Health and Social Care Bill

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The Chairman: Order. There is a Division in the House. I am concerned about the amount of time we lose for these Divisions, so with the consent of Members and providing the Clerk is back, we shall resume in less than the normal quarter of an hour.

5.25 pm

Sitting suspended for a Division in the House.

5.38 pm

On resuming—

Mr. Burstow: I was questioning whether the Government would be as transparent as they ought to be about the provision of information. I cited the example of an answer that I received yesterday, which is published in Hansard today, in which the Department declined to publish information from a survey of nursing homes covering the year October 1999 to October 2000, on the grounds that that was not part of the usual national collection of statistics. It said that, as a consequence, the survey was merely intended to help Ministers to form a judgment about the local performance of the national health service. For that strange reason, it was unwilling to publish the information—the words used were, ``it would be inappropriate''. Perhaps that is the sort of answer that we shall get on such issues in future.

Finally, there is tension in a system that is managed by criteria that are set at the centre, but that seeks to be flexible in relating to local circumstances. I am thinking of health improvement programmes in particular. To what extent will the Government try to ensure that local health authorities will be effective partners with local government and other stakeholders in the local health economy in delivering health improvement programmes that are fit for the purpose according to local circumstances? That is perhaps harder to achieve with national targets set at the centre: it is about trying to make the health improvement programme fit with what appears to be coming from the centre.

It would be useful if the Minister could say how that tension between local and national priorities will be resolved within the traffic-light performance management system. We certainly subscribe to the view that there is a need to have a performance system. We have some concerns about the linkage of resources to such a system, and in particular, about the impact on the morale of those who find themselves categorised in the red-light zone.

Mr. Denham: I shall not repeat our earlier debate, but reply to some of the specific points that have been raised.The performance system that we have been discussing today, although it goes much wider than clause 2 is not about identifying and stigmatising failure. Rather, it is very much about rewarding and identifying success. The consultation paper that we published last week outlines a series of measures of greater freedom and autonomy that would be enjoyed by the best performing health authorities and trusts. At the same time, the Department would have the power to identify, intervene in and support organisations that are failing. My personal belief is that a performance regime should include incentives to encourage people to do better and provide the necessary support for failing organisations. Clause 2 is intended to help to achieve that.

Mr. Hammond: I should like to make sure that the Minister did not inadvertently mislead anybody when he talked about greater autonomy and greater freedom. I believe he means that organisations that are graded green will have the autonomy and freedom that all have at the moment and those who do not achieve that status will lose some of the freedom that they currently enjoy.

Mr. Denham: Clearly, the exercise of sending out the consultation document at the end of last week was just a waste of time, as the hon. Gentleman for Runnymede and Weybridge has not read it. It says that health organisations will have automatic access to discretionary capital funds without having to bid, greater freedom to decide on the local organisation of services, the ability to address the persistent failure of red-light organisations and lighter touch monitoring by the regional office. It refers to a series of other measures on which consultation is taking place, including ways of reducing progress monitoring and prescribed processes for service development, ways of introducing lighter touch routine monitoring, the ability to develop service strategies without regional office approvals and flexibility over land sales. It covers a whole series of measures which, compared with what is uniformly applied to all trusts today, would provide greater levels of freedom. Therefore, I stand by what I say.

Mr. Hammond: For the sake of clarification, will the Minister make it clear to the Committee which level of traffic-light grading represents the current position, so that we can see which trusts and health authorities will lose some of their autonomy and freedom and which ones will gain?

Mr. Denham: Those that are categorised as green-light trusts will enjoy enhanced autonomy, but I do not wish to suggest that that is not possible for those that are showing progress as yellow-light trusts. We want to have incentives throughout the system.

The reason why we are consulting with the service on the document is clear. The process will be seen by the service as an attempt to identify the parts of the current management process that appear to be unnecessary hindrances, bureaucratic obstacles or time consuming exercises, which in well-run trusts could be done away with, in whole or in part, to achieve greater freedom. That is what the exercise is about.

I now refer to the specific issues that were raised. First, I was asked whether the grading and the allocation would be the result of a Commission for Health Improvement evaluation. In other words, would the Commission for Health Improvement categorise health organisations? That is not exactly what we intend. We intend that the trusts should be allocated into red, yellow or green categories by the regional office, against published criteria that have been set out and notified and that the Commission for Health Improvement should validate that process. It will require further work, however. We recognise the need for a double check in the system against favouritism, arbitrary decision making or simply wrong decision making. For that reason we would look to the Commission for Health to validate the process.

Mr. Hammond: Will the Minister confirm that the Secretary of State will have no discretionary power to intervene in that process?

Mr. Denham: The Commission for Health Improvement is set up as an independent statutory body and the process of validation would be part of its role. The hon. Gentleman knows that, in legal terms, a regional office the embodiment of the Secretary of State. That is a minefield, but the intention is clearly for the process to be validated by the Commission for Health Improvement to ensure confidence in the operation of the system.

5.45 pm

The second question was whether an organisation might appeal against its grading. We are open to considering the responses to the consultation document but we have not yet envisaged a formal appeal process. In our experience of the publication of performance assessment frameworks, when somebody appears to be performing particularly badly he or she almost always immediately rings up and says, ``Actually, the data that we sent and that you published was completely wrong; if you had used the right data we would have been okay.'' It is reasonable to expect that if a trust finds that it has been graded less well than it would have liked and that there are flaws in the published data, it will be able to discuss that with the regional office, but the emphasis is on dealing with an organisation's problems rather than engaging the service in a major formal appeals process.

The question of public scrutiny came up several times. The data that would be used, whether for the core objectives or the wider set of objectives in the performance assessment framework, will clearly be published data. The Department already publishes data through the performance assessment framework. The data being used for the assessment will therefore be in the public domain.

The hon. Member for Sutton and Cheam asked who would collect the data. The data are overwhelmingly information that is produced by the health service in exercising its normal management; as he knows, the health service generates far more data than is collected centrally and published. Data would be collected by the Department of Health but, as an additional safeguard, the responsibility for publication of the performance assessment framework data will be transferred from the Department to the Commission for Health Improvement so that the latter organisation has the opportunity to assure itself of the validity of the data being published. The existing route for the collection of the data is in practice the only sensible route and would continue to be used.

The final point raised by the hon. Member for Sutton and Cheam was about health improvement programmes. They are an important part of the planning process and we want health improvement programmes to reflect local as well as national priorities. In practice, many of the indicators that we have suggested for the performance assessment framework deal with the sorts of issues that one would expect to be the outcome measures of the health improvement programme. They do not necessarily specify how health improvement should be achieved but will look at the outcomes.

Mr. Hammond: Once again, the Minister has sat down without answering the question that I have now asked four times: how many health authorities and trusts are expected to be graded red in the first wave?

Mr. Denham: As I said in answering the hon. Gentleman's question when he first asked it, we have not set a figure for that—and, in response to the question from the hon. Member for Sutton and Cheam, nor have we run the data against the consultation document that we have put out.

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Prepared 23 January 2001