Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 640 - 659)

WEDNESDAY 28 JUNE 2006

MR KEN ANDERSON, MR BLEDDYN REES AND MR GEOFF SEARLE

  Q640  Mike Penning: There are more than seven. How many?

  Mr Anderson: I do not have a number in front of me. Any scheme that has not made it to ITN typically is not in ITN because we are having discussions with the local health economy and we are trying to figure out what the case mix is.

  Q641  Mike Penning: Could you supply the Committee with a list of the ones that have not made it to the ITN.

  Mr Anderson: I believe we should be able to do that, yes.[2]


  Q642  Chairman: It would be very helpful if you could also give us the reasons why.

  Mr Anderson: Certainly.

  Q643  Mr Amess: Mr Anderson, as you will recall, when you came before the Committee to give evidence before some of us were a little bit disappointed with what we perceived to be your lack of robustness and you seemed to be a little vague on issues. As you know, the whole purpose of these sessions is to call witnesses and gather information which we determine as evidence to produce a report. You have turned up today with an army of minders behind you. We are now on to, I will tell you, question 7, and you still seem to be vague about things. Anyway, here we go, let us see if we can get an answer. If Phase 2 is all about extending patient choice, will the establishment of independent sector treatment centres in areas with no capacity shortage be a problem but NHS bodies with funding issues such as West Hertfordshire or South-West London?

  Mr Anderson: I will return to the way I answered the question earlier. We have discussions with the local health economy to determine what their needs are. We do not go in and impose a needs package on a local health economy. We have that discussion with them because the data that is needed to come to the conclusion you have just asked me to draw is not held in our offices, it is held in the local health economy, so we are not at that point basically qualified to make decisions about that local health economy of the order of magnitude that you are talking about. So I cannot answer that question. I can tell you that, once we have had discussions and the health economy has come to the conclusion that this is a part of the way they are going to provide treatment to patients, we then go out and we procure an ISTC.

  Q644  Dr Taylor: Can I take you back to the March 6 meeting again, when we talked about additionality and integration particularly, because so many of the people we have been to see felt that integration is really absolutely vital between the NHS and the ISTC. At that time Mr Ricketts told us that additionality was being relaxed for the second wave. In the last three months, has there been any change in that idea? Or are you still relaxing additionality?

  Mr Anderson: No, additionality will be relaxed for Wave 2.

  Q645  Dr Taylor: Are there any groups of staff for which it is going to be more difficult to relax it?

  Mr Anderson: I cannot specifically answer that.

  Q646  Dr Taylor: You told us last time radiology, radiography and some of the specialist nurses.

  Mr Anderson: I am sorry, I do not have that data in front of me. I can write you a note about it.[3] As far as I am concerned, I think Mr Ricketts gave you that answer. I do not think any of those providers have changed from the standpoint of where it is difficult to start to relax additionality.

  Q647  Dr Taylor: We have also had some comments from witnesses, and letters, that, when ISTCs were rather foisted on areas that did not need them, additionality was bringing in extra capacity that was not needed. Do you have any comment on that or has that been expressed to you at all?

  Mr Anderson: There has been press around that. There have been health economies that have expressed concerns around that, but ultimately—and I am honestly not trying to be abrupt on record here—it is up to the local health economy to determine what the needs are for that health economy, and then the ISTC programme was placed in those localities because they stated they wanted that throughput or that capacity to cure—

  Q648  Dr Taylor: We have had letters to the contrary of that, to say that they were forced on them, but that is probably nothing to do with you. Do you think additionality being relaxed will lead to a migration of staff to ISTCs? Or do you think integration will then be so easy that we will see a real coming together of them without detriment to the NHS?

  Mr Anderson: I think the initial positive that will come from the relaxation on additionality will be a crossover from a training perspective. There is a lot both sides can learn from each other and probably one of the big frustrations that has been expressed to me personally has been the fact that doctors or consultants would like to learn in ISTCs and vice versa. The relaxation in additionality will allow that two-way traffic to start occurring—and I think appropriately so, and then, hopefully, as they become integrated into the health economy—and they are—that will allow an exchange of ideas. The only way I think you get an exchange of ideas is with an exchange of people.

  Q649  Dr Taylor: You would agree it will reduce the resistance in the NHS to the independent sector treatment centre if they are working as one with shared staff.

  Mr Anderson: That is correct.

  Q650  Chairman: What implications does that have on things like pay differentials between the independent sector and the NHS? Have you thought this through?

  Mr Anderson: First of all, we do not get involved in pay between whoever is involved in the ISTC and the employer. I cannot answer that question.

  Q651  Chairman: Has your team looked at the issues around people working alongside one another on different pay or, indeed, on different pensions in terms of the second phase?

  Mr Anderson: I cannot answer that. It may well have been looked at, and I am not aware if it has been, but I could get a note back to you.

  Q652  Chairman: Do any of your colleagues know.

