House of Commons - Work of the Committee 2007-08

Work of the Committee 2007-08 - Health Committee Contents

2 Core Tasks

12. In accordance with a Resolution passed by the House in May 2002, the Liaison Committee has set Select Committees certain core tasks to perform which are designed to provide a framework to encourage 'a more methodical and less ad-hoc approach to the business of scrutiny'.[5] The following section describes the core tasks and gives a commentary on how our work relates to them.[6]

13. 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 these 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

14. 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task is "to examine policy proposals from the UK Government and the European Commission in Green Papers, White Papers, Draft Guidance etc, and to inquire further where the Committee considers it appropriate".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 task one, is to "examine specific output from the Department expressed in documents or other decisions".

15. We scrutinise the Department of Health's policies through inquiries on specific proposals which lead to a report and through one-off evidence sessions with the Secretary of State or relevant Ministers covering a range of their responsibilities. In 2007 Professor the Lord Darzi of Denham, the Parliamentary Under Secretary of State at the Department of Health, began "to conduct a nationwide review of the NHS in England", and to set out a "vision for health services in the 21^st Century". This review was heralded as a major piece of work which would have a significant effect on the future of the NHS. Accordingly, we decided to undertake an inquiry into his review and did so following its publication in the summer of 2008. We concluded that although there was much to commend in the report, notably its emphasis on quality, we doubted whether PCTs had the ability to implement the proposed reforms.

16. We also put questions about policy proposals to witnesses in one-off evidence sessions, for example asking Ivan Lewis about two recent consultation papers: Putting People First on social care and The future regulation of health and adult social care in England which set out proposals to change the regulation of health and social care by establishing the Care Quality Commission to take over the functions of the Healthcare Commission, the Commission for Social Care Inspection (CSCI) and the Mental Health Act Commission (MHAC).

17. We examine EU proposals in a variety of ways. We visited Brussels and have arranged a meeting with the Health Commissioner at Westminster. These meetings enable us to discuss informally a number of directives or proposed directives, including those relating to cross-border healthcare, food labelling, working times and proposed Green Papers such as those on health inequalities and the health workforce. We also consider EU papers in our inquiries; for example the Health Inequalities inquiry touches on EU proposals in respect not only of inequalities but also of food labelling.

TASK 2: IDENTIFICATION OF EMERGING POLICIES OR DEFICIENT POLICY

18. Core task two requires the Committee "to identify and examine areas of emerging policy, or where existing policy is deficient, and make proposals". In this session the Committee published reports on two areas of policy which have widely been seen as deficient: Modernising Medical Careers (MMC) and Dental Services. In 2006-07 we had expressed our serious concerns about the failings of workforce planning in the NHS. The extent of these failings became more apparent during our inquiry into Modernising Medical Careers which arose out of the Department of Health's disastrous implementation of its proposals to reform post-graduate medical training. Our inquiry exposed serious problems with the management of the MMC reforms, and particularly the introduction of NHS Medical Training Application Service (MTAS), by the Department of Health and its partners. A divided and inappropriate governance structure, flawed project management and poor communication with junior doctors were the most seriously failings. Co-ordination between the Department of Health and the Home Office on restricting medical migration was also woefully inadequate. These practical shortcomings were responsible for some of the direct causes of the 2007 crisis, including the defective short-listing process, the unsafe computer system and the failure to limit the number of applications from overseas doctors.

19. Our investigation into dental services was instigated as a result of the increasing evidence that the new contract introduced in 2006 had so far failed. Our inquiry found that the Department's original goal that patient access to dental services would improve from April 2006 had not been realised. The Chief Dental Officer admitted this, but claimed that the situation had stabilised and that improvements would soon be realised as a result of new facilities being established. However, the various measures of access all indicated that the situation was deteriorating.

20. Another inquiry appraised Foundation Trusts and Monitor.[7] The Committee looked at whether foundation trusts (FTs) had achieved as much as the Government had expected and, conversely, had been as disastrous as their critics had predicted. We found that FTs have some proven strengths, but it is unclear how much of their achievement was due to FT status as many were high-achieving institutions before they became FTs.

21. We also began inquiries into Health Inequalities and Patient Safety. Health inequalities have been a major concern for the Government and it has put in place many policies to combat them. Unfortunately, it seems that inequalities are increasing. We decided to hold an inquiry into this important subject, focussing in particular on the effectiveness of the measures the Government has taken. The Government has also taken a great interest in patient safety; again, it seemed an appropriate time to examine the effectiveness of these policies.

22. In addition, in our Public Expenditure evidence session with the Permanent Secretary at the Department of Health, the Chief Executive of the NHS and other senior officials we were also able to ask questions about a range of emergent or deficient policies, including the NHS IT programme and Independent Sector Treatment Centres.

TASK 3: SCRUTINY OF DRAFT BILLS

23. 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 2008. However, as in 2006, when we examined provisions relating to smoking in the Health Bill after second reading, and 2007, when we looked at the proposals for patient and public health aspects of the Local Government and Public Involvement in Health Bill, this year we questioned the Minister, Ivan Lewis, about the proposal contained in the Health and Social Care Bill to establish a new regulator, the Care Quality Commission.

24. In January and February 2008 two Members of the Committee also served on the Public Bill Committee which scrutinised the Health and Social Care Bill.

