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Dr. Stoate: Will the right hon. Gentleman give way?
Mr. Lilley: No, I will not. I am being frank and honest and not trying to make partisan points. I am saying that not everything was perfect about the reforms. We should try to make them better, not worse. If the problem was that the system was based too much on contracts and not enough on money following patient choice, we should move towards a system in which money follows patient
choice. That is what I want, and what I hope my hon. Friends will increasingly propose as an alternative.
Dr. Evan Harris: I have listened to the right hon. Gentleman with interest, and I think he is right in that abolishing extra-contractual referrals and renaming them contract service level agreements reduced, at the margins, even such choice as was available. Those were reforms introduced by a Labour Government who claimed that they would get rid of the internal market.
Mr. Lilley: Indeed, and not only I, or politicians in general, have said it. No less a person than the director of the College of Health said of the directive that did abolish the residual right of choice through ECRs that it would mean patients' having "less choice than ever" in the history of the NHS. She was absolutely right, and we should go back to giving patients more choice. A precondition of that, however, is our giving patients and GPs facts on the basis of which they can make informed choices. There has been some progress in that regard, but I want to see more.
I welcomed the announcement that information would be provided about the performance of individual heart surgeons. I hope we will learn from the example of the Americans, who ensure that such information is related to patients' pre-operative condition. That makes possible a much better assessment of surgeons' performance and ability. There should also be sensible discussion of what the figures mean. Mr. Yacoub, a surgeon who deals with the most difficult heart cases, may sadly lose more patients than someone dealing with minor cases; but everyone knows that he is the best heart surgeon, and will therefore be anxious to be treated by him. People are intelligent enough to use the information that they are given, so let us make more facts available to patients.
Most important of all, let us make the money follow the choice. When a patient chooses a hospital, that hospital should be rewarded for treating the patient: it should receive the money it needs to provide that treatment. The more popular and successful a hospital is, the more able it should be to treat patients. Funding should not depend on how soon a hospital runs through its budget and has to close wards. We must also give hospitals more independence and autonomy, so that they can reflect the desires of patients without needing to respond continually to directives from on high.
Mr. Dawson: The right hon. Gentleman is making interesting points, some of which I agree with; but is he not missing the most fundamental fact of all? It is a commonplace among Labour Members that poverty underlies ill health. The right hon. Gentleman's Government did not face that fact—they hid from it—but this Government are prepared to confront it. Is it not the case that until the Conservatives are ready to face that uncomfortable truth, they will never have any credibility in terms of reform and improvement of public services?
Mr. Lilley: I do not agree that the cause of ill health is poverty. Poverty is a bad thing: we ought to be against it, and try to get rid of it. Ill health is a bad thing, which often causes poverty, and we ought to try and get rid of that.
I refer the hon. Gentleman to an article that appeared in the British Medical Journal on 5 January this year. It stated
- "Evidence favouring a negative correlation between income inequality and life expectancy has disappeared."
I have emphasised the importance of restoring choice, giving people information that will enable them to make informed choices, ensuring that money follows choices, and giving hospitals the independence they need to respond to those choices. I can give a constituency example showing how important that can be. As I have said, the constituency is surrounded by five hospitals. One—I will not name it, because steps have now been taken to improve it—has the worst record in the country for treating patients after hip operations. One in six patients used to die within 30 days of their operations. My constituents had to go to that hospital, however, because the local primary care trust was contracted to send them there. Only when we exposed concerns about the figures did the doctors say "We knew, but we could not afford to change the contract because that would have destabilised the health economy". They could not make a marginal change; it was all or nothing.
Siobhain McDonagh (Mitcham and Morden): Will my right hon. Friend give way?
Mr. Lilley: I am glad to be the hon. Lady's friend, and I will respond to the warmth she has displayed by giving way in a moment.
Only if hospitals can respond to the choice of patients, and those patients are allowed to move if they want to, will changes be made. The change will usually be modest; even if the information is made available, we see no huge change in referral patterns. If that happens, however, there will be a sufficient change to induce hospitals to recruit surgeons who are more skilled in certain areas, and return others to performing operations at which they were particularly good. I now give way to the hon. Member for Mitcham and Morden (Siobhain McDonagh).
