Examination of Witnesses (Questions 660
- 679)
THURSDAY 16 FEBRUARY 2006
RT HON
JANE KENNEDY
MP, MS ROSIE
WINTERTON MP, DR
FELICITY HARVEY
AND MR
BEN DYSON
Q660 Chairman: He is all right, he
does not need them anyway. Can I ask you about best practice within
the NHS for getting information about the Low Income Scheme. Could
we take it as read that would be the case for the private providers
that the NHS do now contract with, that we are likely to see these
things in the areas where people go for private provision as well?
Jane Kennedy: Yes. Certainly we
will look to make sure it is understood that such advice should
be available.
Q661 Chairman: We may be going on
a visit to one or two of these so we look forward to seeing them
displayed in these areas.
Dr Harvey: In terms of the transport
scheme, as part of the consultation that will be taking place
over a three month period one of the issues they are going to
be looking at is how to raise awareness of the HC2 and HC3 for
the Low Income Scheme help with travel costs for both staff and
patients.
Q662 Chairman: We are moving on to
another area now. You probably know that last week we had Patientline
in here and questioned them, and earlier today we had Ofcom questioning
them as well about their report and their letter that was sent
to the Secretary of State in relation to the policy on telecommunications
in hospitals. Could you comment on the failings of the Department
in regards to its policy on telecommunications services and what
clearly most people would say is an inability to protect patients'
relatives particularly and friends from unreasonably high charges?
Ofcom were very diplomatic this morning but it is quite clear
from the contents of the letter they sent to the Secretary of
State on incoming telephone charges that they are extortionate—my
words, not theirs—in terms of what people have to pay to
phone a relative. How wrong do you think coming to a contract
with these people was?
Jane Kennedy: First of all, I
would say Ofcom had undertaken an investigation into the provision
of these services. They have now dropped that investigation because
the Department and the contractors have expressed a willingness
to work with Ofcom to address some of these criticisms that have
been raised. There were about 70 complaints raised, which is a
significant number, but when you think of the total number of
people who have been using the services actually it is a relatively
small number of people who are complaining. The majority of the
complaints were about the costs. Among those people who have been
using the service there is quite a high customer satisfaction
rate with the services that they are receiving. In comparison
with what was there before the services are seen as a very big
improvement.
Q663 Chairman: I accept that, but
Ofcom stated in their letter to the Secretary of State that they
had: "not therefore reached a final conclusion in respect
of the lawfulness under competition law of the contractual arrangement
entered into by the NHS Trusts and the providers". That does
suggest this particular contract is suspicious, even to suggest
it may or may not have been lawful in their view. It was not against
competition law, they have clearly said that, but they have not
passed it back to you with any glowing references about the scheme.
They made it quite clear you need to do a critical analysis of
what people have signed up for here.
Jane Kennedy: On the day that
Ofcom communicated with us to say that they were not taking their
inquiry forward we made quite clearly a statement to say we accepted
we need to review the arrangements and that is what we are doing
and we will be in a position to announce the membership of the
review group very shortly. It would be wrong of me to go into
too much detail about what the perceived shortcomings might be
in the current scheme. I need to let that group of people do their
work.
Q664 Chairman: You do not think that
in any way the Department was duped into buying what some people
would say is an expensive toy?
Jane Kennedy: I take comfort from
the fact that a lot of the users of the service have said that
they think they are getting a good service.
Q665 Chairman: I have to say my niece,
who has just had a child, is in Rotherham Hospital and I was there
Sunday evening and she said the system they have got there is
wonderful, but I am not sure the relatives who have been phoning
in will think that when they get the phone bills.
Jane Kennedy: If I can just add
one further point. The reason why I think these services are important
is my elderly father-in-law went into hospital and spent a long
time in hospital in his declining months. His one pleasure in
life was watching Liverpool Football Club. His daughter took a
television set in so he could watch the FA Cup Final when Liverpool
were playing in a recent FA Cup Final, as they often do, and she
was told she could not plug the TV in until it was checked by
an electrician. She left the TV with the hospital ward for them
to do that, it was never plugged in and the old gentleman did
not get to see the last FA Cup that he would have been able to
see with Liverpool playing. To have a service that is there that
they can purchase that is there to provide that kind of service
to patients is infinitely better than that kind of experience.
If we have not got it right here we are working with the contractors
to see what we can do to improve it.
Q666 Mr Campbell: Sometimes it is
a bit of a rip-off though.
Jane Kennedy: I hear that criticism.
Chairman: I have to say I was hospitalised
in 1992 and I hired a television at the bottom of my bed and it
kept me sane in a sense. I did not like visitors because they
were interrupting my viewing pattern!
Q667 Charlotte Atkins: I think we
are being a little bit complacent here. Yes, of course the system
is great for patients but it is a nasty shock for people who are
ringing in when they get a huge bill. Maybe the complaints are
not very high because they get it in their quarterly telephone
bill three months later. That is the issue, is it not?
Jane Kennedy: You have to appreciate
that when we said we would develop this scheme it was to be at
no cost to the NHS, therefore the contractors are investing significant
sums in the roll-out and development of this facility for patients.
Part of the quid pro quo of that is that they have to recover
their costs. These are all issues that we will want to look at.
We have taken the Ofcom comments very seriously and we want to
review the arrangements.
Q668 Charlotte Atkins: Maybe you
could have a look at the people who are calling in and are being
subjected to these very high costs. It may well be that you are
talking about poorer friends and relatives of people in hospital
who cannot afford to visit them in hospital or are unable to for
whatever reason. Is it not the case also that, yes, they have
got to recoup their costs but the point is they are recouping
their costs for a very expensive bit of kit which is not being
fully used by the NHS?
