Select Committee on Health Minutes of Evidence

Examination of Witnesses (Question Numbers 120-126)


3 JULY 2008

  Q120  Dr Taylor: Going back to our first report again, one of the recommendations was: "In line with the general move towards rationalising inspection and regulation in healthcare we recommend that CHAI" (as it was then) "and the proposed independent regulator act in a complementary way integrating their work". Is that actually happening? We had Maria Goddard as a witness who gave written evidence at that time and she has written, I gather, in September's Health Policy Matters that there is a rather crowded regulatory environment covering economic regulation, quality and public safety. Is it crowded or are you working with the Healthcare Commission or the Care Quality Commission as it comes?

  Dr Moyes: With the Healthcare Commission we have a very good relationship and I think we are both very clear about our respective roles. We work together; I see Anna Walker regularly, my team see her team regularly. Where we have problems in a Foundation Trust we will ask for their advice. Where they identify problems with quality or with service delivery that is serious enough, they will refer these things to us. I think there our respective roles are very clear and the legislation underpins that. My ambition is to develop a similarly clear and good relationship with the Care Quality Commission and similar clarity of role. The Care Quality Commission is a very different animal with a much wider remit. One of the things that Baroness Young and I have started to talk about is how do we make sure that the fact that they have a degree of intervention power in relation to registration does not produce two regulators trying to do either different or the same things to the same trust. We recognise the issue and we have just started to talk to each other about how is that issue going to manifest itself and what are we going to do about it.

  Q121  Dr Taylor: Without you listening, Bill, have the other two been more frightened of you or of the Healthcare Commission, or has that not come into it?

  Mr Gregory: I do not want this to sound arrogant but I am not afraid of either Monitor or the Healthcare Trust.

  Mr Firn: I am afraid of the consequences of both if we get things wrong because they both have significant powers and so have our commissioners. Speaking on behalf of Mental Health Trusts we fully recognise Monitor's desire and reasons for strengthening the quality indicators in the compliance framework for Mental Health Trusts which Monitor has done this year, but it set some very challenging targets, particularly around an area of delayed discharges. We want to be reassured that the Healthcare Commission will adopt the same indicators and that we are not at risk of double jeopardy. That is why I am reassured to hear that they are talking.

  Q122  Dr Taylor: So your talks are absolutely vital. Can you give us a rough idea of the costs of regulation?

  Dr Moyes: I cannot really, no. We had some work done for us by Dr Foster in 2005 once we had authorised the first 25 Foundation Trusts. At that stage the feedback we had from the trusts was that on the whole they were absorbing the costs of our compliance system within their overheads, that the information we were asking for of a financial and non-financial nature was not requiring any special work that they did not do anyway for themselves. We have not repeated that work since maybe because the cost question has not really come to us as a particular issue that Foundation Trusts are anxious about and I think if they were they would tell us. I cannot give you a figure I am afraid.

  Q123  Mr Syms: The research conducted by the University of York (Marini et al) analysed year on data for a small subset of trusts. Subsequent performance analysis of performance was prevented by Monitor being unable to facilitate the access to that particular data. How would you respond to the argument that decentralisation in the NHS may deny researchers the essential data to investigate performance and thereby reduce accountability? Is it just part of the decentralised process that there are not going to be the figures available for research?

  Dr Moyes: It is a new idea; I have not heard that said before. However, I would say that Monitor is more transparent, we publish more and maybe in a better format. Things like our quarterly reports, for example, our consolidated accounts and our annual report. I have not come across researchers saying that they cannot get the data. They may have to do a little bit more collating themselves because we are very punctilious about what we get from Foundation Trusts; we are trying very hard to reduce the burdens on them. I do not myself believe that researchers cannot get the data. As I say, they may have to do a little bit more collating themselves but I do not think that data is being concealed; I think there is more information around than there has ever been.

  Q124  Dr Naysmith: Figures suggest there has been a lot of activity in Foundation Trusts—it has gone up quite considerably over the last two or three years—and yet this has been happening at a time when care is supposed to be being transferred into the primary sector. Do you think you are working hard enough to fulfil that agenda from the Department of Health which is moving care into the primary sector?

  Dr Moyes: Again I think this is for the commissioners. I do understand the question but I think what we need to see is commissioners creating the capacity in the community to make transfers of care and then in their contracts with Foundation Trusts making sure that they limit the activity in Foundation Trusts to what they want to see there. I would not say in Monitor we have a lot of evidence of this, but what I can say is that the income of Foundation Trusts is not that much higher than their planned levels of income. It is not as if we are seeing 5 or 10% increases in activity as reflected in the income; it is 2 or 3%, and that is within the error of parameters of the kind of planning that Foundation Trusts do. I am not sure there is evidence of a lot more activity taking place in Foundation Trusts than was planned and I do think commissioners are the mechanism by which we shift activity from hospitals to the community.

  Q125  Dr Naysmith: Richard, how is it in your area?

  Mr Gregory: We would like to engage in more primary care activity. This is the recurring theme when I meet with the chair of the Primary Care Trust and I really hope that the changes that have recently been flagged give us the opportunity to do that. Chesterfield is very close to its community; it is a small community in many ways and it makes absolute sense to deliver our services in the most effective way for the patient. Looking at integrated care is the obvious thing to do so I really hope we make progress on that front over the next 12 months.

  Q126  Dr Naysmith: Stephen, you are involved with your community, I am sure.

  Mr Firn: Yes. I would be surprised if that level of activity applied to Mental Health Trusts because, as you know, if we do more expensive interventions like admit people to hospital we do not get any more money for that so it is not in out interests financially and it is often not in the patients' interest either. A lot of the way in which we generate its surpluses has been by reducing our occupancy levels, providing more home treatments, providing more crisis treatments and working more closely with GPs to try to both respond quickly to their referrals but also transfer people back to GP care whenever possible. That is what we have been working on and we will continue to do so.

  Chairman: Could I thank all three of you very much indeed for coming along and providing evidence in this session. Clearly there will be no report coming out of this inquiry but I have no doubt that the things that have been said this morning are going to be commented on. Thank you very much indeed.

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