Examination of Witnesses (Questions 20-39)
ROSIE WINTERTON
MP
26 JANUARY 2006
Q20 Mike Penning: What happens if
he or she ignores them?
Ms Rosie Winterton: There is an
independent Reconfiguration Panel which gives advice to the Secretary
of State and in a sense you could take the argument completely
down to the local level and you could say—
Q21 Mike Penning: But that is where
the delivery is; it is at the local level.
Ms Rosie Winterton: That is where
delivery is and I do think it is important that we have a debate,
as we move forward, about issues like local priorities because
very often, and I have come across cases recently where, in a
sense a kind of pre-consultation has gone out about service changes
in an area and within this report a whole range of options has
been put forward about almost everything that anybody has ever
come up with. Now, that has caused quite a furore locally because,
when anyone sees their particular perhaps community hospital or
their particular service being talked about as being possibly
open for change, there has been a lot of local concern about it.
However, in a sense that is not what the trusts have put out for
final consultation. They have not yet decided that, and they have
been looking at where people feel that it may be wrong, something
which should not be on the table at all, and where people say,
"Well, we can understand that". I think it is also important
to recognise that very often, and this is where I want to get
to in terms of the future, we have to have a proper debate about
how decisions are taken locally and how people understand the
priorities that are made in terms of funding because it is undoubtedly
true that there are some areas where local people might say, "Well,
because all these beds are not used all the time, there may be
over-provision in an area". I am not saying this is your—
Q22 Mike Penning: That is over-simplifying
it. That is not the case in my area.
Ms Rosie Winterton: That is not
your area.
Q23 Mike Penning: Or a lot of other
areas.
Ms Rosie Winterton: I am not saying
that that is your area. What I am saying is that, to a certain
extent, when we are looking at how you use the resources, which
inevitably are going to be finite, and I am sure that whatever
government is in power, that is going to be the case for obvious
reasons, but when we look at changes in how services are delivered,
I think what is important is that we are able to create at the
local level a system where people understand the different priorities
that there are and understand how decisions are arrived at. In
the same way as there are always difficult decisions within government,
there are difficult decisions within local councils, but it is
whether people feel that the system has been fair in allowing
them their say. Now, then there is a problem of explaining to
people very often, and this is where we need to look at how we
can improve that because if people have said, "We don't believe
any changes should be made", but then, through one system
or another, whether it is because you would be cutting front-line
healthcare delivery if you were not making some structural changes,
making sure that people understand how that decision has been
arrived at. That is a challenge and what I am saying is that I
think, if we can get the system right in terms of things like
forums that patients and the public can be represented on and
the relationship as we increasingly see a joining together of
services between, for example, social services and health services
whereby you do give the ability to scrutinise the delivery of
services, then people can understand more about how decisions
are arrived at.
Q24 Mike Penning: That is a very
long answer to a very simple question—
Ms Rosie Winterton: Yes, I know
and I am sorry.
Mike Penning:— which was: what
happens when they ignore the public forums or the patient forums?
I do not want to go on because other people will want to ask you
questions, but I was also going to ask you about patient involvement
in PCTs and what happens if they have been ignoring them and whether
patients have been involved in PCT restructuring, but your answer
to my other question was so long, I think I should hand back to
the Chairman now.
Q25 Chairman: That question is about
the fact that we did an inquiry into the reconfiguration of PCTs
and what we were told was that in the pre-consultation consultation,
if you like, there was little or no consultation with the patient
forums in relation to what was likely to happen. You may want
to comment on that or we may take it as read. I think it was admitted
by witnesses here in this room that that was the case. Obviously
you are now out for statutory consultation, so we assume it will
be taking place now within the 90-day one.
Ms Rosie Winterton: Yes.
Q26 Dr Naysmith: What I want to do
now, Minister, is ask you a little bit about the view which is
current in some parts of the country that the whole system is
very fragmented and confusing, and it can seem that way to patients.
