Examination of Witnesses (Questions 60-79)
DR JOHN
LOW, MRS
RUTH THOMSEN
AND MR
JEFFREY MURPHY
8 MARCH 2007
Q60 Dr Naysmith: The academy said
something like 50% had to have further treatment after they had
been to the private sector. That is a very strong criticism. Is
there any truth in that?
Mrs Thomsen: We were very lucky
with the girl we had at PPP. She was very professional, she was
well trained. She was not educated in any way near the level of
the audiologists working in our department. but she was in our
department and we were able to liaise with her and iron out any
problems immediately. A hearing aid patient is a patient for life,
so the 50% that were seen again may have needed more fine-tuning.
Q61 Dr Naysmith: But the contract
was just at an end, and they could not go back to the original
one, or what?
Mrs Thomsen: If the PPP contract
had finished, then obviously they will move back. If they are
our patients, they will stay our patients. Hearing loss is progressive.
Their hearing may have changed, they may have needed extra fine
tuning or, for one reason or another, the person who was fitting
them in PPP may not have had the skills and the knowledge in rehabilitation—which
you get in the NHS, because you have been fitting digital hearing
aids for a long time to people.
Q62 Dr Naysmith: That is really a
matter for a contract in the future, to make sure that is picked
up in the contract.
Mr Murphy: Ruth is saying that
the person they had doing the PPP was working in the hospital.
I think people are talking generically about a PPP. Under the
actual PPP contract, we could not work in the hospital, so that
dispensation was not part of the PPP. Generically there were other
public/private partnerships. That number cannot be correct. Outside
of the PPP—whatever you would call those contracts—maybe
there were 50% referrals, I do not know, but Ruth did not experience
a PPP. Generically, she did, but the PPP contract was not carried
out in any hospitals, so those submissions are not about the PPP,
in my opinion.
Q63 Mr Amess: Do not start falling
out with each other.
Mr Murphy: We love each other.
Q64 Dr Naysmith: They are not falling
out.
Mr Murphy: We will have a love-in
later! This is fine. We are all friends.
Q65 Mr Penning: At this stage I need
to declare an interest. I am part of the campaign for fairer pensions
for our servicemen who have had hearing damage while in the Armed
Forces and I compliment the RNID on what they have been doing
there. Could I quickly go back to Mr Murphy, and these huge profits—whichever
way you want to swing it—that are being made by companies
selling hearing aids in the private sector to my constituents
and others. The profit margins are quite huge. I am a great believer
in the market and competition driving down prices. It has worked
in other areas, in opticians, why is this not being driven down
in your area? Are my constituents and others being ripped off
by these costs?
Mr Murphy: They are coming down.
Q66 Mr Penning: They have not come
very far, have they?
Mr Murphy: Digital introduction
has reduced prices by £200 or £300 per hearing aid over
the last two or three years.
Q67 Dr Naysmith: And the costs, you
have admitted, are coming down as well. Why is that not being
passed on?
Mr Murphy: The costs have not
come down the same. The NHS buy 400,000 hearing aids a year and
they are paying £49.
Q68 Mr Penning: There is a marketplace
out here.
Mr Murphy: Yes.
Q69 Mr Penning: There is competition
in the marketplace.
Mr Murphy: Yes.
Q70 Mr Penning: You all basically
charge the same.
Mr Murphy: That is the average
selling price.
Q71 Mr Penning: Throughout the market,
you charge the same. Why is the market not driving this price
down? Why are you still being allowed to have 400% or 500% mark-up
on a hearing aid which costs the NHS 70% and you say it costs
a couple of hundred pounds to you?
Mr Murphy: It costs £200
or £300.
Q72 Mr Penning: You are earning thousands
out of it, so why?
Mr Murphy: The market is, from
the point of view of the size of the market, supplying the market
and the cost of getting the hearing aid to the patient. For example,
there are lots of products where the service is the most expensive
part of the product.
Q73 Mr Penning: Every company which
is selling this in the private sector has exactly the same costs
and exactly the same overheads and no one is willing to undercut
anybody else.
Mr Murphy: There is undercutting.
There is marketing promotions, there are price—
Q74 Mr Penning: I am very suspicious.
Could I take you on to private sector involvement. I was very
conscious of a little whisper that went on between Dr Low and
Ruth Thomsen to do with post cuts and position cuts and frozen
posts. Could the NHS cope with the waiting lists without the private
sector involvement? In the light of the fact that you are losing
posts and then saying it is great having the private sector coming
in, if you were not losing posts would you be able to cope with
waiting lists, with that investment coming in to you rather than
going into the private sector?
Mrs Thomsen: I would love for
the Government to have faith in its modernisation process and
really carry on with the investment and put the correct number
of audiologists to patients in the NHS. We have developed a fantastic
BSc degree and we are looking at a foundation degree to have the
appropriate skill mix. I think hospitals are generally well placed
for patients. The transport systems all run in there. We operate
in three or four centres in West London. We go out to the patients.
We are in the community. We fit in local GP centres and we do
home visits. The wait for our home visits is three to four weeks.
Q75 Mr Penning: You could increase
your capacity of treating patients if your posts were not being
cut, your posts were not being frozen, and the money came to you
rather than going to the private sector.
Mrs Thomsen: I cannot see why
it is so much better to go somewhere else when there has been
no data to say that it can provide a cheaper solution or it can
provide a more cost-effective solution. I think we have had four
fallow years with the BSc degree and no audiologists coming through.
We have had no earn and learn. Audiology has been on the list
for people to come in from outside the UK to work and we have
benefited greatly from that. We have had some very well educated
audiologists from different parts of the world come to work with
us and share knowledge. But I have worked in the Workforce Confederation
in building up these degrees, in making sure that the training
is appropriate, that there are clinical placements and that we
have built a workforce for London in the Strategic Health Authorities
I was working with, and there are no posts for these guys to go
into.
Q76 Mr Penning: We have qualified,
dedicated people being trained by the NHS at taxpayers' expense
who cannot find a job. You are laying people off and then we are
going to the private sector to employ people. In a nutshell, that
is where we are, is it not?
Mrs Thomsen: Absolutely. And the
degree is funded.
Q77 Mr Penning: We are losing capacity
within the NHS.
Mrs Thomsen: We are putting people
through four year degrees which are fully funded degrees—
Q78 Mr Penning: And then cutting
the posts at the end of the day.
Mrs Thomsen: We have spent all
this money in education and there is no jobs for them.
Q79 Mr Penning: That is fascinating.
Dr Low: I think it matters not
where the patient is seen. I am interested in large numbers of
people who are waiting to get a hearing aid to have a significant
improvement in their quality of life, and I do not mind whether
it is done in the private sector or in the NHS. Honestly, I do
not. It is not an issue for RNID as an organisation.
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