Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 820 - 839)




  820. Good morning. May I welcome you to this session of the Committee and welcome our witnesses. Could I ask you briefly to introduce yourselves, starting with Ms Bryson. I would like to thank you particularly for coming along today, you are a substitute for a colleague who, unfortunately, is ill and in hospital. We are grateful to you.

  (Ms Bryson) I am Karen Bryson. I am currently Director of the Cancer Services Collaborative for the South East Region but was Project Manager and Assistant Director in East Surrey Health Authority this time a year ago for the Private Provider Project.

  (Mr Hassell) My name is Barry Hassell. I am the Chief Executive of the Independent Healthcare Association, frequently called the IHA. The IHA represents the majority of the mainstream independent acute hospitals in this country plus mental health units, medical screening units, nursing and residential care homes.
  (Mr Auld) I am Charles Auld, Chief Executive of General Healthcare Group.
  (Mr Huntley) I am Peter Huntley. I am Chief Executive of Channel Primary Care Group and I am responsible at the moment for co-ordinating the overseas treatment test beds.
  (Mr Fieldhouse) I am John Fieldhouse. I am a consultant surgeon and I am here representing the Federation of Independent Practitioners Organisation, usually shortened to FIPO. FIPO is an umbrella organisation that brings together the Independent Medical Practitioner Committees of the multiple generalist and specialist organisations across the profession, and also the MACs of private hospitals.

  821. Thank you very much. Can I begin by asking Mr Auld and Mr Hassell, obviously we are looking at the Concordat and you know where I am coming from on this issue because we have talked over many years and we have slightly different perspectives on these questions. In looking at where the Government is going at the moment, and we are told a statement today is going to be made on issues of relevance to this inquiry, what proportion of doctors within GHG and covered by your association, Mr Hassell, also work in the NHS?
  (Mr Hassell) My recollection, and I am trawling the back of my mind, is that—I might not be absolutely accurate with this percentage—when the Monopolies and Mergers Commission looked at an issue some years ago their estimate, which I think is probably the best one around, was that something like 80 per cent of all NHS doctors undertake some form of private practice, but that varies quite considerably from just a few operations a year to fairly significant private practice aspects.
  (Mr Auld) We would believe, Chairman, that probably of the order of 17,000 out of a possible 21,000 will be having some form of private practice.

  822. The question was working within your organisations, not within the NHS.
  (Mr Auld) Working within them?

  823. Yes. I think you misunderstood the question. What proportion of the people you are employing within the private sector also work part-time within the NHS?
  (Mr Auld) That is a very different question, forgive me I did not understand that.

  824. Of course it is, absolutely.
  (Mr Auld) The Committee may not be fully aware of the way in which private practice in the acute elective surgical side of business of the independent sector works, but essentially the consultants are clients bringing their patients to the private facilities. It follows, therefore, that in very few of the independent hospitals in the sector, and I am sure I am no exception to what my colleague would say for the whole industry, there are very few consultant surgeons who are employed by us. I am desperately trying to think of any outside of IVF, fertilisation, but in terms of most of the specialities that I think this Committee would be particularly concerned with, I could safely say that all of the consultants who are using our hospitals are, in fact, not employed by us.

  825. Perhaps I am not making it clear. What I am trying to get at is how many consultants who are using your hospitals for private treatment are actually working as well in the NHS?
  (Mr Auld) The vast majority, Chairman.

  826. So we are talking 90 per cent?
  (Mr Auld) In excess I would think.

  827. In excess of 90 per cent?
  (Mr Auld) Yes, I would think so.

  828. That is the figure I am looking for, to get an idea. We are talking about at least 90 per cent. Mr Hassell, would you broadly agree?
  (Mr Hassell) I have no evidence to counter that. What I think is important, although you are only particularly talking about consultants, is recognising the sector is actually an important sector overall. We employ about three-quarters of a million people, which is significant. Although you are taking a narrow view, I think you need to remember that the sector is an important employer of health care professionals.

  829. Can I come to you, Mr Auld, in respect of your evidence. On page five of your evidence, which is very detailed and very helpful, you state in the first paragraph: "General Healthcare Group estimates that without the operations carried out under the Concordat, NHS waiting lists would now be some 70,000 patients higher than their current level." Can I turn it the other way round. What would your estimate be of the impact on NHS waiting lists if NHS part-time consultants who are not also working in the private sector worked whole time in the NHS? What would the impact on the waiting lists be?
  (Mr Auld) I think that would be quite difficult to estimate because the question is predicated on an assumption that the only reason why the consultant could not perform that equivalent procedure in the National Health Service is his absence from that hospital and that is by no means the only reason that the procedure would not be carried out. It is perfectly possible, as many people have reported, to find that consultants are present in the National Health Service, in their NHS practice, and not able to operate for reasons that are not to do with their inclination.

