Examination of Witnesses (Questions 660
- 679)
WEDNESDAY 28 JUNE 2006
MR KEN
ANDERSON, MR
BLEDDYN REES
AND MR
GEOFF SEARLE
Q660 Mike Penning: What will happen
to the staff who lose their jobs when a treatment centre comes—which
is what will happen in West Herts Hospital Trust, for instance,
where three theatres will close at Hemel and five theatres at
St Albans. Those staff will have no jobs. Which is why 750 job
losses were announced at this Committee last week. Those staff
will not be transferred to the ISTC if and when it is built.
Mr Anderson: First of all, I do
not think we are familiar with those numbers. Secondly, I have
not seen an announcement from Hertfordshire, so it would be hard
to comment on something.
Mike Penning: You have lots of civil
servants who would have read what went on in the Committee last
week who would know.
Mr Amess: You are a good stonewaller,
Mr Anderson.
Q661 Chairman: If he does not know.
Mr Anderson: May I say, Mr Chairman,
that this was called quite quickly. This portion of it was handed
to us, I think, just last week, and the amount of preparation
in between our day job that we could put forward towards this
has been minimal. We were told it was around a specific area and
issue, so if we are not answering questions to the fullest extent
that we can, I apologise. I think the short timeframes have not
helped with that.
Mike Penning: Was that the same last
time, then?
Chairman: Let me say that I do understand
that very well, and what is happening in West Herts is a moving
picture. None of us is going to be able to second-guess what is
happening.
Q662 Charlotte Atkins: Mr Anderson,
are you aware that the first phase of ISTCs was criticised heavily
because of the lack of training grant.
Mr Anderson: We are very aware
of that.
Q663 Charlotte Atkins: In Phase 2,
therefore, will it be a contractual requirement for training to
be provided?
Mr Anderson: I think it will be
on a scheme by scheme basis. Having said that, because of the
amount of criticism—and understandably so—in wave
1—and that was a result of expediency through the procurement
process and less about not wanting to do it, and we have learned
quite a bit—that goes back to some of the questions that
we were asked earlier from a learning standpoint and we have learned
quite a bit from that process. I think Mr Rees could answer specifically
on a contractual basis how that is being handled.
Q664 Charlotte Atkins: It surprises
me that you say it is not going to be contractual.
Mr Anderson: I would say I did
not say that.
Mr Rees: Perhaps I could help
you in answering the question. In Wave 1, in a number of contracts,
it is contractual. There are pilot training programmes designed
to ensure that we understand how best to buy training services
from ISTC providers. They are signed and they will start training
when full service commencement starts on the particular schemes.
Mr Anderson: Specifically, Nottingham—which
was one of the last ones that we signed—had £4 million
worth of training contractually bound to it.
Mr Rees: We have worked with the
deans around exactly what training they wish to see in ISTCs.
For Phase 2, the contract volumes and case mix has been given
to the deans to establish what training they would like to purchase
in future from ISTCs. I am not sure whether you are familiar,
but with the reforms it will be the deans who decide where they
commission training from. Bidders on Phase 2 schemes are required
in the ITNs to submit bid prices with training and without training,
and we have given them as much information as we could about the
types of training that would be required at the time the ITNs
went out. We are now developing a generic training schedule to
incorporate in the contracts. Essentially, it will be a form of
call-off contract, where the provider will agree contractually
to provide the training specified in the schedule. That will be
worked in more detail with the local NHS to ensure that it meets
their requirements and needs. They will have bid a price for that
training. All that will have to happen for training to be undertaken
in the ISTC is for the deans to decide that they wish to buy training
and to commission it. It will effectively be a call-off arrangement.
Q665 Charlotte Atkins: On top of
the increased price for operations at the ISTC, there will be
an extra levy for training.
Mr Rees: No. There will be a training
price which is a component of the total price that is signed off
on the contract.
Q666 Charlotte Atkins: That will
be over and above the tariff which was determined for the first
phase. Already ISTCs we are paying over the top of the NHS price.
Mr Rees: It is not new money.
It will be training money allocated from elsewhere in the system.
The tariff only has a proportion of contribution to the total
training costs. There are specific grants given to trusts that
would cover training costs. In the future, it is intended that
the deans will have the full training budget, so the price that
they pay will be for all training requirements. It is giving effect
to the new rule and the reforms that are coming.
Q667 Charlotte Atkins: I am a bit
confused. You are saying that only some Phase 2 ISTCs will be
training.
Mr Rees: I did not say that.
Q668 Charlotte Atkins: Can you answer
whether all of them will be doing training.
Mr Rees: That depends whether
the deans wish to commission it. In theory, if the deans choose
to have training in every ISTC, they can have training in every
ISTC. It will not be a decision for the providers, it will not
be a decision for the commissioners, it will be a decision for
the deans.
Q669 Charlotte Atkins: I am talking
about Phase 2.
Mr Rees: I am talking about Phase
2.
Q670 Charlotte Atkins: The British
Medical Association have said that they were very concerned that
the procedures most suitable for training purposes are being transferred.
