Examination of Witnesses (Question Numbers
220-239)
MR DAVID
MOBBS, MS
RUTH JARRATT
AND MR
STEPHEN LLOYD
8 JULY 2008
Q220 Mr Prentice: Well, what about
fee-charging hospitals? Do you think you get a bad press? You
seem a bit defensive to me.
Mr Mobbs: Well, sometimes I think
there is a degree of cynicism. For example, if you have a hedge
fund manager who decides to donate a few million pounds to set
up a foundation, or there is a plc out there that decides to reserve
a few percentage of revenue to do some good, or a big, multi-national
corporation decides to embrace the corporate social responsibility
agenda, or somebody comes up with some new form of organisation
called a `social enterprise', this is all applauded by politicians
and the public, but here you have an organisation, such as Nuffield,
which is value-driven, it is going the whole hog, there are no
half measures here, we have dedicated our assets and our property,
we are investing all of our surplus for the public benefit and
we are generally greeted with cynicism during this overall process,
and I believe that is absurd.
Q221 Mr Prentice: Okay, that is very
clear. In this era of patient choice, if I had something wrong
with me, could I say, "I want to go to that Nuffield hospital
that David Mobbs keeps banging on about because it's so good and
it's just round the corner"? Would I be able to exercise
a choice?
Mr Mobbs: Broadly, you would,
depending on the range of services that we are able to provide.
Q222 Mr Prentice: Do you have any
say at all in who you include or exclude?
Mr Mobbs: Yes, we determine what
services we will offer under the patient choice system.
Q223 Mr Prentice: Looking at the
10% that comes via the NHS and the 90% that are paying, do the
10% that come via the NHS get the same hospital experience? Do
they get flowers in their room? Do they get Wi-Fi? Do they have
exactly the same kind of hospital experience as the people who
pay?
Mr Mobbs: Absolutely.
Q224 Mr Prentice: No difference at
all?
Mr Mobbs: No difference at all.
Mr Walker: There will be an undercover
journalist there next week!
Q225 Mr Prentice: You say you are
not for profit, but of course you, Nuffield, will decide how much
you are going to charge the NHS and retain any surpluses.
Mr Mobbs: No, we operate the tariff
that the NHS determines, so we only charge the NHS what it says
it can afford.
Q226 Mr Prentice: Do you contract
with the private sector at all?
Mr Mobbs: We contract with insurance
companies.
Q227 Mr Prentice: What I am trying
to get at is that you can use this retained surplus for expanding
your operation, buying land, buying buildings, paying consultants
over the odds and indeed paying yourself, although I am sure you
do not decide your own salary, a huge sum of money. It is in the
public record, is it not, that in 2004 you were getting £200,000
a year, and perhaps you would tell the Committee what you are
getting now.
Mr Mobbs: Well, I would rather
not bring that up in committee. It is in our Annual Report, if
you would like to refer to that, or I am more than happy to provide
it in writing, Chairman, unless of course the Committee insist
that I bring this up.
Q228 Mr Prentice: No, I am not insisting,
but I am just wondering why you are so coy, that is all. The general
point I am making is that you can, by contracting with other health
organisations, make a surplus and it is up to the trustees how
they spend that surplus by paying your medical people over the
odds, by attracting nurses, by paying them more presumably than
they would get in the NHS and by paying people like you stratospherically
high salaries.
Mr Mobbs: Well, I will not respond
to the last point, but I will respond to the other point. You
are absolutely right, we do make a profit, by and large, each
year. It is only a temporary profit because it is immediately
reapplied for the purposes of the charity for the public benefit.
The Committee suspended from 4.34pm to 4.45pm
for a division in the House.
Q229 Chairman: I do not know if you remember
where you were at, Mr Mobbs.
Mr Mobbs: I am happy for Mr Prentice
to remind me, if you wish, but I believe it was a question of
what we spend our surplus on.