Objective B: To examine the expenditure of the Department

TASK 5: EXAMINATION OF EXPENDITURE

25. Core task five is "to examine the expenditure plans and outturn of the Department, its agencies and principal NDPBs". We consider this responsibility central to our work. With a budget of over £90 billion in 2008-09, the Department is Whitehall's second largest spender of public money.[8] Continuing our practice 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. The answers relating to national and regional information were published in hard copy as well as on our website; we also included on our website spreadsheets containing a further breakdown of data relating to Primary Care Trusts.[9]

26. Shortly after the publication of the PEQ, we held an evidence session with senior Departmental officials, including the Permanent Secretary and the NHS Chief Executive. These sessions allowed us to explore important areas of financial expenditure by the Department in more depth than was possible in other inquiries. In 2008 we gave particular attention to considering whether the Department was getting value for the huge additional sums of money it had been spending. We questioned the officials about productivity, staff numbers and costs, the waiting target, the weighted capitation formula, programme budgeting, PFI, ISTCs, dentistry, the National Programme for IT, the European Working Time Directive and Payment by Results as well as future funding of the NHS, its financial balance.

27. In addition to our Public Expenditure Inquiry, our other inquiries considered NHS expenditure and, in particular, value for money. Our Foundation Trusts and Monitor inquiry looked at FTs' financial surpluses, whether they were too large and, if so, why. In other inquiries, notably Health Inequalities, the examination of the cost-effectiveness of policy has been central to our investigation.

Objective C: To examine the administration of the Department

TASK 6: EXAMINATION OF PUBLIC SERVICE AGREEMENTS AND TARGETS

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

29. Our major inquiry into Health Inequalities is focused on a key Public Service Agreement (PSA) target which states, "By 2010 to reduce inequalities in health outcomes by 10 per cent as measured by infant mortality and life expectancy at birth".[10] In the oral evidence session with the Secretary of State we pressed him on whether these targets were likely to be met. As part of this investigation we have also looked at a number of other targets, including those relating to infant mortality, obesity and teenage conception rates.

30. As usual we examined the Department of Health's PSA targets in our PEQ exercise. Chapter 9 of the Questionnaire covers PSA targets and chapter 10 Comprehensive Spending review PSAs. A number of targets were pursued in oral evidence with the Permanent Secretary and NHS Chief Executive, including the commitment "to ensure that, by 2008, no one waits more than 18 weeks from GP referral to hospital treatment", questioning them on the evidence base for this target.

TASK 7: MONITORING OF ASSOCIATED BODIES

31. Task seven is "to monitor work of the Department's Executive Agencies, NDPBs, regulators and other associated bodies". We continued to monitor the work of a number of the Department's agencies and arms length bodies during 2008. The NHS itself, which we scrutinise in all of our inquiries, is a federation of Non Departmental Public Bodies.

32. Two of our inquiries have been focussed on the work of NDPBs. We held a major inquiry into the National Institute for Health and Clinical Excellence (NICE), the body which is responsible for providing national guidance on promoting good health and preventing and treating ill health. Our inquiry made a number of recommendations to improve its work, which were accepted by the Government, in particular that it should produce quicker initial evaluations.

33. We examined the work of Monitor, the regulator of Foundation Trusts, and took oral evidence from its Chief Executive, Bill Moyes during our inquiry. In addition, an important facet of our inquiry into Patient Safety is an examination of the work of the National Patient Safety Agency. We also took oral evidence from the Chair of Postgraduate Medical Education and Training Board as part of the MMC inquiry. We also met the Human Tissue Authority at one of the informal Monday meetings.

34. In addition, we have considered proposals to establish new NDPBs, including the Care Quality Commission, NHS Medical Education England (as part of the Modernising Medical Careers inquiry) and, in our inquiry into the Next Stage Review, Lord Darzi's proposals for the establishment of an NHS Leadership Council, a National Quality Board and a Health Innovation Council.

TASK 8: SCRUTINY OF MAJOR APPOINTMENTS

35. Task eight is "to scrutinise major appointments made by the Department". In 2008, the Committee held a formal appointment hearing, according to the procedures agreed by the Liaison Committee, in respect of Baroness Young of Old Scone, the candidate for Chair of the CQC, questioning her about how she saw her role, her independence, her relevant expertise and experience and her priorities for the new organisation. Immediately after the meeting we published a report in which we concluded that Baroness Young was a suitable candidate.

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

36. Task nine is "to examine the implementation of legislation and major policy initiatives". Our inquiries into NICE, Modernising Medical Careers, Dental Services, The Appointment of the Chair of the Care Quality Commission and Foundation trusts and Monitor all considered major policy initiatives. Modernising Medical Careers and Dental Services looked at how and why a major initiative had failed. During the NICE inquiry, we examined the Institute's track record since its creation and the vigorous debates about the organisation's future role. Our examination of Foundation trusts and Monitor looked at whether these bodies, which were formed as part of a major reform, had fulfilled the Government's expectations of them.

Objective D: To assist the House in debate and decision

TASK 10: INFORMING PUBLIC DEBATE

37. Task ten requires us "to produce reports which are suitable for debate in the House, including Westminster Hall, or debating committees". Our reports on The Electronic Patient Record and NICE were debated in Westminster Hall on 21 February and 8 May 2008 and our Report on Dental Services was debated on an Estimates Day in the House on 16 December 2008. We were, however, intensely frustrated that no less than three Statements on that day meant that there were less than two hours for the whole debate and placed a severe limit on backbench speeches. Subsequently, the Government published a second response to the Report, in which it accepted our conclusions that access to dental services had deteriorated and establishing a review.[11]