  Mr Anderson: It has been looked at.

  Mike Penning: Your colleagues had better come and sit up here and tell us what is going on.

  Mr Amess: We are wasting our time, chaps.

  Mike Penning: If there are people here who know this information, surely we should have it.

  Mr Amess: What is the point of this? It is farcical.

  Q653  Chairman: If you feel that you do not know and somebody who is sitting behind you might know, could you ask them to proffer the words.

  Mr Anderson: If I might ask Bleddyn Rees, our General Counsel, and Geoff Searle who takes care of procurement.

  Mr Rees: Good afternoon. The answer to the pay grade question is that about 18 months ago the Government issued guidance about the two-tier workforce. At that time, there was some extensive correspondence inter Department around the application of the two-tier work code to the ISTC programme. The ISTC programme benefits from a specific exemption, which does not apply the two-tier work code to the programme. Strictly speaking, the   Department's position is: No, there is no requirement to impose obligations on the private sector to engage any medical workforce on identical terms to the NHS, so Agenda for Change does not apply. The Department is simply testing its value for money on procedures by reference to the procedure prices. We have no visibility of the terms and conditions on which any staff engaged by the IS sector are employed, so we are not able to answer the question as to whether there are two workforces operating and doing the same things with different prices. We do not know. Neither do we know that that is the case either.

  Q654  Chairman: Richard has just asked about the issue of additionality. If restrictions are lifted, what is the likely effect that that would have on the local health economy in the immediate area of the ISTC? Has any work been done on that?

  Mr Rees: I am sorry, could you ask me the question again.

  Q655  Chairman: Correct me if I am wrong on this, because this is something the Committee has only been looking at in recent months, but our understanding is that the additionality rule was tight so that ISTCs would not recruit from within the National Health Service and potentially weaken the National Health Service in terms of its ability to deliver. If we say there is going to be relaxation of the additionality rule for Phase 2, then has anybody looked the implications of that on Phase 2? That potentially could happen. There could be recruiting from the NHS which, as a consequence, would affect the ability of the NHS to do the work we expect of it.

  Mr Rees: Yes, there has. The workforce directorate at the Department of Health has analysed the availability of NHS staff. The Secretary of State previously said you have to place things in context. The number of procedures that are being bought by the ISTC programme is a small fraction, therefore, following through, we are only talking about a relatively small proportion of the total workforce who could be recruited. The point to understand is that the relaxation of additionality relates to non-contracted hours. First of all, we are not talking about the recruitment of NHS, full stop; we are only talking about their non-contracted hours, if you like, their overtime hours. Those overtime hours and the use of those overtime hours is controlled by virtue of the consent process involving the NHS employer, so there is a safety procedure to ensure that the use of the staff does not detract from services that are provided in NHS hospitals and facilities.

  Chairman: Thank you for that indication.

  Q656  Dr Taylor: You said that the ISTC work is really a small proportion of the total amount that is done. Does that not make that graph on the back of the Department of Health paper extremely misleading, because, with the rapid fall, the only points above are: first ISTC operational, 10 ISTCs operational, 18 ISTCs operational. That gives the impression to somebody who does not know that the total improvements in the waiting times are due to the ISTCs rather than to the increased work the NHS are doing.

  Mr Rees: I sat in the hearing when the Secretary of State answered that question, when she made the point, I believe, that the ISTC programme was a small proportion of capacity but it was having a significant effect on the NHS services. The contribution overall to the waiting time reductions, whilst in terms of pure numbers might be relatively small, she believed had a more major effect as a change agent. I still believe that to be true.

  Mr Amess: That graph is misleading.

  Q657  Dr Taylor: I wonder if the graph has been circulated, because it at least ought to have "NB" on it or a caveat.

  Mr Rees: I am not familiar with that graph, I have not seen that graph, so it is difficult for me to—

  Dr Taylor: It is a Department of Health graph. We will follow that up.

  Q658  Mike Penning: Would you accept that in areas where elective surgery units are closed to facilitate an ISTC will have a very large effect on the National Health Service? Secondly, if an ISTC was in Phase 1 but has not gone ahead yet, can you confirm, if it does go ahead, that they will not be drawing staff from the NHS?

  Mr Rees: In effect, the relaxed additionality policy only allows non-contracted hours to be used. The IS providers are not free to recruit those members of staff. That part of the additionality still applies. "No poaching", if you like, simplistically, is still there. That protection is still there.

  Q659  Mike Penning: If a chief executive of a trust has said his staff will go, under a Phase 2 regulation, into the ISTC, that is not correct.

  Mr Rees: That is not correct. No contract in Wave 1 has involved the TUPE transfer of staff. The deployment of the Retention of Employment secondment model is designed to ensure that no NHS staff TUPE transfer.


2   See Ev 218 Volume III Back

3   See Ev 218 Volume III Back


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2006
Prepared 25 July 2006