Examination of Witnesses (Questions 115-119)
MR IVAN
LEWIS MP, MR
NICK CHAPMAN,
PROFESSOR SUE
HILL AND
MS HELEN
MACCARTHY
8 MARCH 2007
Q115 Chairman: Good morning. Welcome
to our second evidence session this morning. I wonder if I could
ask you if you could just introduce yourselves and the positions
that you hold for the record.
Ms MacCarthy: I am Helen MacCarthy
from NHS Purchasing and Supply Agency.
Mr Lewis: Ivan Lewis, the Minister
for Care Services.
Professor Hill: Sue Hill, Chief
Scientific Officer, Department of Health.
Mr Chapman: Nick Chapman, National
Director, 18 Weeks, Department of Health.
Q116 Chairman: Could I actually start
around that area about 18 weeks and really, I suppose it is to
you, Minister. How can you justify keeping assessments of fitting
of hearing aids outside of the 18-week target?
Mr Lewis: First of all, Mr Barron,
can I say that I am delighted to make my first appearance before
the Select Committee. I am a former member of the Committee. I
can see one or two people are still on the Committee. I take accountability
to this Committee incredibly seriously. The situation is—and
I think in a way, in the context of the announcement we made this
week, and a lot of people were not aware of this—there is
already a commitment and an expectation, both, that the NHS will
ensure that nobody waits for more than six weeks for an assessment
by March 2008. So that is already an expectation that is out there
in terms of what the NHS understands to be required. What this
does really is it goes beyond that and says, for the 50% of people
who are not covered by the 18-week target, which is a target which
is about all the way from assessment to fitting in the context
of audiology, that we are not prepared to tolerate excessive waits
for those people, because 50% who go straight to ENT, who require
highly specialist services, are already covered by the 18-week
target. What this week's announcement did was supplement the commitment
to a six-week maximum assessment for everybody, irrespective of
how specialist their problem is, by saying that we believe, with
modern technology, quite a number of people could have their hearing
aid fitted literally on the same day as the assessment and that
the vast majority of others should only have to wait literally
for a few weeks. It is complicated, and it would be much simpler
to be able to say every single person is simply covered by the
18-week maximum but, because 50% of those who need audiology were
excluded from the 18-week target initially, the Department's position,
understandably, is if we start adding extra things into the 18-week
target on a regular basis, it makes a mockery of the target. It
creates instability and it sends out messages to managers and
others who are expected to implement these changes which are inconsistent.
Q117 Chairman: Could I say, Minister,
with all respect, this is about as clear as mud to me. We have
had a written submission from the Department in relation to this,
dated 8 February, where in 3.6 it talks about "The NHS Improvement
Plan set out an ambitious new aim that by 2008 no one will wait
longer than 18 weeks from GP referral to hospital treatment."
We have had evidence earlier that says if we were to try and meet
those targets in that timescale, we would never do it because
the system would be in absolute chaos because of its inability
to handle such a target. What is the reality? I am just confused
about how we are going to move from where we are now, which my
understanding is we get some waits after the initial referral
and the initial test that go on sometimes for over a year or even
two years, looking at some of the areas, before the hearing aid
is fitted—obviously, this is the initial stage—which
would never be able to fit round any of the targets we have from
the evidence laid in front of us for today's inquiry. What is
the real story?
Mr Lewis: First of all, the real
story is that when we committed ourselves to the introduction
of digital hearing aids and did the modernisation project in partnership
with the RNID, in my view, there was no serious analysis or assessment
of the consequences of that for demand. If you look at the graph
in terms of waiting times and waiting lists, the irony is it is
very flat and then suddenly, exactly coinciding with the time
when we were embarking on this modernisation programme, when we
were saying we were going to offer people digital hearing aids,
waiting times and waiting lists rocketed. If you want my honest
opinion, Mr Barron, there was little, if any, serious anticipation
of the consequences of making that commitment. In the partnership
that we had with the RNID, which was excellent in terms of that
modernisation programme for the 0.75 million people who benefited
from it, there was simply no anticipation of the strain that that
would put on the system and the expectations that that would give
to people. If I can just go back to your specific question, there
are essentially two groups of people who access audiology services.
There is a group of people with specialist, complex hearing conditions
and they tend to be referred to ENT specialists. That group of
people is already covered by the 18-week target. There is then
50% who essentially go, either through community health professionals
of one kind or another or, more likely, a GP, who go straight
to the audiology department because it is believed that their
problem is not that complex or not that serious. It is that 50%
essentially that we would not have been changing behaviour in
the NHS to ensure that that 50% saw a massive slashing of the
waiting times for those individuals. The announcement this week,
coupled with the commitment that is there anyway for everyone
that, not the fitting but the assessment—let us be clear—for
everybody, must be everywhere in the country a maximum of six
weeks by March 2008. The framework, alongside that commitment,
in our view, means that the 50% of people who would not technically
be covered by the 18-week target because they are not going through
ENT will see, in every part of the country—and we will make
this happen; this is a commitment from us to make sure the Health
Service honours its responsibility in this area—will see
waiting times and waiting lists slashed. The other thing I would
say to you is, if you look at the variability of performance across
the country in terms of PCTs and Strategic Health Authorities,
there is no excuse for the excessive waiting lists and waiting
times in some areas. The NHS has taken its eye off the ball to
some extent. Audiology has not been given the priority it deserves.
Alongside that, to be fair to the NHS, the demand, because of
the new technology, because of medical advances, has shot through
the roof.
Q118 Chairman: What research has
been done to make sure you can hit this 2008 target? I think you
have explained to us that there has been little research done
before the modernisation programme was put into place. Do we have
any evidence of what is likely to happen between now and then?
Mr Lewis: The research that has
been done is into a number of things: first of all, identifying
best practice within the NHS in terms of pathways all the way
from referral through to fitting: in areas where it works, why
does it work, how do they organise their system, how do the different
professionals work together, how do they make best use of technology
and how do they make most efficient use of resources? That is
one issue. There has been dialogue with the SHAs in terms of we
can see massive variations in performance about what will be needed
to achieve this very demanding target that we have placed on the
system as a consequence of the new framework. As you know, we
have said to them that there is the opportunity to procure, we
believe, if you look at the capacity issues, our assessment is
up to 300,000 additional pathways that would need to be purchased
in order to meet demand and to get these waiting lists and waiting
times down. What the SHAs have said to us, Mr Barron, is that
is fine, but they want to be absolutely sure in terms of, first
of all, their in-house capacity, whether they are making best
use of their in-house capacity, because many of the SHAs acknowledge
that frankly, they are not necessarily making best use of their
in-house capacity. But then, very soon, we will be told by each
Strategic Health Authority the number of pathways they believe
will need to be purchased from the independent sector to enable
them to slash these waiting lists and waiting times. So the research
is about best practice in the areas where it is working but it
is also about a very intensive dialogue, SHAs to PCTs to the Department,
about the scale of the problem, the likely demand and how we close
the gap in a very short period of time.
Q119 Chairman: Is there any measure
about how long people will then wait beyond that in terms of,
once they have had the initial test, how long they will wait for
the fitting and everything else, or at this stage are we not too
sure?
Mr Lewis: Our assessment is that
over 50%, we believe, with modern technology that is now available
could, based on best practice in areas around the country, have
the digital hearing aid fitted on the same day as the assessment.
The other 50%, we believe, also because of modern technology,
should only have to wait a matter of weeks—certainly not
months and certainly not years—from the stage when they
have had the assessment to the point of having their hearing aid
fitted, which is why we are able to be as confident as we are
that these excessive, unacceptable waiting lists and waiting times
can in a very short period of time be slashed.
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