Select Committee on Health First Special Report


The Health Committee has agreed to the following Special Report:—




1. This, our first, Annual Report provides an overall picture of the Committee's work for the sessions 1997-98 to 1999-2000. It also aims to ensure that pressure is maintained on the Government to address areas of difficulty in subjects we have examined. The Annex to the Report helps to do this by listing the Committee's recommendations from all its inquiries and detailing the action taken by the Government in relation to each recommendation made by the Committee. We are grateful to the DoH for its efforts on completing these tables.

Main direction of Committee's work

2. Since May 1997 the Committee has carried out 13 inquiries. These are listed in below.[8] In addition, it publishes an annual memorandum on Public Expenditure on Health and Personal Social Services.

Session 1997-98

    First Report:Tobacco Advertising and the Proposed EC Directive
    Second Report:Children Looked After by Local Authorities*
    Third Report:The Welfare of Former British Child Migrants*

Session 1998-99
    First Report:The Relationship between Health and Social Services*
    Second Report:Primary Care Groups
    Third Report:Future NHS Staffing Requirements*
    Fourth Report:The Long Term Care of the Elderly
    Fifth Report:Regulation of Private and Other Independent Healthcare*
    Sixth Report:Procedures related to Adverse Clinical Incidents and Outcomes in Medical Care*
Session 1999-2000
    First Report:The Cost and Availability of Generic Drugs to the NHS
    Second Report:The Tobacco Industry and the Health Risks of Smoking*
    Third Report: Consultants' Contracts
    Fourth Report:Provision of NHS Mental Health Services*

*indicates substantial inquiry

3. Our inquiries vary in both length and complexity, ranging from in-depth examinations of a particular issue to one-off sessions on key policy developments. Since May 1997, we have carried out eight substantial inquiries. An analysis of each of these is provided below.

4. The report on Children Looked After by Local Authorities provided a wide-ranging analysis of problems faced by some of the most vulnerable members of society; it aimed to complement the report People Like Us[9] drawn up by Sir William Utting, into the safeguards for children living away from home. It came up with some 93 recommendations to Government, the great majority of which the Government accepted. As is the case with most recommendations from select committees, it is difficult to 'prove' conclusively a chain of causality between Committee recommendation and Government action. Nonetheless, a reading of the Department's own analysis of action taken indicates that the Government has now taken a range of measures which accord with the tenor of our report. A new framework has been developed to assess children in need; extra resources have been provided for foster parents; foster care and children's homes are now subject to new regulatory frameworks, vetting procedures, codes of practice and national training standards; and new mechanisms have been established to co-ordinate policy and legislation in this area. The Government has taken some measures to increase the quality of educational provision available for these children and to tailor their health provision to make it sensitive to their age. The Government did not accept our recommendation that there should be a separate Children's Right Commissioner for England.

5. The Report on The Welfare of Former British Child Migrants drew attention to an international scandal that had for too long remained hidden. The Government accepted our recommendation that a central information index should be established to allow child migrants to trace their roots. The Government also acted on our recommendation to establish a travel support fund, which supports first time reunions between former child migrants and their immediate relatives. It has, as we recommended, increased funding to support the Child Migrants Trust in respect of the invaluable work it carries out in terms of tracing families and offering counselling. Finally, a Child Migrants information website was set up on 1 March 1999 in response to our recommendation that information should be made more readily available to former child migrants.

6. The problems that users and their carers sometimes encounter with the provision of health and social services led us to examine The Relationship between Health and Social Services. The Committee found that many of these problems arise, or are exacerbated by, separate NHS and social services provision; barriers between the organisations frustrate the goal of "seamless" service provision and the division often appears confusing to the users of the services. We consider that the problems of collaboration between health and social services will not be properly resolved until there is an integrated health and social care system. We welcome the moves the Government has made to strengthen joint working between the NHS and local government and will watch the development of Care Trusts with interest.

7. The Report on Future NHS Staffing Requirements called for a review of planning procedures, which subsequently occurred, and for at least another 1,000 medical students to be trained each year. The Government has announced over 1100 new medical places. It remains to us unclear whether the Government's measures to address shortages in nursing, professions allied to medicine, pharmacists and scientists will be sufficient to avert a potential major shortfall in the future. The Committee's recommendation that the Department should move to a single pay spine for all NHS staff was not accepted, though some reforms to the pay spines have been implemented.

8. A particularly difficult and sensitive report was our inquiry into Procedures related to Adverse Clinical Incidents. We heard from many patients, and their relatives and carers, who had suffered dreadfully following adverse clinical incidents or poor performance by doctors and nurses. Too often, they had found it hard to get an explanation of the incident from health providers; they felt the NHS closed ranks. The complexity and lack of apparent independence of the NHS complaints procedure were highlighted as key problems. We look forward to the outcome of the Government's review of the NHS complaints procedure. We are pleased that the Government has accepted the need for patients' advocates. However, we are concerned that the reforms proposed in the NHS Plan do not meet our recommendations on the need for such mechanisms to be independent of local health authorities and trusts.

