| Previous Section | Index | Home Page |
Rob Marris (Wolverhampton, South-West): May I take the hon. Gentleman back a couple of sentences? He mentioned targets. His comments and the proposed Liberal Democrat amendment suggest that he and his hon. Friends are opposed to any targets at all and that they want accountability for massive spending on the NHS to be taken away completely from the Secretary of State? Is that the hon. Gentleman's view?
Dr. Harris: There are two points in relation to performance monitoring. First, there should be adequate measures of quality so as to assess the impact on patient outcomes. In the end, that is what matters, not statistics but patient outcomes. Secondly, on the political targets that the Government have imposed for their star-rating system, the Government have never offered a shred of evidence of clinical support for good outcomes related to the achievement of those targets. I invite the Secretary of State to tell me whether there is any evidence in the literature to suggest that meeting his targets leads to a solid improvement in patient outcomes, or whether, in fact, the opposite applies.
Mr. Milburn: I can give the hon. Gentleman a concrete example. It is estimated that 500 patients die every year waiting for a heart operation in the NHS. The shorter the waiting time, the fewer people die. That has come about precisely because of setting a target, focusing effort and getting the good will and commitment of NHS staff. That is why, after 40 years of rising waiting times in the NHS, waiting times are starting to fall, with improved outcomes for patients.
Dr. Harris: I am grateful to the Secretary of State for choosing cardiology. He should know that the people who die while waiting for their procedure are the urgent cases—those with critical ischaemia, left main-stem disease or severe valvular disease. Clear evidence is emerging that people with those urgent conditions are being forced to wait longer. Instead of waiting for only days, they have to wait for weeks because so many slots have been given over to less urgent cases, the long waiters who also need to be treated but who are political rather than clinical priorities. I can cite for the right hon. Gentleman cardiologists up and down the country who know that their patients are now more at risk due to his maximal waiting-time target. Surely, it is straightforward for the right hon. Gentleman to see that the sickest are not being treated the quickest, because his maximum waiting time targets apply only to the least urgent cases. He must accept that there is a distortion of clinical priorities, and the hon. Member for Wolverhampton, South-West (Rob Marris) should realise that one can have quality inspection and quality standards without distorting either resource allocation or clinical priorities. That is what we want, not the political targets imposed on hospitals.
The Bill shows the Government's obsession with secondary care. It is clear from their language—from schools to hospitals; and it starts with the sham decentralisation and democratisation of the secondary care sector providers. It is sad that secondary care issues dominate the Government's agenda and the Bill. For example, the GP contract is central to the future delivery of primary care, as Ministers will agree, and we expect resolution of that negotiation, through a ballot, while the Bill is still in Committee. Will Ministers give us an undertaking that, if the Bill is still in Committee when GPs agree the new contract—as I suspect they will—the House will give Government amendments proper Standing Committee scrutiny; or is it true, as we have heard, that Government amendments to insert critical clauses on the new GP contract will receive only inadequate scrutiny on Report? I should be grateful if Ministers would give that undertaking when they reply to the debate.
The Government have missed a golden opportunity to do something about the desperate need to increase capacity. I sometimes think that the Secretary of State, having announced that he is putting in more resources, is complacent about capacity. Even if the Government meet their target for 2004 of increased numbers of NHS beds, they will still end up with 3,000 fewer beds than they inherited in 1997.
The Government know that huge amounts of their resources are spent on paying agency nurses over the odds, instead of being adequately used to recruit and retain nurses in the health service. There is a massive backlog of hospital repairs: £3.4 billion, or £117 for every taxpayer in the country. Six years after the Government came to power, less than half the people of this country are registered with a GP.
