Examination of Witnesses (Questions 80-93)
DEPARTMENT OF
HEALTH
3 NOVEMBER 2004
Q80 Mr Bacon: Do you think that there
are direct relationships, but that the study so far has just failed
to show them and you need to do more studies?
Sir Nigel Crisp: I would guess
that there will be some direct relationship, but there is also
a direct relationship to how you run the place and the systems
you use within A&E and how it links in with primary care and
those may be more significant in some cases than the number of
staff in A&E departments.
Professor Sir George Alberti:
There is a workforce model which is being tested at the moment,
which is based on how many patients you think a particular sort
of health professional can see of a particular case mix, giving
us some crude ideas. We have just under 600 A&E consultants
at the moment. You can then start doing some sums, if you want
a consultant available all the time, which I do, and that starts
taking it up to quite high numbers. We are building slowly but
surely towards those and you can do the same for emergency nurse
practitioners. If we want all our minor units or walk-in centres
to be properly staffed at least 18 hours a day, then you can calculate
that you need eight as a minimum. You can start building up your
numbers. We have done the same for ECPs, where we think by the
end of the year we will have not far short of 600 or 700. We need
probably many, many times more than that and we can now start
working towards it.
Q81 Mr Bacon: The Report refers to the
British Association of Emergency Medicine and their recommendations
for staffing levels and of course the funding implications of
this. Does the Department basically accept the Association's recommendations?
Professor Sir George Alberti:
I have been working on the basis that those are reasonable numbers,
but that is me working on that basis.
Sir Nigel Crisp: We do not have
a precise answer. All specialty groups identify what they think
is needed in every specialty and we always look at them with interest.
We do not always accept them.
Q82 Mr Bacon: Are you saying that there
is always an element of a wish list about it?
Professor Sir George Alberti:
Having come from the other side of the fence, I looked at these
numbers very carefully, but to provide a 24-hour service, which
is what our patients need, you are into six to eight per department.
Q83 Mr Bacon: How soon do you expect
the shortage of radiographers to be eliminated?
Sir Nigel Crisp: Do you mean the
shortage generally?[5]
Q84 Mr Bacon: Yes; it is paragraph 2.12.
Sir Nigel Crisp: Is this about
diagnostic delay?
Q85 Mr Bacon: Yes, because 11% of all
delays are diagnostic delays.
Sir Nigel Crisp: It is worth noting
that this is 11% of the people who wait more than four hours.
Q86 Mr Bacon: It does not say that, although
I presume it is.
Sir Nigel Crisp: It is actually;
it is not 11% of all patients.
Q87 Mr Bacon: I take your word for that,
but it is a big, big chunk, is it not, over one in ten.
Sir Nigel Crisp: I think it is
the biggest single reason. I think the calculation is 0.2% of
patients through A&E.
Q88 Mr Bacon: I am running out of time
so can we go back to my question?
Sir Nigel Crisp: I think the answer
is probably nearer "as soon as we can"; we have a whole
lot of things in process, but I do not think we have yet got absolute
milestones for when we will do it.
Q89 Mr Bacon: How many can you see in
the pipeline?
Sir Nigel Crisp: I could send
you a note on that; I do not know.[6]
Q90 Mr Bacon: If you could, that would
be very kind.
Sir Nigel Crisp: Shortage of radiographers
is an international issue, as you probably appreciate.
Q91 Mr Bacon: Like lots of other things,
as we discovered; like nurses, as we discovered with the United
States. One other question which relates to your recent report,
Sir George. In the back you talk about—and there is a reference
to emergency care networks in the NAO's Report—all these
different stakeholders or partners or whatever the right word
is, everything from acute trusts to ambulance trusts to SHAs,
to out-of-hours people, to social services and local councils.
In your report you talk about breaking down the barriers being
a key challenge. What are the biggest existing boundaries? Apart
from the fact that they are geographically and institutionally
separate, what are the biggest problems that you need to break
down?
Professor Sir George Alberti:
I suppose finance would be a major element of this, each with
its own budget and not wanting to hand over—
Q92 Mr Bacon: We were in Northern Ireland
yesterday looking at how health and social care are integrated
there and lo, it did not seem to make a lot of difference. There
was one guy in front of us who was responsible for both, but it
did not seem to solve the problem.
Professor Sir George Alberti:
We have examples of that beginning to occur here. We are going
to encourage much more of it. What I would see is the emergency
care network being charged with commissioning for all the emergency
services you require in that patch and that includes the social
service support, etcetera. When you get to that stage, then a
lot of the problems will disappear. I am very much in favour of
health and social services being much more closely integrated.
Sir Nigel Crisp: This is a commissioning
model rather than a management model, which is what the one in
Northern Ireland is.
Mr Jenkins: Two quick points and you
may send in a note, if you would, please. How and when do you
intend to get the poor performers up to the best with regard to
this 98%?[7]
What do you mean by unmet need? Can you tell me what you mean
by unmet need and do you have an estimate for it? [8]
Q93 Chairman: Gentlemen, thank you very
much. I apologise for the delays earlier on, but we have managed
to make up for lost time. I congratulate you on a good Report.
Good progress has been made, but of course we can always do better.
Sir Nigel Crisp: May I pass on
your congratulations through a bulletin I send out tomorrow to
the NHS?
Chairman: Of course. Thank you very much.
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