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7.23 pm
Mrs. Caroline Spelman (Meriden): I add my congratulations to those of my colleagues to the new Economic Secretary to the Treasury. May I reassure her
that we are in no doubt that she is a human being? I also congratulate the Committee on its excellent report, which recognises the growing role of statistics in the political process.
Nowhere is that more true than in health, the subject on which I speak, and which I would like to draw into the debate. Statistics are critical in measuring performance, determining the allocation of resources and setting policy targets--all uses of statistics that were singled out by the Select Committee.
A Government's performance on health is seen as a barometer of their overall success or failure, so the use of statistics to demonstrate relative success or failure will have an important effect on the future electoral chances of any Government. I therefore argue strongly the case for health statistics to be taken into the ambit of the Office for National Statistics.
As we know, the ONS does not collect centrally data on health or expenditure on health. As a relatively new politician, I say that there is a need for independent collation of statistics, so as to allow more objective assessment. There are many areas in which the Department of Health does not publish national data, despite the fact that we are talking about a national health service. As a former member of the Select Committee on Science and Technology, I inquired about the booking system for the maternity services required at the time of the new millennium, and the crisis that we may face at the end of the year. When I asked about the additional number of bookings for women due to have babies at the time of the date change, I was told that the information was not available centrally.
I found that frustrating in my work, because I was trying to assess whether there had been a rapid increase in demand for maternity services at that time, and to assess the sort of provision that had been made in our national health service.
Many other important health statistics are not collected centrally. So as to be even-handed, and in case my point about the lack of centrally collected data might appear partisan, I did a little research on questions asked by Members from other parties.
The hon. Member for Newport, West (Mr. Flynn) asked a question about MRSA. I shall not attempt to pronounce the full version of that term, but it is a drug-resistant infection by the staphylococcus bacterium. When the hon. Gentleman asked for the basic statistical information about the number of infections by that bacterium, the response was:
Another important national issue is the high rate of abortions in this country, about which questions have been asked by Members in all parts of the House. Specifically, the hon. Member for Richmond Park (Dr. Tonge) wanted to know the cost to the national health service of abortions carried out in the first trimester. She received the same sort of reply--that the information requested was not centrally collected. That is another example of an important area of the national health service's responsibility in which it is difficult for Members of Parliament to carry out their work and make assessments based on nationally collected data.
Another important question--indeed, it was raised by the Opposition during Health questions today--is the rise in the instance of autism, and whether there is any correlation between that and the introduction of the triple vaccine for mumps, measles and rubella. The hon. Member for Warrington, South (Ms Southworth) once asked how many health authorities held a database with detailed information about how many people had autism. Again, she received the dry reply:
As several hon. Members have said, statistics about patients waiting for treatment in the national health service have become something of a political football. In that regard, the trust in statistical information that has been mentioned has been called into question. There is a huge temptation for Governments to manipulate statistics to meet political targets.
In closely examining the use of waiting lists, we have discovered that not a little use of smoke and mirrors is being practised. It transpires that there are main waiting lists, subsidiary waiting lists and lists of people who are not on any lists at all. Only the main list counts, and it concerns the time that somebody waits between seeing a specialist and getting treatment.
The officially collected statistics on the waiting list of patients in the national health service take no account of the number of people who are waiting to get on the waiting list. According to the Government's own statistics, that number is about 190,000, which is an increase of 140,000 since they came to power. That staggering increase in the number of out-patients who are waiting to get on to the list has arisen as a direct result of the Government's attempts to reduce the main waiting list. It creates great confusion for people who are waiting for treatment and whose experience does not match the vaunted claims about falling waiting lists.
There has been a policy of removing certain patients from the list, and that has been done by creating a subsidiary list. There are several examples of that practice around the country, but I shall just use one of them, which is sufficient to make my point. A memorandum from the Bradford Hospitals NHS trust states:
Certain operations are being collated on an alternative list, which does not count in the overall tally. It is significant that this ruse started in June 1998, which was the month when the numbers on the main list supposedly began to fall.
We are also beginning to see the use of time-efficient operations--as opposed to more complex operations--to manipulate the figures. The trouble is that, if the target is to reduce statistically the number of patients on the list, that will have a huge impact on clinical priorities. It is a fact that to reduce the numbers on the main waiting list, there has had to be an increase in the number of minor conditions that are treated. If all cases of in-growing toenails are treated quickly, that will reduce the size of the list, whereas if the operations that are carried out are for cardiac by-passes, which take longer, are more expensive and reduce the budget, the wait will be much longer. My right hon. Friend the Member for Fareham (Sir P. Lloyd) pointed out that this use of statistics distorts priorities for health care. Not only do we deplore that, but, in the decision of the new Secretary of State for Health to have what he called a change of tack and to put fresh emphasis on the treatment of cancer and heart disease, we detect a recognition on his part that clinical priorities have been distorted by attempts to reduce the waiting list statistically.