There is a huge amount to do on capacity. If the Secretary of State is interested in the secondary care sector, why does he not start by legislating to prevent the giving over of vital NHS capacity, through pay beds, to paying patients who jump the queue and thus distort clinical priorities? At a time when the limiting factor is the number of NHS beds available to treat patients, how can the right hon. Gentleman justify, even on the questionable ground that it raises revenue, giving over thousands of NHS beds—the equivalent of three district general hospitals—to treat patients more quickly simply because they have the money? That cannot be right, especially at a time when the Secretary of State is forcing trusts with pay beds to pay over the odds to the private sector to treat NHS patients. That is crazy. The Health Committee told the right hon. Gentleman that it was crazy, yet nothing in the Bill would reverse that situation. Merely keeping stable the proportion of income in foundation trusts from private payers does not tackle that distortion and the unethical situation whereby people jump the priority queue.
What will the Secretary of State do about the commissioning side of the health service? Surely he accepts that the critical decisions in health economies are made in the planning and purchasing of care. There is little point in a sham democratisation of hospitals if commissioners—the buyers and planners of health care—remain unaccountable. In response to a pertinent intervention from the hon. Member for Vauxhall
(Kate Hoey), the right hon. Gentleman announced that he is now against that reform. He is against democratising and decentralising control over primary care trusts. That sounds as though he is simply against reform.There was support for measures that we proposed for the decentralisation and democratisation of PCTs from the right hon. Member for Charnwood (Mr. Dorrell) and, perhaps, from the hon. Member for Woodspring (Dr. Fox), yet the Secretary of State has said that that is no longer his priority. There will not be decentralisation now and the hospital sector will take priority. That is a big mistake.
Mr. David Drew (Stroud): I have been in the Chamber since the debate began and I am not sure that the Secretary of State actually said that. He said that he would wait until things had bedded down properly. Does the hon. Gentleman agree that there is nothing wrong in principle with the concept of mutuality in health? Although I have some sympathy with his comments about PCTs, why should we not mutualise the hospital sector? Is he prepared to admit that that is a fundamental and new direction, and that it should be followed?
Dr. Harris: Yes, I am prepared to do that. I shall come to that point in a moment. However, on PCTs, does the Secretary of State accept that, by the time he gets round to some form of democratisation of commissioning, it will be too late? As the hon. Member for Woodspring and the right hon. Member for Charnwood rightly said, there will be an alternative competing democratic interest—a quasi or sham democratic interest—in the hospital sector. Why will the Secretary of State not consider merging the local commissioning function of health care with the existing local authority commissioning function for social services? If he believes that local authorities are fit to commission social services care, why does he think that they cannot commission health care? We supported the integration of commissioning at local authority level. Will he say—he was unclear about this—whether the giving of commissioning powers in health care to local authorities is a model that he supports? He said that it would be destabilising to do so, but I—let alone his own Back Benchers—can think of no policy that is destabilising the NHS more than his own policy of a sham democratisation of foundation hospitals.
If the Secretary of State believes that providers need freedom from overweening Government control through choking targets, why does he not simply drop the targets? If his argument is that foundation hospitals deserve that status only if they are dragged towards a three-star rating by his centralisation, how can it be appropriate to leave them alone once they have achieved foundation hospital status? The truth is—
Mr. Milburn: How, then, would the hon. Gentleman guarantee any form of equity in the system? How can equity be guaranteed if we do not have a National Institute for Clinical Excellence, and if cancer drugs are available in one part of the country but not in another? I thought that he was opposed to that.
Dr. Harris: The Secretary of State knows that we support NICE. If he is asking a legitimate question
about what to do if, under a system of local authority commissioning, people in one area voted democratically for their local authority to have priorities that differed from those in another area, my answer is that that would not necessarily be a bad thing, so long as local commissioners had tax-varying powers to raise resources, if required, from local people. The Secretary of State cannot have it both ways, which is what we are seeking to avoid. He cannot say that he wants local discretion over commissioning, yet the same provision everywhere in the country. We have accepted that if there is democracy locally and tax-varying powers for commissioners, differences will inevitably exist throughout the country, just as they do in the provision of social and other services by local authorities. What is critical is that patients who are rationed against have the ability, with their families, to vote to end that, and that the people with the power to make those decisions have the means and the discretion to raise the resources to meet that local need.
| Next Section
| Index | Home Page |