House of Commons - Health

Hansard

Archives

Research

HOC Publications

HOL Publications

Committees

Select Committee on Health Second Report

2 Core Tasks

14. In accordance with a Resolution passed by the House in May 2002, which requested the Liaison Committee to establish common objectives for Select committees, Select Committees have been asked by the Liaison Committee to perform certain core tasks which are designed to provide a framework to encourage 'a more methodical and less ad-hoc approach to the business of scrutiny'.[12] The following section describes the core tasks and gives a commentary of how our work related to them.[13]

15. They are grouped under four separate objectives:

Objective A: To examine and comment on the policy of the Department

Objective B: To examine the expenditure of the Department

Objective C: To examine the administration of the Department

Objective D: To assist the House in debate and decision.

It is for each individual Committee to determine how it meets these objectives. This Report describes the work the Health Committee has done in relation to our core tasks and to our inquiries.

Objective A: To examine and comment on the policy of the Department

TASK 1: EXAMINATION OF POLICY PROPOSALS; AND TASK 4: EXAMINATION OF DEPARTMENTAL DOCUMENTS AND DECISIONS

16. The first core task is "to examine policy proposals from the UK Government and the European Commission in Green Papers, White Papers, Draft Guidance etc, and to inquire further where the Committee considers it appropriate". Core task four, which is linked closely to the preceding task, is to "examine specific output from the Department expressed in documents or other decisions".

17. We scrutinise the policy originating from the Department of Health through inquiries on specific proposals and through evidence sessions with the Secretary of State or relevant Ministers. Our inquiry into Audiology Services[14] was in response to the Government's announcement in March 2007 of a new framework for audiology, Improving Access to Audiology Services in England, which sought to address the extremely long waiting times for patients wishing to upgrade their analogue hearing aids. During our oral evidence session we explored whether the Government's proposals would succeed in delivering digital aids to those who needed them most. Our Report, Audiology Services, drew attention to the position of patients in certain areas of the country who had to wait for up to two years to receive treatment and recommended that the Government should include audiology in its 18-week targets. In its response, the Government conceded that "no local health system will be credible in claiming success on 18 weeks if it does not make excellent progress in tackling long waiting times affecting large numbers of its local population".[15]

18. In October 2007, we held an evidence session with Professor the Lord Darzi of Denham who, in June 2007, had been appointed Parliamentary Under Secretary of State. Lord Darzi, an eminent surgeon, who combines his clinical and ministerial work, has been given a specific task "to conduct a nationwide review of the NHS in England", and to set out a "vision for health services in the 21^st Century". Lord Darzi is due to report his conclusions in June 2008 but, in October 2007, he gave some indication of his thinking when the Government published an interim report, Our NHS, Our future. This interim report set out principles against which the Government judged the NHS should operate in the future and announced a number of immediate actions such as measures to tackle Healthcare Acquired Infections (HCAI) in hospitals, and the establishment of a new Innovation Council in the NHS.

19. We questioned Lord Darzi on these matters in some depth, including the evidence base on which the Prime Minister had judged deep-cleaning of hospital wards to be a cost-effective method for tackling HCAI. We expect to take evidence from him in the summer of 2008 when he concludes his review and publishes his final report.

TASK 2: IDENTIFICATION OF EMERGING POLICIES OR DEFICIENT POLICY

20. Core task two requires the Committee "to identify and examine areas of emerging policy, or where existing policy is deficient, and make proposals". In 2007, the Committee conducted a major inquiry into Workforce Planning. The inquiry, which began in late 2006 and ended in the spring of 2007, arose out of concerns that the sudden end of the rapid expansion in recruitment which the NHS had experienced in the early part of this century had resulted in a significant reduction in vacant posts and great difficulties for newly qualified staff in finding jobs. Our Inquiry examined how effectively workforce planning, including that for clinical and managerial staff, had been undertaken and how it should be done in future, particularly in the light of the 2006 Government White Paper Our health, Our Care, Our say, which outlined the Government's intention to increasingly shift the provision of healthcare out of hospitals to the primary sector. Our Report, Workforce Planning, published in March 2007, was critical of the Government's failure to avoid a boom and bust cycle in workforce numbers and pay levels.

