Health Select Committee

Posts Tagged ‘Health Select Committee’

NHS reform plans - key MPs’ committee critical

BBC Health - 22nd January 2012 9:35 am

Government plans for reforming the NHS in England are set to be criticised by an influential group of MPs.

The cross-party Commons health select committee is this week expected to say major changes, such as the abolition of primary care trusts, are obstructing efforts to save billions of pounds.

One member of the Conservative-led group said there was now huge pressure on health secretary Andrew Lansley.

The committee is said to have concluded that the plans are making it more difficult to achieve the target of £20bn efficiency savings by 2014-15. However, minister’s aides said £7bn savings had already been made and re-invested.

“Revalidation must identify problem doctors earlier”

By Mike Broad - 27th July 2011 10:08 pm

The cross-party health select committee has released a report evaluating the performance of the GMC and Nursing and Midwifery Council (NMC) generally, and the progress of revalidation more specifically.

Here’s a summary of its recommendations:

1. The committee recognises that the GMC achieves a high level of operational competence, but it remains concerned that the leadership function of the GMC within the medical profession, and within the wider health community, remains underdeveloped particularly in the areas of fitness to practise, revalidation, education and training and voluntary erasure.

2. The work undertaken by the Society of Cardiothoracic Surgery of Great Britain and Ireland in setting standards for that part of the medical profession is commendable. Its transparency will be welcomed by patients and should be a template for further refinement of the revalidation process.

3. The GMC clearly has a considerable amount of work to undertake between now and the implementation of revalidation in 2012. Although we agree that all disciplines will not have developed their standards to an advanced level by that date, the GMC needs to accelerate its work with the medical royal colleges to further refine the standards for revalidation in specialist areas and to ensure that the process is meaningful to clinicians and transparent to the public.

4. The GMC needs to ensure that it monitors the number of doctors who retire, leave the profession, have conditions placed on their practice or fail revalidation. It must develop and share this evidence with employers to ensure that future workforce planning includes the developing outcome of the revalidation process.

5. Of the officers who will have to make recommendations about revalidating doctors, only a minority feel that the process will help with the early identification of doctors with performance issues. Early identification of problem doctors is a core task of the professional regulatory system, and the GMC needs to ensure that its systems of appraisal and revalidation achieve this task.

6. The committee notes the negative media reports about the time taken to undertake revalidation and hopes that the GMC will ensure that lessons are learned from the revalidation pilots, particularly in how it can support locum doctors. It also needs to ensure that the underlying processes that doctors are expected to undertake are not unwieldy and overly time-consuming, and that they are an effective means of gathering the required evidence.

7. Doctors from the European Economic Area and Switzerland seeking to practice in the UK cannot routinely be language and competence tested by the GMC. The GMC along with the government is working towards resolution of this with partner organisations across Europe. The committee takes the view that current legal framework is at odds with good clinical practice, which is clearly unacceptable. The GMC has plans, within the boundaries of UK law and the EU Directive, to manage the constraints on language and competence testing by using the Responsible Officer role to establish that EEA (the EU plus several other European countries) doctors are fit to practise in the UK. The committee accepts this way forward as a short term measure.

The committee looks to the government, GMC and the relevant European bodies to work as a matter of urgency to produce a long-term solution to this problem.

8. The committee notes that there is an increase in referrals of doctors to the GMC, and of nurses to the NMC, as well as an increase in the number of general NHS complaints. It is welcome that the GMC has commissioned research into this phenomenon in order to better understand what is driving this increase, and to ensure that their systems and processes are adequate for meeting the future needs of the public.

9. The committee welcomes the ongoing good performance of the GMC in resolving 90% fitness to practise cases within fifteen months. However, we agree with the GMC that fifteen months is indeed too long to conclude such cases and we recommend that the Council for Healthcare Regulatory Excellence (CHRE), its regulatory body, should set the GMC a more demanding target for future years.

10. Some of the decisions made by fitness to practise panels of the GMC defy logic and go against the core task of the GMC in maintaining the confidence of its stakeholders. Furthermore, they put the public at risk of poor medical practice.

We urge that performance management of fitness to practise panellists commence as soon as is practicable.

11. The GMC currently has no right of appeal over decisions made by independent fitness to practise panels. The committee does not seek to undermine the existing power of appeal held by the Commission for Healthcare Regulatory Excellence, but agrees that the GMC needs also to have a right of appeal in cases where it thinks panellists have been too lenient. We urge the government to move quickly to make the necessary legislative amendments.

12. Doctors from Mid Staffordshire NHS Foundation Trust whose practice was in itself blameless but who failed to act and raise concerns about colleagues are now also under investigation by the GMC. A clear signal needs to be sent by the GMC to doctors that they are at as much risk of being investigated by their regulator for failing to report concerns about a fellow registrant as they are from poor practice on their own part.

13. The committee recognises, however that doctors and other practitioners who have raised concerns by other staff have sometimes been subject to suspension, dismissal or other sanctions. The committee therefore intends to examine this issue in more detail in due course.

