SELECT COMMITTEE INQUIRY Devolution offers new freedoms - but DoH can intervene

Published: 16/12/2004, Volume II4, No. 5936 Page 8

Primary care trusts can make their own decisions about whether they want extra capacity from the private sector - but the government reserves the right to intervene if they get it wrong, MPs heard last week.

Department of Health director of delivery John Bacon and health secretary John Reid gave evidence last week at a health select committee inquiry on public expenditure. They were quizzed on the extent to which PCTs were free to make their own choices.

Mr Bacon told MPs that it was 'for individual PCTs to take the decision' to decide whether or not they need extra capacity under the government's national independent sector treatment programme.

But Mr Reid tempered Mr Bacon's statement by stressing that the government would 'still reserve a bit of a right [to intervene in a local decision] where self-interest is concerned'.

'If, for example, there is a particular group of surgeons who are opposed, we will take that into account in deciding whether to push or accept the local decision, ' he said.

Mr Bacon expanded on Mr Reid's comments by adding that 'if [strategic health authorities or PCTs] come back and say we want more or less capacity [in their area], then we are prepared to have these talks with them'.

During the discussions, Mr Bacon referred to 'last summer's kerfuffle around the Oxford PCTs' where plans for an independent treatment centre, part of the DoH's national chain of cataract centres run by South African corporation Netcare, were opposed by clinicians from the Oxford Eye Hospital and ultimately rejected by South West Oxfordshire PCT.

Although plans for the independent treatment centre went ahead, non-executive directors at the PCT claimed that they had been put under undue pressure to reach a positive decision.

However when pressed by committee member and Liberal Democrat MP for Cheadle Patsy Calton, Mr Bacon confirmed that PCTs would be obliged to offer a private sector option to patients as part of its choice menu by December 2005.

He added that the DoH 'would want to look at these plans to make sure that we meet the aspirations we have set for the NHS'.

Mr Bacon also said that PCTs should make public their decisions to increase capacity through independent contracts.

Asked about treatment centre capacity, Mr Reid told committee MPs that under the current ITC programme, both NHS and private sector ITCs would not be operating at 100 per cent capacity. 'Optimum treatment capacity would be between 82 and 85 per cent, ' he said.

Defending the fact that Londonbased NHS Elect treatment centres were operating below capacity, he said that the treatment centres should not operate at full capability because this would not utilise their resources most efficiently.

Mr Reid said that NHS treatment centres were currently operating at between 78 and 82 per cent capacity and he wanted to see this increased to 85 per cent.

'If we try to tackle MRSA, for example, it is much more difficult to do this if treatment centres are running at 95 per cent rather than 85 per cent, ' he added.

Mr Reid said his ultimate plan was to 'bring down the independent sector'.

'Patients will be able to choose from any hospital, private, charitable or NHS - all will meet NHS standards and prices - and it will be illegal to charge more than the NHS price'.

Mr Reid also admitted that the introduction of payment by results would 'increase the risk to any individual hospital', 'and that there will be a greater pressure [to perform well]'.