Examination of Witnesses (Questions 80-99)
DR JOHN
LOW, MRS
RUTH THOMSEN
AND MR
JEFFREY MURPHY
8 MARCH 2007
Q80 Mr Penning: I completely agree
that what we need is patients treated. I am concerned about whether
the capacity with the NHS is being cut to fund the private sector
use within the NHS. We are all agreed on the principle. Especially
as a Conservative, I very much just want patients treated and
it is whether the taxpayers' money is being wasted at one end
to facilitate a private sector involvement at the other.
Dr Low: If you will forgive me,
I will make one comment before answering your question. That is
that most people want to receive a hearing aid in a convenient
location. They do not need or want to go to an acute care hospital
to receive a hearing aid. They would not go to an acute care hospital
to get a pair of glasses.
Q81 Mr Penning: That is an argument
for having it moved into private care—on which I would probably
agree with you.
Mr Murphy: To answer your question:
the NHS does not have the capacity. There are half a million people
waiting. It fits around half a million people a year. That is
about a year's worth stacked up in the system and there is no
way that the NHS is able to raise the capacity, increase the capacity
by any means to eradicate that list, to bring it down within the
18 week target by the end of next year.
Q82 Mr Penning: Dr Low, we said earlier
on that the capacity within the NHS was being cut. Posts are frozen.
You said that in your evidence earlier on. We are not saying that
they could do everything which is in their capacity within the
18-week list. Are you saying that you are happy for posts to be
cut so that the NHS has involved more private sector. Are you
saying that the capacity that is there you are happy to lose,
so that more people come into the private sector.
Dr Low: That is not what I said.
The action plan has a whole number of things that need to be done
to achieve the target of bringing the waits down under 18 weeks.
I said earlier in my evidence that each of those are important
but the most important item of them all, because it has the biggest
capability of bringing huge additional capacity, is to contract
with the private sector where there is existing capacity and there
is the potential to bring on stream more capacity more quickly
than the NHS could do it. I do not think posts should be frozen
in the NHS. Of course they should recruit the degree qualified
people who are available and they should do everything in terms
of skill mix, new technologies and so on to increase efficiency
and capacity in the NHS, but even doing all of that will not be
enough. More will be needed.
Q83 Mr Penning: You have indicated
it would not be enough but we have capacity there. It is of concern
that that is being lost. I can image where you are going to come
from, Mr Murphy, but I will ask the same question of you. Could
the NHS cope without you?
Mr Murphy: They have up until
three years ago. From our point of view, we are only here saying
that if there is a capacity problem we can help, we have the resources.
We have no comment really on what should be done on posts or what
should be done in investing in the NHS's training. I would welcome
it anyway. A healthy NHS service helps our business. We all want
patients to be treated in a timely manner. On what the NHS should
do about their capacity: yes, please, increase it. All we are
saying is that, if there is a short-term need, we can invest in
the capacity in a different way and we can deliver an effective,
compliant, cost-effective service.
Q84 Mr Campbell: Specsavers have
suggested that the system is failing. It is failing in delivery,
in speed of delivery. They are a private outlet. What is your
concern there? You are saying people would like to go everywhere
but Specsavers are saying it is not working.
Dr Low: I am not sure I fully
understand your question.
Q85 Mr Campbell: Specsavers is saying
the current system is failing on speed and delivery. That is a
private company saying it is failing. You said before that people
are going to go anywhere but they are saying it is failing.
Dr Low: Yes, but they are saying
the NHS is failing. They are not saying they are failing themselves.
Q86 Mr Campbell: The current system,
anyway. I am not sure if it is saying themselves. People are very
demanding now: they want speedy service. They should be saying
that but they are saying that the current system in which they
are involved is failing.
Dr Low: Specsavers are not involved
in providing the NHS services at all. They have never been involved
in any of the contracts, as I understand it. They have a huge
appetite and a huge growth programme in terms of hearing aid services
and I know that they would welcome the opportunity to fit NHS
patients. I imagine you have to read their evidence with that
perspective in mind.
Q87 Mr Campbell: Would an optical
place, like Specsavers, be a proper place to have hearing aids
fitted?
