Standing Committee E
Tuesday 23 January 2001
(Afternoon)
[Mr. John Maxton in the Chair]
Clause 2
Payments relating to past performance
Amendment proposed [this day]: No 67, in page 3, line 5, at end insert—
`(3CC) The Secretary of State shall within 28 days of notifying objectives or criteria to Health Authorities publish details of them as—
(i) objectives to be met in performing their functions; and
(ii) criteria relevant to the satisfactory performance of their functions
together with details of the methods of measuring their performance against those objectives and criteria which he will use in assessing them for payments of further sums to them in accordance with subsection (3C) above.'.
4.45 pm
Question again proposed, That the amendment be made.
The Chairman: I remind the Committee that with this we are taking amendment No. 68, in page 3, line 5, at end insert—
`(3CC) The Secretary of State shall publish annually a report detailing, in respect of each Health Authority to which he has made payments under subsection (3C) above—
(a) the objectives notified to that Health Authority under (3C)(a) above; and
(b) the criteria notified to that Health Authority under paragraph (3C)(b) above; and
(c) the methods of measuring their performance which he has used in assessing them for payment of further sums in accordance with subsection (3C) above; and
(d) his assessment of their performance against the objectives notified in accordance with paragraph (3C)(a) above and the criteria notified in accordance with paragraph (3C)(b) above; and
(e) the further sums paid to them in accordance with subsection (3C) above.'
Perhaps it would be convenient for the Committee if I let right hon. and hon. Members know that I intend breaking for dinner at 7 pm and resuming at 8 pm. However, that is flexible and if it appears that we can finish today's business within a reasonable time scale—15 or 20 minutes—we will continue until we have finished.
The Minister of State, Department of Health (Mr. John Denham): Before lunch, the hon. Member for Runnymede and Weybridge (Mr. Hammond) made several points about the amendments, which are essentially concerned with the publication of information. He made further points about the two-week waits for cancer patients and the financial element in the performance assessment framework. We are moving the NHS on to a much sounder basis of performance assessment, as promised in our manifesto, so that all issues of interest to the patient are considered. We criticise the previous Administration because they focused on financial matters to the exclusion of clinical or patient issues.
Right hon. and hon. Members who have had an opportunity to look at the consultation document that we circulated last week will have seen the indicative spider diagrams at the back of that document. They illustrate how different types of performance can be taken into account in assessing health organisations. They show how health outcomes, health improvement, fair access to services, effective delivery of appropriate care, efficiency and the experiences of patients and carers can all be taken into account in judging the progress of individual organisations.
That is an important element in the performance framework that we are setting out for the NHS. We are consulting on the detail of that with the paper that was published last week. It is right that financial performance should be considered, but it should not be the only criterion. That is the big change that we have made, as compared with the previous Administration.
The introduction of the two-week cancer referral target was an important first step in improving the speed with which patients move through the system. I am sure that the hon. Gentleman will recognise that the national cancer plan, which was drawn up last autumn, took us much further forward. We are focusing on the whole process of treating cancer patients—not just on the point of referral, but on the point of treatment, and we are setting targets. That work—led by the national cancer director, who is a leading clinician, with the support of experts from across the field—has been widely welcomed in the health service as laying the basis for better cancer services in future. We have also taken that approach in other clinical areas.
We are laying down, year on year, an increasingly robust framework for performance assessment. It is true that, at the moment, we do not have all the information that we would like to be available for assessment, but every year more data is collected and published than ever before about the performance of the NHS and individual organisations. That is the background to the two amendments.
Amendment No. 67 would require the Secretary of State to publish details of the objectives, criteria and methods of measuring the performance of health authorities within 28 days of notifying them to health authorities. The amendment is unnecessary. First, health authorities are already informed of their objectives for each year in a letter that sets out the priorities for the year ahead, which is publicly available.
Secondly, anyone can request details of individual health authority objectives for the year. As I said earlier, the precise method of measuring health authority performance against some criteria may not be notified to health authorities at the same time as the criteria. I shall not repeat the arguments advanced in earlier debates.
Mr. Philip Hammond (Runnymede and Weybridge): Is the Minister saying that the Secretary of State will notify objectives or criteria to health authorities only at the time of the annual letter? Will there be no opportunity for him to issue additional criteria or objectives at a later date?
Mr. Denham: I am not saying that the only opportunity to indicate how performance may be measured is at the time of the allocation. The clause allows flexibility for in-year performance to be taken into account. Health authorities may need to be notified of the criteria to be taken into account, but in some circumstances it will not be possible for the exact measurement of those criteria to be made simultaneously or necessarily within the 28-day period in the amendment.
Mr. Hammond: I accept what the Minister said, but a few minutes ago he said, in effect, that the amendment was redundant because health authorities would be notified of the criteria in writing. Is he saying that the Secretary of State will not issue supplementary criteria or objectives? The amendment was designed to take account of circumstances in which the Secretary of State, under the terms of the clause, may wish to issue supplementary, in-year criteria or objectives. Is the Minister ruling that out?
Mr. Denham: No, I cannot rule out that possibility. The hon. Gentleman is right to say that it might be necessary.
Amendment No. 68 would require the Secretary of State to publish annually details of the objective criteria and the method of measuring the performance of health authorities, his assessment of their performance and the further sums paid to them. We could not accept the previous amendment on the basis of policy and we reject this amendment because there is no need for it. The NHS plan set out proposals for the annual publication of the results of performance assessment; it forms the basis of the health authorities' objectives and the measurement of a variety of indicators. Publication will be the responsibility of the Commission for Health Improvement, in association with the Audit Commission. The Commission for Health Improvement will have a role in validating the traffic-light system to prevent the arbitrary allocation of individual trusts to a particular level in that system.
The performance assessment framework will show how each health authority and NHS trust performs during the year and present a comprehensive picture of its overall performance against its objectives for the year and against other indicators. Publication by the Commission for Health Improvement will show the public that the assessment results are genuine and independent. The amount that a health authority receives from the performance fund each year will be in the public domain and available on request.
Mr. Hammond: If the amendment were accepted, there would be a single-source document stating the criteria set, the measurement methods, the Secretary of State's assessment and the payment made. It would thus be possible to compare health authorities and to judge how they performed against common criteria and objectives. The amendment would ensure that such information was readily available; there would be a level playing field and health authorities would have even-handed treatment.
Mr. Denham: The information necessary to assess the operation of the performance fund, the distribution of funds and the assessment of criteria will be in the public domain and enable that exercise to take place. The Government have no intention to deceive about the process and we are not convinced of the need to adopt the amendment. I believe that the information will be available. However, I will consider the points that the hon. Gentleman has made, to make sure that the assurances that I am giving him are correct.
Mr. Hammond: On amendment No. 67, the Minister has accepted the possibility that the Secretary of State would wish to issue supplementary criteria, or objectives to a health authority. He said that the Government had no wish to conceal anything, but would it not be possible—in the absence of amendment No. 67—that people who had a business to know would not be aware of the criteria to which a health authority was working, if the Secretary of State had issued supplementary criteria, and they were not contained in a published letter? We are asking for an assurance that whenever new criteria or objectives are set, they immediately become public information, so that everyone understands what is driving a particular health authority.
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