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
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