Mr. Desmond Swayne (New Forest, West):
Does my hon. Friend agree that it is not only clinical priorities that have been distorted, but the figures for NHS personnel? Will she comment on the British Medical Association's discovery yesterday that the announced additional400 consultants are already in the system?
Mrs. Spelman:
I was going to come to that, because it is another example of the "Jack Straw style of creative accounting" to show the number of people working in a public service.
The statistical debate on waiting lists has obscured the facts about how long people are actually waiting. That is all that matters to a patient. They do not want to know how many people are in front of them or behind them on the waiting list: they want to know how long it will take. It is hard for an ordinary person to get that information. That is yet another case for having health data collected, collated and published through the Office for National Statistics.
There has been a large increase in the number of people waiting more than a year to be seen. The figure is up from 30,000 to 48,300 since the election, which is an increase of 61 per cent. in two years. During the past two years, the number of patients waiting to be seen after being referred to a specialist has also increased.
MPs have recourse to the House of Commons Library and, if requested by our constituents, we can obtain information. In March 1999, in response to a request from a constituent, I asked the Library about the number of people waiting more than 13 weeks for treatment. The figure given to me was 248,000. By June 1999, that figure had risen to 485,000, so between March 1999 and June 1999 there was an increase of 84 per cent. That statistic shows what happens when clinical priorities are distorted so as to produce a reduction in the headline figure for the main waiting list.
The House of Commons Library has also given me the figure for the number of patients still waiting for more than 13 weeks. The number of people who have waited 13 weeks or more has increased by 115 per cent. The average waiting time is a more useful statistical measure of the performance of the national health service,
and closer to people's experience of treatment under the NHS. The average waiting time between being referred to, and being seen by, a specialist has gone up from six to seven weeks. Without an independent official statistical source, it is difficult to get such information into the public domain.
Although the Government have said today that, with only 30,000 to go, they are on target to meet their promised reduction in the in-patient waiting list, the number of people on the out-patient waiting list is steadily increasing. It will be easy for the Government to achieve their target and to pronounce that their early election pledge has been fulfilled, but it will not reflect the true position or people's real experience of having to wait longer to be seen and, on average, to be treated.
Other statistics for the health service have been quoted, such as the 400 extra specialists. The new Secretary of State was quoted in The Guardian as saying that they were extra resources, but only a day later that was denied by the BMA. In fact, those specialists are already training in the system. The correction of such information by the profession concerned does nothing to build trust in the use of statistics by Departments.
The use of statistics in a misleading way can undermine trust. The new Secretary of State announced that the £15 million was new money, but it is not new money: it is part of the £21 billion allocated to the health service in the spending review that was announced by his predecessor. The money is new only in the sense that it will not be borrowed from other NHS departments. That nuance is lost on the public. When it becomes the subject of a debate about the truth of the matter, public confidence in the initial statements is undermined.
I want to make a strong case for the inclusion of health statistics in the remit of a reformed Office for National Statistics, rather than leaving their publication to the Home Department. The right hon. Member for North Durham (Mr. Radice) said that the collection of statistics should be free from political interference. Nowhere is that more true than in the health service.
I could not agree more with the recommendation that the decision about which data the ONS ought to publish should lie with a statistician outside Government.A cursory reading of the White--or black--Paper led me to identify only one item that troubled me greatly. I read very clearly that it was the Minister who would decide, and that leaves me dissatisfied. I fear that insufficient independence will be involved in the remit for data collection--in decisions about what should be collected, and about how it should be published--if the final decision rests with the Minister. I fear that the temptation will be too great for the Home Department to restrict access to information which, as my hon. Friend the Member for West Dorset (Mr. Letwin) pointed out, could prove inconvenient to Government if it came out.
"there are no centrally held statistics on deaths from this cause."--[Official Report, 5 May 1998; Vol. 311, c. 352.]
That would have frustrated him in his work as a Member of the House in trying to get to the bottom of the subject.
"The information requested is not held centrally."--[Official Report, 9 June 1998; Vol. 313, c. 539.]
All those examples show how difficult it is for Parliament and parliamentarians, whether they are on the Government or the Opposition side, to carry out their work when data concerning our national health service are not centrally collected.
"Following new NHS guidelines, patients on waiting lists for operations to remove metalwork are not to be included in the monthly returns. To enable us to identify patients more easily, a new list '05' has been set up."
One wonders what list 05 is. One thing is for certain, it does not appear in the headline figure for the waiting list of patients by which the Government invite the electorate to judge their performance. That causes me considerable disquiet as a parliamentarian, because the people on the 05 list have disappeared from the national statistics that we have received from the Government and that have been used as a measure of their performance.
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