14. We suggest that the GMC further considers risk-based approaches to proactive regulation and how these could be developed with its employer liaison services.

15. The committee appreciates the seriousness with which the GMC has treated the suggestion that doctors from black and minority ethnic backgrounds are over-represented in fitness to practise cases. The finding that this relates to overseas trained doctors and not ethnicity per se does not alter the fact that a problem exists.

The GMC needs, as matter of urgency, to do more to understand the risks associated with overseas-qualified doctors. It should offer timely induction and needs to assure itself that those doctors in peripatetic locum positions are adequately supervised and supported. If a doctor is not safe to practise in the UK then the GMC must ensure that they do not do so.

16. Several cases have been brought to the attention of the committee of doctors applying to remove themselves from the register during an ongoing investigation into their practice by the GMC (so called voluntary erasure). The committee has no objection to the principle of voluntary erasure as it can be a useful tool to protect the public. However, in some cases, interested parties have been given little or no time to raise an objection to applications for voluntary erasure, and the GMC was not able to offer a clear explanation of this.

Applications for voluntary erasure must not be granted by the GMC unless interested parties have been given adequate notice of an application.

17. The committee fully supports the publication of the facts of any case of voluntary erasure where there is a fitness to practise allegation about the doctor concerned. The GMC needs to ensure that turning voluntary erasure into an admission of guilt does not have a perverse impact in reducing the numbers seeking it and therefore erode public protection.

Read the full report.

Tags: GMC, Health Select Committee, Revalidation
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“Spending plans test English NHS to the limit”

By Mike Broad - 14th December 2010 12:57 pm

Government spending plans will test the NHS and social services in England to the limit, according to a report by the Commons Health Select Committee.

The MPs say the plans assume efficiency savings on a scale never before seen in the NHS, or in other countries, and the government needs a “credible” plan to deliver them.

Committee chair Stephen Dorrell said the NHS had to save 4% a year for four years which was a “huge ask”.

Responding to the report, chair of BMA council Dr Hamish Meldrum said the NHS is already falling victim to cuts.

He said: “Doctors have been working hard to help identify how services can be delivered more efficiently without affecting patient care, and are at the forefront of leading innovation and improving services that will benefit patient and reduce costs. However, doctors are also seeing widespread cuts to staffing and services. There is evidence of posts being frozen and services rationed.

“Despite the Government’s pledge to protect the NHS budget, it would appear that the sums are wrong and there is a now an additional shortfall of over £2 billion. NHS Employers has asked staff to plug this gap by hammering their pay even further. Yet there are whole areas of NHS expenditure that seem to have special protection, such as commercial returns on investments in new drugs and PFI projects, and it is estimated that around £3 billion will be spent on the planned reforms for the NHS.”

But Liberal Democrat Health Minister Paul Burstow said savings were already being made with reductions in the length of stays in hospital and the number of unplanned and unscheduled attendances at A&E departments.

NHS chief executive Sir David Nicholson has estimated the health service needs to make efficiency savings of between £15bn and £20bn over the next four years.

The select committee calls for the Department of Health to deliver a “credible plan” on where the efficiency gains will be made.

The BMA agrees. “We urge the government to give greater clarity and to explain to healthcare staff, professional bodies and patients, the true scale of the savings required and to ensure the service has a proper strategy as to how it is going to find them. The strategy must involve savings falling fairly across the NHS and not just targeting staff pay,” said Meldrum.

NHS Employers has written to all trades unions setting out proposals to freeze pay increments for all NHS staff for two years from 1 April 2011. This would be on top of the pay freeze that consultants are already experiencing.

The select committee also raised concerns over the government’s estimate of the cost of NHS re-organisation. The report says it is “it is unhelpful for the government to continue to use the figure of £1.7 billion which is the figure included in the NHS Operating Framework for 2010-11 which was published before the election of the current government”.

It’s also sceptical about the government’s belief that 40% of the efficiency gains demanded by David Nicholson can be achieved simply by reducing the tariff. “Although the committee recognises that opportunities exist for efficiency gain as the tariff is reduced, it is concerned that excessive reliance on this instrument will result in both quality reduction and crude cost shunting,” it says.

Read the full report on public expenditure.

Tags: Funding, Health policy, Health Select Committee
Posted in Hospital Dr News | 2 Comments »

Management consultant spend to be monitored

By Mike Broad - 31st October 2009 9:48 pm

The government is to start centrally monitoring the NHS’s expenditure on management consultants from next year.

Earlier this year, the health select committee strongly criticised the government for having little idea of how much the NHS spends on management consultants.

It’s estimated that that management consultants are charging up to £1,000 a day for advice and cost the NHS as much as £600 million in 2005/06.

The government last week conceded that it should collate overall expenditure on management consultancy but warned: “at present, the level of reporting is neither consistent nor complete across organisations. It is therefore the Department of Health’s intention to issue guidance to NHS organisations as part of the financial reporting manual for 2009/10 to bring consistency to this reporting.”

The government will not, however, monitor the day rates that management consultants charge as requested. “It is preferred practice to negotiate costs for a whole piece of work rather than agreeing individual day rates. This process provides protection from the financial risks being exposed if day rate based contracting is used. This makes provision of day rates impossible to provide,” it explained.