  830. I understand the point you are making about capacity.
  (Mr Auld) So I do not know what the answer would be.

  831. I understand fully.
  (Mr Auld) What I certainly would not accept would be what could perhaps be the drift of the question, that is to say if the private sector did not exist then that 70,000 would actually be done in the NHS, because it would not. I do not think it would take too long to demolish that argument.

  832. That was not necessarily what I was suggesting. What I was suggesting was there was another view of this, and you know my perspective because we have discussed this on previous occasions. Can I come to Mr Fieldhouse, if I just flick through and find your evidence.
  (Mr Fieldhouse) May I just respond to that last point because I think your question did make the supposition first of all that consultants working in the private sector were not already fulfilling their entire contractual commitment to the NHS and all of the evidence is that those part-time consultants on maximum part-time contracts that do work in private sector more than fulfil their contracts to the NHS. The answer to your question would require an estimate of what it would take to buy out their free time to achieve that extra amount, also supposing, as Mr Auld has mentioned, that the facilities were available either by buying out private sector facilities or by increasing NHS facilities which are already working to capacity.

  833. You are making an assumption, that was not the basis of my question. I think it is worthy of this Committee looking at what the position would be in terms of waiting lists if we had those consultants working full-time within the NHS instead of part-time in the NHS. I accept entirely your point about capacity, that is an issue we have looked at. What I wanted to ask you about from FIPO's evidence is in your evidence you talk about the principles and philosophy of your organisation and I am anxious to understand where you are coming from because you say, in particular, "we support treatment according to clinical need".
  (Mr Fieldhouse) Correct.

  834. I do not see how that squares up with the situation we have had since the NHS came in where if you allow part-time NHS consultants to have private practice we see quite regularly the issue of patients not being treated on the basis of clinical need but on the basis of their ability to pay for that treatment. How do you square up your statement with that point?
  (Mr Fieldhouse) The concept of a part-time consultant is misguided and misleading. These consultants actually have a contract within which they deliver a whole time commitment to the NHS and their contractual commitment, as defined by part-time, simply allows them to use their free time in an appropriate manner. I must refute the concept that maybe Members of the Committee might be gaining that they are somehow taking time away from the NHS. It is on that basis that I must respond to your question. If consultants are, therefore, already giving of their full time the concept of FIPO and the ethos is that we are all consultants in the NHS, all the board members are, and our members are almost exceptionally, there are a few full-time consultants but the majority are NHS consultants, and we believe in the NHS.

  835. That does not answer the question at all. I was saying I do not understand how you can state in terms of your philosophy that you support treatment according to clinical need when clearly your members are involved in systems that distort that basic objective in the National Health Service.
  (Mr Fieldhouse) I do not see there is a contradiction in terms of members utilising their free time to further their profession in the same way. It does not act as a contradiction given the facilities, and as a point of principle they do believe that patients should be able to receive treatment which is free at the point of delivery.

  836. That does not answer the point about clinical need. What your organisation stands for is presumably allowing patients to be treated not in accordance with clinical need.
  (Mr Fieldhouse) The organisation essentially stands for and believes in a plurality of provision of health care provider. We do believe that there should be a mixed agenda of provider, be that the state, the independent sector or the charitable sector. We also believe in a mixed economy of funding streams to health care, again be that the state, personal contributions and through the PMI medical insurance industry.

  837. And you do not see that that in any way distorts this basic principle of treatment according to clinical need?
  (Mr Fieldhouse) We do not feel that it distorts the motivation of consultants, which is primarily the patient in front of them and the delivery of optimum care to them. The funding stream that brings that into being is a secondary issue, the delivery of optimum care is the primary issue.

  838. I do not think you have answered my question. I cannot see how that squares up with what you stated in your evidence because to me basically what your members, or some of your members, are doing appears to completely undermine that principle.
  (Mr Fieldhouse) I do not take that point, Sir, I am afraid.

  839. You do not take the point or you do not understand the point?
  (Mr Fieldhouse) I do not agree with your point. I have no problem with the fact that the consultants' first motivator is the delivery of high quality of care to their patients. The concept of where the funding comes from for that is very much of secondary importance.

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