8 February 2007
Thank you for all your webchat questions to the Health Secretary. Mrs Hewitt answered as many as she could in the time available. Sorry if she didn’t manage to answer yours. Watch out for more policy review webchats with senior Cabinet members coming soon.
Read the transcript
Moderator says: Thank you for joining our public services webchat. We’ve had more than 600 questions for Patricia Hewitt. We’ll get through as many as we can in the hour we have.
Patricia says: Hello! Thank you so much for joining me today. The best thing about being Health Secretary is the chance to go round our country seeing the superb work that NHS staff are doing, day in, day out, in hospitals and communities. Of course, there are problems - and we’re doing our best to tackle them. But there is also so much to be proud of too - and it’s frustrating when we don’t always hear about it. And now for your questions …
Becky Tregidgo: I would like to know where Patricia Hewit sees the position of general practice in the next 10 years . Colleagues negotiated a new contract over a prolonged consultation period that was signed and agreed by the government.This was in response to a recruiting crisis in general practice and the low morale of the workforce .We are a profession who over the last 10 years have watched their role extend considerably and were over worked and under resourced. The latest " headlines and Gp bashing " in the press all points to a political spin, and the suggestion the government made an error, for which it is trying to blame GPS . The implication is that the government is trying to push gps ,(as a previous government did the dentists into leaving the NHS.) .
Patricia replies: Far from wanting GPs to leave the NHS, we have already got over 4,000 more GPs than we had ten years ago. We are paying them more - and quite right too, since the main reason is that GPs and their colleagues - like community nurses - are doing far more to prevent ill-health and to support people with long-term conditions so they don’t end up in hospital. There is an issue about the increase in profit that GPs are getting from the new contract, and we’re discussing that with the BMA to ensure that we go on getting value for the public’s money. But GPs and their staff will be an increasingly important part of the NHS - and we are giving them even more responsibility and freedom to ensure that they get the best possible care for theri patients from NHS budgets (through practice-based commissioning).
Sheila Holmes: The NHS has been subjected to changes and re-organisations since the 1970s. The current re-organisation is the most traumatic ever and the morale of the field level staff is at an all time low. Why does the Health Secretary not understand that the changes must be allowed time to settle before she makes even more ‘adjustments’?
Patricia replies: I really do understand that every change is difficult for staff. It sounds as if you’re talking about the recent reorganisation of Primary Care Trusts. There were several reasons why we asked PCTs to look at their structure and decide if they needed to change. We had some PCTs wanting to merge, but not being allowed to. We had others who couldn’t find the chief executive or other senior person they needed and were already sharing staff. Patients were saying they wanted the NHS to work far more closely with local social care services - and that’s difficult when the NHS doesn’t have the same organisational boundaries as the local council. And with GPs taking more responsibility for commissioning, we didn’t necessarily need so many small PCTs. So it did make sense to re-organise, and cut management overheads in the process. I know that is difficult for staff, particularly for people who have lost their job … but it will also give us another £250 milion a year to put into front-line care.
Mik Norman: Every time a public service such as health is restructured it causes massive disruption to the service itself, to the morale of the workforce and to continuity of partnership working. It therefore mitigates AGAINST, not for, effective partnership working. Staff are there one day and their posts "restructured" the next. Their natural tendency is therefore to look inward, not outward. Would you not agree that this policy of constant change is actively working against the avowed government ideals of joined-up thinking and community cohesion?
Patricia replies: As I said to Sheila Holmes, I really do understand the problems youi’re talking about. But I am also hearing from staff in many parts of the country who are saying how much easier it is for the council and the NHS to work together now they have the same boudnaries. In my own city of Leicester, for instance, almost everyone agreed that it was far more sensible to have one PCT instead of two - adn although that was very difficult for the staff affected, they couldn’t have been more professional in the way they handled the change. And both the PCT and the council say it’s already working much better.
Claire Formby: I am a newly qualified physiotherapist who would be willing to travel anywhere in the country for a job, I achieved consistently high marks throughout university and have had much work experience. Yet I, like 70% of this years physiotherapy graduates am unable to find a job in the NHS. Why?