Dr Low: We have experience of
private companies fitting NHS patients with NHS digital hearing
aids and the feedback from the patients was very positive. They
liked the experience of being able to go into a shop on the high
street and get their hearing aids rather than having to go out
to an acute care hospital where they have to wait as part of a
kind of "sick patient syndrome" in the NHS. They like
that. They like the access.
Q88 Mr Campbell: Would you agree
with that?
Mrs Thomsen: We gave our patients
the choice. We informed them that if they wanted to they could
take part in the PPP and be seen by a private dispenser working
within our department. A lot chose not to do that, even though
they knew it was within our department. I am sure those who chose
to go to the high street were happy because that is what suited
them. We try to meet the patients as close to their local environment
as possible. I do think audiology should be out there in the community.
You are not sick if you have a hearing loss but you do have fundamental
communication needs. I do not always think the delivery of a hearing
instrument is all there is to it. There are often other quite
significant problems that need to be dealt with. The patient needs
to be dealt with holistically and not sold a pair of glasses as
they walk out.
Q89 Mr Campbell: Why should Specsavers
be saying that they are failing to deliver? Why should they be
saying this?
Mrs Thomsen: I do not quite understand
who is failing. Are the NHS failing?
Q90 Mr Campbell: I presume that is
what they are saying. I thought they were saying it was the whole
system.
Mrs Thomsen: I have outlined my
reasons in the NHS why there are long waits in the NHS. I think
there is a lack of investment in audiologists in the department.
The skill mix is not quite there. We have redeveloped the way
we are educated and trained. Unfortunately that all happened as
a result of the introduction of the Modernised Hearing Aid Services.
I think there are areas covered by audiology departments which
geographically are very large. Getting all those patients in is
a big problem and there are some big waits and that is where PPP
have been able to come along and help. Probably there are not
enough audiologists in the country to see all the patients and
that is why it is on the list to bring these people in. What is
good and is hopefully going the right way is that we are looking
at educating and training and putting these things in place. But
they take time. You cannot teach someone in a week. The BSc degree
is four years with a one year clinical placement, so that we do
have them in the department and we do have them working, and the
foundation degree will be a minimum of two years. That has not
started yet. In order to get the education levels up to match
the technology that we are using in the ever-changing world of
medicine, we cannot expect everybody to be fitted straight away,
we just do not have those reserves. We are very fortunate that
we have some excellent audiologists coming in from overseas to
help us out.
Q91 Mr Campbell: Jeffrey, would you
like to comment.
Mr Murphy: I have not seen their
submission, but Specsavers are a spectacle company. I presume
they do not have enough information of the hearing aid market
to make a significant statement. That is my opinion. I do not
think the system is failing. I think there are capacity issues,
and, as I said before, the PPP has gone a long way to go to show
how that can be resolved.
Q92 Mr Campbell: I am pleased to
hear that. We can write that question off. Do you believe that
vulnerable people who obviously will have to go and get hearing
aids in the private sector could be looped up to get an upgrade
when that is unnecessary?
Mrs Thomsen: I think they have
very strict contracting rules because that has been a concern.
I hope it will be the case that if they are going for an NHS fitting
that is what will happen. I am sure the big companies will keep
their houses in order and make sure that they deliver according
to the contract to fit in NHS aid. There are issues about the
cosmetics of hearing aids. Some NHS centres fit small ones in
the ears but the majority of the digital hearing aids are still
behind the ear. If a patient chooses to buy a hearing aid, that
is their choice. Not during the PPP—it would be unfair to
insinuate that, because I think the contracts were rigorously
followed and the companies were very, very careful to keep their
house in order during that period—but I do hear sob stories
where a little old dear has maybe answered an advert in the newspaper
and someone has knocked on her door, got their foot in the door,
and sold them a hearing aid in the living room. That practice
is checked by the Hearing Aid Council—which is disbanding
now—but it is not allowed in the majority of countries in
Europe. It is legislated against. There are possibly only two
other countries in Europe where this knocking on a door and selling
a hearing aid in someone's home is allowed. I think that is really
not very nice. That is the sort of sob story we get time and time
again.
Q93 Mr Campbell: Dr Low, do you have
anything to add?
Dr Low: We know that hearing loss
increases with age. Roughly 60% of people when they are over 60
have a hearing loss; 80% of people over 80 have a hearing loss.
