Examination of Witnesses (Questions 100-119)
RT HON
JOHN HUTTON
MP
1 NOVEMBER 2005
Q100 Mr Prentice: But we have to
take people with us. If we are not taking the Royal College of
Nursing, this is going to be a pipedream. It is going to be deliverable,
is it?
Mr Hutton: No, I agree with you,
we should take people with us, and that is why it is going to
take more time.
Q101 Mr Prentice: And you think the
Government is doing enough to take people who work in the public
sector with it?
Mr Hutton: That is the responsibility
of the Secretary of State for Health and I am sure she will discharge
that responsibility.
Q102 Mr Prentice: Patricia Hewitt
has been running these discussion groups, moderated by opinion
leader research. I think people who turn up get paid £125
or something like that. There have been sessions in Leicester
and in Birmingham. Is this a good way to shape policy?
Mr Hutton: I do not know the details
of those consultative arrangements. I am sorry, I am not really
able to comment on that.
Q103 Mr Prentice: Do you think it
would be a good idea to ask people who work in the public services,
not just members of the public? Let's do that. Let's pay them
£125. Do you think it would be a good idea to get nurses
together or health visitors together, occupational therapists,
physiotherapists, chiropodists together—perhaps even paying
them £125 to turn up—to ask them what they think of
the Government's proposals in health—and, indeed, in education—and
invite them to help shape policy?
Mr Hutton: Yes, I think that would
be a good idea. Yes.
Q104 Mr Prentice: Good. Do you think
the National Health Service should move towards a commissioning
role?
Mr Hutton: I do not understand
your question. It already has a commissioning role.
Q105 Mr Prentice: The Primary Care
Trusts are going to be commissioning agencies. If we follow the
logic through, why not have a National Health Service which is
a commissioner and just hand the hospitals over to other providers:
not-for-profit, charities, private sector?
Mr Hutton: The Government is not
proposing to do that. The Government wants to see an effective
world-class healthcare service. The reality is that the vast majority
of that will be National Health Service provided—because
that is the reality on the ground—and there will be a role
for new providers to come in to boost capacity and provide innovation,
support and flexibility around the delivering of services. I think
that is a sensible mix. I think that in the context of history
of the National Health Service we should not lose sight of one
thing, that primary care—which in many respects is the jewel
in the crown of the NHS, which most people see as instrumentally
a part of the National Health Service—has always been provided
by private sector operators. 90% of all patient journeys in the
NHS begin and end in a GP's surgery. GPs are small businessmen
and women who work independently and make a profit out of it—and
good luck to them—but they provide a fantastic service for
the NHS.
Mr Prentice: We all know that GPs contract
with the National Health Service.
Mr Hutton: In exactly the same
way that the independent sector treatment centres contract with
the National Health Service.
Q106 Mr Prentice: I was talking earlier
about hundreds of thousands of people who were directly employed
by the National Health Service. It says on their pay-cheque "National
Health Service". There is a distinction.
Mr Hutton: You are talking about:
"Why do we not just commission all of this," and "We
do not care about the providers" and I am trying to say to
you that a very large amount of the provision that we have always
commissioned in the NHS has been from the private sector. It has
been provided by GPs, who are small businessmen, who employ their
own primary care staff and make a profit.
Q107 Mr Prentice: I think we understand
the direction of travel is commissioning. There are only two areas
that are exempt: the Armed Services and enforcing criminal justice.
Everything else is up for grabs. The State, in its many guises,
takes on a commissioning role and leaves it to other agencies
to provide. That is pretty radical stuff. It is set out in the
speech you gave here on public sector reform in August. You talked
then about "continuous reinvention and renewal", so
it is very clear which direction the Government is taking.
Mr Hutton: Could I be quite clear.
The direction the Government is taking is the direction we said
we would take in the manifesto. It is not my agenda; it is the
Government's agenda.
Q108 Mr Prentice: I know, I know.
You have mentioned the word "manifesto" many times.
Mr Hutton: Well, it is important.
I think people stand on the manifesto and defend it, not see themselves
at liberty then to decide it meant something else or to say that
they are not bound by it at all. That is not the sort of politics
we are aiming at.
Q109 Mr Prentice: I do not want this
to develop into an arcane discussion on the nuances in the manifesto,
but the reality is—and you accepted it—that the implications
of the policies spelt out in the manifesto were not clear. We
were just talking about 250,000 people who are directly employed
by the Primary Care Trust: it was not clear in the manifesto.
I do not want to labour the point, but let us understand what
we are talking about here. Could I finish on complaints and so
on. Last week or the week before we had the Ombudsman before us.
She had issued a damning report on NHS complaints procedures.
You would be familiar with it in your former incarnation as a
Health Service minister. Did the Ombudsman just get it wrong?
She was saying that there were huge problems in complaints handling
of the National Health Service: it was just a catalogue of disasters,
constant reorganisations.
Mr Hutton: It is up to health
ministers to respond to the Ombudsman's report and I am sure they
will respond properly and thoroughly to it.
