Examination of Witnesses (Questions 680
- 699)
THURSDAY 16 FEBRUARY 2006
RT HON
JANE KENNEDY
MP, MS ROSIE
WINTERTON MP, DR
FELICITY HARVEY
AND MR
BEN DYSON
Q680 Charlotte Atkins: I can understand
that, but if you are elderly and are unable to cut your own toenails,
the impact of that can be as devastating as if you have a condition
which requires you to have professional help. If you literally
cannot cut your toenails then it will affect your ability to walk
and mobility. I have had constituents who have said they are unwilling
to go to a chiropodist to have their toenails cut because they
do not think this is something they should be doing on the NHS
sometimes, and some who can afford to will go private but there
are others who will not be able to afford to do that on a regular
basis.
Ms Winterton: I think there may
be some examples where PCTs may commission those kinds of services
for particular groups and perhaps it might be helpful if we look
into where there are good examples of that for the Committee.
Charlotte Atkins: I think so otherwise
we are talking about a whole group of elderly people being housebound
when there is no need for that to happen.
Q681 Chairman: Could I ask you about
the likely effect of changes in the NHS to the structures of charging.
This "greater diversity of providers" mentioned in the
White Paper, does that not suggest there is likely to be an extension
of charges?
Ms Winterton: I do not think that
should automatically follow from that. The White Paper is about
looking at how we can provide more NHS services in the community,
making it more convenient to people, making it closer to home,
but it is not allowing within that an ability to say if you have
day care surgery that comes under a different provider—I
accept the point about the following medication—that provider
would be allowed to charge for the service. It is about NHS services
being offered in a different setting.
Q682 Chairman: I have not got the
White Paper with me but what about areas of alternative medicine?
I go along to a private sector person for acupuncture. I know
you can get it in some pain clinics in hospitals but I decided
to do that myself. It is mainstream in some parts of the NHS and
I could foresee a situation where a GP could turn round and say,
"Maybe acupuncture is a way of doing it. My commissioning
says I can give you one hour and we will see how that goes",
whereas somebody might then go along and say, "For a small
charge I will extend what the GP has commissioned". Do you
see things like that could happen?
Jane Kennedy: GPs are limited
in what they can charge for NHS patients who are on their list.
It is a very limited range of services that they can charge for
and we have not got any plans to change that. If somebody like
yourself was looking for acupuncture provided through a referral
from a GP you would not be able to be charged for it unless it
was on that very narrow list. In effect, the patient would have
to come off the NHS list for the doctor to then say, "If
you want to go privately"—
Ms Winterton: I think NICE is
looking at some of the alternative therapies that are available.
Q683 Chairman: The White Paper suggests
that will be part and parcel of looking after people's wellbeing.
Ms Winterton: If NICE looks at
therapies that it thinks are effective it can, in a sense, recommend
those. It might be up to individual PCTs as to whether they want
to fund them completely in the first instance.
Q684 Chairman: What would you say
if you had a private provider who was in deficit and they said
they would like to develop some chargeable services at the margins
of their activities? Presumably you would not be able to stop
them. In the case of a Foundation Trust, if they were to offer
services like this would you say that was simply a matter for
the independent regulator?
Jane Kennedy: Foundation Trusts
are strictly limited in how much private work, if you want to
call it that, they can do. They are specifically prevented in
law from expanding the private provision that they provide within
that Trust faster than their expansion of service delivery through
NHS provision. There is a private patient cap.
Chairman: You will know where this is
going because we took evidence on this last week from a National
Health Service Foundation Trust. I am going to bring Charlotte
in now.
Q685 Charlotte Atkins: I would be
interested to know what your view is of the Jentle midwifery scheme
at Queen Charlotte's. We had evidence from Dame Gill Morgan who
said it made her feel slightly uneasy and she described it as
an "uncomfortable situation". What is your view?
Jane Kennedy: I would share that
view. I have asked for a report arising from the evidence you
have received about this and I am looking for officials to investigate
what has been developed at Queen Charlotte's. The other response
to make is one-to-one midwifery support is part of the National
Service Framework, it is a commitment we made in our manifesto.
The brake on us delivering that is the lack of midwives and we
are working hard, as in other areas, to increase the numbers of
people in that area. I think it has increased by 2,200. Progress
is being made on that score but it is slow. In the meantime I
want to really understand what is happening in this particular
case because I am also uncomfortable with what I have heard about
this example.
Q686 Charlotte Atkins: In your view,
a one-to-one midwifery service should be available to people on
the NHS?
Jane Kennedy: Yes.
Q687 Charlotte Atkins: It should
not be seen as a way of getting half price private treatment?
Jane Kennedy: It is what we believe
should be the service that women should get from the Health Service,
yes. The only reason they are not getting it is because we do
not have enough midwives to be able to provide it and that is
why we are increasing the numbers and trying to raise the profile
of midwifery as a career and promoting it as a career.
Q688 Charlotte Atkins: Schemes such
as the Jentle midwifery scheme could reduce the number of midwives
still further.
Jane Kennedy: It has caused a
degree of concern to me, yes.
Q689 Chairman: Could I ask you a
question I asked a witness last week. Do you think there is anything
different in principle from that additional charge that there
is in Chelsea Hospital to the charge for a prescription?
