Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 20 - 39)



  20. Thank you. That was useful because I was not clear from the breakdown. By 2007/2008 will the United Kingdom total health expenditure on current plans be higher than the unweighted European average?
  (Mr Douglas) Yes, it will be. On current plans we will be 9.35/9.4 per cent. The current unweighted EU average is 8 per cent.

  21. What is the projected?
  (Mr Douglas) We do not have projections for the forward EU average, we are assuming that it is not going to move significantly.

  22. Why do we assume that if we are moving quickly and they are not?
  (Mr Douglas) In the evidence over the last 10 years the average has not varied significantly, it has varied between 7.7 per cent and 8.2 per cent for the last 10 years.

  23. Okay. By 2007/2008 how will the United Kingdom compare to Europe in terms of the share of public sector contribution to total health spending?
  (Mr Douglas) Assuming that the share remains the same in the EU countries, the EU share is currently 6 per cent of the 8 per cent and we will be 8.2 per cent of the 9.35 per cent.

  24. What basis do you have for that? We know there is a lot more that the Health Service has to pay for now compared to a number of years ago?
  (Mr Douglas) Assuming overall proportions stay the same we have made the assumption that as there have not been significant shifts over the past 10 there would not be over the next five or six.

  25. What has been the United Kingdom shift over the last six years, has it been significant for the past 10 years?
  (Mr Douglas) I am afraid I will have to see if I have the figures. The United Kingdom was 6.5 per cent in 1991, rising to 7.3 per cent in 2000.

  26. Can you give me the European ones again for 1991 and 2000?
  (Mr Douglas) For 1991 the average was 7.7 per cent and for 2000 it was 8.0 per cent and it peaked as a proportion at 8.2 per cent in 1995/1996.

  27. We obviously had a slightly better increase and that may be due to government, it may not be, it may be because of the increased demands. Could you provide evidence for the last 10 years of European spend so that the Committee can have a look at it before we give it to the minister?
  (Mr Douglas) We can give you a figure for the EU average and every EU country we can provide you with that help.

  28. Okay. Again looking at your response to the comparative health spend, you have assumed that the share of private spending will remain static, 1.15 per cent. I was fairly convinced this had been rising over the past five years at least. Can you tell me what premise that is based on, please?
  (Mr Douglas) We used them on the latest data we derived from the Office of National Statistics. I am not aware there has been any significant rise, there might have been a small increase, but I am not aware.

  29. Can you check that? I think most people would accept that the sign-up to private health care plans has been fairly static and there has been a big increase in the number of people paying for one-off operations.
  (Mr Douglas) My understanding is that has not had a significant impact as a proportion of GDP, but I will have to check. It may well be that that has not shifted them significantly.

Dr Taylor

  30. Can I confirm something on those figures, it strikes me as very odd it remains at 1.15 per cent for the next however many years, however it is when there is going to be an increased use of the private sector by the NHS? Are those figures hidden from the private sector?
  (Mr Douglas) They are public sector funded, they are within the public sector figure.

  31. The amount spent in the private sector is going to go up a vast amount and a lot of that is coming from public funds.
  (Mr Douglas) The amount spent in the private sector will increase as we increase the plurality of providers. In terms of NHS spending it will mean an NHS spending rise.

  32. Can you give any assessment of the impact of the European Working Time Directive on doctors availability?
  (Mr Foster) We have been conducting a dialogue principally with the Royal Colleges and also the BMA across the summer which has concluded there is really a huge plurality of solutions to complying with the Working Time Directive depending on the medical speciality concerned, depending on the size of the hospital we are talking about and the nearness to other hospitals. The approach that we are taking offers effectively a menu of compliant solutions to local health communities and to take next year as the planning year to comply with that. Because of the plurality of solutions it is difficult to give you an answer to your question at this stage.

  33. It will be looking at sharing expertise and doctors rather than a wholesale closing.
  (Mr Foster) The NHS is in expansive mode I do not see any room for closing services but reorganising the way we do things to make best use of our resources.


  34. Can we move on to the concordat. Your Department undertook a survey about a year ago, as I recall, autumn of last year, on how much acute care was being purchased by the NHS, what specialties and what prices. Can you tell us the response to that survey? Obviously our Committee when we look at the NHS in the private sector it was interested in exactly how the concordat would work in practice? A number of us had serious doubts about it, as you are probably aware. A number of us were told in our own areas that it was a preference for spending concordat money within the NHS more effectively. What was the response rate to that survey? What did the survey tell you about the purchase of the acute care?
  (Ms Edwards) We did commission a survey of all NHS providers to identify what price they had been paying and what use had been made of the private sector. Unfortunately the survey was not well responded to, about half of all providers responded. On that basis the decision was made that the evidence that we got from the survey was not reliable enough to publish and we have not published a survey. We have asked for it to be reworked and we have gone back to the providers. We thought on the evidence we did get it was too important an area not to pursue and we have asked to redo the whole survey to get the information again.

  35. What kind of conclusions do you draw from that exercise? Is it normal for there to be such a limited response to a fairly important questionnaire?
  (Ms Edwards) It was first time we had done the survey and we have shared the limited information we received back with some of the chief executives and said, this is the information we can provide you with and this can be used to encourage them to cooperate with the survey in the future. We think this is really helpful. It was not a good response and we were very disappointed.

  36. Is it fair to ask, can you give us a rough idea of what the 50 per cent said about what they were purchasing and what their comments were. We do note the questions asked and what the overall impression given was.
  (Ms Edwards) One of the key comparisons with reference costs response we got indicated on average the NHS was paying slightly higher. One of the reasons for that is the NHS tends to spot purchase within the private sector and they do not enter into a planned basis at the beginning of the year. Particularly towards the end of the year we see an increase in the amount of contracting right towards the end of the year. We are encouraging through the capacity planning work to contract on a much smoother basis, on a planned basis and that is one of the reasons we have been able to reduce the costs to get them matched with NHS reference costs. It is difficult to compare it to such a small group of patients and the case load is different and it has come out slightly more expensive.

  37. Did you come to the conclusion those managers who were aggrieved about that point may have been more likely to respond to the survey?
  (Ms Edwards) I do not think we had any information to say that one way or the other. With the 50 per cent response rate on a relatively small activity it starts to get very difficult to get reliable figures.

  38. You are re-running this now?
  (Ms Edwards) Yes.

  39. When do you anticipate the results being available?
  (Ms Edwards) I do not have the date on me. We can get that to you when we have that information.

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