Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 20 - 39)



  20. Which they object to, do they not?
  (Mr Crisp) Well, the negotiations are going all right at the moment actually.

  21. That is good. They threatened to strike about three months ago, did they not?
  (Mr Crisp) I think you are thinking about the GPs, I am talking about the consultants at the moment. The consultant contract renegotiation is looking at issues such as productivity and workload and also issues such as—

  22. Tell us about the private work they do.
  (Mr Crisp)—private work and exclusivity to the NHS.

  23. How much private work can they do in their contracts? How much are they allowed to do?
  (Mr Crisp) It depends on whether or not you are a full-time consultant or a maximum part-time consultant. If you are a full-time consultant, you are allowed to do an amount which should not add up to more than 10 per cent of your salary, but you can also be a part-time consultant, at which point you are entitled to do more private work.

  24. So every consultant who is on a full-time contract can do 10 per cent private work?
  (Mr Crisp) That is my understanding.

  25. How many consultants are there in the country?
  (Mr Crisp) There are somewhere between 17,000 and 20,000.

  26. Exactly. That just about answers the question, does it not? If they did full National Health Service work instead of private work, how many more operations could be done a year in the National Health Service?
  (Mr Crisp) I have never attempted to do that calculation.

  27. I bet you have not.
  (Mr Crisp) I would just make the point that if people were not doing some operations in the private sector, those operations would have to be done in the NHS.

  28. But they might have to wait their turn?
  (Mr Crisp) That may be the case. This is not a simple adding and subtracting issue.

  29. I accept that. How much private work is done in National Health Service hospitals?
  (Mr Crisp) Again, I am sorry, I will have to give you a note on that, I do not know the answer.

  30. How many National Health Service beds are used for private care?
  (Mr Crisp) Again, I do not know that answer.[1]

  31. Shall I tell you? I knew this meeting was coming up so I asked a Parliamentary Question last week and I asked the number of admissions from non-National Health Service hospitals into National Health Service trusts, and last year alone, 1999-2000, there were almost 7,000 beds taken up by private operations in the Health Service. That does not seem to be right to me.
  (Mr Crisp) If you looked at the same set of figures, you will also see the NHS had actually reduced in the last year the number of private patients it treated.

  32. It did, by about 200 or 300?
  (Mr Crisp) Yes.

  33. It also increased from 1996-97 though.
  (Mr Crisp) There is an element in which the NHS is providing service to private patients and there will be a number of private patients who would rather use the NHS for a whole series of reasons, including they are dealing with some of the most—

  34. I am not against private medicine, if people want to pay, that is up to them, but what I do object to is them using the National Health Service hospitals and creating longer waiting lists.
  (Mr Crisp) But the argument about allowing it within the NHS has three or four prongs to it, and one of the important things is it does actually produce some additional revenue into the hospital which then provides for more beds. So you will find that if there were 7,000 beds—and I have to say I do not recognise that figure—private patients are paying more than those 7,000 beds and contributing to the bigger pot.

  35. I do not think that answers the question.
  (Mr Crisp) That is one argument for it. There are other arguments for it as well, including it is important for many hospital managers to have their consultants doing their private practice actually within the hospital, because that actually supports the hospital as well. So there are some good arguments for having a mixed economy.

  36. I do not want to get bogged down in this so I will move on. Figure 5 on page 11 shows us the inpatient waiting list is falling, the number of operations is going up, and that sounds great and so it is, so why is it then that some people do have to still wait 18 months?
  (Mr Crisp) We do not want it to happen. These figures here say that 70 per cent of people are admitted within three months.

  37. That is not the question though.
  (Mr Crisp) That is where we are building from. To get everybody else admitted within six months, which is where we are aiming to be by the end of—

  38. But you are missing the question. I want to know why people have to wait 18 months. I cannot understand why they have to wait 18 months. If there are more operations and the lists are coming down, why is somebody having to wait 18 months?
  (Mr Crisp) Year on year it is moving in the right direction, but it will take some time because this is a very, very big organisation, these are huge numbers of people. We have some estimates of the further increases in activity we need to get our waiting lists down, so we can bring everybody in.

  39. It is still not answering the question though, why do they have to wait 18 months?
  (Mr Crisp) I am sorry, I am being obtuse here as to what the answer is. Clearly, we need to put more resources into the system, we need to put more money, more capacity and more staff into the system, all those things are happening but they take time to build up.

1   Ev 24, Appendix 1. Back

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