Select Committee on Health Minutes of Evidence


Examination of Witnesses (Questions 80 - 99)

WEDNESDAY 13 FEBRUARY 2002

MS DENISE PLATT, CBE, MR DAVID GILROY, MR RICHARD HUMPHRIES, MS MARGARET EDWARDS AND PROFESSOR IAN PHILP

  80. Do they have a better record on minimising delayed discharges?
  (Ms Platt) I would have to go and specifically answer that question for you.

  81. It would be interesting to know whether they do because you might have a more seamless—
  (Ms Platt) Yes. It is certainly the case that where we are looking towards integrated ways of working local authority charging policies can be difficult to explain to someone when the NHS part of the package is still free, even in an integrated service. Certainly that can get in the way of people's understanding.

  82. You mentioned better working between health and social services. I certainly see it in my area, the Wigan borough. Guidance was issued last year, a document called Reflecting the True Patient Experience, which said that NHS Chief Executives and Director of Social Services ". . . should jointly review and agree protocols around discharge which minimise time awaiting assessment of future care needs and handle choice of future accommodation in a way which does not delay discharge. No discharge should be delayed because the patient is awaiting suitable intermediate or other NHS care". Has that happened? Have those protocols been agreed all over the country?
  (Ms Platt) The protocols have been agreed but they will not be the same protocol and they will allow for some leeway if the facilities have not been developed and that is what we have to get properly in place.

  83. Do you have a deadline for when you want all these protocols in place, agreed and public knowledge?
  (Ms Platt) Not a specific deadline but we can certainly go back and see how far they are and by the time you finish your inquiry let you know.

Mr Burns

  84. We have had a lot of evidence given to us and also as constituency MPs we are constantly told that the basic problems of delayed discharges will not be properly resolved until social services get proper resources. I do not suppose you would agree with that assessment, would you?
  (Ms Platt) You might be surprised. There are certainly systems issues. Throwing money at this problem is not the only thing which will achieve a difference. There are cultural issues there and there is the way that systems work. We need to ensure that we have the best processes in place and the best systems in operation. We would agree that the current situation, where the growth in resources in the NHS is almost twice the growth of resources in social services, is an untenable position if you wish the system to motor along at the same pace.

Chairman

  85. You said "twice". The figure we got from the Government in our expenditure inquiry was much more marked than that. My recollection was that it was eight per cent in real terms for the NHS for the last financial year and 1.4 per cent for personal social services. There is quite a big difference.
  (Ms Platt) Whatever the difference is, we are agreed that the difference should be narrowed and it would be untenable if it grew. Those who were at the event this morning for the NHS Chief Executives would have heard the Secretary of State for Health say that in his view that dissonance in percentage increases in funding was untenable and it would be something he would actively seek to address in the context of the spending review.

Mr Burns

  86. Presumably this is not a problem which has grown up overnight. Why has the Department of Health not done more in recent years, given the pressures from local government and the pressures of the system, to fight harder, given that they have fought successfully with the Treasury to get money for the NHS? Why have they not done more to get more money for personal social services rather than in effect tolerate a system where there is a wide discrepancy between the two areas of funding?
  (Ms Platt) The Department has achieved significant increases for the personal social services and more increases since 1997 than the personal social services had before. There has been a consistent increase in personal social services. Some settlements before that date resulted in very little increase, other than specific grants. I do think there has been an increase in resources for personal social services. Far be it for me to understand what goes on in spending review negotiations between Secretaries of State and the Treasury; how those sorts of things are ultimately determined seems a rather arcane process. However, the Secretary of State is clear that he is going to try to fight as hard as he can for social services resources this time.

  87. In view of your statement, which I suspect the statistics will not back up, could you supply the Committee, from 1990 onwards, by social services department—because the figures are kept in that format—with the increases in personal social services for each year?
  (Ms Platt) Yes.

  88. I am not arguing with you about what the increases might have been since 1997. What I am contesting is the fact that there were significant increases between 1990 and 1997 and unless I misheard you, you were suggesting that it was not always the case during that time period.
  (Ms Platt) A significant amount of the increase in personal social services funding from 1990 onward would have been the transferred funding from social security to deliver community care resources which are of course an increase and additional resources but they did come with very substantial policy imperatives as well.

  89. I will not argue with that.
  (Ms Platt) Indeed and if you wish to establish that, then that is fine.

  Mr Burns: The way you answered the question to begin with was trying to suggest that there were not significant increases.

  Chairman: May I throw one complicating factor in? It is fair to say, in my experience, that some of the resourcing from the NHS in recent years has genuinely been used for what has normally been termed personal social services expenditure. Is it possible to confirm that point? Would you also be able, in providing the figures Simon is asking for, to give any indication of how that measures up? I have come across personally, and probably other colleagues in their own constituencies, resourcing which has been spent on personal social services which has come through the health route.