I want to illustrate that just a little bit by describing what
I think I may have described to you before which is the situation
in the south Gloucestershire/Bristol area, and I am the Member
of Parliament for a bit of south Gloucestershire and a bit of
Bristol. There is no criticism intended of any of the individuals
involved in the organisations I am about to describe, and may
I say, first of all, that I agree with you totally that PALS in
the ICAS bit of the organisation are working really well, I think
most people would accept that, and doing better probably than
what happened with the community health councils. However, in
my area there are two major acute trusts which includes six hospitals,
most of which are teaching hospitals, so they have got accountability
to the local universities as well as everything else, there is
one ambulance trust, there is a separate mental health trust and
there are four primary care trusts. Now, all of these have patient
forums. We have also got on top of that three, sometimes four,
local authority scrutiny committees because people travel in the
area to the hospitals for different reasons, so it can involve
four different local authorities, but it is usually three, Bristol,
South Gloucester and North Somerset, and, luckily, we do not have
counties involved, and also they are unitary authorities or there
could be another one. Then of course, on top of that, there are
the strategic health authorities and stuff coming from the Department
after you have done a public consultation, telling people what
it is that the people want. Now, the effect of all this, not surprisingly,
is a bit of confusion which leads to the fact that it is difficult
to get people to understand, because the situation is so complicated,
where in all of this patient consultation set-up they go to make
their voices heard. I know that you say, "What you have got
to do is publish reports", and in some parts of the country
it works quite well, but it is much more difficult in an area
like this. The other thing it makes difficult is getting people
to participate. Most of the organisations in my area have one
or two vacancies and it is not easy to get people to be members
of these forums, partly, I suspect, because again it is so diffuse.
It is also difficult for the providers because, if you think about
what they have got to do, they have got to trot around lots of
patient forums, giving reports, and they have got to make those
reports available for scrutiny committees and all that sort of
thing. Therefore, are you satisfied, particularly in an area like
this, that the different parts of the PPI system can possibly
work effectively together?
Ms Rosie Winterton: Well, that
is exactly what we are looking at at the moment because that is
something that has come back where I think patient forums and
perhaps the public sometimes, as you have said, feel a bit isolated,
and as I said earlier. Whether you could look to a more effective
way of structuring the system so that you did not have in a sense
the numbers that you are talking about there, but also that you
focus very much more on, as I said earlier, kind of the patient
journey which is about looking at how individuals are affected
by the services as opposed to being necessarily attached to every
single acute trust or whatever within the system, that is the
challenge that I think we have got for the future and that is
exactly what we are looking at.
Q27 Dr Naysmith: I know you are looking
at it and reviewing it and there are going to be changes coming
almost inevitably through the primary care trust reorganisation,
but the patient journey in a place like Bristol does not depend
geographically on where they live, but they can go to a hospital
for a particular reason on the other side of the area. There is
a hospital in Weston-super-Mare which is in north Somerset which
does hip operations and it can do hip operations for anyone in
that huge area I am talking about, so it is really quite difficult
even to get the patient journey idea right.
Ms Rosie Winterton: Well, you
are quite right to say that that will be the challenge of the
future and particularly when you look at the issues around choice
and offering people different choices, and it is quite important
to look at how perhaps the PCTs are commissioning services or
providing them, whichever of the two they are doing, how they
are arriving at decisions with regard to what is going to be available
for patients within their area. I think we need to look at a system
which can monitor that very closely because that is how you find
out what is available for local people within your area, so even
though they may be going somewhere else, it is that person, that
patient, who is having the service from the NHS and it is whether
the service they are receiving, no matter where it is, is adequate
for their needs.
Q28 Mr Burstow: I have one very quick
question really which is about this issue around overview and
scrutiny and the fact that the documents which have been published
to do with commissioning a patient-led NHS and the other things
which have been coming out recently around the Choice Agenda do
not really seem to address quite how the whole process of public
and patient involvement, through the forums or otherwise, actually
works. One of the concerns I have been picking up from overview
and scrutiny committees is what remit they will have in respect
of practice-based commissioning. Just as it now is the case with
PCTs and other NHS organisations where they can be called to give
account to an overview and scrutiny committee, in the future will
those who hold budgets through practice-based commissioning have
a similar duty to give account to overview and scrutiny committees?
Ms Rosie Winterton: Well, the
overview and scrutiny committees can decide what particular sort
of reviews they wish to undertake. If they wanted to look at the
system of practice-based commissioning, then they would be able
to ask those responsible for overseeing it to give evidence to
them.
Q29 Mr Burstow: But specifically,
as at the moment they have a power to call chief executives to
come and give evidence and ask them questions, will there be a
similar right for the overview and scrutiny committees to call
those who are within the practice itself making those decisions?
Ms Rosie Winterton: Individual
GPs?
Q30 Mr Burstow: Well, the GP who
is the person responsible for dealing with practice-based commissioning—will
they be accountable or will it be the chief executives?
Ms Rosie Winterton: I am not sure
they will be able to call individual GPs. We will have a look
at that certainly. Remember, this would be overseen by local PCTs
and, in that sense, the issue would remain the same, but I will
certainly have a look at whether they can call individual GPs.
Q31 Mr Burstow: It really goes to
Doug's original question about the fragmentation and lack of,
if you like, clarity of the roles of the different parts and also
this concern that, because of the way the travel direction of
public policy now with regards to commissioning is going, some
of the things that were envisaged for the role of these overview
and scrutiny committees have been left behind by the policy movements
and they need to catch up really.
