At the Health Select Committee hearing on 30 October 2003 I promised to write with more detail on a number of issues. These are covered in the paper attached to this letter. Sir Nigel Crisp also agreed that he would send details of the redeployment of CHC staff. I have included the information on this point in this letter for ease of reference.

  The Committee asked for the following additional information:

  1.  Simon Burns MP asked for the total cost to the NHS to date of NHS-commissioned operations in overseas facilities.

  2.  Paul Burstow MP requested more details of the functions that would be retained in the Department of Health (DH) after the Change Programme has been completed.

  3.  Paul Burstow MP asked for details of the current DH estimate of the number of people who we consider likely to make retrospective claims for the cost of providing continuing care that the NHS should have provided.

  4.  Dr Richard Taylor MP asked for details of the PALS national development group—who it reports to, who the members are, what relationship it has with the CPPIH?

  5.  David Amess MP wanted an explanation of figures in a reply to a recent written PQ (PQ08781). He cited that only 24% of patients were seen and admitted within two hours in the first quarter of 2003-04 but that in the same period the year before it was 57%.

  6.  David Amess MP wanted more details of NICE's decision on photodynamic therapy and what was happening in Cheltenham and Gloucester where it is alleged that the PCTs have stopped providing this treatment.

  7.  I agreed to write to you with details of a South London centre I had visited which has brought together health and social care facilities.

  8.  Sir Nigel Crisp agreed to write to you with details of the proportion of CHC staff retained in NHS employment including those re-employed in PALs etc.

  On point 7, I was referring to the Bromley-by-Bow Centre which is in East rather than South London. I apologise to the committee for this error of geography. I give more details about the work of the centre in the attached paper.

  I hope the attached response meets your requirements and I look forward to working with you and the other members of the Health Committee in the future.

10 November 2003

  1.  Purchases from Overseas Providers

  Simon Burns MP asked for the total cost to the NHS to date of NHS-commissioned operations in overseas facilities.

  The information available cannot be broken down into a simple financial year analysis. The invoices received from the NHS Overseas Commissioners have in the past been for work completed which ran over the financial year-end and some of the treatment in Europe has not yet been invoiced.

  The costs of the projects tend to be front-loaded to meet contract set-up processes, for example. Now that model contracts have been established, and have sourced sufficient capacity for our needs such cost in the future are likely to be considerably lower.

  Note:

  1. A breakdown of costs is not available between years for major joint episodes

  2.  DH Change Programme

  Paul Burstow MP requested more details of the functions that would be retained in DH after the Change programme has been completed.

  The Department's role is to help improve the health and well being of the population. The Change Programme was initiated to ensure that the Department of Health continues to fulfil this role in the 21st century.

  The Department is changing to reflect the environment in which it works, particularly:

—  The reform of the NHS and local government to meet the public's expectations for better health and social care services.

—  The government's drive to shift the balance of power from Whitehall to staff in frontline hospitals, GP surgeries, care homes, social services and the community.

—  The creation of new independent bodies to inspect NHS and social care services, such as the Commission for Healthcare Audit and Improvement (CHAI).

  The Department's new role will focus on providing strategic leadership to NHS and social care organisations, concentrating on:

—  Setting overall direction and maintaining core values.

—  Ensuring national standards are set.

—  Securing resources.

—  Making major investment decisions.

—  Ensuring the whole system operates for the benefit of patients and the public.

—  Holding the NHS to account.

  The Department will work closely with a number of important partners to deliver better health and social care services.

  The Department will employ a much lighter touch on performance management, enabling the 28 Strategic Health Authorities to operate as the local headquarters for the NHS. By operating at arm's length from successful NHS organisations, the Department will intervene only where most needed.

  The Department will also work with the Commission for Healthcare Audit and Inspection (CHAI) and the Commission for Social Care Inspection (CSCI), who will independently inspect NHS and social care services.

  On the specific issue of data collection, we are continuing to develop new measures to reduce the burden of data collection on the NHS. The Department is currently undertaking a rigorous assessment of all DH data collections, and looking at options for further rationalisation or reduction. The Department is also developing methods of collecting data by sampling which could replace some full national data collection exercises.

  3. Continuing Care

  Paul Burstow MP asked for details of the current DH estimate of the number of people who we consider likely to make retrospective claims for the cost of providing continuing care that the NHS should have provided.

  The final accounts do not give detail of the number of cases. The latest estimate by SHAs of the provision for recompense of continuing care wrongly denied is some £230 million. DH has made funds available to meet the costs of recompense. The SHAs have reported to us separately that this £230 million represents about 5,500 cases but we can not be sure of the precise numbers until all investigations are complete.