Patricia replies: I know there is a real problem with newly qualified physiotherapists (and other professions) at the moment, and I’ve met several people in the same position as yourself. We have checked the position with the local NHS and been told that of the 1,619 physio graduates, 630 - about 40% - have got jobs. But it does vary a great deal from place to place, which is why we have asked NHS Employers to work with CSP in each region to try and find posts. For instance, in West Yorkshire, a number of newly qualifeid physios are working as community care officers for local councils, helping to support hospital discharge. We’re also asking hospitals to do more to move existing staff up into more senior jobs - where there are more vacancies - to make space for newly qualified staff. This problem is a top priority for the Social Partnership Forum, which we have recently strengthened as a result of discussions with CSP and the other unions. I do hope you succeed in getting a job very soon.
Isabel Green: The aging population is putting increasing strain on the already tight local authority funding. With elderly population numbers set to rise significantly over the next 50 years, how will the mismatch between need for care provision and funding available be resolved?
Patricia replies:
This is one of the most important issues facing the NHS and social care services - not just in Britain but in every developed country. We do have to get much smarter about how we use taxpayers’ money to support elderly people, for instance with integrated teams of social care workers, community nurses physios and others who can support people in their own home. In Dudley, for instance, they have created a superb community nursing service that looks after people with long term conditions. I met an elderly man with very serious heart disease: in the year before the new service, he’d been in hospital as an emergency admissions 6 or 7 times; in the first year of the new service, he hadn’t been in hospital at all and he said the new service had transformed his life. The result is that emergency admissions have been slashed … and the new Dudley hospital has just over 600 beds, compared with over 900 in the old hospital. Fewer beds - but much better quality of life for elderly people - and better value for money. As we look ahead longer term, though, with more and more people living far longer, we will need to think as a society about how we share the costs between individuals, families and society as a whole through taxes.
By the way, someone’s asked whether I’m really here. Yes, I am! And I’m writing and typing my answers (thanks to the time I spent as a temp typist when I was younger!)
George Wells: Do you honestly and truly think that New Labour after pouring in all this taxpayers money into the NHS without any checks or balances has actually improved anything?
Patricia replies: We have put in a great deal - more than doubled already compared with 1997, and it will have trebled by next year. And yes, we are seeing real improvements as a result of the investment and the reforms we’ve made. Waiting times down to their lowest levels ever - and almost no-one waiting more than 6 months for an operation like a hip replacement that people used to wait 18 months or even two years for in the old days. Cancer care transformed - almost every patient who’s urgently referred by a GP with suspected cancer now seen and started on treatment within just 62 days - and over 50,000 more people alive today because of better care. A&E departments far better - just remember those appalling trolley waits in corridors for 24 hours or longer. And 9 out of 10 patients telling us they are satisfied with their care. I think NHS staff should be very proud of these achievements … and they ought to get much more credit from the media, even though of course there is still more to do.
Amanda Butler: Could you tell me what is being done about the ongoing postcode lottery? It seems ridiculous that people have to move house so that they are in an area where that particular PCT will fund certain treatments. I refer in particular to the item in the press last week regarding the gentleman who was moving over the border to Scotland in order to receive cancer treatment. Thank you.
Patricia replies: The biggest thing we’ve done to deal with the postcode lottery is to set national standards (like shorter waiting times for operations) and set up NICE - the National Institute for Health and Clinical Excellence - to evaluate new drugs and treatments. Once NICE says that a particular drug should be used, then the NHS has to make it available to all patients whose doctors prescribe it, in every part of England, usually within 3 months. As a result, new cancer drugs are spreading through the NHS much faster than they used to.(Scotland, Wales and Northern Ireland - where health is devolved - usually follow NICE guidance too.) But a problem does arise before NICE completes its evaluation when it is up to the local NHS - through Primary Care Trusts and their clinically-led professional executive committees - to decide on a case-by-case basis whether a particular drug should be funded by the NHS. In some cases, the Scottish Medicines Committee makes its decision before NICE (because their evaluation isn’t so thorough), and different PCTs may take different views. That is why we have speeded up NICE’s work so that their evaluation is ready as quickly as possible after a new drug is licensed.
