Examination of Witnesses (Questions 100-116)
RT HON
PATRICIA HEWITT
MP AND SIR
NIGEL CRISP
27 OCTOBER 2005
Q100 Dr Taylor: But you have got
to keep some of the simple procedures in the NHS centres for training
and tariffs ought to be adjusted to account for training because
if a surgeon is training a junior the operation is going to take
him twice as long.
Ms Hewitt: I would put it a different
way. You have got to make sure that wherever the simple operations
are done, the training is also done. That was another, I think,
absolutely proper criticism of wave one, because we could not
do everything in wave one. We have been talking to the BMA about
how we can get more training done in the independent sector treatment
centres as well as obviously within the NHS hospitals themselves,
and that will be built into the contract for wave two.
Q101 Dr Taylor: So you will have
NHS junior doctors being trained in the independent sector orthopaedic
treatment centres?
Ms Hewitt: That is my understanding,
yes. In fact, it is already happening.
Sir Nigel Crisp: In at least one
place.
Ms Hewitt: Nigel reminds me that
I was talking to a surgeon describing that the other day in relation
to a particular centre.
Q102 Dr Taylor: I am told by the
British Association of Orthopaedics that they have sent in a list
of complaints about complications from ISTCs and they have not
had a reply. I would be ever so grateful if you could look into
that.
Ms Hewitt: I have not seen the
letter myself but I will chase it up and make sure that there
is a reply.
Dr Taylor: Thank you.
Q103 Chairman: Secretary of State,
I wonder if I could just ask you about the evidence that there
is on phase two. I visited my local three star foundation hospital
trust in September along with the two other Members of Parliament
who cover the Rotherham Borough and was shown a letter that was
being sent to yourself that united all the South Yorkshire hospital
trusts against the second phase on the basis that their belief
was that £17 million was going to be taken from their budgets
and given to this ISTC that is about to come on stream in South
Yorkshire. What evidence is there that they would be unable, as
it were, to get down the waiting lists? I am talking about an
area that has done marvellously well in terms of reconfiguration,
changing and improving services. Practically all of the South
Yorkshire trusts are a far cry from where they were 10 years ago
and a far cry from where they were three or four years ago in
most cases. They are deeply hurt by this threat to their improvement
plan by the second phase. Was it evidence based? Was it clear
evidence that the only way to reduce hospital waiting lists further
in South Yorkshire was to set this second phase up?
Ms Hewitt: I agree with you about
the very big improvements that have been made in South Yorkshire
and I think it is very important that I, as well as you, register
our real appreciation of what has been done there. All of the
wave two proposals that we have put out to the independent sector
for tenders have been discussed very thoroughly with strategic
health authorities around the country. What we have been looking
at is not what is going to be comfortable for providers but what
will actually help patients to get the best possible services,
quality as well as speed, and support patient choice, get us the
greater innovation and so on that we have talked about. I am very
aware of the real concern that there is from those foundation
trusts in South Yorkshire, and I know Lord Warner had a very helpful
meeting with yourself and a number of other parliamentary colleagues
to discuss that the other day. We are at a very early stage of
this wave two procurement. The description of the proposals has
gone out; we do not yet know what responses we will get from the
independent sector either to that proposal or, indeed, any of
the other proposals in wave two. I think we need to wait and see
what responses come in and then, of course, continue to discuss
that with colleagues in South Yorkshire.
Q104 Chairman: Lord Warner did say
that he was going to get back to the South Yorkshire group who
met him on the basis of what evidence there was for taking that
decision and hopefully we will see that at some stage.
Ms Hewitt: He will do that.
Chairman: I recognise that it is 1.30
now and we have a whole host of questions. We wanted to ask you
about past reports of this Committee and the Government's responses
to them. Given the time, I think it would be quite logical if
we write to you and ask for those responses on paper, but there
are two issues here.
