Presentation by Doug Naysmith MP
19th March 2005
The Health Select Committee has a formal structure and it has done some interesting work. Doug was appointed to the Committee four years after he entered the House.
This Committee is very popular with Labour MPs and there were 71 applications for 4 vacancies in 1997. Doug is in favour of evidence-based politics and the Committee fulfils a very useful role in this regard. The government has not always approved of its work.
The Committee has neither executive functions nor the power to change things. Members of the public can get involved by suggesting areas of policy that require investigation – through Committee members, the Committee chair and the Committee clerks. The Committee then selects a topic and takes evidence from interested parties, including both written and oral evidence.
If an enquiry is small, a research assistant who works for the Committee will produce a draft report. If it is a big enquiry, there will be a principled discussion before the draft report is published. The government has to respond to the Committee’s recommendations and say if it will accept them and, if not, provide reasons.
The composition of the Committee reflects the party balance in the House – currently it has seven Labour members, three Conservatives and one Liberal Democrat. At the start of the session the Tories gave one seat to Dr. Richard Taylor MP, who has been a very valuable and independent member of the Committee, so it is unlikely the Tories will offer him a place in the next session if he is re-elected. Neither will either of the other parties. The drawback of the Committee is the party influence and, although Committee members are not supposed to be whipped, this means that some reports may be softened at the edges.
Examining health policy and the funding of the NHS has been very interesting and exciting since 2001 and the work of the Committee has been very influential. Since 2001 there have been 19 inquiries, with two reports still to come – one on the pharmaceutical industry, with some very good things in it and some difficult matters. The government does not want to see this one published because of the forthcoming general election.
The Committee has four objectives:-
To examine and comment on Department of Health policy;
To examine the expenditure of the Department of Health (a mammoth task!);
To examine the administration of the Department of Health, including its executive agencies, regulators and non-departmental bodies;
To assist the House in debate and decision-making – which can be very difficult given the speed of some legislation.
It has been suggested that there should be two Health Committee working in parallel – there is enough work to justify this, but it is unlikely that the government will agree. The reports from the Health Select Committee are of a higher quality that those of most other Committees and its members have the best attendance record of any Committee.
Doug believes that the Labour government has three major achievements to its credit – the minimum wage, the establishment of the Foods Standards Agency and setting up NICE – a key component of the government’s quality agenda that is vital to support evidence-based medicine. The Select Committee would like in future to monitor the implementation of NICE recommendations and also look at technologies and whole treatments.
Key reports since 2001 include:
Obesity (as a result of this inquiry, Doug has lost two stone!). This has had the greatest impact of any report since Doug has been in parliament and it considered two volumes of evidence. The final report sets out a clear statement of the problem, its causes and makes recommendations to all areas of government and the food industry.
The Committee encountered many vested interests during this inquiry and took much expert evidence, including during trips abroad. It is assumed that the biggest obesity problem is in the USA, but the UK is fast catching up. There is a public health programme in Colorado – Colorado on the Move – with which everyone collaborates and which seems to be working. Lessons were also learned from Denmark and Finland about town planning for health. At the moment there is no motivation to walk and cities can be much better designed to suit walking and walkers. In Odense there are bike parks in the town centre and 75% of all journeys there now are by foot or on a bike.
The sources of the problem include children’s lunch boxes, a lack of exercise and sedentary work. Simple things like walking that last half-mile, using stairs rather than lifts, etc. are all promoted. Why are children eating the wrong things? For a start, because of advertising and food promotion. Work done by the Food Standards Agency shows that advertising does affect what children eat – and their parents are subject to similar influences.
One recommendation is for a time frame of three years for the industry voluntarily to regulate itself, otherwise regulation will be mandatory. The food industry will do as little as is necessary and the Committee unfortunately could not persuade the government to accept its recommendation for a traffic light labelling system, so instead there will be a review at the end of the three years. This sort of thing fuels fears of the nanny state in the media, but the obesity report is now on the university reading lists for trainee nutritionists – and it has also influenced the Choosing Health? white paper.
The thrombo-embolism report shows that people who go in for surgery tend to suffer from blood clots like those caused by long haul air travel. There are lots of precautions that hospitals can take. In the UK the death rate is four times higher than that for MRSA and other hospital-acquired infections. There is a pattern of orthopaedic surgery and discharge followed by death. Surgeons do not appear to be aware that this is preventable through drugs, elastic stockings, etc. Each hospital should have a committee to introduce measures to combat thrombo-embolism, but there has been no response from the government yet.
The role of the private sector in the NHS, which is still controversial, especially the requirement for 15% non-NHS service provision. There are also problems with the Private Financial Initiative, including bad planning and poor expertise, although they have improved since the government set up a unit in Richmond House to advise the PFI companies.
Maternity services, led by Julia Drown MP. A special sub committee was set up and three “niche” reports were produced.
Delayed discharges, where the most important recommendation is that one person should oversee the whole process of discharge. The Committee identified an exemplary scheme in Northampton, where a senior nurse has oversight both before the patient is admitted and before discharge. The government decision to charge local authorities for delayed discharges is not evidence-based, but it is probably sensible not to oppose this since it has worked well, although it may just have shifted the problems elsewhere.
The foundation hospitals enquiry. The Committee did not like them, still doesn’t like them and finds that the jury is still out on them. Mutual governance can only work in some areas.
Discussion
· The government has to respond to recommendations, but it sometimes gets wind of them in advance and may then cynically announce initiatives before a report is published, such as the recent £50 million boost for sexual health work.
· The Health Select Committee has no remit in Scotland; it does have a remit in Wales and to a lesser extent in Northern Ireland
· The Committee’s resources are two research assistants, one clerk , one assistant clerk and a secretary. Specialists are also brought in for each enquiry.
· The Committee does take evidence about children’s health services but it is not the Committee with responsibility for them. This matter needs to be clarified.
· Issues such as tracking the any loss of focus on public health as a result of the inclusion of the Health Development Agency in NICE after the arms length review, the implications of the cuts to the Health Protection Agency and the implications and consequences of the 15% non-NHS service provision are all areas that the Committee does not do well.
· The Committee does try to question every minister during each parliamentary year to cover all areas of work, but this is sporadic, with little follow up.
· The Committee has pointed out that school lunches in Scotland have to meet statutory standards and has advised the government that this is much better than the position in England. (The Jamie Oliver programme revealed that many children have never seen fruit and vegetables in the home and dinner ladies have never been trained in the preparation of vegetables.)
· The whips decide who will Chair the Committee.
· There is in fact a Cabinet level cross-departmental committee on public health, but has hardly met. The Secretary of State for Health chairs it. The Select Committee has emphasised to government that health is a cross-departmental matter.
Council thanked Doug very much for his interesting and excellent presentation.