|Health and Social Care Bill
Mr. Hammond: I shall not try your patience, Mr. Maxton, by going over ground that we have covered previously. The clause develops the process of centralisation and the potential for micro-management of the service. We all know that he who pays the piper calls the tune. If the Secretary of State has large funds at his disposalespecially if they are to be dispensed in a discretionary fashion, which was the import of the previous debatethroughout the service there will be an ethic of doing what the Secretary of State wants. That may not always be the right thing to do in the view of the clinicians working within the service, and it may not reflect local priorities, which, at one stage, under the Secretary of State's predecessor, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), the Government were anxious to emphasise.
The clause will have two practical effects. First, it may distort clinical priorities, as health service managers focus their budgets on achieving the criteria that have been set. This morning, I quoted an example from a health authority in just such a situation. That will lead, in some cases, to the sickest patients not receiving the highest priority within the service, which in our view would always be wrong.
Secondly, the traffic-light systemthe identification of a group of trusts as failingwill lead to a further decline in staff morale. In a minute, I will ask the Minister again, for the third time today, how many trusts he expects to be categorised as red. It is inconceivable that his Department does not have an idea of how many health authorities and trusts are likely to qualify as red in the initial appraisal. I have talked to people in health authorities who know jolly well that those authorities will qualify as red.
That will have an effect on staff morale and the recruitment of clinical staff, nurses and doctors. It may have an even bigger effect on the recruitment of management. Who would want to enter an organisation that is publicly recognised as failing? Typically, in private enterprise, when an organisation is in that position, one would expect people to be brought in to turn it round and to be paid at premium rates. Indeed, in the public sector, in the case of the dome, the Government discovered that it was necessary to pay people premium rates to sort it out when it all went wrong.
It might appear perverse to increase the salaries of managers in failing trusts as against those in successful trusts, but without that incentive it is unlikely that top-flight managers will be attracted to a much more difficult and potentially thankless task in a failing trust rather than staying in a successful green-light trust.
Although much has been written and talked about the likely location of the failing health authorities and trusts that will get the red light, they will not always be in areas of deprivation. It is likely that quite a lot of those trusts and health authorities will be in deprived areas, for the reasons that the hon. Member for Lancaster and Wyre outlined earlier, but it is also the case that on most of the criteria set out in the consultation document, my own health authority in west Surrey, which is not noted as a deprived area, would probably be classified red under the Government's current proposals. That is because of its serious financial problems and the consequent underperformance in many areas, as it attempted to achieve the financial targets that were imposed upon it.
Under the Government's proposals, health authorities and trusts will find themselves veering from one direction to the next as they attempt to meet the Government's criteria. Clinical lead times are relatively long, and I fear that the Government will change the criteria that they ask health authorities and trusts to follow with rather more frequency than might be ideal for the efficient operation of the service.
Let me ask the Minister some specific questions that have not been covered so far in the debate on clause 2. Can he confirm that the grading of health authorities and trusts into red, yellow and green categories will always be as a result of a Commission for Health Improvement evaluation that is carried out on a transparent basis, and not as a result of a discretionary decision by the Secretary of State? Will there be any appeal mechanism for a trust that believes it has been unfairly or inappropriately categorised to institute a review of its categorisation?
As our amendments Nos. 67 and 68 were rejected, will the Minister give us an assurance that, by one mechanism or anotherthe hon. Member for Sutton and Cheam (Mr. Burstow) suggested some form of statutory notification of the local oversight bodies and we have suggested a requirement to publishthe workings of this whole process will be open and available to public scrutiny at the time, so that the date of the information will be available? Finally, will he tell us how many health authorities and trusts the Government expect there to be in the first wave of red-light allocations? Will there be tens or hundreds? Clearly, it will not be hundreds of health authorities, as there are not hundreds of health authorities, but a clear indication of the numbers would be extremely helpful.
The Government told us that competition in the NHS was destructive, yet this model will promote competition between health bodies, encouraging them to vie with each other for the coveted green lights. It will not lead to a model of health service provision that is more focused on patients, but to one that is more focused on doing the Secretary of State's immediate bidding. It will not encourage NHS staff to feel comfortable in their surroundings, and despite the Minister's rhetoric, there are no provisions that will obviously encourage co-operation between NHS bodies. Indeed, it will have precisely the opposite effect.
In my view, the clauses under consideration today do not provide adequate accountability for the increasing sums that will be distributed by the Secretary of State on what appears to be a discretionary basis. While we accept the principle that some allocation of funding on the basis of performance is sensible, we should have grave concerns about the wording in the Bill and the absence of any proper checks and accountability mechanisms for the large sums of money that will be at his disposal.
Mr. Burstow: I want briefly to pick up a couple of points that my hon. Friend the Member for Isle of Wight (Dr. Brand) touched upon and to develop one or two others that occurred to me as I listened to the debate. I should explain that my hon. Friend is in the Chamber taking part in the debate on the Shipman inquiry. While the performance management system is entirely right for a managed system such as the NHS to develop, we must be careful about the language that we choose to use within that system as it inevitably leads to a great deal of interest in looking for and emphasising failure.
I am not arguing that we should not seek to improve the performance of those who are not delivering the best health outcomes, but we should be aware that our actions can lead to a downward spiral in terms of lower motivation and ultimately, as my hon. Friend said earlier, to a lack of additional resources to address the reasons for the failure of performance. We must not proceed along a path that simply turns this into a question of how many authorities will be in the red-light zone, which in turn will be the headline in the next edition of the Daily Mail. The system should not just punish failure, but should drive up the quality of services. Some of the comments so far imply that our aim is to punish failure.
Mr. Hammond: Any Government, of any colour, will have a political imperative to ensure that the number of green-light organisations rises while the number of red-light organisations falls. No Government will want to admit that during their tenure of office the number of red lights doubled and the number of green lights halved.
Mr. Burstow: The hon. Gentleman's helpful intervention leads me on to my next pointI am not sure whether he managed to ask the Minister about this. What lies behind the idea that we need to have fixed proportions, at least initially, within the various colours of light: green, amber and red? It would be far better to base them on merit, rather than on an initial assumption. Given that the Department has already collected most of the data that forms the basis for the criteria and the objectives, has it run the criteria against the existing data? If so, will it at some point publish that information as I am sure that it could inform our deliberations, and it would certainly be helpful on Report and in the other place?
Finally, who will collect the data, how will it be analysed and who will present it? The Minister referred to the central role of the Commission for Health Improvement in the process. I felt that he was arguing that CHI would give the process a degree of transparency and independence from inappropriate ministerial interference. Can the Minister say a little more about the collection of the data? Will it inform the process and enable assessments to be made? Will CHI take that role or will the Department continue to collect the data, as it does now, through the regions and the NHS Executive?
It would be useful to have some clarity on that. If CHI is to collect the data, I hope that the Minister will give us some assurances that it will be under an obligation in the public interest to publish that information at the earliest opportunity.
I am concerned that some data that the Department of Health collects through surveys that it currently undertakes is not always published. Quite recently, in an answer to a parliamentary question that I had tabled seeking information about the loss of nursing home beds between October 1999 and October 2000, I was told that[Interruption.]
|©Parliamentary copyright 2001||Prepared 23 January 2001|