Examination of Witnesses (Questions 80
WEDNESDAY 13 FEBRUARY 2002
PLATT, CBE, MR
80. Do they have a better record on minimising
(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.
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.
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.
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 departmentbecause
the figures are kept in that formatwith 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
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
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.
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
Mr Burns: No, not PQs, the figures.
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?
(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.
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
(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 yearsbut 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
99. So it may be that a large number of people
are waiting a very short time.
(Mr Gilroy) Absolutely.