Examination of Witnesses (Question Numbers
120-126)
MR RICHARD
GREGORY, MR
STEPHEN FIRN
AND DR
BILL MOYES
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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