Increased resources to improve public services; a progress report on departments' preparations (HC 552-i) Public Accounts Committee 26 Apr 2004

Evidence given by Mr David Normington CB, Permanent Secretary, Department for Education and Skills, Sir Nigel Crisp KCB, Permanent Secretary, Department of Health and Chief Executive, National Health Service and Mr David Rowlands CB, Permanent Secretary, Department for Transport.

Q48 Mr. Gerry Steinberg (City of Durham): I just want to put on record that I prepared these questions before this article appeared in the Sunday Times newspaper. In fact I prepared these questions watching Sunderland play Wigan on Sky on Saturday afternoon. If any of these questions look as though they have come from the Sunday Times, they have not. I tell you what; if they had come to me they would have got a better report than the one they put in the paper, that is certain. What does baffle me is that for the last few years we have been told that the government have been increasing resources, considerably increasing resources, particularly in Health and in Education, yet continuously, when I go round my constituency and in my postbag, I am told by the professionals and by the users, the customers, that there is no difference. They do not see any changes in the service at all; they do not see any improvements. Why is that? I know that millions have gone in since 1997, so why do they not see any changes?

Sir Nigel Crisp: It is a very hard question to answer. There are undoubtedly improvements which anyone could point to, including just the simple things like NHS Direct. This is a new service used by approaching seven million people a year with very high customer satisfaction rates. I suspect that if I take that simple example, people do not take that as something on which the money has gone. I also from time to time stand in hospitals with people telling me they do not know where the money has gone to, whilst I am standing next to a large building site and it is fairly obvious but people cannot see it. People are not connecting up the improvements which are being made. Let me also make the other big point here which is that it is not yet good enough. The reason I and others feel passionate in the way Mr Sheridan wanted me to be about this is that these are real improvements, they are happening, they are happening because people are working very hard, a lot of people are very passionate about getting this right, but we still have a long way to go. We are now up to the world standard in some things, but there are others where we have further to go. People are still looking at those and not at the others.

Q49 Mr. Gerry Steinberg (City of Durham): I suspect that the vast majority of MPs participated on Friday in MPs Back to School. I went into two primary schools and was shown around. I was shown around by this head teacher who showed me a room which was a porch in 1997 where he hung coats for kids. That is what it was. Now it is a room, a quarter the size of this one, with about 25 to 30 computers in it. Yet they have the audacity to say that there have been no improvements in the education service. Jim Sheridan is absolutely right: it's the press who cause the problems and there is no doubt about that at all. It is about time somebody told them, because they only produce stories for their own political gain and their own political philosophies. That article in the Sunday Times was partly true, that is all, partly true. The newspapers set the agenda. They talk about the parties spinning but they are the biggest spinners. Jim Sheridan is absolutely right. They told people that things are bad, but things are not bad. You mentioned the people's perceptions. MORI did a survey which asked "How do you perceive the Health Service". 80% said it was rubbish; 80% said the Health Service was rubbish. The same groups of people were then asked and from those who had actually had service from the Health Service 80% said it was fantastic. Why is that? Why did the 80% who have not experienced the Health Service say it is rubbish and the 80% who have experienced it say it is excellent? I tell you why it is: it is because of them over there.

Mr Normington: May I say something about education? To say something positive about the press, the local press often write the positive stories about what is happening locally. If you look at what parents think about schools, they often overwhelmingly think well of improvements in their local school; they do not think the whole education system is improving. There are very, very positive results about primary schools, less so about secondary, but still positive. If you talk to head teachers and teachers, I too have that experience because lots of schools have exactly that experience of the school being flooded with computers in the middle of a big new building project and people saying they have seen no improvement. I have that all the time. Nevertheless, it is the case in all the public services that the ambitions of those professionals ... They always have great plans for the next phase so they sort of take for granted where they have got to and they are looking to the next stage. I do not really blame them for that because that means they have ambition.

Q50 Mr. Gerry Steinberg (City of Durham): I could be completely wrong. You could be spinning me a load of bull to be quite honest. The situation could in fact be that the government are putting billions of pounds of resources in, but are those resources actually getting to the chalk face? Give us examples of where the resources are getting to the chalk face? Paragraph 8, page 5 of the report tells us that in 2003-04 the government's lack of resources caused a huge furore throughout the country, did it not? But in the report it actually says that a lot of the schools are now saying that it was not government's fault, it was the fault of local education authorities because they had not allocated the resources correctly. How can you be sure that all these billions of pounds you are getting, £60 billion over the next three years, are actually going to go to the chalk face, are actually going to be used to improve services? Are you confident? Do you have faith in the local delivery of services?

Mr Normington: I have reasonable confidence.

Q51 Mr. Gerry Steinberg (City of Durham): It is out of your hands, is it not, once you have given them the money?

Mr Normington: In fact over the next two years we are placing quite a lot of requirements on local authorities about the minimum levels they should spend on education and how they should pass that on to schools. We are actually requiring most of the money to be passed on to schools. Then we are looking at the outcomes. In the end it is whether the results are going up, whether the improvements are being seen in terms of the achievements of the children? That is what it is all about. They are, but there is still quite a lot more to be done. I am confident that in this next phase particularly we shall see almost all the money going into the front line.

Q52 Mr. Gerry Steinberg (City of Durham): Can the three of you give us some examples of where there have been obvious improvements in the service because of the money which has actually gone in? Give us some examples.

Sir Nigel Crisp: Big increases in staff, big reductions ---

Q53 Mr. Gerry Steinberg (City of Durham): I could argue that is bureaucracy.