Ms Winterton: In a sense where
you have to draw the line is if we were in a situation whereby
something that should be provided because it is clinically necessary
is being charged for quite independently, that would be very difficult.
The issue of a prescription charge is that it is something which
is in law for whatever for reason but it has been accepted as
a generalised way of operation, it is a national scheme that applies
everywhere. The general principles outwith that are that it is
sometimes possible for people to provide extra facilities but
it is a very fine line when it comes to what is clinical treatment.
That would be my instinct.
Jane Kennedy: I think as far as
this particular case is concerned, if you are a young woman pregnancy
and childbirth is probably the single greatest risk to your health
that you are going to face in that period of your life and, therefore,
if we have established what we believe should be the national
standard of service that you should get when you are facing that
level of risk I think we should be providing that and that should
be a provision the Health Service should provide. In this case
what is of particular concern is that what is being offered is
the national standard as opposed to an additional service.
Chairman: I think we were told that the
only difference—they are both deemed to be NHS patients—is
you would have a named midwife who would be with you in all prenatal
situations and with you at the birth as opposed to having a midwife
with you at the birth.
Charlotte Atkins: They have extras as
well, that was obviously clear.
Q690 Chairman: That was my next question.
In principle is that what your initial thoughts are about the
uneasiness on this?
Jane Kennedy: I want to look in
detail at what has happened here before coming to any judgment
on it.
Q691 Chairman: The other thing that
was said to us, and I would just like your views on this, and
it is quite cold, I accept this, was that this scheme has raised
quite a large amount of money for that particular hospital which
they have reinvested back into employing people in there and improving
their service, as it were, presumably for everybody as opposed
to just these people who are paying this extra money. What do
you feel about that?
Jane Kennedy: We are going to
face this kind of initiative happening. We want to be sure that
when such initiatives are being taken forward by NHS Trusts, they
are doing it in a way which does not set precedents for other
examples that we would not wish to see happen. We do need to be
well informed about what exactly is being developed.
Q692 Charlotte Atkins: Can you just
outline what the Government responsibilities are in terms of these
sorts of services being offered by independent hospital Trusts?
What responsibilities do you have? They operate independently,
so what is the role of the Government in this respect?
Ms Winterton: In this particular
instance I presume it is a Foundation Trust.
Jane Kennedy: No, this one is
not.
Q693 Charlotte Atkins: In general,
if it was an independent Trust, what would your responsibilities
be?
Ms Winterton: If it was a Foundation
Trust then obviously Monitor are given guidelines, as Jane Kennedy
set out, as to the extent to which they can offer private or add-on
facilities. If there was felt to be something going outside of
that then it is possible for ministers, in this case it would
be Norman Warner, to draw that to the attention of Monitor, particularly
if it had been raised by Members of Parliament, the public and
so on.
Q694 Chairman: The other one that
we got information on was a dermatology clinic in Harrogate. I
cannot remember exactly, I have not got the letter with me, but
they were removing moles and what was described to us as "cosmetic
things" and they were charging for that whilst other things
were being done on the National Health Service. Do you have any
views on that?
Ms Winterton: Again, that is something
Norman Warner has asked for further information about because
it is not quite clear in terms of what I have seen whether in
a sense that was cosmetic surgery being offered or it is something
which should be part of the clinical pathway, if you like.
Q695 Chairman: One of the things
in the letter was about botox. There are botox clinics up and
down the land now. If they are offering that service in an NHS
establishment but charging for it, what would your feelings be
about that? Obviously it is cosmetic. You would not be against
that, would you?
Jane Kennedy: I am less concerned
about that than I am the maternity example. I do not have the
thorough detail but what I understand of the second example is
they are offering services that otherwise would not be available
on the NHS because it is treatments that are not being done for
clinical reasons and in those circumstances it does not seem to
me too unreasonable for a Trust to do that.
Q696 Chairman: It is a bit like a
large part of dentistry which is cosmetic as opposed to a medical
or clinical need.
Ms Winterton: It may well be.
As I say, I do not know the complete details of it. I know that
Norman Warner has asked for more information about it.
Chairman: We will be interested to hear
your views on that.
Q697 Mr Campbell: Now that we have
got a lot of private providers coming into the Health Service,
do you see the charges increasing over this period of time?
Ms Winterton: As we have said,
the key to the way that we invited private providers in is to
always say that these are services which are provided free to
NHS patients. That is the way the contracts are drawn up. There
is no question of saying in any sense the patient has to contribute
to the cost of their operation.
Q698 Mr Campbell: If I want to go
to a hospital with a gourmet meal with a glass of wine, a pint
of beer in my case, would I have to pay for that?
Ms Winterton: I suspect you might,
yes. Free beer on the NHS is not necessarily the point.
Q699 Mr Campbell: These private people
are getting in there and doing the business and I expect over
time we will get these gourmet meals in hospital but will there
be a cap put on it?
Ms Winterton: There are issues
here that if a private hospital was offering a service, it would
not be able to charge back for the beer because it would be on
the tariff as would take place in any other. It might say to you
that it was making beer available and you might want a pint, if
it was allowed in the circumstances. That might be something that
would make you say, "I would quite like to go there because
I get a free pint". Howard is looking horrified by this.
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