§ Mr. Dobsonasked the Secretary of State for Social Services under what conditions National Health Service ambulances transport patients to private hospitals; how many such journeys were made in the last year for which figures are available; what was the total mileage travelled; how much income was generated by these journeys; and what was the average income per mile travelled by the ambulances.
§ Mr. John PattenSuitable transport, usually to the nearest National Health Service hospital, treatment centre or convalescent home, is provided by the ambulance service for any patient considered by a doctor, dentist or midwife to be medically unfit to travel by other means. On the same terms, the ambulance service is also available to transport patients to and from private nursing homes and hospitals as long as the distance involved is not materially greater than would be the case in travelling to or from the nearest appropriate NHS hospital. Subject to there being no detriment to NHS patients, a private patient who wishes to attend a more distant centre may be transported on condition that the actual cost of the additional mileage involved is met by the patient.
Information in the form requested is not collected centrally. Following are the data available for 1983 in relation to ambulance service journeys carrying non-NHS patients (ie, to both NHS hospital premises as private patients and to non-NHS establishments).
Ambulance services—Non-NHS patients 1983—England Thousand Number of patient journeys* Mileage 141 1,157 * A 'patient journey' is the carriage of one patient in one direction.
§ Mr. Dobsonasked the Secretary of State for Social Services whether, when district health authorities enter into contractual arrangements so that National Health Service patients are treated in private clinics by consultants who normally work in the districts' own hospitals, those consultants are (a) expected to carry out the operations as part of their contractual obligations, (b) paid private fees by the health authority, (c) paid by the clinics or (d) donate their services.
§ Mr. Kenneth ClarkeThe nature of the contractual arrangement between the health authority and the private clinic determines the method of payment for medical services.
- a. If the agreement with the private establishment provides for the National Health Service to supply medical services, then it is for the health authority to arrange for consultants to carry out the work as part of their duties.
- b. There is no arrangement whereby fees can be paid by health authorities for consultants to work in private institutions over and above their normal salaries.
- c. Where the agreement with the private institution leaves it to that institution to supply the medical services, then it is for the private institution to recruit and pay the
65 medical staff. NHS consultants may undertake this work and be paid accordingly, subject to the limitations on private practice in their NHS contracts, and providing priority is given to NHS work. - d. It is open to NHS consultants to donate their services as they wish, provided they first meet their contractual obligations to the NHS.
§ Mr. Dobsonasked the Secretary of State for Social Services whether consultants are entitled to participate in discussions concerning the possibility of district health authorities entering into contracts with private clinics for the treatment of National Health Service patients when the consultants (a) practise at or (b) hold shares in those clinics.
§ Mr. Kenneth ClarkeStanding orders of health authorities provide for the declaration of interests by members and staff. They are required to notify the health authority of any financial interest they may have or relationship with a manufacturer, supplier, or contractor with whom the authority is, or is likely, to enter into a contractual relationship, and of any financial or other interest which may affect the authority's planning or policy decisions. This includes individuals holding posts as consultants to firms. Any individual whose advice is specifically sought by the authority in relation to any commercial transaction where such an interest arises is required to declare that interest.
§ Mr. Dobsonasked the Secretary of State for Social Services whether health authorities are entitled to enter into contractual arrangements so that National Health Service patients are treated in private clinics by consultants who hold shares in those clinics yet who normally work in the districts' own hospitals.
§ Mr. Kenneth ClarkeYes. Provision for the use of non-National Health Service facilities to provide, or assist in providing, NHS services is contained in section 23 of the National Health Service Act 1977. There is no statutory limit to the extent to which this power can be exercised, and health authorities are free to negotiate contractual arrangements with any type of independent establishment.
§ Mr. Dobsonasked the Secretary of State for Social Services if he will place in the Library documents setting out the formulae and figures used to calculate the present charges to private non-resident patients under section 66 of the National Health Service Act 1977.
§ Mr. Kenneth ClarkeI will arrange for a suitable note to be prepared and placed in the Library.
§ Mr. Dobsonasked the Secretary of State for Social Services what percentage of the weighted unit cost per inpatient day as used in the calculation of pay bed charges to patients not paying consultants' fees separately is attributable to medical pay.
§ Mr. Kenneth Clarke5.2 per cent. in classes A-C2, and 6.6 per cent. in classes D-G.
§ Mr. Dobsonasked the Secretary of State for Social Services what was the cost to his Department of the audit inquiries into the handling of private patient fees.
§ Mr. Kenneth ClarkeThe cost of staff time devoted by our Department's auditors to the special review of the handling of private patient charges in England is estimated at £130,000. The effect was to delay completion of the66W annual audit of health authorities' accounts for 1983–84 by about two weeks which will he recouped during the current year.
§ Mr. Dobsonasked the Secretary of State for Social Services in how many years since 1970 the expected cost movements used in the calculation of pay bed charges were (a) above, (b) below and (c) equal to the actual cost movements.
§ Mr. Kenneth ClarkeThis information is not readily available and could be assembled only at disproportionate cost.
§ Mr. Dobsonasked the Secretary of State for Social Services why no allowance is made for the costs of his own Department in calculating pay bed charges.
§ Mr. Kenneth ClarkeWe have included such an element in the calculation of private patient charges for 1985–86.
§ Mr. Dobsonasked the Secretary of State for Social Services why pay bed charges are weighted to reflect private patient occupancy rates; and what effect this has on the charges.
§ Mr. Kenneth ClarkeThe hospitals making up the different classes have different unit costs. The average cost per bed day is weighted to reflect the pattern of bed use by private patients within each class. Thus, if private patients occupy more beds in higher costing hospitals, this will be reflected in the charge for that class of hospital. The reverse also applies. The effect will be to raise or lower charges accordingly.
When weighting was introduced in 1982 it was estimated that the effect on charges would be to increase them on average by about 5 per cent.
§ Mr. Dobsonasked the Secretary of State for Social Services if he will give separately for the latest available year the total income from charges made under section 65(1) and under section 65(2), respectively, of the National Health Service Act 1977.
§ Mr. Kenneth ClarkeThis information is not recorded separately.
§ Mr. Dobsonasked the Secretary of State for Social Services if he will indicate the extent to which the calculation of the 3 per cent. addition to the weighted unit cost per inpatient day in the determination of pay bed charges takes account of the 4.44 per cent. proportion of health authorities' turnover in 1982–83 which was accounted for by administrative costs.
§ Mr. Kenneth ClarkeThe 3 per cent. addition in the calculation of pay bed charges for 1984–85 covers health authority administration costs, hospital management costs having already been included in the basic cost per patient day. The management costs identified as 4.44 per cent. of turnover in 1982–83 included health authority and hospital management costs.