Examination of Witnesses (Questions 180-190)
MR IVAN
LEWIS MP, MR
NICK CHAPMAN,
PROFESSOR SUE
HILL AND
MS HELEN
MACCARTHY
8 MARCH 2007
Q180 Dr Taylor: Obviously, commissioning
is the responsibility of the Primary Care Trusts. You are elevating
audiology services to a priority. Is that actually going to cut
any ice with the PCTs who are struggling to meet their deficits?
Mr Lewis: I would say that that
is related to the much bigger picture debate that we have on almost
a daily basis about the NHS these days. We have been the first
Government that has looked the NHS in the eye, has not blinked
and said, "You have to achieve financial balance." I
do not apologise for it. You have been in the NHS far longer than
I have but, if you are honest about it, it has been one of the
NHS's great weaknesses over the years, and the consequences of
not having financial discipline are not just about finance actually;
they are also about the quality of the service that patients get,
the value for money. We have heard in this process of how the
cost from assessment to fitting for audiology has been slashed
as a consequence of doing things very differently than historically
than the NHS would ever have dreamt of doing things. My answer
to you would be that all the evidence is that this financial discipline
that we are placing on the NHS is working. Many organisations
that were in danger of spiralling out of financial control have
got their act together. There are a small number who are still
facing pretty serious difficulties and will continue to need lots
of support and help to get their financial balances sorted out
but, in that context, the NHS continues to treat millions of people
in an incredibly effective way in this country and in a way that
we can be proud of. All I am saying today and this week really
is that people who have hearing problems are entitled to be regarded
as a priority. For me, hearing is not just another problem. It
is a fundamental capacity to participate in everyday life. If
the NHS in this country does not and cannot prioritise audiology,
that would be a sad reflection on what we regard as being important.
The bottom line will be, when we appear before this Committee
or whoever in a year's time—and I will be delighted to be
the person that comes back—have we made massive progress
on waiting lists and waiting times? You know one benchmark, which
is that by March 2008 there should be a maximum weight of six
weeks everywhere for accessing audiology. That is a clear, transparent
benchmark that you will be able to judge us against. You know
that there is another benchmark that by the end of 2008 50% of
people accessing audiology must do so within the overall 18 weeks,
and you know as a consequence of the evidence that we have given
to you today and the framework we published this week that the
other 50% should be waiting far more reasonable times to have
their fitting from the moment of assessment, because every body
will be at six weeks, than they are doing at the moment. So I
think we have given you, to be fair to us, some very clear benchmarks
to judge the NHS's performance by, certainly by the end of 2008.
Q181 Dr Taylor: So you will keep
a very close eye on the commissioners so that when you come back
to us in 12 months' time you can say they have spent the amount
of money they ought to have done on hearing aids?
Mr Lewis: What I commit to doing
is, at a national level, with the RNID and other stakeholders,
monitoring progress. I am not so much worried about reporting
back to you on the amount of money we have spent; I will be reporting
back to you on the outcome and hopefully that outcome will be
considerably less waiting times both for assessment but frankly,
more importantly actually, ultimately for fitting.
Q182 Chairman: Sir Humphrey would
say, "That is very brave, Minister."
Mr Lewis: By the end of 2008 though
remember.
Q183 Dr Naysmith: It seems a pity
to break into that stirring speech. We have talked a lot about
value for money and we have talked a lot about how much money
is to be spent on waiting times but what about the quality of
the service? Presumably, the hospital side is assessed by the
Healthcare Commission but what about the private sector side of
it? How will the quality of care in the private sector be monitored?
Mr Lewis: As far as I know, if
the NHS has a contractual relationship with the independent sector,
the Healthcare Commission monitors their performance, because
essentially it is an NHS service that is using the private sector
to ensure its delivery. I think there are also quality standards
that apply in terms of any relationship which exists between the
NHS at a local level and a private provider, where we give them
guidance, if you like, about how to monitor, how to demand certain
standards.
Q184 Dr Naysmith: That will be monitored
as well?
Mr Lewis: Yes. So it is not just
numbers, as you quite rightly say, Doug. It has also got to be
about quality of experience for the patient.
Q185 Mr Jackson: Minister, and Mr
Chapman, I listened carefully on the issue of collating of data,
and you said you were working to very clear benchmarks. Given
that we were told in evidence by the British Society of Audiology
that there are no standards for recording referral or appointment
types, no systematic interfaces with NHS systems, and no standard
reports that can be aggregated easily, do you not think that it
would have been appropriate to begin collecting data a lot earlier,
and is not the true fact of the matter that part of the problem
is that you do not know what the numerical situation is because
you have no data that is accurate in measuring how successful
or otherwise you are going to be?
