NHS Reform & Health Care Professions

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Mr. Burns: The Minister is being a little naive in coming out with that pious point. He knows as well as anyone that under the discredited waiting list initiative of the previous Parliament, clinicians and hospital managers were under such pressure to meet the politically motivated number deadlines that clinical decisions were grossly distorted. That was done to ensure that Ministers, including the Prime Minister, were not embarrassed by a failure to meet promised targets.

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Mr. Hutton: The hon. Gentleman will not be surprised that I disagree with every word of what he said. He is wrong. It does not serve the quality of our debate for the hon. Gentleman to pretend that his Government were not interested in doing the same. We should not forget that the Conservative party set the original maximum waiting time of 18 months for treatment in the national health service in England. He cannot now pretend that his Government were not fundamentally concerned with that matter.

Mr. Burns: We were talking about times, not about numbers.

Mr. Hutton: The hon. Gentleman must follow the logic of that conclusion. I know the view of the hon. Member for Oxford, West and Abingdon, which could also be the view of the hon. Gentleman; we may yet find out. Perhaps the hon. Member for Oxford, West and Abingdon believes that even setting a maximum waiting time could distort clinical priority.—[Interruption.] That is his view. I wonder if that might be the view of the hon. Member for West Chelmsford, whose party set the original waiting times target.

Mr. Burns: The initiative of the last Parliament, which was based on numbers, distorted clinical priorities. However, I have sympathy with the Minister when he says that all of us—apart from the Liberal Democrats, it would seem—want people to wait less. I believe that having maximum times and then reducing them will improve and enhance health care for our constituents.

The Chairman: Order. I am sure that hon. Members will be mindful not to stray too far from the amendment.

Mr. Hutton: I must apologise, Mr. Hurst; I lured the hon. Gentleman into that. I generally give way when it suits me, and he does the same. I have given way when it did not suit me, and I have had to bear the consequences. However, we all make mistakes.

The amendments are unnecessary because they would have no practical consequence. I have explained that the issues are already subject to inspection and review. The amendments have served the purpose of winkling out a wider sense of what we mean by ''the environment''. I have tried to give practical examples of what that might mean, but it would have been a mistake to attempt to produce an exhaustive list.

The hon. Member for Wyre Forest was right that we need some laxity in the definition. That suits our purpose. However, we want also to broaden the concept of health care under section 18 of the 1999 Act—that is obvious from the Bill—so that the Commission for Health Improvement, in its inspection and monitoring role, can look at the issues, which are important to patients. I have tried to respond positively to the hon. Gentleman's points, but I am unable to accept his amendments.

Dr. Harris: I am grateful that the Minister gave some response to amendment No. 160, which relates to the quality of the environment. I am disappointed that he did not address human resources policies, which I

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included in my introduction. The quality of such policies impacts indirectly—and directly—on patient care. I am not clear whether the Commission for Health Improvement has a remit to consider the quality of human resources policies and occupational health within the NHS. Will the Minister respond?

Mr. Hutton: I am sorry. I assumed that the hon. Gentleman knew that the Commission for Health Improvement already has that responsibility and can look at those issues.

Dr. Harris: I am grateful. Perhaps I shall be able to see whether it does so in due course. I have spoken informally to the hon. Member for Wyre Forest and we would be happy to withdraw amendment No. 160.

The hon. Member for Wyre Forest expressed some sympathy towards amendment No. 161, which is tabled in my name. I am not convinced that the Government have addressed the issue. I am conscious that we should not stray too far from the amendment. The fundamental test posed by the amendment is whether the Commission for Health Improvement—which is the quality body, as opposed to the value-for-money body, which is the Audit Commission—has the ability to look at the impact on the quality of health care of policies that commissioners and providers are directed to follow by the Department of Health.

The decisions of Ministers should be accountable to this place in so far as they impact or might impact on the quality of health care. The expert body charged with investigations and reviews on quality should be entitled to give a view. In holding Ministers to account, the House should be entitled to reports and reviews from expert groups looking at those issues.

The Minister says that we have charged that a Department of Health policy of maximum waiting times distorts clinical priorities. That dismisses the distortion of clinical priorities that are not concerned with quality. The policy has a huge impact on quality if the most clinically urgent patients have to wait for more managerially, politically, directionally or policy-driven urgent patients, who may be less clinically urgent, who are subject to maximum waiting times. That is why our party has changed its view on maximum waiting times; we regret that the Labour and Conservative parties have not done so.