They are worried about the bread-and-butter training. Given that
the ISTCs do the more straightforward operations, it is absolutely
crucial, for training our future medics—
Mr Rees: That is why it is a contractual
requirement to provide training if the system wants the training.
Q671 Charlotte Atkins: UNISON gave
evidence in another inquiry a few sessions ago that they were
very concerned about the way that training within the NHS was
not being ring-fenced and was likely to be the subject of an easy
target for sorting out deficits. We have a situation where the
NHS may cutting back on training and we have a situation within
the ISTCs where it is not going to be a contractual requirement
for all ISTCs but it will be determined by commissioners.
Mr Rees: Our programme is to put
in place ISTCs. We do not control training. The individuals here
do not have responsibility for training. We are required to ensure
that training can occur in an ISTC if those responsible for training
wish it to do so, and that contractual commitment is there.
Q672 Charlotte Atkins: If training
does take place—and there appears to be a big "if"—how
would we ensure that it is of the same standard as training within
the NHS?
Mr Rees: All I can give you as
an answer to that is that the training specification is effectively
approved by the deans, so it is to the NHS requirements and standards.
The licensing requirements for operating the ISTCs are still there,
so all law has to be complied with, and there is consultation
with the Royal Colleges occurring around the quality of the training.
I believe those are the safeguards that ensure that the training
will be of the appropriate standard.
Q673 Charlotte Atkins: You mentioned
earlier that in the price for operations there is an element of
cost for training. Where you have ISTCs that are not commissioned
for training, will they still be paid an allowance for training?
Mr Rees: No, because they are
not paid tariff. It is not a same comparison.
Q674 Charlotte Atkins: In Phase 1,
ISTCs have been paid for work on operations that they have not
done. Because they are guaranteed a certain volume of operations,
they have been paid for operations that they have not performed.
In the same way, it would be logical, therefore, for ISTCs to
be paid for training that they do not necessarily do. Or is that
a completely separate contract?
Mr Rees: I do not understand the
question, I am afraid. The debate in training in the NHS is, as
far as we are concerned, a commercial question. Our understanding
is that the debate is really about lost productivity. When you
are looking at remunerating training in terms of the ISTC programmes,
you are looking at a concern that you will have less procedures
performed because training is taking place. The cost position,
we understand, is likely to be claimed for lost productivity from
providers. That is why we have pilots to establish whether as
a matter of fact there is lost productivity there. There are some
commentators who believe there is no lost productivity; there
are others who believe it is substantial.
Q675 Charlotte Atkins: My concern
is that our workforce should be properly trained. If the ISTCs
are taking some of the bread-and-butter operations from the NHS,
which the BMA consider to be very important in terms of training
our future medics, I would have hoped the ISTCs would take their
fair share of training.
Mr Rees: I do not believe there
is any suggestion that they will not. The point is that the contracts
have arrangements in Phase 2 for the delivery of training provided
the deans, as the people who are responsible for training, wish
training to be undertaken in that facility.
Mr Anderson: It is the same people
who have responsibility for ensuring that training takes place
in the NHS. Therefore, if there is a disparity it will lay with
them and not with the ISTC provider.
Q676 Charlotte Atkins: There are
concerns from some of the staff organisations that perhaps training
is being targeted for cuts. We are concerned about training overall
in the NHS, but, particularly, if the ISTCs are going to be expanding
their level of commitment in terms of doing operations, then obviously
they should also be committed to doing training across the board.
Mr Anderson: As providers they
are. But Mr Rees is trying to explain that they do not really
have control over whether or not they are going to be allowed
to do training. The deans are the people who sit down and decide
where training will occur. A lot of the independent sector providers
would dearly love to do training. Just from my travels in the
NHS, quite a few of the NHS consultants would like to do training
in the ISTCs. It goes back to Dr Taylor's questions. From the
standpoint of, maybe, consultants not wanting to be engaged in
it, I do not think there is an issue. I think the issue will lie
with the deans and whether or not they allocate training funds,
as they do to the NHS, to independent sector treatment centres
to do that training.
Q677 Chairman: Mr Rees, you mentioned
pilots. Do you have any information readily available on these
pilots?
Mr Rees: Do you mean has the pilot
started? No, because the time between the contract being signed
and the treatment centre opening can be up to 18 months, and the
shortest pilot is six months and the longest is 12 months, it
will be some time before we have the results of the pilot—which,
to some extent, makes it a little bit harder to do Phase 2, which
is why we have separate arrangements.
Q678 Mr Amess: Mr Searle, Mr Anderson
and Mr Rees—I will show no favouritism—who would like
to answer this one? The Department told us that the general principles
for ensuring value for money included "selecting the best
value . . . offer received." Are there any circumstances
under which that would be a consideration? It seemed to us that
it was an absolutely meaningless statement.
Mr Anderson: We are constrained
and bound—
Q679 Mr Amess: Mr Searle was nearly
going to answer.
Mr Anderson: Go ahead, Mr Searle.
Mr Searle: Sorry, just to clarify,
was your question are there any circumstances in which we would
not take the lowest price?
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