Peter Hinchliffe: What implications does the comprehensive spending review have on the NHS services within the regions?
Patricia replies: We haven’t yet finalised the comprehensive spending review, which will decide how much money we invest in the NHS after April 2008. But over the last several years, we have put record investment in the NHS, to make up for the shocking under-funding of the previous two decades - and by April 2008, after another year of record growth - we will have pretty much caught up with European average healthcare funding, as we said we would. So we will not need to continue with the same unprecedented levels of growth - although the NHS budget will continue to grow faster than the economy as a whole. That means we need to continue making sure that the NHS gives the best possible value in return for the extra contributions we’ve asked people to pay. We know, for instance, that if every hospital did as well as the top 25% - for instance, in day case surgery and getting patients home as soon as they ready - the NHS could save over £2 billion, which we can then use for new drugs and other services.
Kate Eveleigh: Considering that the NHS do not control the causes of ill-health, will there be any shift in funding of public health initiatives to Public Services which do influence health?
Patricia replies: You are absolutely right about the need to invest more in measures like stop smoking programmes, promoting exercise and healthy eating. Compared with many other rich countries, we still spend a very small proportion of our total health service budget on public health - although that is now changing. One of the biggest challenges facing the NHS, and most other health services, is the epidemic of ‘lifestyle diseases’ - the rise in diabetes, for instance, even amongst younger people, which is a direct result of too much junk food, drinking too much and exercising too little. We have just issued thousands of pedometers to 250 schools, to help promote walking. This investment of £495,000 will help improve activity rates in young people. On the 1st July, England will go smoke-free in all enclosed public places - a huge step forward for public health. And the NHS ‘5 a day’ campaign is really helping - we’ve just seen the new figures that show families on average spending far more on fresh fruit and veg, far less on take-away food.
susan smith: How far is Ms Hewitts’ nearest Accident and Emergency Department to her current residence? How many minutes does it take to drive there? How would she feel if these services were taken away and she had to travel over 40 minutes to her nearest A and E for live saving treatment?.
Patricia replies: Because I divide my home between two cities - Leicester and London - I’m reasonably close to A&E’s in both areas. But what I’ve learnt is that, because of the way medicine is changing, the life-saving treatment we may need - for instance if my husband had a heart attack - isn’t necessarily going to be at my local hospital. These days, if you have a heart attack, the best treatment is for the highly skilled paramedics in the ambulance to do the initial tests and stabilise you - and then rush you to the specialist hospital where they have a 24/7 team of surgeons, anaesthetists and other specialists ready to do a ‘primary angioplasty’ - the operation that unblocks the artery and saves your life. That treatment simply can’t be available in every local hospital, because thankfully there aren’t enough patients who need it. But going further - in a road or air ambulance - is more likely to save your life. That’s not ‘downgrading’ your local A&E, because it will still be needed for other injuries - but it is definitely improving services. We recently published two fascinating reports from Sir George Alberti, our clinical director for emergency care, and Professor Roger Boyle, clinical director for heart and stroke, that explain all this in vivid detail. If you’re interested, they are on our website - www.dh.gov.uk
ANDREW GRAY: Choose and Book has become a way for hospitals to manage their waiting lists, not a way for increasing choice. Hospitals are taking whole departments off-line when they are approaching a 14 week wait time. 2 fridays ago, there wer no available Orthopaedic appts from Bedford anywhere. Is this what you intended? If not, what are you proposing to do about this?
Patricia replies: Hi Andrew. Thanks for drawing this to my attention. I’m not sure what is behind the problem you mention in Bedford, so I’ll check back on it. More generally, more and more patients are telling us they’re being offered a choice - already, patients can choose from over 100 different hospitals, and that will go up to over 200 in the summer. Obviously, most people will probably want their local hospital - but some will want to go elsewhere, for personal reasons, or simply to get faster treatment. The growing number of GP practices where the computerised Choose and Book system is available are generally telling us it’s working well - and patients love it - but even where it isn’t yet up and running, patients can book directly. The more we can give patients appointments that they’ve chosen - instead of simply being sent one by the hospital - the more we can cut the ‘did not attends’ that cost the NHS that cost so much.