Q110 Mr Prentice: Do you think we
need a review of the Ombudsman, given that the Government is now
involving private sector and other providers in areas that were
traditionally solely a matter for the public sector?
Mr Hutton: Yes. I think we should
keep these things under review if we are going to involve a new
range of providers in delivering NHS care. It is the case that
there must be an effective NHS complaints procedure that applies
to them, and in those cases, as I understand it, the Ombudsman
has jurisdiction and competence. We are undertaking a review,
as you will know, through the Regulatory Reform Order route of
some of the legislation affecting the work of the Ombudsman. I
would be very happy to keep the Committee involved in that. There
is a consultation exercise underway—I do not think it is
yet finished—where we are trying to implement as many of
the recommendations that you and others have suggested should
be made in relation to the work of the Ombudsman. But I think
it is very important, if we are going to improve the quality of
public service, that we should regard the complaints procedure
as being a very, very important part of that. The one thing that
hacks people off, probably more than anything else, is the inability
of the public services sometimes to deal with complaints sensibly
and seriously and quickly and in a way that addresses people's
concerns, and we have to take those concerns full on.
Q111 Chairman: The outstanding argument
with the Ombudsman is about this wretched MP filter, the idea
that you have to go through the MP to get to access the Ombudsman
system. All the recent Ombudsmen have said this makes no sense
in terms of the work that we do. The Ombudsman, with this Committee,
has surveyed Members of Parliament, the majority of whom now say
it makes no sense. Outside organisations, Citizens' Advice Bureaux,
consumers, everybody else, say this is inconsistent with modern
complaints handling, yet in your response to our report on choice
and voice[11]
you say, "The Government takes the view that there is a strong
argument of principle for retaining the role of the constituency
Member in dealing with complaints from his or her constituents".
The Government seems to be completely at odds with everybody else
on this issue.
Mr Hutton: That is not necessarily
uncommon, is it? It is our view that there is a relationship there
that is worth protecting and preserving, which is the relationship
between the Member of Parliament and his or her constituency.
We all deal with complaints from our constituents all the time.
Many times we are asked to endorse and sign off a complaint to
the Ombudsman. I personally feel it is an important part of the
system that there is that involvement of Members of Parliament
in that process. I think we should tread warily in this area.
Q112 Chairman: People can go directly
to a local government Ombudsman. They can go directly to the Ombudsman
in her Health Service Ombudsman role. In the parliamentary side
of her work, we have this intermediary system. You know it makes
no damn sense. I mean, you are repeating the lie, but it makes
no kind of sense, does it? Why not just sweep it away?
Mr Hutton: In our response to
your choice and voice report we did set out our view on it. Our
view has not changed in the meantime and I do not think I am in
a position really to add very much to it. The one thing I can
say is that on the reforms that we are taking through on the Regulatory
Reform Order route, we could not make this particular change in
that role. I think this would require a revisiting of the primary
legislation.
Chairman: I understand that.
Mr Hutton: This is probably too
important a reform to do through that route.
Chairman: I understand that.
Q113 Mr Burrowes: Could I follow
up on the issue of complaints. Recognising the importance of complaints
and the importance of being customer focused, no doubt with that
you recognise that it is important for there to be seen to be
a proper response when customers are aggrieved.
Mr Hutton: Yes. Absolutely.
Q114 Mr Burrowes: Would you agree
that it is important for there to be a proper response when the
Ombudsman makes his or her recommendations?
Mr Hutton: Yes.
Q115 Mr Burrowes: Absolutely?
Mr Hutton: Yes.
Q116 Mr Burrowes: If people have
been aggrieved, there is an absolute need to respond. Would you
agree that there is a concern when customers do not see their
grievances properly followed through, where recommendations have
been made and they have not been followed through?
Mr Hutton: Yes.
Q117 Mr Burrowes: In the instance
where we have two reports: Tax Credits and Debt of Honour,
where recommendations not having been fully followed through by
ministers, there are grievances there that have not been properly
addressed. You must agree that that is a concern of customer focus
not being followed through.
Mr Hutton: Governments should
try to respond constructively to criticism always. But governments
also have the right to say, "We don't agree with the criticism"
of course.
Q118 Mr Burrowes: Is it not unusual
that in the last three months the Government has specifically
not followed through the recommendations from the Ombudsman? That
is unusual.
Mr Hutton: Give me some examples?
Q119 Mr Burrowes: Tax Credits,
Debt of Honour.
Mr Hutton: In relation to the
tax credits, ministers are trying to respond to the concerns that
have been raised about them. I understand the Paymaster-General
made an announcement last week about how this work could be taken
forward. We are trying to deal with the concerns. We are trying
to deal with them seriously and sensibly.
11 Cabinet Office, Choice and Voice in the Reform
of Public Services: Government Response to the PASC report-Choice,
Voice and Public Services, Cm 6630, July 2005, available at
http://archive.cabinetoffice.gov.uk/opsr/documents/pdf/choice_voice.pdf Back
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