Examination of Witnesses (Questions 140-159)
SIR IAN
CARRUTHERS, OBE, PROFESSOR
DAVID COLIN-THOMÉ,
MR GARY
BELFIELD AND
MR CHRIS
SHAPCOTT
22 MAY 2006
Q140 Mr Bacon: You mean the £6,000
taken from the GPs?
Sir Ian Carruthers: Yes.
Q141 Mr Bacon: Is it right that the
£163.6 million is a GP contract amount that was removed from
them and handed over to the PCTs?
Sir Ian Carruthers: Yes.
Q142 Mr Bacon: That gets us to £322
million which was what the Department expected to be the cost.
There is a further £70 million to get to what it actually
cost, or is expected to cost, namely £392 million?
Sir Ian Carruthers: Yes.
Q143 Mr Bacon: What was that £70
million? Where has it come from? Who has paid it?
Sir Ian Carruthers: That £70
million was the sum of money which PCTs chose to spend in establishing
a service, and it came from their general growth allocation.
Q144 Mr Bacon: It came from their
general budget?
Sir Ian Carruthers: Yes.
Q145 Mr Bacon: Did they spend it?
There are two figures here: a contracted cost of £380 million
and a likely cost of £392 million. Do you anticipate that
the £392 million is the more accurate figure?
Sir Ian Carruthers: I would not
like to say what is the most accurate figure, but in those areas
I am taking it at value because I believe that it is the best
survey we have without going round to every PCT. As the National
Audit Office did it I am not going to dispute the £70 million.
Obviously, that is the difference between the £322 million
and the £392 million. If it was that high—I have no
reason to say whether it was or was not—it would have come
from the growth allocation budget of the primary care trust, which
has been on average around 9%, and it would have meant that they
had made a positive choice to invest in this rather than in other
things.
Q146 Mr Bacon: Rather than paying
dentists, or something like that? I am just picking an example
from the air. They had to make a decision?
Sir Ian Carruthers: Yes, and they
chose this.
Q147 Mr Bacon: To turn back to paragraph
4.6, it says: "The Department is clear that it funded the
service based on the average cost per GP of £9,500",
which is a slightly curious way of putting it. I take it from
the way that the NAO normally drafts their reports that it means
the Department is clear, even if no one else is. It goes on to
say that despite the Department being clear "some PCTs did
not understand that the £6,000 opt-out sum was not the full
cost of the service." I add that that was despite the fact
that, as we see in the second sentence, the Department had "also
set up a programme to support PCTs in implementing the new out-of-hours
arrangements." Not only did you calculate an amount based
on an average cost of £9,500—you were clear that that
was what you had done—but you set up a programme to support
PCTs in implementing the new out-of-hours arrangement, and still
some PCTs did not understand that the £6,000 opt-out was
not the full cost of the service. Why not?
Sir Ian Carruthers: Mr Belfield
can answer that; he has the detail.
Mr Belfield: The £9,500 was
identified from doing an economic analysis of out-of-hours costs
across the country before the GP contract was negotiated. Based
on the information that we had from the GP co-ops, we understood
that the average figure was about £9,500 per GP to provide
the current service before the negotiation. That is how we get
to the £9,500.
Q148 Mr Bacon: My question was not
about how you calculated the £9,500 but the sentence: "Despite
this, some PCTs did not understand that the £6,000 opt-out
sum was not the full cost of the service." My question is
why, particularly given that you had spent all this taxpayer's
money on setting up "a programme to support PCTs in implementing
the new out-of-hours arrangements", the PCTs did not understand
that the £6,000 opt-out was not the full cost. Why did they
not understand that? Was it because they were all thick or it
was not explained to them properly, or at all—or were they
told that it was £6,000?
Mr Belfield: They certainly were
not told it was £6,000; they were told consistently that
it was £9,500.
Q149 Mr Bacon: How do you account
for the fact that they seemed to think it was £6,000?
Mr Belfield: It was not all but
only some. We do not know the individual details.
Q150 Mr Bacon: How can you make such
a basic error? It is more than a 50% difference, is it not?
Sir Ian Carruthers: I think the
point being made is that PCTs were told what the contribution
was.
Q151 Mr Bacon: What I want to know
is why it is possible for the PCTs to get it wrong by over 50%.
If you multiply £6,000 by 150% you get to £9,000, so
it is more than 50% wrong. How did they get it so wrong if they
were told clearly that it was £9,500?
Sir Ian Carruthers: There are
two points. First, this came from a survey conducted by the National
Audit Office. I do not know why PCTs would write and say that
the cost was £6,000 when they were told it was a different
sum.
Q152 Mr Bacon: But it was your Department
that calculated the £9,500?
Sir Ian Carruthers: Yes, but I
do not know why people would return a survey saying that they
did not know. We would have to ask them.
Q153 Mr Bacon: The number going round
in the media was £6,000. If you are planning a new service
like this surely it is your responsibility as a department to
make sure that PCTs are aware what the costs on which you have
made the calculation will be. You could summarise that in simple
Noddy language on one side of A4 in a way that could not be open
to misinterpretation?
Sir Ian Carruthers: Mr Belfield
will correct me if I am wrong, but he said that that information
was provided to PCTs. I cannot explain why they should complete
a survey in this way.
Q154 Mr Bacon: In what form was it
provided to PCTs?
Mr Belfield: We ran a series of
workshops and put people in each SHA to talk to each PCT. We also
ran a website on a number of portals to give people the information,
but I still cannot answer your question.
Q155 Mr Bacon: The information itself,
namely, "We have calculated this on the basis of an average
cost of £9,500 and this is how we have done it", could
have been summarised clearly in simple language not open to misinterpretation
on less than one side of A4, could it not?
Mr Belfield: Yes.
Q156 Mr Bacon: Did you do that?
Mr Belfield: Yes.
Q157 Mr Bacon: Can you send us a
copy of what you sent to the PCTs at the time?[5]
Mr Belfield: We can.
Q158 Mr Bacon: Last week I was abroad
but I saw on BBC Breaking News that NHS Direct had closed
12 call centres and sacked 1,000 staff. Are those the correct
numbers?
Mr Belfield: That is not true.
They are consulting on the closure of 12 centres. Some media reported
1,000 and that is just wrong.
Q159 Mr Bacon: If all of them were
to be closed how many jobs would go?
Mr Belfield: The maximum number
of posts at risk is 500, of which about half are management and
114 are nurses. We would want to look at the relocation of staff
into other parts of the NHS.
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