Simon Rippon: Why can I not get access to an NHS Dentist within 15 miles of my home? It seems all my local Dentists are only interested in private health care, when will this issue of demand/capacity and choice be tackeld head on - the new contracting arrrangements seem unhelpful to me as a consumer!
Patricia replies: Hi Simon. I don’t know where you live, but I would urge you to ring your local NHS - the Primary Care Trust - to find out what they’re doing about this problem. Most dentists are self-employed businesses and we can’t force them to work in a particular place or indeed take NHS patients at all. But the new contract we’ve put in place last April already means that far more people can get access to an NHS dentist … and in a number of places that were particularly short of dentists, the PCT is directly employing dentists or bringing in new practices to deal with the problem. Indeed, we’ve taken on about 1500 new dentists over the last year or so.
dilys baldwin: Hello,
i’m speaking on behalf of lots of carers looking after very sick loved ones.My husband for the past 5yrs as been living with cancer doing so with the help from very dovoted nurses from hospice.what plans do the government have for hospice and the funding for the future.I would like to hear that it’s funding is going to be set at a sustainable level so that hospice can go on supporting all of us who need it without the worry of loss of income.Dilys
Patricia replies: Hello Dilys. Thank you so much for your question - since it affects thousands of families with carers. Hospice nurses and others working in palliative care are doing a brilliant job for people like your husband, and I’m so glad that you are benefiting from this. Obviously, many hospices have been set up as charities and it is wonderful that they can get such support from local communities. But we are also looking at how we can increase NHS funding for hospices and hospice-at-home services, so that more people can benefit - and fewer people die in hospital when they don’t want to. Our development of NHS community specialist nurses can also help people be supported in their own home - something carers like yourself want to see.
Mark Collins: One of the biggest challenges facing the NHS, and most other health services, is the epidemic of ‘lifestyle diseases’ - the rise in diabetes, Community Pharmacists are ideally placed to identify screen and support patients with long term conditions, how do you propose to use them better
Patricia replies: Hi Mark. You’re absolutely right about community pharmacists. We’re already using them to do more prevention and support for people with long-term conditions. For instance, a lot are offering stop smoking services and medication reviews. More and more are installing small consulting rooms so they can give advice and immediate treatment. In London, we’ve been trialling chlamydia screening in Boots - which is working really well with young women (though it’s a problem getting young men in!) And we certainly intend to do more, because it works so well for patients.
mornhy: Your answer relating to mental health is interesting, but I find it sad that in your own area of Leicester, Leicestershire and Rutland there is no allocation to tackle mental health by public health as the region struggles to cope financial cuts. How can this be seen as acceptable given the economic impact that many research studies has shown will impact on Britain as a whole and mental illness increases. Mental health seems to be important providing no money is spent on it.
Patricia replies: Hi Mornhy. I’m sure you’re right that the NHS in Leicester, Leicestershire and Rutland should be investing more in mental health services. But as you say, there is a real problem with over-spending in this area - despite the fact that Leicester in particular, gets more money per head than many other places, in recognition of the fact that local people generally have much worse health. But it clearly isn’t fair if one area overspends - and then has to be bailed out by other NHS services in other parts of the East Midlands. So it is absolutely right that Leicester University Hospitals Trust and the local PCTs are making difficult decisions to move more services out of hospital and into the community - for instance, more GPs and community nurses doing diagnostic tests and out-patient apopintments - which is more convenient for patients and also better value for money. I’ve seen that working very well in other places, and I want that for my own constituents in Leicester West. It’s only by making the best possible use of every £ of the public’s money we put into the NHS that we will get the money we need for better mental health services (and new drugs as well).
rose reuben: Why are nurses or anyone working in hospitals allowed to wear their uniforms when travelling to work? Is this not another way of picking up and passing on germs to patients?
