Examination of Witnesses (Questions 80
- 99)
THURSDAY 19 JANUARY 2006
DR FELICITY
HARVEY, MR
MIKE BROWNLEE,
DR BARRY
COCKCROFT, MR
BEN DYSON
AND MR
ROB SMITH
Q80 Anne Milton: So even if it is
not, I mean for physiotherapy, speech therapy, something like
that.
Dr Harvey: The stipulation is
that you are under the care of an NHS consultant.
Q81 Anne Milton: If you are having
physiotherapy, are you? Yes, you are.
Dr Harvey: It would depend, I
presume, whether that is a referral through your consultant.
Q82 Anne Milton: Yes, it would be.
What about visitors? I think it is particularly relevant for elderly
people, particularly the frail elderly, whose contact with visitors
could be said to be part of their treatment—they do much
better, they get less disorientated if they are out of hospital
for care. Are there any exemptions or is there help for car parking
for those visitors?
Dr Harvey: I think if I might
add just from the NHS Low Income Scheme perspective, it does cover
patients but also, where those patients require escorting because
of the condition that they have, on medical grounds, then those
escorts would also be exempt from travel costs.
Q83 Anne Milton: But not the visitors.
As I say, it is particularly relevant, I think, to elderly people?
Mr Smith: I do not believe that
the hospital travel cost scheme does cover visitors unless they
are escorting people, so that would not help. In terms of visitors
in the majority of acute hospitals—we have no collected
central information on this, this is just information that I have
observed in places that I have worked in or have visited—a
reduction in cost is usual. If you have a relative in a critical
care unit and there is a recognition that you will be visiting
and staying for long periods of time, the local organisation usually
provides relief in those circumstances, but the median of charges
in hospitals is £1 an hour, the median cost across hospitals
in the UK, for the first three hours, so it is only after that
time that charges generally start to escalate significantly, but
those charges are levied on all visitors.
Q84 Anne Milton: Do you have any
information about how people get to hospital: because, I think,
on the small bits of research I have seen, irrespective of where
this problem is, irrespective of how good public transport is,
people will always travel by car? They will get a neighbour, they
will get somebody to take them to hospital by car.
Dr Harvey: I am not aware of any
research personally, but certainly, of course, some people will
have travel to hospital covered under the patient transport services—the
non-emergency ambulances—and those would be on medical grounds,
and that would be that it has been recommended by a doctor that,
either due to a physical condition or particularly a medical condition
that they have, they would need transport plus or minus an escort,
depending on the conditions, and so those people would be covered
under the patient transport services. I am not aware of any other
issues. I wonder whether it is worth raising that some of these
issues have been raised during the consultation, Your Health Your
Care Your Say, around the patient transport services and, indeed,
hospital travel cost schemes and we know that they are being looked
at at the moment.
Q85 Dr Taylor: The crucial question
to me is where do the profits go from car parking: because they
are mostly run by private contractors? Do they get the profits
or does the NHS get the profits?
Mr Smith: I think it is difficult
to say that car parking situations are normally run by private
contractors. I certainly have no evidence for that, but, equally,
I find it difficult to disprove it.
Q86 Dr Taylor: You mean many hospitals
run their own car parking?
Mr Smith: Absolutely.
Q87 Dr Taylor: Surely you must have
some figures for that, because every hospital I know does not
run their own car parking system.
Mr Smith: I do not have figures
for that, but I am talking from the visits that I have made to
hospital. I was going to go on to say that in many cases, although
the facilities may be operated by a private company, they are
paid a fee for that and, if there is any excess income over and
above that fee, it will go to the hospital trust—those are
the circumstances that I am used to—other than where the
trust, because of space constraints or lack of availability of
finance, may have worked with a private car park operator who
will have financed and built a car park adjacent to the hospital,
and an example of that would be at Queen's Medical Centre
in Nottingham—one exists there—and in that circumstance
it is the operator of the car park who keeps the revenue from
people using that car park.
Q88 Dr Taylor: Would it be possible
to have a breakdown of figures across the country, or would that
be a huge work?