Q230 Mr Prentice: Well, we can take
that as my question, yes. Let me focus it a bit more narrowly.
It is possible for Nuffield, or is it not the case, that you can
pay your clinical staff, your nurses, doctors, consultants and
so on, more than they would get from working in NHS hospitals?
Mr Mobbs: Leaving the doctors
to one side for the moment, when it comes to all the other staff,
we broadly pay at the market rate.
Q231 Mr Prentice: Broadly, so there
is no question of you poaching staff, giving them better terms
and conditions, inducing them to leave NHS hospitals to work for
you in Nuffield? Why are you smiling? That was a very straightforward
question.
Mr Mobbs: Well, it is the term
"poaching staff". I think staff have a choice to think
about where they want to work and I think, if there is competition
for employment, with such a large employer as the NHS, all this
can do is help the NHS improve its standards on how it treats
its staff, but no, we do not offer packages which are generally
above the market in comparison to the NHS. In fact, we probably
suffer by comparison because, for example, a couple of years ago
we had to wind up our final salary pension scheme because it became
unpredictable and unaffordable, whereas the state sector continued
to provide this under a state subsidy, so, in comparison, no,
I do not believe we offer exorbitant packages for our broad range
of staff. Doctors are actually independently employed and we are
in a marketplace for doctors out there, just as the NHS is.
Q232 Mr Prentice: How do your terms
and conditions compare then with the independent sector?
Mr Mobbs: Broadly the same.
Q233 Mr Prentice: So the patient
experience is the same, whether they are from the NHS or they
are the 90% who pay fees, and there is nothing that distinguishes
the experience patients get from your hospitals from the private
sector or the NHS?
Mr Mobbs: Well, I did not actually
say that. I believe that the experience that patients get with
Nuffield is better than they will get anywhere else. Our patient
satisfaction rates are above 96%. Last year, we only recorded
one case of MRSA bacteraemia. I think those sorts of standards
are very hard to maintain and that is the sort of thing that we
spend our surplus on for the public benefit.
Q234 Mr Prentice: But why should
that be the case? We are all interested that there has been only
one case of MRSA in a Nuffield hospital, and you will remind me
in a minute—
Mr Mobbs: In 2007.
Q235 Mr Prentice:— how many
Nuffield hospitals there are, but do you spend a lot of money
on cleaning?
Mr Mobbs: Well, we believe we
spend the right amount on cleaning and we believe we spend the
right amount on ensuring our staff have the right skills when
it comes to infection control. We have a whole network of infection
control link nurses across our hospitals business, something that
the NHS are only just recommending, so we do have very high standards
and we do pioneer in those areas. I can give you a copy of our
Integrated Clinical Governance Report, which is the first report
ever published in the independent sector that brings together
all of the quality statistics there. We have extremely high standards,
as an organisation.
Q236 Mr Prentice: That is good. I
ask you all these questions because the boundaries between health
organisations, if I can put it that way, NHS bodies and independent
sector people like Nuffield, are becoming increasingly porous,
so these questions are relevant. Now, in the letter that you sent
to the Charity Commission in June on their consultation on the
draft Public Benefit Guidance, there was one thing you said there
which smacked me between the eyes. You said, "We", that
is Nuffield, "are very clear that attempting to report a
balance sheet of public benefit against tax breaks received would
be an onerous and arbitrary exercise, and one that should be rejected".
Why should that be? If members of the public think that Nuffield
is getting all these tax breaks, that they can generate sufficient
surpluses to pay their top people huge sums of money. Is it really
asking too much for there to be a list of the public benefit received
and the benefits that you, as an organisation, receive from the
State?
