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Mr. Eric Martlew (Carlisle): Will the hon. Gentleman give way?

Mr. Bacon: No, I do not have time. Before examining and boasting about extra expenditure, we should discuss serious, proper financial management of it. The Government are good at playing fast and loose with taxpayers' money. I recently came across an example of a farmer who succeeded in claiming two different subsidies under the arable area payments scheme and the fibre flax scheme for the same piece of land. He also claimed for territories which, on closer inspection, when people could be bothered to examine the grid references that he had supplied, turned out to be in the North sea between Scotland and Denmark and on the mainland of Greenland and Iceland. Basic management, not targets, is what is needed to deal with that.The reason why £4 billion-worth of Apache helicopters are sitting in a shed on Salisbury plain is not targets but sheer mismanagement and forgetting to train the pilots in time.

We have a chief executive in the health service who was sacked and paid £149,000 in compensation. Most of the payment was found to be ultra vires and it should have been possible to reclaim it, but the six-year time limit had elapsed and it could not be claimed back. The individual was subsequently hired elsewhere in the NHS and later summoned to an industrial tribunal to answer allegations of sexual harassment. He did not turn up and was therefore sacked. However, as any lawyer would tell us, it is unlawful to sack someone for not turning up to an industrial tribunal, so the individual received a further £195,000 in compensation. We do not need targets, but basic management.

A classic example of poor application of targets and its consequences is education. Let us consider the halcyon days of 2001–02, when the Department for Education and Skills underspent its budget by £1.7 billion and £6 billion was underspent throughout the public sector. It is a shame that the Economic Secretary is not present because he was the Minister with responsibility for adult skills at the time of individual learning accounts, which were a model of how not to do something and showed why targets by themselves do not work. The cost was £300 million. Much, possibly even most—the Department cannot say—was wasted. Seventy civil servants are spending two years trying to sort out the mess, which was caused by targets.

In a unanimous report, the Select Committee on Education and Skills stated:

"It should have been possible to design a scheme to encourage new providers that was not wide open to abuse by unscrupulous people posing as learning providers, but the lack of quality assurance made it almost inevitable that it would be abused."

Subsequently, the Public Accounts Committee examined the individual learning accounts scheme. Its report stated:

"In the absence of quality assurance, the decision to give a positive incentive to providers to recruit learners was fundamentally flawed."

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In other words, the fraudsters envisaged easy pickings and came steaming in. The PAC report continued:

"Because of ineffective monitoring, the Department was not aware of unusual patterns of activity, including very large payments to individual providers".

The permanent secretary to the Department, Mr. David Normington, said that the large amount of activity on the individual learning accounts scheme was taken as a sign of success. The Department budgeted £199 million for two years, but it was spending three times that rate: £25 million a month, which is a total of £600 million over two years. It did not realise that it in spending that money it was being diddled and defrauded. It believed that it was a sign of success. There was no control of cash. In evidence to the Education and Skills Committee, the Economic Secretary, who was formerly responsible for adult skills, said:

"At the moment because of the uncertain number of individual learning account discount payments we are going to have to pay we simply cannot give you a sense, even a ballpark I regret to say, of what the possible overspends are going to be."

There was a complete lack of financial control, yet the Chancellor had the gall to boast about spending extra money.

How did the Government get into such a mess? They were genuinely interested not in quality but in quantity—never mind the quality, feel the width. The Government had a manifesto target to include 1 million people in their programme. As the Education and Skills Committee said of the individual learning accounts scheme:

"Presented with a manifesto commitment, and a single target of one million users, insufficient attention was given both to the reasons for the previous rejection of an ILA scheme and to ensuring that quantity was balanced by quality."

That is a perfect example of too much emphasis on targets and not enough on information for users of public services.

In the health service, we need to enable people to understand what goes on in hospitals and what happens to waiting lists and mortality rates, and let them make the decisions. In schools, we need to enable people to understand what is happening with class sizes, exam results and university entrance performance and let them choose. Dare I say it, parents should be given the money to enable them to make the decisions. What we need to do is to diminish the emphasis on targets and increase the emphasis on choice.

