1 Introduction
1. The new Committee set up after the General Election
in 2005 has continued the practice of its predecessor committees
in examining a wide range of matters. In the past session this
has included public health, NHS finance, the administration of
the NHS, workforce planning and the increased involvement of private
healthcare providers in the health service.
2. The highlight of the period covered in this report
from July 2005 to December 2006 was the Committee's Report on
Smoking in Public Places which was instrumental in persuading
the House to amend the Health Bill and include a more comprehensive
ban (see paras 14-18). A major theme has been the financial situation
in the National Health Service. The Committee carried out an important
inquiry into NHS Deficits[1]
and continued its annual Public Expenditure Questionnaire
[PEQ] exercise (see paras 24-27). One of the causes of
the NHS's deficits has been the failure to co-ordinate financial
and workforce planning: the Committee started a major inquiry
into Workforce Planning which should be published in the
first half of 2007. We published the following Reports:
First Report (Session 2005-06) Smoking
in Public Places (HC 485-I)
Second Report Changes to Primary
Care Trusts (HC 646)
Third Report NHS Charges
(HC 815-I)
Fourth Report Independent Sector
Treatment Centres (HC 934-I)
First Report (Session 2006-07) NHS Deficits
(HC 73-I)
3. The Committee has taken evidence from Ministers
on several occasions. The Committee questioned the Secretary of
State as part of the PEQ, Independent Sector Treatment
Centres (ISTCs) and NHS Deficits inquiries.
We also held an evidence session with her on her full portfolio
of responsibilities soon after we were set up. We have held similar
sessions with Rosie Winterton MP, the Minister of State for Health
Services, and Andy Burnham MP, the Minister of State for Delivery
and Quality and intend to call other Ministers in the Department
to answer on their responsibilities. We have also taken evidence
from senior civil servants including the Permanent Secretary of
the Department, the Chief Executive of the NHS and the Department
of Health's Finance Director.
4. We undertook a number of visits in connection
with our inquiries. In the course of our inquiry into ISTCs
we went to three treatment centres in the south of England, including
a privately managed Treatment Centre at Gillingham, an NHS Treatment
Centre at Dartford and the Redwood Treatment Centre which is a
partnership [outside the ISTC programme] between BUPA and the
NHS.
5. Since prescription charges are to be abolished
in Wales, we visited Cardiff as part of the NHS Charges
Inquiry, meeting the Minister for Health and Social Services,
Assembly Members, including past and present Committee chairmen
and senior civil servants in the Department of Health and
Social Care. We were able to discuss the arguments for abolition,
in particular the difficulty in reforming the system of exemptions.
6. In 2005 as part of the inquiry into Smoking
in Public Places the Committee visited Dublin where a comprehensive
ban is already in force. The possible consequences of a smoking
ban in England have been much debated; we were able to find out
what the actual consequences had been in Ireland. We also met
those who worked in the industries affected and those responsible
for the implementation and enforcement of the legislation.
7. We visited Sweden in relation to our inquiries
into NHS Charges and ISTCs. In Stockholm we met
the Parliamentary Committee on Health and Welfare and the state-owned
pharmacy Apoteket. We also met officials from local, regional
and municipal government who provide healthcare in Sweden, and
the Ministry of Health and Social Affairs who frame and monitor
health policy. In addition, members of the Committee were shown
round a privately run hospital, managed by Capio, a Swedish company
that is now operating in England. The visit gave the Committee
the opportunity to study how a system of patient charges quite
different from those used in England work within a widely admired
healthcare system.
8. The Committee went to San Francisco as part of
the inquiry into Workforce Planning. We met academic experts,
policy makers and health service providers with workforce expertise
to discuss how planning is done in a free market system and the
likely shape of the future workforce. Representatives of Kaiser
Permanente explained how the workforce is planned and managed
in the largest healthcare provider in the US. Experts from the
Center for California Health Workforce Studies provided an insight
into workforce planning across the US and some interesting contrasts
between the UK and the US workforces. Senators at the State Legislature
gave the Committee an insight into the limited role of the state
in workforce planning and the willingness to rely on overseas
clinicians to make up any shortages. A highlight of the trip was
a stimulating discussion with Bob Brook, Director of RAND Health,
who challenged many of the Committee's perceptions and shared
some innovative ideas about the future of the healthcare workforce
in the UK and beyond. The Committee also found time to visit US
hospital facilities in San Francisco. We are very grateful to
all those who put so much work into briefing the Committee during
our visits and to the FCO officials who organised them.
9. The Committee also received visitors from overseas
Parliaments, including a delegation of Czech Parliamentarians
who wanted to discuss the role of the private sector in healthcare
in England, and Irish Parliamentarians who wanted to discuss developments
following our Report on the Influence of the Pharmaceutical
Industry.
10. Our relations with the Department of Health have
in general been good. Ministers and officials have been helpful
and have readily attended evidence sessions when requested. However,
some aspects of the relationship have been unsatisfactory. As
part of the ISTC inquiry we asked the Department for information
about value for money, including a study the Department had commissioned
of the ISTC programme and its effect on the NHS. Although other
Committees have been shown similar evaluations of schemes, our
request was refused on grounds of commercial confidentiality which
made it difficult for us to draw conclusions about the programme.
In the same inquiry the Secretary of State gave evidence to us
about the ISTC programme which failed adequately to describe what
was happening in respect of Phase 2 of the programme.[2]
We were also disappointed that none of the Government witnesses
to the Smoking in Public Places inquiry chose to inform
the Committee that the legislation would not extend to Crown Property.
11. While there have been a few problems, for the
most part we have found the Department helpful. We would like
to thank those in the Parliamentary section, who have efficiently
and courteously transmitted our requests for information to relevant
sections of the Department. In addition, we would like to thank
all those involved in preparing the answers to the PEQ.
We do appreciate the amount of work that goes into producing the
document. We must also thank Adam Mellows Facer from the House
of Commons Library for his assistance in revising the PEQ.
1 The NHS Deficits inquiry concluded just after
prorogation and the Report was published on 13 December 2006 Back
2
In our Report on Independent Sector Treatment Centres,
we noted, "There has been confusion about the scale and nature
of Phase 2. When the Secretary of Stae gave oral evidence on 26
April 2006, she told us that ITNs had been issued for 12 elective
schemes, in two tranches, and that responses had been received
for five of those bids. However, the Health Service Journal reported
the next day that Phase 2 had originally comprised 24 schemes,
of which seven had subsequently been scrapped, with only 17 proceeding
(perhaps with some delay).The Secretary of State conceded in a
letter to the Committee that Phase 2 would indeed probably consist
of 17 schemes." HC (2005-06) 934-I, para 23 Back
| 