Mr Smith: We do not collect that
information at the moment. We ask trusts to tell us whether they
charge or not and the level of the charge. We do not ask them
to supply the information about is that car park run, operated
or where does the finance go. The information is not collected.
Q89 Dr Taylor: Maybe it is on the
telephone side, because in the information you have given us the
cost of incoming telephone calls ranges from 15p to 49p a minute
for somebody who is phoning up the patient at their bedside phone.
Where do those profits go to?
Mr Smith: It is a different circumstance.
The installations have been paid for by private sector companies,
who retain the income from the telephone charges, the charges
for the television, for the provision of those additional services.
They retain a basket of income from those services to pay for
the capital investment and the running costs of operating that
service. That money does not go to the NHS.
Q90 Dr Taylor: Is there any reason
why the range of costs is so wide—15p to 49p a minute?
Mr Smith: Ofcom have been running
an investigation into that which concluded with the closure notice
yesterday, and they have asked the Department of Health to work
with the providers of those services and with Ofcom to look into
that, but they have acknowledged that it is a very complex area
and complex issue. The Department of Health has already agreed
to undertake that work, working with the private sector providers,
working with Ofcom, to look at what can be done about those high
charges.
Q91 Dr Taylor: If you phone a patient,
is there automatically a warning of what it is going to cost you?
Mr Smith: It is my clear understanding
that when you phone into the hospital you are always given a warning
message.
Q92 Dr Stoate: This is a fascinating
inquiry, because the more we look into this the madder the system
becomes. I would like to pick up on something that Dr Harvey has
just said about the NHS low income scheme about travel to hospital.
It appears, therefore, if I refer a patient for physiotherapy
the patient cannot claim the money back for travel to the hospital
to get the physiotherapy. If, on the other hand, I waste vast
amounts of public money by referring the patient to the rheumatologist,
who then refers the patient for physiotherapy, they can claim
their travel to the hospital. Therefore, I have got to say to
my patient, "I can save you a few quid", although I
am wasting a few hundred quid by referring someone to rheumatology
that does not need to see them. The whole point about general
practice is that we avoid referring to hospital where possible,
but we do access secondary care services on direct referral because
that is very efficient and very quick, but you are now telling
me the patient cannot claim the cost. It is daft.
Dr Harvey: These are issues that
are being raised during consultation with the National Health
Service and LHAs and they are being looked at at the moment.
Q93 Dr Stoate: The whole system gets
madder and madder by the minute. I am genuinely amazed. I did
not know about this. I am learning a lot this morning.
Dr Harvey: I think the issue is
that the way in which services have been delivered is changing
over time, and I think quite a lot of these issues, as I say,
have been raised during the consultation period.
Q94 Dr Stoate: If under my new practice-based
commissioning arrangements I invite the consultant to drop in
on a Thursday afternoon, presumably at my expense, and the consultant
just signs a load of forms for people to have physio, they can
claim the money back for it, whereas if I do not take the trouble
to invite the rheumatologist over to do that, the patient cannot
get the money back?
Dr Harvey: We can certainly send
you further information on this, but I know this is an issue that
is at the moment being looked at.
Dr Stoate: Thank you, Chairman. I am
gobsmacked!
Chairman: Anne, have you got a supplementary
on this?
Anne Milton: No, I just have to back-up
what Dr Stoate has said. The impression I am left with is that
a lot has been attacked, a lot is under consideration but, fundamentally,
it is all too difficult for anybody to ever change anything. You
do not have to comment. It sounds like a very difficult issue.
Chairman: Maybe that is an issue we can
have when we draw up this report. We are going to the area about
information for patients now.
Q95 Mr Campbell: There have been
many submissions made that patients were not aware of what they
can claim and what they can get in relation to prescription charges.
Even Citizens Advice submitted that a lot of people are now facing
court action because they have been falsely claiming prescription
charges. The question is: are you failing to ensure that patients
are made aware that they can claim? I know you were brandishing
a book before, and sometimes I get worried when I see these because
some of these are very complicated and you need a degree to read
them. It is like when you get a toy at Christmas, when you get
the instructions you need to be a rocket scientist to put it together.