Jane Kennedy: One of the criticisms
which I heard was that when people ring in, the first 25 seconds
or so is a message that says you are going to be charged at premium
rate and this is how much it is going to cost you. If you are
ringing in regularly that is not only irritating but also quite
an expense. We are going to look at all of this and I just want
to give the Committee—
Q669 Charlotte Atkins: It costs more
to ring in than it does to ring Australia. When you are given
the cost in a message when you are anxious to talk to a friend
or relative it does not always sink in what the total price will
be. Of course, you are right, it is an irritation to have that
message especially if you are a repeat caller who constantly has
to pay to hear this irritating message.
Jane Kennedy: I am one of those
people who is very irritated by telephone menus anyway, so I have
a lot of sympathy for callers in those circumstances. I really
cannot say much more at this point other than we are working with
Ofcom and the companies and I will be announcing the membership
of the review group soon.
Q670 Charlotte Atkins: Will you also
be looking at whether the NHS is going to have any prospect of
using this expensive kit or will it just be not a toy but an expensive
white elephant?
Jane Kennedy: It has got about
40% usage, so perhaps part of the review may well look at how
we can promote use of it. There are alternatives. There are payphones
still in most hospital wards and very often TV rooms too. There
are alternatives to this service if patients or relatives choose
not to use it. The basis on which we allowed it to go forward
was that it should not cost the Health Service any money. Working
through that sort of detailed contract, there have to be ways
of paying for it.
Q671 Charlotte Atkins: Real competition
would be the use of a mobile phone. Are you going to be looking
at the issues around the use of mobile phones? I appreciate that
there are clinical reasons why mobile phones should not be used
but that would be the alternative choice for most relatives and
patients.
Jane Kennedy: I had not intended
that this review would look at the extended use of mobile phones
in hospitals. I am told yes, we will be looking at mobile phones.
Charlotte Atkins: Excellent. An immediate
change of policy, marvellous.
Q672 Dr Stoate: It is called manifesto-plus.
Jane Kennedy: But not as part
of this review.
Q673 Chairman: I think that was one
of the things in the Ofcom letter to the Secretary of State, the
issue of mobile phone usage in hospitals. Could I move on to another
area which is the issue of hospitals and car parking. Should hospitals
use parking to raise money?
Jane Kennedy: I see absolutely
nothing wrong with it.
Q674 Chairman: Do you think that
Trusts are providing enough free parking for regular attendees,
such as cancer patients? We have gone from 10 years ago when you
would probably go into the acute sector for a week or a fortnight
to now where you go in every day for an hour a day. Do you think
Trusts ought to be issued with guidelines saying that regular
patients like that should be exempt from charges?
Jane Kennedy: It is very much
for local Trusts to determine how they are going to manage their
car parking facilities. The vast majority do have exemptions from
charges. Hospital staff are pretty good usually at advising patients
when they might get exemptions from car parking. It is very much
a matter for local determination.
Q675 Chairman: Do you keep a check
on them at all?
Jane Kennedy: I think we are content
that the policies are being applied properly. Most hospitals will
say it is enabling them to manage, as I said earlier on this morning,
the space around them more efficiently, it discourages other people
who are not using the hospital from using the car parking space,
which in an inner city area is quite a problem for hospitals,
and there are exemptions in place. Obviously nothing is ever perfect
but I think they are getting it broadly right.
Q676 Chairman: No concerns about
having it on a pro rata basis? Some of these car parking charges
are very high, as high as airports and everything else. I know
you are not there for 24 hours but they are quite high charges
for a short stay on occasions. You do not really have a view,
that is a matter for the Trust, is it?
Jane Kennedy: I would pay easily—I
am not sure what it is in Liverpool now—a pound an hour
to park in the city centre to go shopping. I think these are comparative
charges and, therefore, fair in that context.
Q677 Chairman: Dame Gill Morgan from
the NHS Confederation last week was sitting where you are sitting
and she said that car parking will increasingly be used as a competitive
lever by hospitals to attract patients. Would you be happy to
see hospitals build large car parks to win patients over?
Jane Kennedy: I do not see it
as a draw for patients, I see it as a service for patients, and
I am sure that staff would welcome it as well.
Q678 Chairman: Looked at through
eyes like that, in view of what you said earlier about this issue
of a sustainable transport system and taking things out into the
community, it could have an adverse effect if we were to see this
type of competition as far as transport was concerned, forget
the health side of it. Do you think that there is a danger of
that?
Ms Winterton: I know in my constituency
the constant complaint is there is not enough parking and the
residents nearby say "people visiting the hospital park outside
our house" and visitors and others say it is difficult. I
think it is quite important that hospitals do respond to that.
If people are saying this is making life difficult not only for
them but for people who might want to come and see them, making
life difficult for local residents, I think what she may be getting
at is if hospitals feel that is something that patients are asking
for they will respond to it. I think that is quite good, it can
make people feel quite valued if they think the hospital is responding
to the points they have been making about the facilities available.
Q679 Charlotte Atkins: One of the
areas which I am concerned about is chiropody. It increasingly
seems to be moving into the private sector so elderly people,
who rely very much on chiropody and it can have a real impact
on their mobility, are being charged for that valuable service
by default.
Ms Winterton: I think there has
been a longstanding argument about chiropody services. What I
have been impressed with is the way that nowadays, particularly
for people with diabetes, for example, who do need very good chiropody
services, and beyond that podiatric services, increasingly in
the way some of the centres are operating they do provide that.
There are always issues between whether people in terms of having
their nails cut have that on the NHS or whether you ensure that
because of the terrible long-term effects of something like diabetes
and you do not have proper corresponding chiropody services, you
look at exactly what might happen if it is not treated. It is
important to think we do target our resources where there is going
to be the most effect, in a sense, and where it is going to make
a real clinical difference.
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