  4.  Patient and Public Involvement

  Dr Richard Taylor MP required details of the PALS national development group—who it reports to, who the members are and what relationship it has with the Commission for Patient and Public Involvement in Health (CPPIH)?

  The Department of Health has brought together representatives from each Strategic Health Authority area to work together to identify and prioritise a PALS development agenda. This group formed the basis of the PALS National Development Group (NDG). With representation of PALS staff from each of the SHA areas it looks at providing solutions and sharing learning and best practice.

  To date the group has:

—  Contributed to the launch of revised PALS national standards in August 2003, which built upon the standards from Supporting the implementation of patient advice and liaison services: A resource pack (2002), incorporating best practice experiences of PALS over the past 12 months; and

—  Developed an evaluation tool against which PALS can assess their performance against the national standards.

  Departmental funding has been agreed to support the work of the PALS NDG in:

—  Further developing and strengthening PALS networks both locally and nationally;

—  Developing communication systems to enhance sharing of best practice and effective signposting;

—  Establishing a PALS national directory.

  The work of the PALS NDG is monitored by a project steering group with membership including patient and public involvement leads from SHAs, the PALS NDG and the Department of Health.

  The PALS NDG has no formal link to the Commission for Patient and Public Involvement in Health (CPPIH) but is developing a positive working relationship with this organisation as it is with all key stakeholders.

  5.  A&E waiting times

  David Amess MP wanted an explanation of figures in a reply to a recent written PQ (PQ08781). He cited that only 24% of patients were seen and admitted within 2 hrs in the 1st quarter of 2003-04 but that in the same period the year before it was 57%.

  The performance of Southend General Hospital Accident and Emergency Department against the main standard for A&E services is consistently good—overall no patients are waiting more than 4 hours from arrival to admission or discharge.

  Data provided for the number of patients placed in beds within 2 hours of a decision having been taken to admit them is based on a sample. Where no time of decision to admit is recorded the time of arrival in A&E is used instead which could mean that the number placed in a bed within 2 hours is understated.

  Because of the statistical variation, the figures may therefore not be comparable from year to year.

  6.  NICE's decision on Photodynamic Therapy

  David Amess MP wanted more details of NICE's decision on photodynamic therapy and what was happening in Cheltenham and Gloucester where it is alleged that the PCTs have stopped providing this treatment.

  West Gloucestershire PCT, Cotswold and Vale PCT and Cheltenham and Tewkesbury PCT are funding photodynamic therapy in line with the current draft NICE guidance. Currently, consultants write to the relevant PCT on an individual case basis. These applications are considered by the PCT who then give authorisation of funding for treatment as long as they meet the criteria set out in the NICE guidance. The PCT is not aware of any cases that are in dispute.

  7.  Bromley by Bow Health Living Centre

  The Secretary of State also agreed to write to David Hinchliffe with details of a South London centre he visited which has brought together health and social care facilities.

  The centre visited was the Bromley-by-Bow Healthy Living Centre, which is in East rather than South London. The centre was opened in 1997 as a partnership between a primary care team and a community development project. The Primary Health Care Team works in a shared facility with a community regeneration project, which offers a range of activities. The service provides high quality holistic primary health care that includes employment, environment, training, education and the arts. This approach aims to address the high level need in one of the most deprived areas of the country.

  Activities at the centre revolve around a holistic approach to health care, which recognises the impact; the environment, education, housing, employment and creativity have on peoples' health. The building has been built to a high specification and includes a two-acre garden. The Centre was given a lottery grant and formal Healthy Living Centre status in May 2000.

  The GP team offers extended opening hours and share their reception area with others users of the building. The waiting area is used for many things including a food co-operative, toy library, art studio and gallery, and for community celebrations.

  The centre is based in one of the most deprived inner city areas in the country in a community that is highly socially excluded. Infant mortality is 50% higher than the national average. There is a high incidence of TB, mental illness and poverty related malnutrition. One third of households have no one in employment and one third are overcrowded and much of the housing is in poor physical condition. The area has the highest population density in the UK.

  8.  CHC Staff

  Sir Nigel Crisp agreed to write to David Hinchliffe with the details of the proportion of CHC staff retained in NHS employment including those re-employed in PALS, for example.

  Currently information shows that of the 196 who have already left CHCs 106 have been retained within the NHS. Although it is not possible to pinpoint the exact location of these 106 staff initial estimates are that some 25 have found posts within PALS. Other staff re-deployed in the NHS have taken posts such as Patient and Public Involvement Managers in PCTs, or clinical governance and quality management posts. The final figures of those CHC staff remaining within the NHS will not be clear until after the abolition date of 1 December.