Sometimes these information packs that are produced are very heavy
for an ordinary person to read. Are you failing, because if Citizens
Advice write, and a lot of people are suffering, there is something
wrong with the system?
Dr Harvey: I think since the Prescription
Pricing Authority took over responsibility for the PPCs, and in
fact now they cover all the certificates of exemption for those
that need passporting, like, for example, tax credits, but they
have been working quite hard with Citizens Advice,[9]
with National Union of Students and with other patient groups
because of a concern that some people are not aware that they
may well be eligible for help with health costs. The primary publication
that they have, which is HC11 "Help with Health Costs".
There are also quick guides.
Q96 Mr Campbell: Is it simple to
read?
Dr Harvey: It is very simple to
read, but, in fact, we do also have a number of quick guides.
Q97 Mr Campbell: It is 77 pages?
Dr Harvey: This one is, but there
is another one that is literally a fold-out.
Mr Brownlee: It is a small fold-out.
Dr Harvey: We have provided the
Committee with a pack of the information that is available to
patients and the public that the Prescription Pricing Authority
publish, but I think to start with one needs to say that there
are advice lines both for the Department of Health and for the
PPA, through which all of this information can be obtained, there
is information on every prescription form, on the patient information
side, which also deals with how you can get information about
help with health costs and, indeed, pre-payment certificates.
There is also this information provided through the Waiting Room
Information Services, which many primary care organisations subscribe
to, but also information available to all primary care practitioners,
including pharmacies. However, having said that, we are still
concerned and the PPA are still concerned with making sure that
the way in which they are targeting the information does actually
get to those groups—particularly one group that has been
raised with them and with us those on incapacity benefit who are
not passported—so that they are aware of the fact that there
is help with health costs. The other thing is that all of the
Jobcentre Plus bodies also have these leaflets available for people
and there is information on the DWP websites, and lots of other
government websites and other bodies that have been working with
the PPA also have information on their websites; so we are working
quite hard. I think if you look back to October 2004[10]
before the PPA took over all of this, possibly information was
not as readily available as it should be, but we are now working
and the PPA are working very hard to try and ensure that more
people are more aware that they may well be able to have exemption,
and, indeed, we know that DWP have done a lot of work around the
benefits, many of which are passports to free prescriptions and
healthcare costs so that people are aware that they can claim
those.
Q98 Mr Campbell: How do you monitor
the primary care groups regarding information?
Dr Harvey: I am sorry?
Q99 Mr Campbell: How do you monitor
the primary care groups that have to give this information out?
I was sat on the select committee for the ombudsman for many years,
and in the hospitals there was never a leaflet about how you can
complain to the ombudsman. There was a leaflet about how you complain
to the hospital, but never the ombudsman. He was always left out
of the loop. I have a funny feeling that sometimes the primary
care leaves lot of information out of the loop.
Dr Harvey: Certainly, through
the PPA, they actually do send information to all GPs' surgeries
who are not members of the Waiting Room Information Service Scheme,
but the PPA do have regular discussions with their board and,
indeed, with us looking at the effectiveness of what they are
doing in terms of getting the information about health costs to
patients, but they are always striving to make sure that they
do it better. We know, for example, with the incapacity benefit,
when we increased the NHS Low Income Scheme level by half the
prescription charge, we did have an estimated 44,000[11]
people who went from partial help to full help group. I do not
know if Mr Brownlee has any additional information.
Mr Brownlee: All I would say is
that we are aware that the position certainly was not as it should
have been two or three years ago, which is why we took the action
we did. We are also aware that one can always do more in this
sort of area, frankly, in terms of effort and money spent, and
we are in discussion fairly frequently with the PPA on this, although
leaving it to them to do it. We are not just saying, "Go
away and get on with it". It is a balance of looking at the
overall position.
9 Note by witness: See footnote 6. Back
10
Note by witness: The PPA took over the publicity work
in April 2004, although they have been administering the PPC purchasing
arrangements since October 2002. Back
11
Note by witness: Estimated from a sample, when rounded
is 45,000. Back
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