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Ms Hewitt: The hon. Gentleman raises an important point. Many developing countries are concerned about the impact of intellectual property rights on traditional knowledge, especially in medicines and health. We are considering that, as is the World Trade Organisation. I hope that we will make progress on that as a result of the Doha negotiations.
David Taylor (North-West Leicestershire): Does my right hon. Friend agree that the WTO far too often reinforces the existing competitive advantage of developed nations? Do not some of the proposals for further trade liberalisation at Doha breach basic rules on cultural diversity, environmental sustainability and respect for human rights? If so, what will she do about that in the delegation?
Ms Hewitt: I regret to say that I do not agree with the assumption underlying my hon. Friend's question,
although I am aware of his concerns. Doha will allow us to identify much more effectively how we ensure that further liberalisation of world trade works to the advantage of the environment, development and, therefore, human rights. That is our goal. The development that has occurred in many parts of the world as a result of world trade liberalisation in the past 50 years is a sign that if we continue to build an effective World Trade Organisation and strengthen the rules for free and fair trade we can achieve the objective of spreading sustainable prosperity across the world.
Ann McKechin (Glasgow, Maryhill): I thank my right hon. Friend for her commitment to openness and fairness in the next round of trade negotiations this week. I accept, as I am sure she does, that there is no level playing field in the trade between the south and north. She will appreciate the concerns of developing countries about the benefits of the WTO negotiations. Will she support their demand for an independent impact assessment of the WTO policies before we press the south for further liberalisation of its trade?
Ms Hewitt: It is important to assess the impact of trade liberalisation measures, and work is being done on that. However, for some measures—for example, in relation to textiles—it will not be possible to get full evidence on the impact of liberalisation until we have concluded the phasing out of the multi-fibre agreement in 2005. I am sure that more can be done, especially within international agreements, to build up an assessment of the impact. Let me stress, however, that there is already good evidence of the beneficial impact of fair trade on developing countries, which should enable us with confidence to agree the beginning of a new round of negotiations at the ministerial conference this week.
BILL PRESENTED
Employment Bill
Ms Secretary Hewitt, supported by The Prime Minister, Mr. Secretary Prescott, Mr. Chancellor of the Exchequer, Mr. Secretary Darling, Mrs. Secretary Liddell, Secretary Estelle Morris, Alan Johnson and Malcolm Wicks, presented a Bill to make provision for statutory rights to paternity and adoption leave and pay; to amend the law relating to statutory maternity leave and pay; to amend the Employment Tribunals Act 1996; to make provision for the use of statutory procedures in relation to employment disputes; to amend the law relating to particulars of employment; to make provision about compromise agreements; to make provision for questionnaires in relation to equal pay; to make provision in connection with trade union learning representatives; to amend section 110 of the Employment Rights Act 1996; to make provision about fixed-term work; to amend the law relating to maternity allowance; to make provision for work-focused interviews for partners of benefit claimants; to make provision about the use of information for, or relating to, employment and training; and for connected purposes: And the same was read the First time; and ordered to be read a Second time tomorrow, and to be printed. Explanatory notes to be printed [Bill 44].
Hospital Inspectorate
5.19 pm
Tony Baldry (Banbury): I beg to move,
- That leave be given to bring in a Bill to establish an independent inspectorate of hospitals to provide independent inspection of waiting lists, waiting times, hospital efficiency and clinical cleanliness.
The independent hospital inspectorate that the Bill will establish will be very different from the Commission for Health Improvement. The commission says that it has influence, but there is no point in having influence if it does not lead to improvement. Clearly, an independent inspectorate is needed to respond to the recommendations of the Bristol inquiry and similar investigations, as well as to patients' concerns, to identify weaknesses in the NHS and impartially to ensure accountability.
Those objectives may be within the commission's remit, but the reality is rather more modest, as observed by a recent report in the Health Service Journal. It noted that few establishments in the NHS have experienced intervention. In the commission's first year, only four pilot reviews of acute trusts and two specialist investigations have been carried out, and that is a pathetic rate of inquiry. I very much doubt that Ofsted would have commanded any credibility if in its first year of operation it had inspected only four secondary schools and two primary schools.
Patients need to be sure that hospitals are adequately inspected now, not in four years. The Bill seeks to ensure that the tasks that the Commission for Health Improvement should be doing will be done. The same Health Service Journal report observes that a further problem with the commission is that its reports raise as many questions as they answer and prompt a further inquiry. That suggests that the traffic light system of classifying trusts may run into trouble.
There is little confidence in existing mechanisms to monitor standards in the NHS. The commission is clearly under pressure to claim success stories for the Government's NHS plan, which seriously calls into question its freedom. That is why the Bill calls for an independent NHS hospital inspectorate. Priority must be given to patients, not Government spin doctors trying to claim improvements when patently they are not taking place.