Sir Nigel Crisp: Nurses, big increases in the use of statins, big falls in waiting times, big improvements in mortality from cancer and coronary heart disease. These are all big issues and real improvements.

Mr Normington: For me 24,000 extra teachers, 60,000 extra teaching assistants over the lifetime of the government, seven times more spending on capital and at last getting to grips with the refurbishment of schools; exam results going up every year at GCSE, which is a very critical phase, by between 1% and 2% every year; although we have had this plateauing at Key Stage 2, 12% improvement in the proportion of children who can now read, write and add up at 11. That is a fantastic achievement.

Q54 Mr. Gerry Steinberg (City of Durham): Railways?

Mr Rowlands: Those who have suffered the agonies of the West Coast Main Line ---

Q55 Mr. Gerry Steinberg (City of Durham): After being an hour late this afternoon, I would not fancy your luck on that one.

Mr Rowlands: From September a new timetable cutting the best part of half an hour off the journey to Manchester and Glasgow, Pendolinos replacing all the existing stock, south of the river 1,700 40-year-old life-expired carriages all going, 700 new ones in there already. It is happening. The problem with railways is the timeframes for some of these projects. You cannot change it overnight.

Mr. Gerry Steinberg (City of Durham): The local delivery of services is what we are talking about. I notice the report says that everybody should see a doctor within two days of wanting to see one. This is what really aggravates me, because it is all to do with local delivery of services. In my constituency there is a doctors' practice where you can see a doctor within 24 hours because of the system they use. In another practice you cannot see a doctor for six weeks because of the system they use; that is probably a bit of an exaggeration. Again it is down to local delivery of services. It is not in your hands.

The Committee suspended from 5.28 p.m. to 5.38 p.m. for a division in the House

Q56 Mr. Gerry Steinberg (City of Durham): Why is it that in the same constituency within a radius of six or seven miles you can have one doctors' surgery where you can see a doctor within 24 hours and in another one it takes over a week? That means that it is nothing to do with resources, it is to do with organisation in a local delivery situation and it is about time we centralised rather than all this decentralisation.

Sir Nigel Crisp: The answer to your question is that we are not there yet. Around the country at the moment - and we shall publish the figure for the end of March shortly - in well over 90% of the country, in well over 90% of the practices, you can see a primary care professional within 24 hours and a GP within 48 hours. So the one you are talking about is one of the 10% which still needs to change. We have a very big programme called the primary care collaborative which is rolling out ---

Q57 Mr. Gerry Steinberg (City of Durham): Yes, but why should I have to receive a letter saying my government is rubbish because they cannot see a doctor for a week, yet a mile down the road a person can see a doctor within 24 hours. That is not the government's fault; it is the total incompetence of the people who are delivering the services locally. How can government be held responsible for that and why do you not do something about it?

Sir Nigel Crisp: We are, if I may put it like that. We have a management responsibility for what is happening within the NHS and we have identified this, as you have, as one of the big issues for the public. We have therefore put in a programme which took off about two and a half years ago, where the position was that in a lot of primary care places you could not get to see a doctor within two days. We are now up to 90%; the target is 100% by December everywhere. So in your reply to the letter you can no doubt explain that to your constituent. I am pretty confident that we will get there.

+++

Q138 Mr. Gerry Steinberg (City of Durham): I am sorry to bore you and go back onto the topic I was on, but what I have heard this afternoon gives me no great confidence. Do not get me wrong, I think the public service has improved and I think it has improved greatly, there is no doubt about that at all. You only have to walk into a hospital, you only have to walk into a school to see that. What worries me is that it is not £60 billion worth of improvements. For £60 billion it should smack you in the face as you walk round your constituencies and I am not sure that it is doing that or will do that. Of course there is plenty of time to go. We are also told by the National Audit Office in the report that progress by departments has been very mixed in terms of achieving their targets, which has to be very, very worrying. If you cannot deliver your targets, then clearly the services are not going to be improved to that extent. The point I am making is that what worries me even more is that it is basically out of your hands; it is with the local delivery of services and with Mr Rowlands it is perhaps even worse - I do not mean this to be derogatory to the private sector - because you are in the hands of the private sector as well, are you not, in fact I would suspect almost all your work is in the private sector? How can the three of you be certain that these organisations at local level are going to deliver and how are you going to ensure that they actually deliver?

Sir Nigel Crisp: There is a track record in part. We have had the same mechanisms for the last four years and when I produce this report next week it will show four years of continuous progress against our targets and against what is being measured. That is a very good way of concluding whether or not we are getting it right or not. That does not mean to say that it is not complicated.

Mr Normington: We know the performance of every school in the country. We know which are the strong, which are the medium, which are the weak. There is no difference between us and the local authorities here in focusing on those who need to improve their performance quite hard, including tackling their leadership and the quality of the staff. In the end in the education system, the quality of the leadership and the quality of the staff are everything, but we know an awful lot more than we have ever done about where the weaknesses are and that can give you confidence. What will smack you in the face in the next 10 to 15 years is that you will see the refurbishment of the secondary school estate, you will see modern, well equipped secondary schools everywhere. That is the commitment the government has made and that will smack a lot of people in the face.

Mr Rowlands: On roads, the Highways Agency now thoroughly assesses the capability of its contractors and consultants and factors that into the tender lists which they draw up. On railways, the old style franchises were not right. The new style franchises will deliver the type of performance you are looking for. The first of those got under way on the Greater Anglia franchise this month.

This is an uncorrected transcript of evidence taken in public and reported to the House. The transcript has been placed on the internet on the authority of the Committee. Neither witnesses nor Members have had the opportunity to correct the record. The transcript is not yet an approved formal record of these proceedings.