Examination of Witnesses (Quesitons 300-313)|
MP, MR DAVID
NICHOLSON CBE AND
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
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
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
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
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 fourthI 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
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
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.