6.36 pm

Dr. Liam Fox (Woodspring): This has been a short but informative debate. The contributions of my hon. Friends the Members for Bognor Regis and Littlehampton (Mr. Gibb) and for South Norfolk (Mr. Bacon) were especially informative. My hon. Friend the Member for Bognor Regis and Littlehampton made an interesting, thoughtful and informed speech. Perhaps it was the most thoughtful speech of the day; it gave hon. Members much to ponder. My hon. Friend the Member for South Norfolk had a productive seven minutes. He managed to make many points about the way in which money without new reform is wasted and the need for sound financial discipline and good management in

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public services and taxpayer-financed programmes. He also emphasised the need to give professionals far more autonomy in making decisions about the day-to-day running of the services in which they find themselves.

Much of the debate has focused on targets in the health service. The Government face charges that the targets distort clinical priorities put political interests before those of the patients, and are contradictory and often produce conflicting results. They face charges that they often fulfil the targets by changing them en route or fiddling the figures, and that the targets create a culture that is deeply corrosive to professional people.

There is no better example than that detailed in an article in The Sunday Times yesterday, which stated:

"In one case earlier this year, a team of four surgeons was prevented from operating for five hours while it argued with a performance manager about a patient who was about to breach the 15-month waiting time.


Paul Thorpe, chairman of the British Medical Association's junior doctors' committee and one of the surgeons involved in the argument, said: 'It was decided by the surgeons that the operation should be cancelled because there would not be an intensive care bed available after the operation.


The performance manager came down to the theatre and said, "Don't do anything else; you must do this lady. I could lose my job over this." We spent from 9am to 2pm arguing about this one case because it involved a government target.'"

That happens in the health service throughout the country. It is not the rare event to which the Secretary of State for Health referred; it happens increasingly frequently.

Who should make decisions for an individual patient? Who would be best placed to make them? The best decisions would be made on the basis of sensitive and specific information. However, targets such as the maximum waiting time mean that the decision is taken as far away from the patient as possible. For example, a patient with severe arthritis of the hip can be pushed down the waiting list because someone with an ingrowing toenail has reached the maximum wait. That is illogical.

Even if one agreed with the Government that targets were necessary, these particular targets are wrong. The most logical place for a target is not the time between presentation and diagnosis, which is when doctors have no idea of the clinical urgency needed. Doctors could give a clear waiting time, dependent on diagnosis, from the time of diagnosis to the time of treatment. The Government's targets are upside down.

All this results from a single pledge given by Labour back in 1997 on elective surgery targets. Now all the activity in the NHS is distorted by that one target, which has become the centrepiece. Many of our primary care trusts are having money sucked up from them because the acute trusts have to make their waiting time targets.

Let me give the House an example of how contradictory targets can be. The Government have a target for ambulance response times and a target to reduce accidents. The way to improve ambulance response times is to achieve a better speed between the location of the patient and the acute hospital, yet the Government have been so obsessed with their accident reductions that they have stuck speed limits all over London. Every one-minute delay in getting a patient with a myocardial infarction to hospital results in a 10 per cent. increase in mortality.

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The Government have so many targets, which are often completely contradictory, that they are undoing many of the things that they set out to do in the first instance. The first way that the Government meet their targets is to abandon them along the way. In November 1996, the Prime Minister, then Leader of the Opposition, said when referring to mixed-sex wards:

"Is it beyond the . . . wit of the Government and the health administrators to deal with that problem?"—[Official Report, 19 November 1996; Vol. 285, c. 832.]

In January 2000, Lord Hunt of Kings Heath, then a Health Minister, said that mixed wards are

"wholly unacceptable. We are committed to ensuring that those wards . . . disappear by 2002".—[Official Report, House of Lords, 19 January 2000; Vol. 608, c. 1118.]

However, in July 2002, the target was moved from eradicating mixed-sex wards to introducing more single-sex accommodation. That is an entirely different concept—in other words, "If you can't make the target, change the target."

The second way that the Government meet their targets is to force the staff to fiddle the figures. Ian Perkin, former finance director of St. George's hospital, Tooting, said:

"There's a culture that's grown up where the emphasis of management within the NHS has been about achieving targets, you know . . . come hell or high water. It doesn't matter whether achieved legitimately, you just have to achieve them"

That is a terrible thing for a professional person to say.

A former chief executive, who did not want to be named, for understandable reasons, said:

"It was always my understanding, and that of my colleagues, that certain of the targets were what are euphemistically described as P45 targets. What I mean by that is if a particular target wasn't delivered, it was absolutely a sackable offence."

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