Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 80 - 99)



  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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