mr Burns has had to go, and
I am sure it is important and I am not making any comment about
that, but the idea of reducing bureaucracy, reducing the centre,
putting it to the front line, we have now cut staff by 38% in
the Department of Health, we have saved something of the order
of £2,000 million by renegotiating the drugs contract over
four years, which is the front line, and in the other-line bodies
reducing them from 38 to 20, a 25% reduction in numbers and £500
million saved, so all of that is good. We have tried to make sure
that where the functions are important they are incorporated and
amalgamated, as you said. The particular one you mentioned will
be incorporated, the Health Development Agency, within the National
Institute of Clinical Excellence. I hope that will not diminish
these functions because, you are absolutely right, of all the
bodies that we are looking at, the one which has rapidly gained
a reputation not only in Britain, but worldwide, is the National
Institute of Clinical Excellence. In assessing treatments, in
assessing drugs, in assessing the quality of equipment and so
on in health, it has now got a fantastic reputation and I tell
you, Chairman, that I thought it was great that they were receiving
something of the order of 70,000 hits in a normal week on their
website, but actually after the last assessment they had, I think
it was, 217,000 hits, many of them from North America, from individuals
who were looking to our National Institute of Clinical Excellence
to tell them what sort of drugs they should buy because of course
drugs in North America are very expensive, so I hope that the
HDA will not lose, but rather gain from being incorporated within
NICE.
Q331 Chairman: Can I just say that we
have a number of questions we have not managed to touch on and
both Mr Bacon and Mr Douglas have promised to come back on those
points. Perhaps your office could contact our Clerk regarding
this. We are most grateful to you, gentlemen and Secretary of
State, for your time this morning.
Dr Reid: And I am to you and your
Committee. Thank you, Chairman.
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