If the Minister will not give us a clear indication that the Commission for Health Improvement can look at those broad policy directions and the directions to commissioners and providers from the Department of Health, we will certainly have to revisit this issue. I accept that the phrasing of the amendment does not raise that issue, but amendments can be tabled that would clearly place that power with the Commission for Health Improvement. Today we have heard the Government say, ''No, the Commission for Health Improvement does not have the power to criticise what we do where it impacts on the quality of care and the functions of primary care trusts and NHS trusts, which are going to be inspected by the commission; nor do the Government want it to.'' That is a failure in terms of quality.

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The terms of the Kennedy report were clear; for example, waiting list policies in the early 1990s were partly responsible for the problems at Bristol; they were ultimately problems of quality. The failure to follow the spirit of the Kennedy report is that the Commission for Health Improvement will have no remit even to look at the Department of Health's policy, rather than at its decisions per se.

Mr. Hutton: The hon. Gentleman prayed the Kennedy report in aid, but Professor Kennedy did not make those particular recommendations.

Dr. Harris: I read the Kennedy report with great interest. It cited the waiting list policies—the professor described them as policies ''of 10 years ago'', but they are still with us—as a cause of quality failures. The waiting times target is just one example of Government policy; I do not want the debate to be solely about that. However, when waiting times are decreasing, more and more patients will be considered urgent in terms of waiting list management and will be able to jump the queue at the expense of clinically urgent patients. Kennedy was clear about the need for expert quality checks. Hon. Members may think that they are experts, but they are not always in command of the detail. Expert quality checks on the possible detrimental impact of Government policy on the quality of provision, whether it is intentional or unintentional, are necessary.

Mr. Hutton: I agree with the hon. Gentleman's comments on Professor Kennedy's report. Professor Kennedy welcomed the Government's measures for improving quality. However, the report, which the hon. Gentleman cited in aid of his arguments, did not recommend giving to the Commission for Health Improvement the power that the hon. Gentleman says it should have.

Dr. Harris: Professor Kennedy did not recommend against giving the Commission for Health Improvement the power that I recommend, either. [Hon. Members: Oh!] It is true that the professor did not specifically recommend that the commission should be given such a power. However, I am sure that we could enter into an interesting correspondence with the professor and his colleagues about whether they think that the Government should have carte blanche to implement policies that may run counter to the patient's best interests, simply because the policies conform to those of the politician. That would apply whichever party was in government, and it is an important power.

I do not intend to divide the Committee on the amendment, but I hope that, after consulting outside bodies, we will be able to return to the matter later. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Mr. Burns: I do not want to detain the Committee for long, but I have an important point to raise with the Minister. The clause is about enhancing the quality of

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care and the definition of the duty of care. I was reassured by the Minister, who seemed to suggest that the vagueness of the term ''environment'' was for the common good. I should be interested to hear the Minister's comments on the points raised by the Royal National Institute for the Blind about the care and treatment of blind and partially sighted people in the NHS. As the Minister will be aware, there is great concern among the blind and partially sighted that the health service fails to understand their predicament and introduce the appropriate measures to help them.

Surveys have revealed the extent of the failure of most trusts and health authorities to provide information accessible to blind and partially sighted people and other people with disabilities. The RNIB's recent survey shows that only 4 per cent. of test results are made available in large print. Only 2 per cent. of test results are provided in Braille or by tape. Information about treatments and medical conditions is made available in alternative formats by fewer than half of NHS trusts. Some 86 per cent. of blind and partially sighted patients in eye clinics receive appointment letters in normal-sized print—a format that most find difficult, or even impossible, to read. It would not take much to tackle those sensitive issues, and I hope that the clause will lead to an improvement if and when the Bill becomes law.

11.30 am

The absence from many eye hospitals of trained workers to provide those facing a diagnosis of sight loss with emotional support and information is also of huge concern to the RNIB and its members. We are all fortunate enough to understand that sight is the sense that the vast majority of people most fear losing. When individuals confront that unfortunate possibility, they experience considerable fear, stress and distress. It is important that staff who provide health care have the means to help people through an especially difficult and emotional time. Practice should reflect that in other sectors of the health care system, which deal with highly distressing and emotional conditions by providing back-up support when patients are diagnosed and throughout their treatment.

All too often, those who suffer from conditions such as blindness and partial sightedness are forgotten. Sighted people tend to take it for granted that everyone is like them and to push the concerns of others to the back of the queue, as shown by the experiences in the surveys that I cited. I hope that the clause and the activities of the Commission for Health Improvement will help not only blind and partially sighted patients but patients in other forgotten areas of the health service, where fit and able-bodied individuals in the medical profession and outside it tend to forget the needs of others.

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Prepared 4 December 2001