Mr Lewis: I have a graph here
that basically goes from 1984 through to 2006, and I am happy
to give the Committee a copy of this, and what is fascinating
is that basically, waiting times were practically flat from 1984
all the way through to the year 2000-01 and then shot up to coincide
with the modernisation programme. The graph proves that beyond
all reasonable doubt. So I think to argue that we do not have
robust data is slightly unfair. In a sense, we would not know
how bad the situation is in some parts of the country for people
if we did not have robust data. We would not be able to sit with
each of the Strategic Health Authorities and then sit with the
PCTs to identify the capacity that will be required to slash these
waiting lists if there were not robust, hard evidence to base
our future planning on. It is slightly unfair. Could we have better
data? I have no doubt that we could and I think that we need to
work on that clearly as part of our monitoring of progress, but
I think we have good data which tells us a story which is pretty
clear, which is why we are where we are and the Select Committee
is producing its report, and the Government has produced its framework.
Q186 Mr Jackson: Let me get this
absolutely straight. Are you saying it is not the case that at
the moment there is no central data collected on referral to treatment
times? Are you saying that is the case? I only ask that because
I have asked Parliamentary Questions and your colleagues have
said you do not collect the date centrally, and in fact, the most
accurate data has emerged from professional organisations like
the RNID rather than the Department of Health.
Mr Lewis: Can I be clear? I want
to be clear about this. I think the data that we have, that is
absolutely clear and robust, is on time waiting for assessment.
So at the moment that is absolutely robust and clear. What we
do not have is robust data on the moment from referral through
to fitting.
Q187 Mr Jackson: Do you not think
that is apposite though?
Mr Lewis: Of course. Absolutely,
and as far as I know, and I will be absolutely clear about this,
from next month we will be collecting that data at a national
level. Is that accurate?
Mr Chapman: Yes. As far as patients
going through the 18-week pathway are concerned, we will be collecting
referral to treatment data.
Mr Lewis: The ENT group?
Mr Chapman: The ENT group and,
as it says in the framework, we would consider during the course
of 2007 whether it was appropriate to extend that referral to
treatment data collection to all patients going through audiology.
Q188 Mr Jackson: On what basis would
it not be appropriate?
Mr Lewis: The fact that Honourable
Members like yourself and many others complain, understandably,
about the bureaucracy that we place on the NHS at a local level
which gets in the way of them delivering patient care. We cannot
have it both ways. We cannot constantly say we are fed up with
all this red tape and the requirement to keep statistics and numbers
and all of that, and then say what we demand is detailed information
on every aspect of the service. That is the tension all the time,
that Honourable Members do say contradictory things on these issues.
They ask questions and they say they want absolute detail on every
issue nationally, and then when we debate regulation and bureaucracy,
they say we want this slashing, it is ridiculous, the front line
professionals are spending all their time ticking boxes and filling
in forms. Genuinely, I think what you are saying is reasonable.
I personally think, although I am not committing to it, that what
we should aim to be doing is having comprehensive data for all
people. Because of the state we are at with audiology, which we
are aware of as a result of the reason we produced the framework,
which is that we are not in as good a shape as we need to be in
all parts of the country, I think there is a strong case for collecting
data on all of the people who access audiology, not just the people
that are covered by the formal 18-week target. We are going to
have a look at that. I am not making an absolute commitment to
do it but I will certainly have a look at it.
Q189 Mr Jackson: I am pleased to
hear that. The only reason I sought to press you on that was that
a previous witness, Ruth Thomsen, effectively said that this data
is available locally on a database at the touch of a fingertip.
So we are not talking about splitting the atom, we are not talking
about Soviet tractor figures; we are talking about data that is
already available, Minister, and that is why I pressed you. But
thank you. I am gratified to hear that we are moving in the correct
direction.
Mr Lewis: I just bring to the
attention of the Honourable Member that we have been New Labour
for some considerable time, even the Chairman, probably longer
than most of us. There is an important point here but actually,
you have just identified one of the great tensions about the debate
about how the NHS should be run in this country. You are saying,
and I do not know whether it is true, but if somebody said it,
I assume it is true, but there is a lot of data kept at a local
level because, in a sense, if PCTs are going to make sensible
commissioning decisions, they should be keeping that information
as a management tool anyway. But then the question is, how much
of this information should flow upwards constantly to the Department
of Health and central government? As you know, the whole debate
about foundation trusts, about autonomy—frankly, Stewart,
your party pushes this all the time, maximum autonomy for the
front line—why do we need constantly front-line professionals
to be pushing more and more information up to the centre?
Q190 Mr Jackson: Because my constituents
who are waiting 66 weeks in my local trust deserved to know. That
is why, Minister.
Mr Lewis: As I say, we ought to
be consistent with our positions on these issues.
Chairman: Just before I finish the session,
these two sessions have tended to overlap this morning. We expect
that the transcript will be on our website by Wednesday of next
week, and if anybody in the room has any comments on what has
been said, we would greatly appreciate if you send that in. It
will be after Easter when we will look at drawing up a report
of today's hearing. Could I thank you all very much indeed for
coming and assisting us, and thank the gamekeeper as well.
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