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Dr. Liam Fox (Woodspring): Will the Secretary of State confirm that the data that are to be published will include paediatric cardiac surgery?
Mr. Milburn: We are in further discussions with the British Paediatric Association. By the summer, I expect that details on individual units will be published by the association in order to make that information more available. Over time, more data will be published about individual consultant outcomes, as I shall describe later.
Dr. Evan Harris (Oxford, West and Abingdon): I warmly welcome the Secretary of State's emphasis that the data must be valid and must enjoy the confidence of
clinicians, and his stress on the consequential need to avoid defensive medicine. Does he accept that previous performance league tables lacked the data on patients' preoperative state produced, with the Department's co-operation, by Dr. Foster, and that they fell short of some of the welcome requirements that he has set out today?
Mr. Milburn: Yes, of course, but I want to make a couple of important caveats. First, I have told the House, and the Select Committee on Health when I have appeared before it, that we are never going to have perfect data. There is no such thing, and we should be clear about that. All the data that we publish, whenever we publish them, should come with the appropriate health warning.
Secondly, we will never get better data until we have the courage to publish. Only then will people begin to realise that the data have some significance. That is beginning to happen already with the organisational data that we are publishing on NHS trusts. Trusts are beginning to realise that the assessments that are made have consequences. That is as it should be, as organisations doing well differ from those doing consistently badly.
I do not mean to say that the same principles apply to individual surgeons, but in my time as a Health Minister I have witnessed the remarkable change that has taken place in the NHS and in the medical profession. There is a real recognition that the old order to which the Kennedy report in so many ways looks back has changed fundamentally. That change must continue, and we need to drive it forward.
Mr. Andrew Lansley (South Cambridgeshire): The Secretary of State spoke of the publication of data on the NHS by the new office for information. However, will the office be responsible for acting on the data, or will that fall to the Commission for Health Improvement? Also, does the right hon. Gentleman agree that not only should action be taken on performance failure identified through the data, but that referral should be improved as a way of driving standards up? Does he agree with the report that paediatrics should be more widely available as a specialisation in general practice in order to ensure a greater awareness of good referral for children's services?
Mr. Milburn: The hon. Gentleman's second point is absolutely fundamental, and my speech will touch on the centrality of improving standards in children's services, in both primary and secondary care. Sometimes there is a debate about whether primary or secondary care is the more important, but we must improve the standards in all the services available for children and their families. We have some proposals for doing just that.
As for the relationship between analysis and action with regard to information, the beauty of Kennedy's recommendation that an office be established within the existing inspectorate which will have overall responsibility for overseeing standards of care is that that provides an opportunity to achieve precisely those linkages that were missing when the tragedies in Bristol took place.
People were analysing data at that time. Lots of people had access to data, but no individual or organisation had the responsibility for doing anything about what was found. Terrible tragedies occurred as a result.
It is important that we learn the lessons, and the office will have an important role to play in analysing the data and feeding information back to the service. The CHI will also have an important role, but I stress again that I believe we will secure lasting improvements in the NHS only if the analysis and dissemination of information is done in conjunction with the people who perform the operations.
I do not perform operations, and neither does the CHI. The people who do are among the most skilled in our country, and they should be among the most valued.
Rev. Martin Smyth (Belfast, South): I share the emphasis that the right hon. Gentleman places on that issue. I have just two questions. First, he talked about data and defensive medicine. Is it not possible that some people involved may protect their reputations instead of giving the best service to their patient—in other words, if there is a risk, they will not take it? Medical science has been advanced by those who, using their skills, took risks and helped people. Secondly, are we training and encouraging enough paediatric specialists?
Mr. Milburn: On the second point, I hope that we are training a lot more but we have shortages, as the hon. Gentleman and I are painfully aware. I think that we can deal with that over time. It is worth remembering that the numbers coming through medical schools, training and so forth are a sign of optimism.
The hon. Gentleman's first point is very important. I have discussed that matter at length with Mr. Bruce Keogh from the Society of Cardiothoracic Surgeons. He put to me a sensible proposal, which we will need to discuss with the new office within the commission. We cannot have a situation in which open publication of data means that the surgeons who take on the highest-risk cases feel as if they will be penalised—that they will end up bottom of the league table in The Times. The proposal that we have discussed—obviously, we will need to refine it—is that we publish two sets of information: one to try to identify standard cases, so that we get some evenness and a benchmark; the other on the overall performance of the surgeon. Of course, that will be risk-adjusted and so on.
As the hon. Gentleman knows, there is a strong and credible science behind that. In parts of the United States of America—New York state and elsewhere—that sort of information has been published for many years. I think that we can do better than them, and the society does too. There are some safeguards that we can put in place, but I come back to the fundamental point, which is twofold. First, patients have a right to know. Secondly, surgeons and doctors have a right to be involved in the process of patients knowing. That is the way we intend to take it forward.
Dr. Evan Harris: Will the Secretary of State give way?
Mr. Milburn: May I move on for a moment?
As I said, we are working with the medical profession to extend the number and range of specialties where information on both the consultant's and the unit's comparative performance can be published. In each case
we will work closely with the royal colleges and other professional groups to build on national audit work already in train.That is a courageous step on the part of heart surgeons and the society that represents them. I believe that it is the right step. It will tackle one of the deficiencies that lies at the centre of the Bristol tragedy—patients and parents were kept in the dark about the care and treatment that they were likely to receive. With the safeguards that I have described in place, open publication will not just make for a more open health service but will help to raise standards in all parts of the NHS.
It will certainly help to empower patients and help them to make informed choices about their care. As the House is aware, from July this year heart patients who have waited six months for their surgery will be able to choose between waiting longer locally or travelling further to be treated quickly in another hospital. As capacity expands, choice can grow. Choice will fundamentally change the balance of power in the health service. In the crudest of terms, hospitals will no longer choose patients—patients will choose hospitals. That is a fundamental change in accountabilities, whereby the patient is in the driving seat and the NHS looks outwards to patients rather than upwards to Government or even inwards to itself.
That brings me to the other element of our response to the Kennedy report—
Dr. Harris: May I quickly raise two points with the right hon. Gentleman? First, as regards the six-month limit, is he prepared to introduce safeguards so that hospitals do not try to rush people in within six months at the expense of more urgent cardiac cases where delays of between three weeks and six months have been experienced? I have raised that point with cardiac surgeons.
Secondly, I am so pleased to hear the right hon. Gentleman's qualifications about league tables. With hindsight, does he think that performance league tables for hospitals should be subject to caveats and quality controls similar to those he wants for surgeons' data?
Mr. Milburn: Sometimes I wonder why I bother to try, but let me try once again with the hon. Gentleman—just to test my patience.
I have told the hon. Gentleman on innumerable occasions that when we published the first set of what he calls "league tables" for NHS trusts I said—as I have said on every subsequent occasion—those data were far from perfect. They are far from perfect. However, we have to start somewhere. I hope that the hon. Gentleman is not saying on behalf of the Liberals that the Liberal party, of all parties, believes that the public do not have a right to know what is going on in their local health service. Of course they have a right to know, but caveats are attached to all such matters. However, we really must move to a very different relationship between public services and the public whom they serve.
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