9. For the first time the Committee examined the operation of the private and independent healthcare sector in its report The Regulation of Private and other Independent Healthcare. This is a complex area, and the Committee's report was widely praised as offering an objective and thorough blueprint for future regulation. The Government accepted the key recommendation of this report, namely the creation of an independent regulator for healthcare outside the NHS, with the creation of the National Care Standards Commission. Although a number of less important recommendations were not accepted, we believe that this area of policy was fundamentally influenced by our report.

10. Turning to the Committee's report on The Tobacco Industry and the Health Risks of Smoking we can reflect on an investigation which has made a significant contribution to knowledge worldwide of this major public health epidemic. The Committee used its powers to send for persons, papers and records to uncover several thousand pages of documents from four of the leading advertising agencies with contracts with the major UK tobacco firms. The documents which were disclosed painted a disturbing picture of the tobacco companies and their advertising agencies cynically exploiting marketing techniques to depict smoking as glamorous, thus attracting young people to smoke. The evidence gleaned has received worldwide attention and has been received both by the European Parliament and the World Health Organization. The Committee welcomes the Government's decision to introduce primary legislation to ban tobacco advertising: we remain unconvinced that the exemption for Formula One motor racing is justified. We welcome the fact that the Government agreed to our recommendation that the Department of Trade and Industry should investigate allegations relating to smuggling involving British American Tobacco. The other central recommendation of the Committee was for the creation of a tobacco regulatory authority. The Government has not, at present, acted on this recommendation, a fact we very much regret. We hope that such an authority could be instituted in a future session of parliament, and that the Government will make an early commitment to this effect.

11. Most recently we have completed a comprehensive review of NHS Mental Health Services. The Committee supported the philosophy underlying the recommendations of the Expert Committee on the reform of the Mental Health Act 1983, in contrast to the proposals set out in the Government's Green Paper. We were particularly concerned that mental health services are not adequately meeting the needs of ethnic minority patients. We are pleased that the Government has accepted the need to take action on this and that it will, amongst other initiatives, be charging the Mental Health Taskforce to ensure that these concerns are taken on board. We were disappointed that the Government has not accepted the need for the replacement of the existing high security hospitals with regionally based units.

12. We carried out five short inquiries, which examined issues of immediate relevance to the Department. These were: Tobacco Advertising and the Proposed EC Directive, Primary Care Groups, the Long Term Care of the Elderly, the Cost and Availability of Generic Drugs to the NHS and Consultants' Contracts. Whilst we do not wish to comment in any detail on the impact of the recommendations contained therein we would draw particular attention to the impact of the report on generic drugs: we believe we drew attention to massive increases in the prices of generic drugs and that this in turn led directly to action on the part of Government to alter the pricing mechanisms. We took this matter forward in a Westminster Hall debate[10], and were gratified to see that progress was already being made.

Resource Accounting and Budgeting

13. The Department's 'shadow' resource-based estimates, and a background note, were circulated and approved by the Committee in June this year. We review all Departmental expenditure in the form of an annual lengthy and detailed public expenditure questionnaire submitted to the Department each February. Oral evidence has been taken in each session on the findings of the PEQ and a similar process is likely to apply to the new form of accounts. At this stage, however, the Committee thinks it is too soon to establish the impact of RAB.

Other activities

14. In conjunction with the Agriculture Committee, we took evidence from Sir John Krebs, the new chairman of the Food Standards Agency. We also took evidence from Sir Michael Rawlins when he was chairman-designate of the National Institute for Clinical Excellence. This is the type of hearing is sometimes described as "confirmatory". Whilst we find the use of this term - which has a clear function in the US congressional committee system whose powers are different to ours - to be misleading we thought the exercise was helpful.

15. The Committee has undertaken numerous visits: amongst those that stand out are the visits to two of the Special Hospitals, Ashworth and Broadmoor in the context of our mental health inquiry, visits which directly informed our recommendation that these centres should close; the visit to Australian which gave members of the Committee the most harrowing insights into the conditions of former child migrants; the visit to Washington, where we met some of the prime movers in the US litigation against the tobacco companies; to Northern Ireland, where we saw for ourselves the benefits of a unified system of health and personal social services; and to various parts of England in the course of our inquiry into adverse clinical incidents, where we met many victims of such incidents who would not have felt able to come to London to give us the benefit of their experience.

Relations with the Department of Health

16. In general, we have satisfactory relations with the Department. They have supplied thorough written evidence for each inquiry, clearly stating the current policy position. Witnesses have also mostly been available when requested and the Secretary of State has always been willing to attend.

17. However, we have been disappointed with the timeliness of Government responses to our reports. Seven responses were received more than two months after our reports were published. In five of these cases, the Committee's report was published before the House rose for the summer and the Government's response was received after the House returned. Of the other two, the Department failed to keep us informed of progress of one of the responses, which was only received after approaches by the Committee Clerk. We would urge the Department to ensure that the work of the Committee does not suffer from the late arrivals of responses and other requested information. We also believe that the Department seeks to influence public opinion relating to our inquiries by manipulating the timing of announcements in policy areas which we are examining in an attempt at "damage limitation".

8   These reports, together with House of Commons printed paper numbers and ISBN references can be found at the Health Committee website at  Back

9   Sir William Utting et al, People Like Us: The Report of the Review of the Safeguards for Children Living Away From Home, The Stationery Office, 1997. Back

10   Official Report, 17.05.01, cols. 68-89 WH. Back

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Prepared 13 March 2001