Even the Audit Commission finds that its informative reports have little influence on results. Let us consider its recent report on accident and emergency admissions. It found that, nationally, nearly one third more people are now waiting longer for such admissions. Last June, at the Horton general hospital in Banbury in my constituency, 27 people had to wait more than 12 hours in accident and emergency before they were seen. On average then, almost every day one person had to wait more than 12 hours, whereas a year earlier none had to do so. The situation in our hospitals is getting worse, not better. The Audit Commission finds itself repeating the
recommendations that it made five years ago. The Commission for Health Improvement is incapable of bringing about change, and the Audit Commission finds it hard to do so.We have introduced adequate inspection systems in other public services, such as Ofsted, which has done an enormous amount to make schools' performance more transparent, to improve accountability and to drive up standards. The Bill will establish an inspectorate that would seek honestly to evaluate the strengths and weaknesses of NHS hospitals and trusts without scapegoating staff.
That brings me back to the Government's policy of traffic light classification of NHS trusts as green, yellow or red, depending on their performance. That has introduced a crazy situation whereby trusts in areas that are having difficulties have their budgets cut, but those in areas where things are going well have their budgets enhanced. Perhaps the Government should pause and reflect that almost all the trusts that were recently found to merit no stars for performance on indicators such as accident and emergency admissions and trolley waits were in the south-east. I find it difficult to believe that weaknesses in NHS management are such a geographical phenomenon.
Perhaps the real reason why hospitals and trusts such as the Oxford Radcliffe Hospitals NHS trust appear to perform so badly is as a consequence of staff shortages, especially shortages of nursing staff which are more acute and serious in the south-east. In Oxfordshire—a county where "long in-patient" performance is already 60 per cent. away from target—the Government's current policy will cause the position to worsen, as they take money away from the Oxford Radcliffe Hospitals NHS trust.
Furthermore, simply threatening to sack NHS managers and scapegoating NHS staff is no solution. It certainly does not help my constituents. I doubt that I am alone in receiving almost daily representations from constituents who are frustrated either by the length of time it has taken them to get treatment, or by the number of times that their operation has been cancelled.
From a large number of examples, let me offer a simple one. Last Saturday, Mr. Graham came to see me. All he wants is an out-patient appointment at the audiology clinic at the Radcliffe infirmary where his hearing can be tested to determine which hearing aid might be the most suitable for him. He was referred to the hospital by his GP in January and was told that there would be a three-month wait for an out-patient appointment. When at the end of the three months he inquired when he would be seen, he was told that it would take a further 12 months. About 10 days ago—a week before he came to see me—he was told that he would have to wait a further 14 months. That is a total wait of almost 20 months for a straightforward out-patient appointment.
The outcome of the Government's current policies is that the problems in a county such as Oxfordshire, where "long out-patient" performance is a shocking 75 per cent. away from target, will simply get worse. Oxfordshire health authority is now having to identify cuts of £7 million before it is abolished on 1 April next year. As a consequence, trolley waits will continue at a high and unacceptable level, as will cancellations of operations.
There is a critical shortage of staff in the NHS in Oxfordshire: a recent count revealed that 377 of the 1,250 nursing posts were vacant. As my hon. Friends the
Members for Henley (Mr. Johnson), for Wantage (Mr. Jackson) and for Witney (Mr. Cameron)—all sponsors of my Bill—can testify, the people of Oxfordshire are becoming extremely frustrated and disillusioned by the continuing deterioration in the delivery of NHS services in their county. I suspect that trends in Oxfordshire are repeated in many other parts of the country, especially in the south-east.What the NHS needs is more nurses, more staff and more money. The Government's policies will simply exacerbate the difficulties of NHS trusts that are in trouble. It is not possible further to reduce spending on health services while expecting health authorities such as Oxfordshire's to implement what in NHS jargon are called PIP and PIP2—patient improvement plans. How on earth is implementing such plans possible when one is cutting the budgets of local hospitals? Even if the John Radcliffe hospital and Horton hospital could recruit a full complement of nurses, they cannot now afford to do so because they could not afford to pay them. Their ability to do so will be eroded even further by Government-imposed additional cuts to their budgets.
The Department of Health has instructed Oxfordshire health authority to implement cuts of £7 million in the financial year 2000-01. Those cuts are in addition to the cuts that the Oxford Radcliffe Hospitals NHS trust is expected to make in respect of the John Radcliffe hospital and Horton hospital, whose budgets have to be reduced by a further £4.5 million. Oxfordshire health authority's resource outlook for the coming year diplomatically observes that those cumulative cuts will entail "a reduction in aspirations".
There will be a substantial reduction in NHS services to my constituents and those of every Oxfordshire Member of Parliament, further exacerbated by the fact that Oxfordshire county council is simultaneously having to make substantial savings in its social services budget—savings of so draconian a nature that only those in the most urgent need are now likely to receive social services support. I do not expect the problem of bed blocking to be resolved this winter.
My Bill will ensure that when failings are found, there will be the necessary encouragement to ensure appropriate funding. That does not happen under the Commission for Health Improvement, nor under the Audit Commission. My Bill will introduce an independent NHS hospital inspectorate that will help to direct investment into hospitals that need assistance. That will be better for nurses, managers and patients.
My Bill will also establish an inspectorate that can watch where NHS funding goes at a time when the Government are somewhat chaotically restructuring the NHS. The Government's rhetoric in their NHS plan is that NHS restructuring
- "will develop partnership and co-operation"
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