Siobhain McDonagh: I thank the right hon. Gentleman, and apologise for embarrassing him by calling him my friend.
The right hon. Gentleman mentioned statistics relating to orthopaedic surgery in a hospital in his constituency. Is it not significant that the Government have introduced the Commission for Health Improvement? Is it not significant that local people do not have to worry about those figures, because they have been made public? Although the system is not perfect yet, I assure the right hon. Gentleman that it has brought confidence to people in my constituency who now believe that St. Helier's problems are understood. Would he care to congratulate the Government on CHI?
Mr. Lilley: I have already welcomed the increased release of information. We began a process; it has been
continued, and I welcome that unreservedly. I do not think that it was NICE that released the figures—[Hon. Members: "CHI."] Some Greek letter of the alphabet, anyway. Whoever released them, however, I am all in favour of it.I do not think we should pretend that everything the Government have done is wrong, or that everything we did was right; but, clearly, the Government's general tendency has been wrong up to now. I want to investigate the possibility that they are now beginning to move in the right direction.
The Government's initial response to my proposals was to dismiss them. They said that choice of the kind I was advocating had never existed in the health service, and that it was nonsense to say that they had removed it. They then said the exact opposite—that they had not removed it, and that it still existed—until I pointed out that it had been removed. A Minister then said that, under my proposals, patients would be chasing around the country for shorter waiting lists. That is a bit rich, coming from a Government who are sending patients chasing around Europe—around the Mediterranean now, we understand—in search of hospitals with shorter waiting lists. Why cannot patients at least be given the right to go to hospitals that may have shorter or no waiting lists if they are prepared to do so, or find it convenient?
The Prime Minister said that my proposals would lead to hospitals competing with hospitals. That is just a bit of silly rhetoric. No one wants to see anyone doing down another hospital; what we want to see is hospitals striving to satisfy patients, and to offer them the best care in the most convenient and favourable conditions. We certainly do not want people to slag off competitors in the way that the Government may have implied that they would.
It seems that the Government are beginning to move in the right direction, at least in their rhetoric. Having spent four years centralising, they are now at least talking of decentralising. Having ridiculed the idea of patient choice, they have now said that heart patients who have been on the waiting list for six months—and who are still alive—will be allowed to go to another hospital elsewhere in this country, or even abroad.
That is welcome. It is extraordinary that the Government have chosen to enshrine the move in a bureaucratic process that almost requires minders for anyone considered foolish enough to avail themselves of the choice, but the idea is right in principle. It is sad that it is so limited, and that it is available only to people who have managed to stay alive for six months while waiting for a heart operation. I should like the opportunity to be spread more widely.
The Government have also said that they will encourage greater independence for some hospitals. Those that have met their 248 targets will be allowed to be independent of those targets. Those that have not met the targets will be required to remain in the system and will be threatened with the terrible possibility of private enterprise management, as has been mentioned before. Well, that will be the day. I would certainly welcome other management groups making available other services to people, with money following choice and standard costs applying to other not-for-profit hospitals, as well as to NHS ones.
Is the Government's recent change of tack a genuine conversion? Will it be successful? I hope that it is genuine, but I fear that it will not succeed. There is
something innate in the left-of-centre mind that makes it find centralising, regulating and controlling solutions more satisfactory than those involving delegation, individual choice and independence.By and large, Labour Members—on the Back Benches, but on the Front Benches too—remain centralisers genetically. All the Government have done, I am afraid, is to steal some Conservative rhetoric while retaining the Labour substance. They have spliced together our right-of-centre rhetoric with the left-of-centre practice that is in their genes. The result is a sort of genetically modified Government—a particularly dangerous and odious form of Government.
However, I hope that I am wrong and that the Government are moving in the right direction. I am certain that my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith) is doing the right thing by examining what is happening in other countries and looking at best practice abroad. He is wise to take a measured and timely approach.
I am pretty sure that, when my right hon. Friend the Member for Chingford and Woodford Green has completed his studies, he will conclude that other countries very often offer greater diversity of provision. They have local autonomy in management, more money follows patient choice, and patients have more opportunity to make choices. If we adopt elements of successful best practice abroad and incorporate them into the NHS, we will do more to improve the quality of health care and ensure more successful treatment outcomes than anything that this Government have so far done or promised.
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