We know it is a phenomenon which increases with age. If you cannot
hear very well, the chances are that by the time you have gone
to do something about it, you are quite vulnerable. You do not
know what you need. You do not know what kind of hearing aid to
buy. You cannot go to Which magazine and choose because
it needs professional advice. You are depending on the person
who is advising you to advise you well. Occasionally in the private
sector people have behaved badly. I have to say that they have
tried as a sector very hard to eradicate bad practice but the
Hearing Aid Council is controlled by the Department of Trade and
Industry. It is a consumer protection issue and does not come
under the remit of the NHS. Frankly, I think the two should come
closer together. But we must protect the vulnerable people in
our society. People ought to be able to hear well, regardless
of whether they are wealthy or not. Everybody should be able to
get a good quality hearing aid, well fitted, regardless of whether
they have money in the bank or not. If they have money and they
want something fancy and so on, that is great. If you want to
get one immediately and you want all sorts of extra things, that
is brilliant, but we must protect the vulnerable in our society.
Q94 Mr Campbell: Jeffrey, have we
been behaving badly?
Mr Murphy: Not that I know of.
Going back to your question, if there was an independent procurement,
the contract in the PPP protected the patient more so than under
the Hearing Aid Council. We had compliance issues; we had to follow
the hospital procedures. I think the patients would be safe. From
a practical point of view, we had to measure outcomes, and the
reports that were published summarised that the patient was safe
to go into the PPP. They are vulnerable patients. My answer would
be that the contract, if it is continued, would protect the vulnerable
patients and it did.
Q95 Chairman: Ruth, when we talk
about 40% unemployment of graduates, where did the 40% go?
Mrs Thomsen: I interviewed one
two days ago.
Q96 Chairman: Do they go into the
independent sector?
Mrs Thomsen: He did not. The figures
with the 40% are a little bit premature, in that there is only
one cohort of students from Manchester that has exited this year.
There is one lot of students educated to degree level at Manchester
exiting this year. This summer there will be nine universities
with students exiting. That is when the big concern comes. I am
a little concerned that if they go directly into the private sector
they will not get nurtured and grow and benefit from the crystallised
thinking that you get when you come into a hospital department
with lots of research and development and testing going on. I
do worry about these people going into the private sector, a bit
like opticians, and then just fitting hearing aids day in, day
out. I have seen the adverts for the private sector jobs. They
want people to work from eight to eight, 12 hours a day. This
is for the contracting for the independent sector treatment centres.
Be it for four days a week, fitting hearing aids day in, day out
is not a good way to go.
Q97 Chairman: We could have that
debate about a surgeon, because I would like to go to a surgeon
who was doing what I needed every day, all the time. I would know
then that I would be getting somebody who was experience and skilled.
Mrs Thomsen: Yes. I would not
like to be that person's last patient at the end of the day.
Chairman: Let us leave that. It was just
this issue of 40% of graduates then not doing anything. In actual
fact, it is public money that trains them but they may go and
work elsewhere, not in the public sector. That is what I was trying
to get to. Could we move on.
Q98 Sandra Gidley: I have a question
for Ruth. In your statement you commented that, when bidding for
NHS contracts, private companies hide some of the costs. Are you
able to elaborate on that?
Mrs Thomsen: Yes, we did go through
the PPP. We went through the RNID to contract those services I
think it is a location issue and I think it will be an issue that
comes up, whereby they were unable to find premises to operate
their PPP in the vicinity we were in. That was Hammersmith &
Fulham, Kensington & Chelsea, Westminster. I think they were
unable to rent properties or premises with a soundproofed room
that would meet our criteria for fitting hearing aids. There were
none around. If there were, they were in private hospitals, and
probably the fees were too high. The company we were using were
operating through Boots. Boots was around the corner, but they
were very busy with their own private patients and would not make
room for the PPP so it came under our umbrella. They came to work
in an audiology department we have, a small outreach hearing aid
centre in Kensington. In these very affluent areas it is going
to be very difficult for PPP to want to invest in premises and
property, because the overheads are so high, so we bore the cost
of that in order to get the patients seen.
Q99 Sandra Gidley: You are saying
that they took the money and you bore some of the expense, in
effect.
Mrs Thomsen: Yes. And our receptionists
met the patients, our receptionists dealt with all the problems
on the phone. There was another phone number but we were the local
people. They wandered in.
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