Q105 Dr Naysmith: Secretary of State,
one of your predecessors sat where you were not all that long
ago, two or three years ago, and said, "We are only going
to use the independent sector because we lack capacity" and
there was no intention to build up the private sector by using
National Health Service funds. What you have said in the last
10 or 15 minutes contradicts that. Training National Health Service
people in independent hospitals and so on is exactly what people
were querying at the time. When did this change in policy take
place?
Ms Hewitt: Obviously I do not
know which particular evidence session or which year you are referring
to there. Initially the use of the independent sector was driven
by the absolute need to get more capacity into the system in order
to get the waiting lists down, as will happen with the diagnostics
procurement. Nigel will correct me if I am wrong, but for the
last couple of years at least the desire to bring in the independent
sector in some cases has been driven not only by the need to get
more capacity but also by the need to get even faster innovation,
more choice and more contestability into the system. Since we
started off by discussing the Manifesto, perhaps I can just say
that statement about the independent sector was in the Manifesto
but also, perhaps rather more importantly, it was in Creating
a Patient-led NHS and I think earlier documents as well. I
have not got them all in my head but Nigel can correct me if I
have got that wrong. It was 2003; it was two years, as I thought.
Q106 Mr Burstow: Can we come on to
one final thing which I think a couple of us definitely want to
ask questions about. Can we make sure that when the note on finance
is done that it does cover things like recovery plans and how
many there are now compared to previous years and the five monthly
forecasts that you have had submitted from SHAs. It would be very
useful to have that. The question I want to ask is about the very
welcome statement made on Tuesday at the Breakthrough breast cancer
event about Herceptin, about the fact that PCTs should not refuse
to fund Herceptin on the basis of cost grounds. Can you tell us
how that is going to be communicated to PCTs and how its implementation
is going to be monitored? Certainly at least one of my constituents,
Emma Kearns, who has currently been told that she will not get
this particular drug on the grounds that she is not an exceptional
case, wants to know whether she is going to benefit from that
announcement because she does not understand what it means to
be told that she is not an exceptional case when her life is at
stake.
Ms Hewitt: This is an enormously
important issue. We have seen women with breast cancer who could
potentially benefit from Herceptin faced with this very difficult
situation when, of course, the drug is not licensed for early
treatment and has not been through a NICE evaluation. A couple
of weeks ago, as you know, I announced that we would both speed
up the NICE evaluation but also immediately take steps to get
the testing facilities in place for women who have been diagnosed
now who could benefit from Herceptin when the rest of their treatment
has been concluded around next summer. What I have now done is
to build on what already happens with unlicensed or unevaluated
drugs where, of course, the doctor has always been free to prescribe
them, obviously in discussion with the individual patient. I have
made it clear, and of course we are communicating that directly
to primary care trusts, that where a clinician, having discussed
the risks with the woman, comes to the PCT and says, "I believe
this is the right treatment for this individual woman", the
PCT should not be rejecting that on the grounds of cost. That
was hugely welcomed, of course, by the breast cancer charities
and by a lot of patients. We are in this awkward period, if you
like, where we have started seeing the results of the clinical
trials but the licensing application has not even been made yet
by Roche, and I continue to urge them to get that in as quickly
as possible. NICE stand ready to begin the evaluation as soon
as that licensing application is made so that the two things will
run very much in parallel. Once there is a NICE evaluation, if
that is positive then the normal rule will apply that within three
months we would expect all PCTs to be following it.
Q107 Mr Burstow: Does that mean that
for any of our constituents who have been recommended by their
local cancer hospital, in my case the Royal Marsden, for Herceptin
as being a beneficial treatment to have, if they are then turned
down by their PCT on the grounds that they are not an exceptional
case, the PCT should now revisit such decisions?
Ms Hewitt: I think any woman in
that position should simply discuss that again with her doctor.
One of the reasons why I wanted to make this announcement this
week was we have already had a number of primary care trusts saying,
"Where the clinician comes to us in this situation we will
fund the treatment" and I wanted to make sure that was happening
everywhere.