Patricia replies: Hi Rose. It is up to each hospital to set its own uniform policy. Many hospitals have very strict rules that nurses are not allowed to wear uniforms travelling to and from work. I checked the point about germs with our Chief Nursing Officer, Professor Chris Beasley, and she was very clear that provided uniforms are properly laundered, there is no evidence that bugs like MRSA are carried via uniforms to patients. To deal with MRSA and other bugs like Chlostridium difficile, every hospital has to make sure it has a comprehensive infection control process - including hand-washing, alcohol gel and so on. We have set rigorous targets for reducing MRSA and C-Dif rates in our hospitals and are investing time and money to ensure hospital-acquired infections are significantly reduced.
rod newell: the welsh assembly are bringing foreward nil presription charges for allwhat is to stop people from england crossing into wales and getting their medicine free and is this not going to cost the nhs a lot of money it cant afford
Patricia replies: Hi Rod. In England, nearly 9 out of 10 prescriptions are already free (it’s only about 50% of people who are exempt, but they are generally the people who need the most medicine.) Because health is devolved, it’s up to the Welsh Assembly to decide how to use their money. But English patients won’t be able to get their prescription free in Wales - it depends on where they live and are registered with their GP.
Listra Daniel: How are nurses supposed to feel valued and survive with the 1.5% pay rise planned?
Patricia replies: Hi Listra. We haven’t yet had the report from the Pay Review Body for nurses and of course we will want to look very closely at what they recommend. But it is important to remember that the ‘headline’ pay rise is only part of the total pay increase. Thanks to Agenda for Change, most NHS staff also get annual increments which can double the pay rise. And of course NHS staff have already had substantial pay rises in recent years - and quite right too, given how under-paid NHS staff used to be - indeed, NHS pay has been going up generally faster than in the private sector. Given the financial difficulties that have emerged in the NHS, we do need to balance pay rises for staff with other needs, like the number of staff the NHS employs, or staff pensions - or paying for new drugs.
Keith Cowan: If and when there is a human flu pandemic can you assure us that the Health Departments at UK and devolved administration level will be ready both to deal with the issues raised by the pandemic and to continue with their regular business.
Patricia replies: Hi Keith. Just last week, I was taking part in the most recent stage of a major planning exercise on a possible pandemic, which is taking place over several weeks. That gives us the chance to test our plans - which the World Health Organisation say are amongst the most advanced in the world - against a possible ‘worst case’ scenario. Already, we have stockpiled enough Tamiflu to treat a quarter of the population (which is the likely infection rate in a bad pandemic). And we have made very detailed plans for how to protect the most vulnerable people and enable essential services - like utilities and health workers - to continue despite many staff being ill.
James Peak: Do you still agree that 2006 was the "best year ever" for the NHS?
Patricia replies: Hi James. From the patients’ point of view, there is no doubt that the NHS treated more patients, faster and better than ever before, and saved more lives. And despite the financial difficulties - which have created real problems for NHS staff - the improvements have continued, with waiting lists falling to their lowest level for instance. At the same time, the NHS has transformed cancer care: 1 in 3 people referred by their GP urgently with suspected cancer used to have to wait far too long to be seen by aspecialist, diagnosed and started on treatment. Now, 95% of patients in this position go from GP to starting treatment within just 62 days … and that is saving more people’s lives. I think that’s an extraordinary achievement by NHS staff - which we almost never hear about in the media - and it was achieved despite the financial problems. By the end of March, when I’m confident the NHS will be back in overall financial balance, patients can look forward to even faster treatment and other improvements.
Patricia says: Hi! Thank you so much for joining me in this web-cast. I’d have loved to answer more questions, but I hope I’ve covered most of the issues people were most concerned about. The NHS is probably the fairest health services in the world - it’s part of what makes us all proud to be British. But it’s changing - and changing fast - because medicine and society are changing so fast. We have to make sure we can keep up with the needs of an elderly population and pay for all the new drugs that people rightly expect. We know that better care for patients and better value for the public’s money go hand in hand. That’s why we are willing to make the difficult decisions that are needed to protect the NHS for another generation. And can I particularly thank all of you who work in the NHS or social care … you are doing a superb job, often in very difficult conditions. Thank you.
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