Ms Rosie Winterton: As I have
said, it would be perfectly within the remit of an overview and
scrutiny committee to decide to look at how practice-based commissioning
was operating within their area and call whatever witnesses or
invite people. The question you are asking quite specifically
is whether an individual GP would be required to attend and perhaps
I can write to you on that matter because I am not sure—
Q32 Chairman: I think, in view of
the fact that it has been reiterated by the Secretary of State
this morning on radio that this is going to be happening by the
end of this year in all GP practices, it would be very useful
if you could pass us a note on that.
Ms Rosie Winterton: Sure.[2]
Q33 Chairman: We will have a look at
it and hopefully publish that note along with the minutes of our
proceedings today.
Ms Rosie Winterton: I think it
would be ill-advised if a GP, having been invited, refused, if
I can put it that way. It would look rather odd, I would have
thought.
Q34 Chairman: If they are commissioning
on behalf of their patients, it seems a very relevant point, so
you may want to think about that and write to us. We would appreciate
that.
Ms Rosie Winterton: Exactly, yes.
Q35 Mr Campbell: Personally, I think
the PPIs are very, very important, especially in this modern day
of health technology and privatisation. It seems to be anything
that moves is privatised in the Health Service, so these organisations
are going to have to be a lot more up-front and keep an eye on
these companies that are providing health services because, as
far as I am concerned, Minister, I think some of them are just
coming in to rip off, so they need to be on their mettle and we
need them up and running. My first question is that the forums
and the Commission have only been running for about two years
basically and we have not had much time to get any assessment
of them, but have you made any assessment of how they are working
now after just two years?
Ms Rosie Winterton: Well, what
we have been doing, which is why we are carrying out the review
at the moment, there was obviously the arm's-length body review
which decided that the Commission would be abolished and that
we would look, within that, at what more assistance could be given
in terms of more direct assistance to patient forums on the front
line. As a result of the review that we are undertaking, a lot
of the issues that I have talked about have come to light, whereby
there is, in some areas, a feeling that forums would perhaps like
to work more closely together or to have a system which enabled
a working more closely together because, having 572, as I have
said, does seem to indicate that there are perhaps rather too
many to be as effective as some of them would want to be. That
is the first thing which has come through that. You are quite
right as well to draw attention to when there are different providers,
and it is important, as I was saying before, that the forums and
those involved in public and patient involvement are able to look
at what is happening to the patient, no matter where they are
receiving care. That is quite an important principle within a
new system, which is why many people feel, which is what has come
through the review, that they want to see a system of patient
and public involvement which is not always attached in a sense
to the buildings, but is attached to the patients themselves.
Q36 Mr Campbell: That brings me to
my next question because you have just mentioned that the PPIs
have to be reduced and, from what you just said there, you have
obviously got it in your mind.
Ms Rosie Winterton: They are still
at 572.
Q37 Mr Campbell: But you are going
to reduce them further?
Ms Rosie Winterton: Well, we are
reviewing that at the moment. We are looking at a lot of the comments
which come in and looking, obviously within the context of the
White Paper, as to how can we have an overall system which builds
on the best that patient forums have done so far and also looks
at the role of overview and scrutiny committees and, I hope, will
set out some principles for the future in terms of how patient
and public involvement should develop. I also think it is quite
important, and this goes back to Mr Penning's point, that we allow
at the local level a system to develop which best suits the local
needs. There are some parameters that we have to put down as government
and as Parliament because Parliament has given government some
quite firm rules at the moment as to provision, but it is important
that we allow for flexibility at the local level as to how people
want to operate.
Q38 Mr Campbell: As long as what
we are planning to do does not make them too ineffective. That
is a worry, that they become so remote, because there are so few,
that they become ineffective.
Ms Rosie Winterton: I certainly
do not want them to be ineffective.
Q39 Mr Campbell: No, I know we do
not, but if they are small they might be.
Ms Rosie Winterton: If they are,
that goes back to Mr Penning's point as to how people feel that
their voice has not been ignored. If they have a system whereby
there is effective input but also effective reporting back, people
might not necessarily like the decisions that are finally arrived
at but they have a greater understanding of them because they
have had effective input, and I think you have a system which
is more related to the community and the community's wishes.
Chairman: Quite clearly, Minister, we
will be watching this space in terms of the current statutory
reconfiguration that is taking place. The outcome of that, I suspect,
is going to be important to a number of people in this room, including
this Committee.
2 See Ev 21, supplementary memorandum from the
Minister. Back
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