Q108 Charlotte Atkins: There is a
problem in some parts of the country where PCTs are already running
deficits and unless you, as Secretary of State, make funding available
then there will be people who are unable, because of funding difficulties,
to actually get Herceptin. When do you think that will be available
on the NHS to people with early stage breast cancer?
Ms Hewitt: It is already being
made available to people.
Q109 Charlotte Atkins: In terms of
PCTs not having the money, that is a key issue. You will be aware
that in North Staffordshire there is a very active campaign on
the issue of Herceptin and there are a number of ladies there
who have got cancer and are not getting funding simply because
the local PCTs have not got the money to spend on that particular
treatment.
Ms Hewitt: I understand exactly
the difficulty you are pointing to and, of course, Rosie Winterton
met a number of the women in that position just a few weeks ago.
The hugely increased budget for the NHS has already been devolved
almost entirely to the primary care trusts and, of course, this
issue of Herceptin at this stage is going to cause difficulties
for those PCTs who are already facing financial difficulties of
the kind that you have described. What we are talking about is
a relatively short period that falls over two financial years,
in other words between now and the end of this financial year
and the beginning of the new financial year and the point at which
we have both licensing and a NICE evaluation. Given the very significant
increases in the budget for every PCT in the new financial year
and the continuing work that PCTs are doing to implement the financial
recovery plans that they have agreed with their strategic health
authorities, although it will be difficult, and I was very clear
about that in the announcement I made, I do believe that PCTs
will be able to do this.
Q110 Charlotte Atkins: Time is not
on the side of these women, that is the point.
Ms Hewitt: That is right, and
PCTs will have to find a solution to that.
Q111 Charlotte Atkins: Could you
help them find a solution?
Ms Hewitt: I do not have a little
pot of gold sitting in the Department to give to individual PCTs.
Q112 Charlotte Atkins: What about
Sir Nigel's NHS bank?
Ms Hewitt: Each PCT that has got
a deficit is working with its health authority. They should already—we
are half way through the year—have a robust financial recovery
plan in place. This will put another cost pressure into the system
and I realise that is going to be a problem for some of them but
it was quite clearly the right thing to do. That will have to
be managed in that minority of trusts with a deficit as part of
the financial recovery plan.
Q113 Chairman: Secretary of State,
one more question. You probably do not know this but John Austin
has been a Member of this Committee for over 10 years and it is
his last sitting, he is now moving on to greater things as it
were.
Ms Hewitt: Congratulations.
Q114 Chairman: I thought we ought
to give John his last bite of the cherry as far as this Committee
is concerned.
Ms Hewitt: Not a bite, I hope!
Q115 John Austin: If you cannot answer
it with a date perhaps you can write to us with the answer. I
think one of the most widely acclaimed recent reports this Committee
produced was on sexual health and obviously we are all alarmed
by the recent reports of increases in sexually transmitted diseases.
When do you think we can see some improvements in sexual health
in this country?
Ms Hewitt: It is an enormously
difficult and frustrating area. I absolutely share your concern
and the Committee's concern about particularly what is happening
amongst many young people and what is starting to look like an
epidemic of sexually transmitted diseases amongst many young people.
It is incredibly difficult to get the changes in behaviour that
will really see the improvements that we want. Caroline Flint,
who is now our excellent Minister for Public Health, has made
that one of her top priorities and is working very closely not
only with the NHS but also the excellent voluntary organisations
we have in this sector to try to step up our efforts with parents,
with schools, with the sexual health services and, above all,
with young people themselves. If I may, congratulations on your
longevity.
Q116 Chairman: Could I thank you
both for coming along. I am afraid it has been rather a long session.
We will pick up anything we have not covered by paper.
Ms Hewitt: Thank you very much
indeed, Chairman. I have enjoyed my first session and I look forward
to many, many more.
Chairman: Thank you.
| 
