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House of Commons

Tuesday 11 December 2001

The House met at half-past Two o'clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Hospital Star Ratings

1. Dr. Brian Iddon (Bolton, South-East): If he will make a statement about the hospital star ratings. [19655]

The Secretary of State for Health (Mr. Alan Milburn): Performance ratings for acute hospital national health service trusts were published on 25 September. This is the first time that hospital trusts have been publicly classified according to their performance, with more freedom and rewards for the best performers and more help for the poorest.

Dr. Iddon: I thank my right hon. Friend for that answer, but will the same performance rating criteria, especially the nine key criteria, be used to assess hospitals in the current year as were used in the first exercise? Will they be modified in view of the lessons that we have learned from it?

Mr. Milburn: I expect some modification in the criteria. As my hon. Friend knows, it is the first year that they were used and that each hospital's performance was assessed. As we have said, the criteria and the star ratings are far from perfect. However, it is important for patients to know how well their hospitals are performing. After all, they belong to the patients and no one else.

As my hon. Friend knows, the House is considering a measure that proposes that the Commission for Health Improvement rather than the Department should publish the star ratings and, I hope, provide proper, objective and independent assessments of performance in all parts of the NHS.

Mr. David Amess (Southend, West): How can the Secretary of State justify a crackpot scheme under which one hospital received a zero rating but came top in clinical services? Will he explain to my constituents how giving Southend hospital a one-star rating helps the recruitment and retention crisis? This rotten Government are to blame for the state of the health service.

Mr. Milburn: Sometimes I wish that the hon. Gentleman was more straightforward in expressing his views.

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The sense that no one in authority—in government or elsewhere—cared about hospitals that received a lower star rating or was prepared to do anything about it would be the most demoralising thing for staff at Southend hospital or any other hospital that got such a rating. The point of assessing performance and taking action on it is to try to get incentives right so that the good performers have more freedom and the poor performers receive help, support and, when necessary, intervention to enable them to improve.

Hugh Bayley (City of York): Does my right hon. Friend agree that if we want to improve clinical practice, it is as important to have information on the clinical outcomes of individual doctors as on individual hospitals? Will he consider the feasibility of publishing information so that the public know which doctors achieve the best outcomes?

Mr. Milburn: It is important for the public to have as much information as possible about the performance of organisations and clinical teams in the NHS. As my hon. Friend knows, the medical profession has moved a great deal on that in recent years. For example, I met the Society of Cardiothoracic Surgeons of Great Britain and Ireland before the Bristol statement. It has done impeccable work in considering the performance of individual clinical teams. I hope that, in time, and provided that it has clinical credibility, we can publish more and more information about not only organisational performance but clinical outcomes. In the end, we must all answer a simple question: does the patient have a right to know how well the clinical team, doctor and hospital are performing? The answer must be yes.

Dr. Richard Taylor (Wyre Forest): Does the Secretary of State agree with one of the conclusions of the Whipps Cross inquiry report, that, to comply with hospital ratings,

Mr. Milburn: No, I do not agree. The hon. Gentleman knows from his constituency experience that one of the greatest anxieties about the NHS is not so much the quality of treatment when patients get to hospital, or even to the general practitioner's surgery, but the wait to get there. Waiting is detrimental to patient and public confidence. It is right to continue to decrease waiting times as we improve quality. If the hon. Gentleman considers the star ratings, he will find a variety of measures that consider matters from the patient's perspective and assess the standards of care. It is important that we always get the balance right.

Tim Loughton (East Worthing and Shoreham): Is the Secretary of State happy with a ratings system under which one hospital bumped up its star rating for waiting times by keeping patients waiting in ambulances outside rather than on trolleys inside, and another earned zero stars but received a glowing report from the Commission for Health Improvement? Is this not merely another gimmick to allow the Secretary of State to shift the finger of blame away from the Department? In any case, what real choice does the scheme create for patients whose

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local hospitals have received zero stars? What does it give them besides the knowledge that they are now officially forced to attend a failing hospital?

Mr. Milburn: If I may say so, the Opposition always urge on us greater devolution to front-line services. That is where the responsibility should lie. Quite rightly, it should be for local managers, doctors and nurses to make the decisions. For the first time, the star ratings show that the national health service is a less monolithic organisation than it used to be. As every patient and member of staff knows, the NHS—an enormous and complex organisation—is characterised by some outstandingly good performance and, sadly, by some rather poorer performance. It is about time that we came clean to patients about where the performance is good, poor or indifferent. I should have thought that the hon. Gentleman would be persuaded of the case for more openness and devolution.

Smoking Cessation Services

2. Mr. Gwyn Prosser (Dover): What recent progress has been made on improving smoking cessation services. [19656]

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I am pleased to announce today that we will allocate £20 million in 2002–03 to NHS smoking cessation services in England. That reflects our commitment to the future of the services, which have proved to be highly successful. In 2000–01, they helped 64,600 smokers to succeed in quitting smoking after four weeks. In the first quarter of this year, they helped nearly 29,000 more smokers to succeed in quitting at the four-week stage.

Mr. Prosser: I thank my hon. Friend for that answer, and for her encouraging remarks. Is she aware of the excellent work of the smoking cessation unit in my area of east Kent, and especially in Dover and Deal? Will she assure me that the units do not represent the end of the programme to help people to quit smoking, and that other and better means to do so will be introduced? In particular, does she agree that it is vital that young people should be prevented from taking up smoking in the first place?

Ms Blears: I am aware of the excellent work being done in my hon. Friend's constituency. I think that £175,000 is being spent on smoking cessation services there. Their success means that we are providing funding to allow them to continue. I am pleased to say that nicotine replacement therapies are available on prescription, as is Zyban. Clinics are available for people, offering real help in giving up smoking, especially to young people. However, as my hon. Friend says, the best advice is that people should not take up smoking in the first place.

Mr. David Tredinnick (Bosworth): What percentage of the £20 million has been earmarked for hypnotherapists and homeopaths, who make such a valuable contribution to helping people stop smoking? Will the Minister accept that 80 per cent. of the costs of conventional medicine

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could be saved by using homeopathic medicine? Does she agree that homeopathy should be available in many more than just five hospitals in this country?

Ms Blears: The hon. Gentleman raises yet again the matter of alternative therapies. He displays remarkable persistence and resilience, on which I congratulate him.

Acupuncture and hypnosis can help in smoking cessation. As I have said previously, we are interested in whatever works and helps people to give up smoking. Therapies that are proved to have an effect should be supported by local health authorities. I am pleased to be able to tell the hon. Gentleman that his own health authority has received a cash increase of £46 million as a result of the health allocations. I am sure that he will want that money to be spent wisely and well.

Mrs. Joan Humble (Blackpool, North and Fleetwood): My hon. Friend will no doubt be aware of a recent report from the North West Lancashire health authority that welcomed the smoking cessation services. However, it expressed concern about their future, given the restructuring of the health service. Will she reassure me and my constituents about the role of the primary care trusts and the strategic health authority in developing further these much needed services?

Ms Blears: I am happy to give my hon. Friend that reassurance. We want the services to continue, and that is why we are announcing today that £20 million has been made available for next year. However, it will be crucial for PCTs to commission services that will benefit their local communities. We are especially keen that the services should be targeted on people in manual-worker occupations who need extra help to quit smoking. Something like 36 per cent. of the free prescriptions for Zyban and nicotine replacement therapy are being taken up by people in those especially hard-to-reach groups. We must make sure, as a key issue in tackling health inequality, that many more people from poorer communities can access smoking cessation services.

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