Select Committee on Health Minutes of Evidence

Examination of Witnesses (Quesitons 300-313)


29 NOVEMBER 2007

  Q300  Dr Naysmith: We saw some very good examples of good practice when we were looking at our ISTC report and some not so good, but one of the things that would really help to bring them into the National Health Service family would be if ISTCs were to be paid according to the national tariff so there is fair competition for NHS providers. When is that going to happen?

  Alan Johnson: It is only the initial setting up stage --

  Q301  Dr Naysmith: Perhaps we can give David a chance to come in again given all the comments.

  Mr Nicholson: In practice most of the second wave now are at tariff, and any further would be at tariff. The extended choice network is at tariff and the free choice arrangements are at tariff now, so we have a position where all but a relatively small number of the first wave who had supplements are now at tariff.

  Q302  Dr Naysmith: So they will be brought in eventually as well?

  Mr Nicholson: Yes.

  Q303  Charlotte Atkins: When we come to the end of the five year contracts for ISTCs, given what you have said about the whole process being driven locally, would you be happy for PCTs to decide to pull out of those contracts, or no longer commission ISTC services, even if that means that ISTCs may close down as a result?

  Alan Johnson: Waves 1 and 2 are centrally driven, and whatever happens in them has to be cleared with us. What PCTs do now locally in setting up their own independent sectors is a matter for them, and they have total control over that.

  Mr Nicholson: What we have said to the companies running them is that our expectation is they will be able to operate at tariff in a commercial way after the five years. We have not done any deals with them. That is what we say our expectation is they will do, to give them the incentive.

  Q304  Charlotte Atkins: But will PCTs be pushed into commissioning services from them again?

  Mr Nicholson: By the time we get to that, of course, we will have free choice, so individual patients will be able to choose where they go, so an arrangement with a PCT in that way would not have the same application.

  Q305  Charlotte Atkins: We had a discussion last time you gave evidence that obviously some PCTs on take or pay contracts were paying vastly over the odds with very few patients being treated, and clearly those PCTs like North Staffordshire would wanted to get out of those contracts and not be forced to, as they were before, to conclude contracts which they know are not going to be cost effective.

  Mr Nicholson: There is a small minority of PCTs in that position but that is not the case for wave 2, only wave 1. With wave 2 the risk is taken by the Department, not by the individual PCT, and we would not expect individual PCTs to take the risk in future.

  Q306  Charlotte Atkins: Even if they were involved in wave 1?

  Mr Nicholson: Yes. I would not expect so.

  Q307  Chairman: In several tables in the written evidence there are footnotes or explanations that information from Trusts are missing. I have a couple of examples of that: income and car parking fees, table 9; capital schemes, table 16; and also table 32, agency staff. Are you and your officials confident that you have a full view of NHS monies?

  Alan Johnson: I will let my officials take that up first. Why was that missing?

  Mr Douglas: We do not collect information directly from Foundation Trusts other than that that is published. That is a responsibility of Monitor. As we look more at the operation of the NHS through the commissioning side of the business we are really collecting information through commissioners rather than rely on information directly from providers. So we feel we have enough information to allow us to fulfil our functions.

  Q308  Chairman: You are monitoring Monitor, are you?

  Mr Douglas: We work with Monitor.

  Alan Johnson: A close and happy partnership!

  Q309  Chairman: You are confident you have that view of NHS finances?

  Mr Douglas: We definitely have the view of NHS finance. We have the accounts information; all the accounts for every Foundation Trust is published and publicly available, so you can access accounts data as necessary.

  Q310  Dr Taylor: I am going to digress for one moment because the Chairman has just mentioned parking fees. In our questionnaire we were very keen to try to find out what sort of profit the private contractors who are running the parking are taking. We just got figures for the income the NHS is getting from parking fees but we did not get an answer to the sort of profit that the parking providers are making. Is that something that is available or not?

  Alan Johnson: Probably not, I would not think.

  Mr Douglas: I could not answer honestly at the moment, but I could check that up.

  Q311  Dr Taylor: Thank you. My proper question is this. The Chairman and I can both commiserate with you, Secretary of State, because we have fallen off the bottom of the Health Service Journal "50 Most Important People Influencing the Health Policy in England", and you have been demoted from number one to number four. What is your reaction to this? Is it a deliberate policy to take a low profile?

  Alan Johnson: The answer is blowing in the wind! Can I correct you though, I did not "drop" from first to fourth—I was not in it last year, so in a sense I have "come in" at fourth. My driver confidently expects to be higher than me next year, and probably if I drop much lower you will not want to speak to me at this Health Select Committee!

  Q312  Chairman: Turning to the profile and some of the heat that is in the debate about health, you would probably be happy if you were not in the top 50 at all, would you not?

  Alan Johnson: It does not bother me one way or the other. It is a matter of huge interest to people who read the Health Service Journal.

  Q313  Chairman: And you do not! Can I thank you very much indeed, anyway, for this morning's session. Clearly we do not put any political commentary into our annual PEQ but both of these evidence sessions will obviously be published, so thank you again.

  Alan Johnson: Thank you, Chairman.

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