Select Committee on Public Accounts Minutes of Evidence


Examination of Witnesses (Questions 180 - 199)

MONDAY 19 NOVEMBER 2001

MR NIGEL CRISP AND MR DAVID FILLINGHAM

  180. So that I am not going off in a tangent here, I want to be absolutely clear, have you chased down those figures and those cases and found that they do, in fact, refer to those particular specialties, so that you can now say to this Committee with confidence, "the reason for that is that they happen to be orthopaedic and trauma".
  (Mr Crisp) We do know what the specialities are but we have not asked those individual consultants, neither has the National Audit Office asked those individual consultants, why they think that is, or what sort are inappropriate referrals. It would be interesting to see whether the GPs in those cases also thought they were inappropriate referrals. We have not done that with these 40 people.

  181. That is something where I think it would be helpful if the Committee could have further information from you?
  (Mr Crisp) If we know who these 40 people are, and I do not know whether we do or not.[5]

  (Sir John Bourn) I will certainly make the information we have available.

  182. Thank you. Could we also have a note about what Mr Trickett was asking about on extra contractual referrals, out of area treatments, as you now call it, and the pattern and the penalties that are applied for out of area treatments?
  (Mr Crisp) The pattern for out of area treatment is the levels and specialties, and so on, and then the question of whether there are any penalties, you mean penalties on GPs?[6]

  183. Yes, such as were discussed earlier. Under the 42nd hearing of the Committee in paragraph six, this is when we are talking about the referrals which could be allocated equally across all consultants it says, "existing guidance requires that patients are told in their appointment letters that shorter waiting times may be available with alternative consultants and/or providers", this is largely what my colleague Mr Steinberg had been approaching with you at the beginning. Now what I would be grateful for from you, given that was being said in 1994 is, how is that guidance monitored and how is it enforced, because it certainly sounds from Mr Steinberg's experience that it is not?
  (Mr Crisp) I think you are referring to the fact that in 1994 we were running a different system in the Health Service which tends to get called by the name of the internal market and that that was guidance that was appropriate to 1994. I suspect, although I would be happy to check, that that guidance does not still continue.

  184. That guidance does not apply now?
  (Mr Crisp) I would need to look at the details of it but the way you have described it sounds to me as though—[7]

  185. I understand that things change, often for the better. What I would simply ask you is that given the experience that Mr Steinberg has outlined do you not think it would be appropriate to provide patients with that information, that they might be able to get a shorter waiting time if they went to a different consultant?
  (Mr Crisp) There are two elements there, the first bit of it is, do we provide people with information on the internet or, indeed, elsewhere about waiting times throughout the country. That is something that I think we will certainly be looking at in advance of being able to do it in 2005. The second point is, do patients have a choice based on that information. The second point, as I have said our current Secretary of State says that he wishes to see how we can improve choice within the service, so let us look at it, but let us look at it in a way that does not have some of the counter-consequences and problems associated with it which may have been when it was last done.

  186. I will take that as we will look at it. Thank you very much. It has been quite a political afternoon in many of the questions that we have had, particularly on paragraph 2.22, I only want to touch on the waiting list waiting time matter briefly, it is to ask you this, we have heard a great deal about the distortion of clinical priority because of political priorities effectively and that had we not concentrated on waiting lists, and you said well, of course, we are now concentrating on waiting times.
  (Mr Crisp) Yes.

  187. Why should it be any less likely that by concentrating on waiting times there should be in any given circumstances less likelihood of a distortion of clinical priority?
  (Mr Crisp) I think the answer—

  188. I do not want you to rehearse the answer that you gave earlier. I understand fully about there is no need to distort clinical priority, I understand that argument, and it can be achieved in other ways. What I am putting to you is this, in exactly the same way that the waiting list and the desire to cut waiting list could have distorted clinical priorities so, surely, any political priority such as cutting waiting times can do exactly the same?
  (Mr Crisp) I think it is very important to make another distinction and to move away from politics here and to patients and professionalism, if we actually look at the area where we are being specific about waiting times, broadly at the moment within cancer they are broadly coming out of the cancer plan and also the coronary heart disease plan, which has been built up from the expertise around the country and not from political routes. The things that you will see in the NHS plan about the requirements to get from urgent referral to completion of treatment within two months of surgery is a clinical priority, a different priority, rather than a political one. I think there is a strong driver there to say that that is how we are building up those standards. I think that will help in the context you are talking about because we will be starting with the most serious conditions anyway, like cancer and coronary heart disease.

  189. Would you accept—I have five more questions in the two minutes left to me—that any prioritisation of waiting times could also, in a situation where somebody is coming up against the maximum allowable under the rubric, bring about a situation where there was distortion of clinical—?
  (Mr Crisp) I think when we are talking about the levels we are talking about it is clearly a hypothetical point, a hypothetical possibility that that will happen, but the most important thing is that people need to have planned what is going to happen to the patient at the point of entry to the system. If they have done that, it may go wrong during the course of it in which case you readjust, if they plan at the beginning that should not happen.

  190. Three very easy ones, a fully integrated booking system by 2005, is that going to happen?
  (Mr Crisp) I hear a nod to my left.

  191. The second easy question, cancellations rebooked within 28 days or paid for privately by 2005, is that going to happen?
  (Mr Crisp) That is next year.

  192. Goodness me! The third easy question, the maximum in patient waiting of six months by 2005, is that going to happen?
  (Mr Crisp) We certainly intend it to.

  193. If they do not will you be resigning from your job?
  (Mr Crisp) Thank you for that question, I think that is a policy question.

  Chairman: You have been done very well, Mr Crisp. The last questioner is an easy one, Mr Alan Williams.

Mr Williams

  194. Mr Crisp, I want to follow up where Gerry Steinberg started on the consultants. You gave him a figure of 17,000 to 20,000 consultants. How many of those are full-time?
  (Mr Crisp) There are over 20,000, I got that wrong. I will give you a note on your point, I am afraid I do not know.[8]

  195. Not even a ballpark figure, a rough estimate?
  (Mr Crisp) I would be guessing. It very much varies by speciality.

  196. The full-time are allowed to do private work up to 10 per cent of their salary?
  (Mr Crisp) That is correct.

  197. How much can part-timers do? Mr Steinberg asked that but you did not give an answer.
  (Mr Crisp) Sorry, if I did not. There is no technical limit, however, they have to agree what sessions they are doing with the NHS provider, and they have to stick to those sessions. Therefore the practical limit is what else they can do outside those sessions.

  198. So there is no limit at all on what the part-timers can do and, unfortunately, you do not know what proportion are part-time. My understanding is in many cases it is difficult to get consultants who are willing to be full-time; they want to be part-time.
  (Mr Crisp) Well—

  199. I do not need an answer to that because it was not really a question, it was a statement. How do you monitor the 10 per cent?
  (Mr Crisp) It is monitored by trusts.


5   Ev 25, Appendix 1. Back

6   Ev 25, Appendix 1. Back

7   Note by witness: EL(94)90-Waiting Time Policy-was cancelled on 30 November 1995. Back

8   Ev 25, Appendix 1. Back


 
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