Mr Burns

  90. Both real and underlying percentage increases.
  (Ms Platt) That would be fine.

  91. In the format that it was supplied to Ministers prior to 1997.
  (Ms Platt) Right. And PQs which were answered at the same time?

  Mr Burns: No, not PQs, the figures.

Sandra Gidley

  92. I am particularly concerned about the patients waiting public funding figures which seem to fit in here. I represent a constituency which spans Southampton, South West Hants and North and Mid Hants which is one of the highest rates for this particularly category. What puzzles me, and I do not know wh ether you can throw any light on this, is that both of those authorities will be seeking funding from Hampshire County Council predominantly and probably also from the unitary council in Southampton. Obviously there are quite strong regional variations as well. Is this a funding problem in certain areas which needs looking at or is there something Hampshire County Council is doing wrong, say, in the way it allocates its funding? It would be useful to have a breakdown by local authority as well as to where the backlogs in funding are occurring. Certainly it seems patchy and it cannot be placed at the foot of the health authorities; it seems to be more a local authority problem.
  (Mr Gilroy) That is exactly what this particular category is, exactly what it is. It is people awaiting local council funding.

  93. Could we have a breakdown by local council? I would personally find that a lot more useful than a breakdown by health authority.
  (Mr Gilroy) Do you mean a breakdown of these figures in paragraph 5 of the memorandum?

  94. Yes.
  (Mr Gilroy) Subject to that being do-able, which I think it is, yes.

  95. Is that actually legal? I have had a letter from a constituent recently who contested this on the basis of a Scottish case which said that there was no excuse for withholding care; lack of funding was not an excuse for withholding. Would you care to comment on that?
  (Mr Gilroy) Not on the legal complexities of it. I suspect that there is a very tangled set of legal issues there which I would get my tongue on the wrong side of if I tried to respond to. May I just say that this is the one category in this categorisation of reasons for delay that we expect the additional resources going to local government to knock on the head? The evidence we have, which we cannot put before you because it is not based on proper national statistics but is anecdotal and intuitive, suggests that is the case. It suggests that since the additional resources were rolled out to local government, far fewer people are actually awaiting social services funding.

  96. When were the resources rolled out because these are last quarter's figures.
  (Mr Gilroy) Exactly. These figures are September. The announcement of the new money was 9 October and the cheques went out in November/December. It is all after this data we are looking at now. We are due to see the next update, we hope, by the end of this month, which will take us to December when we expect to see some of what I am saying reflected in the data.

Jim Dowd

  97. Professor Philp mentioned earlier whole systems working. The RCN has given us evidence again to say that these are matters not wholly within the control of individual hospitals but they do require this whole system approach. Is this whole interface with social services not the weakest point, the Achilles heel of it? When you look at the reasons for delay something like 60 per cent plus of discharges are essentially related to local authority matters or matters more within the purview of local authorities. How can you ensure that the different pressures on local authorities on social security budgets do not disrupt the planning process in planning discharges? How durable will be the agreements, because everybody round this table certainly understands the pressure that local authority budgets are always under?
  (Mr Gilroy) It was a worry. When the Government decided to allocate an additional £100 million this year to local councils and £200 million next year in order to address this issue, the first thing we needed to make sure did not happen, was that the £100 million got offset against deficits, potential overspends or was attributed to other local priorities. We have included in the conditions for the grant requirements that that is not the case. This is targeted money aimed very specifically at this issue and we are monitoring it extremely tightly to make sure it gets to the priorities it is being aimed at. There is a broader aspect of your question which is that it is serious money, £100 million this year—£300 million over two years—but it is at the margins of the overall expenditure that local authorities commit to social services. The critically important thing is making sure that there is a proper commitment from local councils to the whole system cost implications of their share of getting it right. In the answer to an earlier question it was clear that we are not in a command control relationship with local government. We do seek to apply influence and get the right outcomes that these policies need.

  98. I am well aware that the planned hospital discharge team at Lewisham Hospital has won a charter mark twice for the work it does there with social services. Just on the target, the 2.5 per cent, you all seem to consent to this target of 2.5 per cent from 6 per cent. It occurs to me that could either include a small number of people waiting a very long time or a large number of people waiting a very short time. It would still come out as the figure of 2.5 per cent or whatever it might be. Do you have any preference within that?
  (Mr Gilroy) Yes and the preference is for it to consist of people waiting for shorter periods of time than this profile at the moment gives, not least in the interests of the individual patients.

  99. So it may be that a large number of people are waiting a very short time.
  (Mr Gilroy) Absolutely.


 
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