Mr Mobbs: I think there are two
issues there. Firstly, we do think it is onerous, but it is probably
going to be more onerous for non-fee-charging charities, and our
view is that, if this approach is going to be taken, all charities
receive tax breaks, not just fee-charging charities, that all
charities receive a relief in terms of business rates, get zero-rating
on some of their VAT input costs, get relief in terms of stamp
duty and that some charities get gift aid. If this approach is
going to be taken, it should be uniform across the whole of the
charity sector because this is not an issue about access, this
is an issue about benefit, and again I think the debate confuses
benefit with access. What we are saying is that actually, for
a fee-charging charity, it might be much easier for us to demonstrate
the balance sheet approach, but, for non-fee-charging charities,
it is going to be much more onerous because they are going to
be in a situation where they are measuring intangible benefits,
whereas our benefits are a bit more obvious and a bit more measurable
than in that case, so, for the charity sector overall, I think
it reduces the whole thing, the whole debate of public benefit
into a commodity and a balance sheet, and I think that is the
wrong direction for the charity sector. That is why we made that
statement.
Q237 Chairman: Do you want to comment,
Ruth?
Ms Jarratt: Yes, I would like
to support this point. I finally got round to making my submission
to the Charity Commission only last Friday and I prepared for
this, so I apologise if you have not had a chance to see that,
but I did make a similar point, that, whilst we probably could
do a monetised version that would stack up, I think there are
many unquantifiables, so how do you quantify in pound notes the
value of creating a new opera? How do you value the preservation
of a ballet which, if it is not performed, literally dies? Once
there is nobody alive who does that ballet, nobody can recreate
it. How do you monetise the value of a young musician out spending
time alongside one of the world's greatest conductors, which we
arrange regularly? How do you monetise those things? You cannot,
so I do think that, whereas one of the questions in the guidance
is, "Should this be tightened up? Should it be made more
of a balance sheet?", which I think was the term you used,
I think that would be unhelpful because, whilst using the idea
may not be such a bad idea, you would lose so much, certainly
in the arts, in my position, you would lose sight so much of what
the public benefit actually is that we are offering.
Q238 Mr Prentice: No one wants to
be kind of mechanistic about these things and it is unfortunate
that we have not had an opportunity to read your submission, but
what are you actually doing to demystify opera? I know you told
us earlier about what you are doing to encourage people to go
along, the screens and so on, but, for a lot of people, they just
choke at the idea of going along to see an opera.
Ms Jarratt: The core of it is
our educational work which is aimed both at the younger age and
at all ages. We talked about barriers and we talked about the
money barrier a lot and there is a geographical barrier I mentioned,
but there is also a kind of "It's not the sort of thing people
like me do" kind of a barrier, if you see what I am saying,
a conceptual barrier, you could say, so we do a lot of stuff and,
increasingly, not least using online techniques. We used to do
sort of talks and all that sort of stuff and now we can do that
so much more easily online or whatever. Our core education work
right throughout the country, starting at a young age, is possibly
the biggest tool, and I think you would find that most arts organisations
would be saying that. If kids are introduced at a young age, if
the idea of going into a theatre, whoever's, becomes something
that happens, it is not too odd, if even opening your own mouth
and making a noise or dancing around is something that you get
to do that even your mates get to see you doing, it becomes something
which is no longer taboo and there are these kind of weird social
taboos, if you like. Our total educational programme, whether
it is aimed at adults, whether it is aimed at people who are coming
to the show tomorrow night or whether it is broadly throughout
schools, community groups and young people, is all aimed at the
demystification, and we see ourselves having a huge responsibility
for, if you like, creating the audience of the future. There is
no performing art without an audience, so it is part of our raison
d'être.
Q239 Mr Prentice: Is it ridiculous to
think of opera as high-brow? Is that a kind of lexicon we should
be using these days?
Ms Jarratt: I do not think I am
here to dictate the terms that people use. If we are talking about
some works of art that can stir the soul in a way that maybe very
few other things can, if you listen to Capital FM on a Saturday
morning when people talk about "the piece of music that reminds
me of what matters in life", how often it is an opera aria,
if you are talking about those things and you want to use those
terms, that is fine, but I think `deep', `profound', those, to
me, are more meaningful terms.
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