Select Committee on Public Accounts Minutes of Evidence


APPENDIX 1

Supplementary memorandum submitted by the Department of Health

INPATIENT AND OUTPATIENT WAITING IN THE NHS

Question 30:  How many National Health Service beds are used for private care?

NHS elective beds are only available for use by NHS patients. Private patients in NHS hospitals can only use beds designated as private beds. Of course, if a patient admitted privately suddenly required unforeseen intensive care this would happen without hesitation.

Private beds are not covered by the Department's annual beds census. However, Hospital Episode Statistics (HES) identify 104,000 private patients admitted to NHS hospitals in 2000-01.

Question 112:  Why is there such an extraordinary capacity variation in acute facilities between different health authorities?

There are a number of factors which can, at any one point, impact on the available capacity in an acute trust to deal with elective inpatient waiting list work. In most instances elective work requires a mix of theatre time, beds and staff, both clinical and ancillary. The non-availability of these elements can impact on the treatment of patients from the waiting list.

Emergency pressures, for example, can reduce the amount of available beds for elective patients. Similarly, delayed transfers of care can have the same effect. Chapter 4 in the NHS Plan acknowledged this issue, and outlined plans for 5,000 extra intermediate care beds. Equally as important as having beds available for post operative care is the availability of operative theatre capacity. The Modernisation Agency is currently leading a Theatre Project to optimise the use of these resources. Obviously without sufficient staff neither beds nor theatre time can be fully utilised. The NHS Plan Chapter 5 highlighted our plans to increase the overall numbers of both doctors and nurses.

At any one point the interaction of these factors will vary from locality to locality leading to different levels of available capacity.

Question 113:  Why does Wakefield Health Authority do worse than adjacent health authorities in terms of inpatients and outpatients waiting longer than 6 months?

We recognise that there are currently wide variations in levels of performance across the country, and the below health authorities, as at December 2001 reflect this:

Indicator
Wakefield
Barnsley
Doncaster
Outpatient over 13 week waiters
1,804
2,175
2,087
Outpatient over 26 week waiters
258
504
548
Inpatient over 12 month waiters
175
18
12
Inpatient over 15 month waiters
5
1
0
However, both Wakefield HA and Pinderfields & Pontefract Hospitals NHS Trust have a good record of achieving local waiting list and waiting time targets in recent years. At the end of December 2001, Wakefield HA was very close to having achieved the 15 month maximum waiting time target and the 175 patients waiting over 12 months represent less than 3 per cent of the waiting list. This compares with 80 over 15 month waiters and 341 over 12 month waiters a year earlier. Wakefield HA, the Trust and the two local Primary Care Trusts are working together closely to ensure patients receive treatment even more quickly in the future. Current initiatives include putting on extra operating theatre sessions, and offering patients the choice to be treated at other hospitals such as Barnsley District General Hospital and by the independent sector.

I set out at the hearing some of the initiatives we are using to address such variations, including the programme of work to implement best practice being taken forward by the Modernisation Agency. We are aiming to reduce the maximum waiting in successive years so that by 2005 no one waits over three months for an outpatient appointment or six months for an inpatient admission. These targets recognise the importance that patients place on waiting time.

Question 167:  What powers do you have to dismiss a chief executive or chairman of a trust?

Section 13 of the Health and Social Care Act 2001 enables the Secretary of State to make an intervention if he is satisfied that an NHS body "is not performing one or more of its functions adequately, or at all, or that there are significant failings in the way the trust is being run". Intervention orders are required to be placed before parliament and would give specific directions that were relevant to the use of the power in the particular case. The Secretary of State's powers include the removal of any board member from the board of the trust. The Chief Executive's employment is a matter for the employing trust.

Question 181:  Can you provide a breakdown, by specialty, of the consultants that considered 80 per cent of referrals were inappropriate?

The table below provides the specialty breakdown requested:

Specialty
Number of consultants
ENT
12
T&O
23
Urology
9
Not stated
2
Total
46
Question 182:What are the patterns for out of area treatment?

There are a number of means through which patients can be treated outside their normal locality.

The out of area treatment (OAT) arrangements were introduced on 1 April 1999 as part of a package of new commissioning arrangements that saw all patient care arranged under service agreements. OATs are used where pre-arranged service agreements are not practical, primarily emergency treatments required while away from home—for example treatment required while on holiday. Under the OAT arrangements each NHS trust has a main commissioner health authority. The main commissioner is funded for OATs through a non-recurrent adjustment to allocations. This is based on past referral levels. The adjustments are:


    —  an addition to the resource limit of the health authority which is the main commissioner for the NHS trust; and

    —  a deduction to the resource limit of the health authority responsible for the patient.

For elective care the local health authority should commission care from each NHS Trust that provides care for its responsible population. Local GPs should be consulted and where possible the agreements should reflect their referral preferences.

These arrangements try to strike a balance between coherent planning for service development, and responsiveness to individual needs.

Question 194:  What percentage of consultants are full time?

The following table details the number of consultants in the NHS and the percentage of the total number of consultants who are full time.

Consultants in the NHS, 30 September each year

Year
Total headcount
Full time
Maximum part time
Part time
Honorary
Whole time equivalent for part time staff
Percentage of consultants who are full time
2001
25,690
14,464
5,628
3,878
1,720
1,992
56%
2000
24,306
13,877
5,750
3,005
1,674
1,690
57%
1999
23,225
13,383
5,640
2,692
1,510
1,534
58%
1998
22,224
12,645
5,381
2,545
1,653
1,442
57%
1997
21,373
11,880
5,451
2,357
1,685
1,352
56%

Source: Department of Health medical workforce census

Department of Health

April 2002



 
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Prepared 18 September 2002