Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 180 - 199)



  180. Do you not feel that is a weakness of the system if we are attempting to direct policy away from dependence on care homes and nursing homes if we forget about people who have resources who are not featured in the evaluation of each local authority? If you are saying to my authority it has got proportionately more people in care than anywhere else, I would say these are all rich ladies from Harrogate who have come here because they choose to come here because it is such a nice place. It does not seem to add up to an analysis of the situation. What steps have you taken to pull in that information and does the Care Standards Commission have any role in assisting you with that kind of material?
  (Mr Denham) I think the Care Standards Commission will certainly in time have comprehensive data on the care homes it is registering and the number of places that are in those homes for which they are registered. They have certainly got a requirement to report annually to the Secretary of State on the state of the care homes sector. I am not sure that we will expect them to tell us who is resident as a so-called self-funder and certainly the performance indicators that I have talked about are entirely based on council supported residents, not on those who are paying for their own care who will have made their own decisions about whether they want to enter a care home or not.


  181. The other pattern you have picked out from the SSAs is that unitary authorities tend to receive their SSAs for social services via higher average amounts than other classes of authority. Is that something you have tried to analyse in more detail? Is that something you have tried to look at in the review of the formula?

  (Mr Denham) Councils make their own decisions on what they spend so in a sense it is quite difficult for us to know without talking to all of them individually about why they have reached the decisions they have reached. The SSA formula is a local allocation mechanism for a national sum of money. We have looked at demand for social services as part of the Spending Review certainly, and that is what in part led to the additional resources that have been put in. But the distribution of those resources has traditionally, as I say, been done on a formula basis. We have certainly underpinned the system by looking again at the formulas used to see whether they make sense, and that is why there has been a period of consultation, to get people's views on whether the formulas used do make the best sense.

  182. So you do not know why whether it reflects particular needs or costs in the unitaries as against other authorities?
  (Mr Denham) Unitaries have a fairly widespread mix of needs. They are not a uniform set of authorities. There would be batches of them in particular positions but they range in terms of levels of deprivation quite broadly, so it does not seem to be, as far as I can see, just down to the simple point they are all in a particular category.

  183. It is interesting that a pattern has come out and it might be something about fixed costs or something in the way they are run.
  (Mr Denham) I guess so. People will no doubt make their views known. As with the NHS we get a pretty wide range of views.

  184. Moving on to maternity services, if I may. Within the general expenditure data you gave us maternity services used about five per cent of NHS funds. Does that include the spend on litigation?
  (Mr Douglas) No.

  185. It does not, so there is litigation on top.
  (Mr Douglas) Litigation is within the "other" spend figure. It is not allocated across any of the services.

  186. Remind me how much is "other". Would it increase it significantly by five or six per cent?
  (Mr Douglas) I am not sure how much of it. The "other" figure at 2000/01 prices is about 12 per cent.

  187. It would be interesting to know that because I imagine a large part of it is maternity related. If it is easy to do, not if it is a lot of work —
  (Mr Douglas) We will see if we can pull out the maternity element litigation figures.

  188. Obviously one of the other things you point out in your report is that the Department is collecting some of the maternity data and we recognise that major progress has been made with timeliness. In terms of getting the data from units which are not submitting what is called "maternity tail" data, what is happening on that? What is happening on collecting data from the private sector and improving collection of data from outside hospital, particularly home births, which is a key issue?
  (Mr Denham) I do not think we have an answer, can we give you a note on that?

  189. Okay. Information Strategy on children is included in maternity services within it, will that look at this issue of data collection and deliveries in England linking those with the relevant data about mothers and babies?
  (Mr Denham) It will certainly look at information needs. At this stage I cannot say how far that has got nor can I pre-empt what proposals it will come up with. The selection of complete maternity data is a big issue. As you can see from the figures the percentage collection is not complete and it does not represent a collection of all births because it does not include home births, as far as I can see, or births GPs are responsible for, except where in hospital. The most helpful thing is if we cover what state the maternity module of the NHS has reached in terms of information.

  190. We would like an update on where you are getting to in terms of the maternity data project, which was supposed to be complete by April 2003, that would be useful for us. One other question within it, there is a huge variation in terms of deliveries, if we look across the regions in the south west 42 per cent of mothers are giving birth in a consultant ward and that goes up in the north west to 86 per cent, the northwest are not getting as much choice as against the south west. What is you comment on that?
  (Mr Denham) It could suggest a number of things, it may suggest the reverse.

  191. I doubt it.
  (Mr Denham) The issue that I know is being looked at is NICE has taken on the issue around caesareans, as opposed to asking about where deliveries take place because at the moment we do not have data. Home birth is a classic example, we do not have data as far as I know.

  192. You mention caesareans there and NICE is going to come up with guidelines on it as you say. What will happen in terms of delivering that across the country, if we look across the south west we see Truro had 15 per cent caesarean deliveries compared with my local hospital, the Princess Margaret in Swindon, which had 28 per cent.
  (Mr Denham) At the moment we do not know what the optimum level is.

  193. Most people would seriously question 28 per cent.
  (Mr Denham) Without knowing the locality and without knowing what types of mothers—

  194. We are not that strange in Swindon.
  (Mr Denham) It could be where else they are coming from.

  195. What management action is being taken?
  (Mr Denham) The management action being taken is around NICE.

  196. It will not change things very quickly on the ground, will it?
  (Mr Denham) I think it will probably have more impact than anything else at the moment.

  197. There are already guidelines set out. People referring to the World Health Organisation saying caesareans 10 per cent, we accept it is a bit more than that now, but 28 per cent is not—
  (Mr Denham) Without knowing the breakdown—


  198. Do you have any knowledge—looking at these percentages it interested me as well—the extent to which certain areas may have mothers-to-be who would more often choose to have a caesarean?

  (Mr Denham) There are three categories mothers will fall into, emergencies, elective caesareans are caesareans where the clinical view is that somebody needs one, maternal choice, which is the type you are referring to, we believe to be small, but I do not think we have separate figures.
  (Ms Edwards) I am not aware of the figures but it does vary quite dramatically. There are parts of the population where that is an issue.

  199. I am conscious of what is happening in America and the extent to which they are having caesareans there. When you look at these figures do you have any opinion as to the proportion of the 28 per cent you are talking about, would they be choice?
  (Ms Edwards) We do not have that centrally. Locally having run a hospital with a very low rate and one with a very high rate we did have that information locally. I imagine that information is kept locally.

  Julia Drown: That is fine. Thank you

  Chairman: Mr Burnham, with the most recent experience on the Committee.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 4 December 2002