The health select committee also recommended that a sample of contracts with management consultants be subject to external peer review. This should include an assessment of the value of consultants’ output.

The government said responsibility for assessing value should rest with trusts and they should draw on the expertise of their non-executive board members.

“Nevertheless, as part the government’s ongoing drive to improve the transparency of NHS expenditure, it will examine steps organisation should be taking to understand the value that is being achieved through the expenditure on management consultancy,” it said.

A BMA spokesperson commented: “It’s good that we’re going to get a clearer idea of the sums being spent on management consultants. Recent estimates indicate that it’s £350 million a year by trusts in England, and around £150million by the DoH. That’s a huge amount of money to be spending on outside opinions at a time when front-line services are being targeted for funding cuts.

“This may be money well spent if it is delivering genuine improvements to the way hospitals operate, but as most doctors will tell you, some of the best ideas are coming from within the NHS, not from the private sector.”

Alan Leaman, chief executive of the Management Consultancies Association, commented: “Management consultants are providing a wide variety of benefits to the NHS, helping to improve patient care and reduce costs for the taxpayer.

“Besides some strategic and practical advice, this is most often about helping to find good solutions to problems and then getting them implemented. We support moves to greater transparency.”

Read a blog on management consultants.

Tags: Health Select Committee, Management consultants
Posted in Hospital Dr News | 3 Comments »

Health committee fear finances supercede safety

HSJ - 5th July 2009 8:34 pm

NHS boards “too often” prioritise governance, finances and targets above patient safety, the Commons health committee said today.

Its report on patient safety said progress had been made, citing health minister Lord Darzi’s next stage review and the creation of the National Patient Safety Agency.

However, it said not enough evidence was available about how much harm was being done to patients.

The committee found there was confusion about the role of different NHS bodies, particularly the Care Quality Commission and foundation trust regulator Monitor.

Cuts should also affect our private sector friends

By Mike Broad - 23rd June 2009 11:09 am

Everyone is aware that the NHS is screwed for funding for the foreseeable future.

Debate has raged over just how much the NHS is going to have to cut sorry, save through ‘efficiencies’ - but it’s going to be many billions.

We know this because we keep being told it. David Nicholson (you know the one, your boss, head honcho of the NHS) has been particularly active in the media warning that we’re all going to have to tighten our belts.

Fair enough. Though it does make his recent appearances in front of the health select committee (HSC) over the use of management consultants appear paradoxical.

It’s estimated that the NHS spends at least £600m a year on management consultants - and that’s a conservative guess. The truth is we don’t know hence the HSC’s interest.

In his first appearance in front of the HSC, in December 2008, Nicholson said all the right things. The HSC suggested that NHS should know centrally how much it is spending, and Nicholson agreed.

Nicholson also said that expenditure was set to fall in the first half of this year as they’d set up an internal consultancy that would perform the same role but using existing employees. Considering that some management consultants charge the NHS more than a £1,000 a day for their services, it makes a lot of sense.

However, Nicholson then changed his tune when he appeared in front of the HSC again a few months later. This time he was adamant that the Department of Health shouldn’t be monitoring the spend centrally - it amounted to micro-management. “We do not think it is the right thing to do,” he said.

Why did he change his mind? Presumably he decided there are enough checks and balances locally to ensure transparency and accountability around the use of management consultants. I don’t think there are.

Fortunately, the HSC urged the government to centrally record overall spend, and day rates, and coordinate the assessment of value.

The big management consultancy firms are very powerful, with their leading figures often advising - and sometimes sitting within - government. One could imagine that they wouldn’t want too much scrutiny around all their public sector contracts.

The common experience from the front-line is that management consultants come in and, with great fanfare, tell managers and senior doctors what they already know. It recently prompted Dr Jonathan Fielden, chair of the BMA’s consultants’ committee, to call for the NHS to stop using them altogether.

I don’t agree. Maybe they can be useful. Nicholson claimed they were instrumental in taking the NHS from deficit into surplus. But, we need more evidence on the value of their work.

I’d also like the HSC to throw a little light on the role of senior civil servants and their advisors within the Department of Health. There have been a steady stream of them - with some big name new additions - who have tub thumped for the introduction of the private sector into the NHS only to then move into that sector and benefit from the reforms.

I’m sure they’ve made their decisions for the right reasons - but we should have procedures in place to prove it.

Tags: David Nicholson, Health Select Committee, Management consultants
Posted in Dr Blogs | No Comments »

£600m spent on management consultants a year

The Guardian - 4th June 2009 5:41 pm

Management consultants are charging the NHS up to £1,000 a day for advice, and the health service has no way of knowing whether it is getting value for its money, a report by MPs warns today.

More than £300m was spent on outside advisers last year and probably as much as £600m in 2005-06, according to the Commons health committee report.

The study dismisses the explanation provided by the chief executive of the NHS, David Nicholson, that collecting the information would involve wasteful interference and centralised “micromanaging” of expenditure.