21. Building on our long tradition of examining areas where Government health policy is deficient the Committee decided to hold an inquiry into the NHS National Programme for Information Technology. Our Electronic Patient Record Inquiry was undertaken in response to widely-held concerns about delays experienced by the programme (the largest civilian Information technology project in the world). During this Inquiry we discovered evidence of an over-centralised management and that lack of co-ordination between the Department, its suppliers and the NHS had contributed to delays in the project.

22. Our disquiet about the quality of workforce planning in the NHS was reinforced by serious concerns, both within the medical profession and more widely, about the difficulty experienced by some junior doctors in attaining hospital training posts following the introduction in 2007 of the Modernising Medical Careers (MMC) programme, a major reform of medical training. That concern was compounded by the abandonment of the Medical Training Application Service (MTAS), a national computer system designed to support the MMC recruitment and selection process.

23. Immediately before the Summer Recess of 2007, we announced our Modernising Medical Careers Inquiry which would examine these issues and identify lessons to be learned. We began taking oral evidence in November and we expect to conclude our inquiry and publish our Report in the spring of 2008.

24. The one-off oral evidence session which we held with Rt Hon Alan Johnson MP in July 2007, soon after his appointment as Secretary of State, enabled us to consider deficiencies in Government policy over a range of health issues and to follow-up on some of previous inquiries.[16] We took the opportunity to question him on Healthcare Acquired Infection rates, the cost-effectiveness of Independent Sector Treatment Centres (ISTCs) and the 18-week waiting time target. We were able to follow-up these issues with the Secretary of State when he appeared before us again in November.

TASK 3: SCRUTINY OF DRAFT BILLS

25. The third core task is "to conduct scrutiny of any published draft bill within the Committee's responsibilities". The Department of Health did not publish any draft bills during 2007. However, as in 2006 when we examined provisions relating to smoking in the Health Bill after second reading, we looked at the proposals for patient and public health aspects of the Local Government and Public Involvement in Health Bill in our Report, Patient and Public Involvement in the NHS (HC 278-1) which was published in time to inform the House's debate on the Bill's report stage. This Report found that the Government's proposals were too ambitious for the budget; the demands placed on the new organisations charged with carrying out patient and public involvement should be tailored to the budget the Government was able to provide.

26. In December 2007, two members of the Health Committee were appointed to the Public Bill Committee scrutinising the Government's Public Health and Social Care Bill. The Bill makes provision for the establishment of a new Quality Care Commission to inspect health and social care provision in England. The proposed establishment of a new Arms Length Body is a development that this Committee notes with interest.

Objective B: To examine the expenditure of the Department

TASK 5: EXAMINATION OF EXPENDITURE

27. Core task five is "to examine the expenditure plans and outturn of the Department, its agencies and principal NDPBs". We consider our responsibility to examine the expenditure of the Department of Health and NHS as central to our work. With a budget of over £90 billion in 2006-07, the Department is Whitehall's second largest spender of public money.[17] Continuing our custom of many years the Committee undertook an inquiry into the Department's finances as part of our Public Expenditure Questionnaire (PEQ) inquiry. Each year we send the Department a questionnaire asking for answers to a range of finance-related questions under six headings: General expenditure; Capital investment; NHS Plan reform expenditure; the NHS spending programme; Activity, performance and efficiency; and The Departmental Annual Report. In all we asked the Department to provide information in 137 areas. Many questions sought updated figures and so added to an important consolidated data series. Other questions, included for the first time in 2007, related to areas that we felt required further scrutiny, such as health inequalities and productivity. Following the completion of the data set we published the PEQ on our website and included spreadsheets containing further breakdown of data relating to Primary Care Trusts.[18]

28. Shortly after the publication of the PEQ, we held two evidence sessions so that we could question the Department further in particular areas. The first session was with senior departmental officials, including the Permanent Secretary, the Department's Finance Officers and the NHS Chief Executive. The second session was with the Secretary of State. These sessions allowed us to explore important areas of financial expenditure by the Department in more depth than was possible in other inquiries. In 2007 for example, we examined how the NHS had gone about turning a substantial financial deficit into a similarly large surplus so quickly, and what effects this might have had on staff and services—an issue subsequently reported widely in the media. Some of this questioning allowed us to follow up our NHS Deficits Report, published in December 2006, particularly in relation to our concerns that financial restrictions on SHAs might lead to cuts in training provision. We also focused much of our attention in this year's PEQ on the cost-effectiveness and value for money provided by the NHS, an organisation that has seen its budget doubled in ten years.[19]

29. In addition to our Public Expenditure Inquiry, we asked the Department to provide us with a memorandum explaining the changes to its budget provision which it sought in the 2006-07 Winter Supplementary Estimate. Our Electronic Patient Record Inquiry and our Workforce planning Inquiry both examined areas where substantial amounts of public money are spent. In both Reports we made recommendations where we considered greater cost-effectiveness could be achieved.

Objective C: To examine the administration of the Department

TASK 6: EXAMINATION OF PUBLIC SERVICE AGREEMENTS AND TARGETS

30. Task six is "to examine the Department's Public Service Agreements, the associated targets and the statistical measurements employed, and report if appropriate".

31. We examined the Department of Health's Public Service Agreement (PSA) targets in our PEQ exercise. We asked the Department, in both our Questionnaire and oral evidence sessions, about its performance against a key Government performance indicator, PSA target 5, "to ensure that, by 2008, no one waits more than 18 weeks from GP referral to hospital treatment". We were particularly interested to hear from the Secretary of State about whether he remained confident that the Department would reach target 5 in the light of media reports suggesting that the target would be softened. The PEQ also gave us the opportunity to examine the Department's performance against PSA Targets 10 and 12 relating to achieving value for money with NHS resources.

32. Our inquiries into Workforce Planning and Audiology also considered areas in which the Department had imposed targets: managing the staff and the resources of the Department so as to improve performance; and improving the health of the nation. Our Health Inequalities Inquiry, which we announced in December 2007, will involve consideration of the key Department of Health PSA target that states, "By 2010 to reduce inequalities in health outcomes by 10 per cent as measured by infant mortality and life expectancy at birth".[20]

TASK 7: MONITORING OF ASSOCIATED BODIES

33. Task seven is "to monitor work of the Department's Executive Agencies, NDPBs, regulators and other associated bodies". The Committee continued to monitor the work of the Department's Arms Length Bodies during 2007. The NHS itself, which we scrutinise in all of our inquiries, is a federation of Non Departmental Public Bodies. We held a major inquiry into the National Institute for Health and Clinical Excellence (NICE), the NDPB that is responsible for providing national guidance on promoting good health and preventing and treating ill health. During the NICE Inquiry we took oral evidence from the NICE Chief Executive and received written evidence from Professor Sir Michael Rawlins, Chairman, and from Andrew Dillon, Chief Executive, NICE. We also took written evidence from the Healthcare Commission during our Workforce Planning Inquiry.

34. During our evidence session with Lord Darzi, we asked him about the Government's proposals for the establishment of another Arms Length Body, the Health Innovation Council, which, according to Lord Darzi, will act as "the guardians of innovation, from discovery to adoption".

35. Our Chairman has continued the practice of hosting regular informal meetings which other members of the Committee also attend, with representatives of health sector organisations and other organisations that have a particular interest in our inquiries. The purpose of these meetings is to provide an opportunity for the exchange of information and to discuss any mutual areas of concern. These meetings have proved a useful exercise in informing our work. Sometimes valuable insights are gained from meeting informally with organisations outside of the health field. During 2007, for example, the Chairman held meetings with the Higher Education Funding Council for England and the Refugee Council.

TASK 8: SCRUTINY OF MAJOR APPOINTMENTS

36. Task eight is "to scrutinise major appointments made by the Department". During 2007, the Committee did not hold any evidence sessions specifically to examine appointments but we did take evidence from Ministers and officials soon after their appointment. In July 2007, we took evidence from Rt Hon Alan Johnson MP soon after his appointment as Secretary of State. In October 2007 we held an evidence session with Lord Darzi, three months into his post as Parliamentary Under Secretary of State for Health. During our PEQ inquiry, we questioned David Flory, newly appointed as Director General of NHS Finance, Performance and Operations.

TASK 9: EXAMINATION OF THE IMPLEMENTATION OF LEGISLATION AND MAJOR POLICY INITIATIVES