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Dr. Evan Harris (Oxford, West and Abingdon): Does the hon. Gentleman agree that it is a damning indictment of the culture of fear in the health service over targets that so many managers with real concerns were too scared to have their faces shown on "Panorama" for fear of the repercussions from their political masters?
Dr. Fox: I will come to that point in a moment, but it is entirely right that there is a culture of fear and intimidation throughout the NHS. Those who might be willing to speak out about what they perceive to be failings in the system are afraid to do that. Indeed, the Government are intent on introducing a gagging clause for consultants in the negotiations on the consultants' contract.
Perhaps the most obvious example of the Government attempting to fiddle the figures occurred in the recent exercise on the four-hour accident and emergency waiting time. The British Medical Association survey, which was mirrored by the "Panorama" survey, said that two thirds of A and E departments in England put special arrangements in place during the monitoring week.
Preliminary results from a questionnaire sent to 500 A and E consultants found that the temporary use of medical and nursing staff was the most common tactic, at 56 per cent., followed by staff working double or extended shifts, at 25 per cent. Indeed, 14 per cent. of
respondents were aware of routine surgery being cancelled so that extra beds would be available to admit patients through A and E. The majority of respondents believed that efforts to meet Government targets distorted clinical priorities. That involves not isolated cases, as the Secretary of State would have us believe, but 60 per cent. of A and E consultants.Don Mackechnie, an A and E consultant and chairman of the BMA's A and E committee, said:
- "I am appalled to see how A&E departments have been forced into taking extraordinary measures for a week-long period just to meet political targets. It is completely immoral of the Government to claim that it is raising the standard of performance in the NHS when this is how they measure it. It is quite wrong for patients expectations to be raised in this way . . . the Government's obsession with waiting times is nothing more than bean-counting. Patients deserve better than being treated simply as goods on a production line."
It is not only medical staff who are involved. Brian Dolan is an emergency nurse consultant—one of the grades that the Government have been proud to introduce. He confirms the suggestion of further manipulation:
- "There's an awful lot of scams and an awful lot of juggling of the targets. For example, 5 cubicles and you count only 3 of them when you're counting the trolley waits. You put a patient on a bed and they say you stop counting the hours they're there because . . . they're . . . effectively admitted . . . Putting a door up and saying, Well that's an observation unit, its no longer a cubicle, so . . . we won't count those trolleys. Putting a bit of a wall up and putting five or six patients in there and saying . . . that's the observation area, so we won't count those ones either. Sending them up to CT scan and stopping the clock. If they're being discharged and they're . . . simply waiting for transport, discharging them off the computer so it doesn't look like they've been there for quite as long."
- "The system is being distorted to meet those targets in the sense that money was intended for longer term purposes, like buying medical equipment, buying computers, simply maintaining the buildings, that's being diverted in order to be able to meet waiting time targets."
Today's debate began a great new double act—the Chancellor and the new Health Secretary. Interestingly, between them they apparently did not know the difference between heart disease and a stroke. That was either poor evasion by the Chancellor or a deeply worrying indication of the state of medical knowledge in the Government. However, we will give the Chancellor the benefit of the doubt—he was simply being evasive, as usual.
We saw the amazing sight of the Chancellor—swivel-eyed and charging at imaginary demons during his 30 or 40 minutes at the Dispatch Box—abandoning any pretence of defending his record on targets in government. Instead, he ranted about Conservative proposals to liberate patients and to liberate British taxpayers. We saw the man once regarded as the
intellectual bedrock of new Labour, if that is not an oxymoron, reduced to the propaganda equivalent of Comical Ali.Then we saw the even more sinister spectacle of the Health Secretary accusing, first, the hon. Member for Yeovil (Mr. Laws) and then the Conservatives of trying to run down NHS staff. I remind the Secretary of State that some of us on the Conservative Benches have been NHS staff. We were questioning the integrity not of NHS staff, who are as much victims of the Government's programme as the patients are, but of Ministers, who force NHS staff to act in a way that they find deeply unprofessional. Again, I quote the outgoing BMA chairman:
- "You would think wouldn't you that the government would be distancing itself from these corrupt and immoral practices. Instead, it has turned a blind eye, been triumphalist about its 'achievements' and colluded in the deception and doublespeak."
The tactic of claiming that any criticism of Ministers' running of the NHS is an attack on NHS staff is deplorable and disgusting. Using NHS staff as a political human shield shows the deep moral corruption that is new Labour. NHS staff will rightly be appalled that they are being used in that way.
We have had tax, spend and fail. There has been no real reform, just more spin. No wonder no one believes a word the Government say any more. New Labour is as corrupting as it is corrupt. The quicker the Government go, the better.
6.48 pm
The Secretary of State for Health (Dr. John Reid): Is it not significant that the hon. Member for Woodspring (Dr. Fox)—in the very last minute of his speech and the very last minute of 45 minutes of speeches from the Conservative Front Bench—finally had a good word to say about national health service staff? Let me start by paying a tribute from the Labour Benches to every one of the 1.3 million people who work in the NHS. We founded the NHS, we have defended it, we will modernise it and we will stand by it against every attack from the Conservative party.
The truth of the matter is that tonight's debate is not about targets. It is about something much deeper: the great debate that is opening up as a result of the breakdown of the post-war consensus on health in this country. It is about a clear choice for the people of this country: between those of us on the Government Benches, who believe that health care should be free at the point of need to everyone in this country, irrespective of their background; and those on the Conservative Benches, who want to push people out of the national health service with 20 per cent. cuts, and to pull them into the private sector through partial subsidies—a point to which I shall return.
Dr. Reid: Sit down—you have had 45 minutes to say your piece.
We make no apologies for targets. Targets identify priorities, and I say that not just because priorities are, as Nye Bevan said, the "language of socialism", but because they are also the language of good business. We should compare the Conservative Front Benchers' observation that targets are not used by business with that of Lord Browne, chief executive of BP-Amoco, who has run slightly bigger businesses than most of the Conservatives. He said:
- "Targets are two things really. They set standards for compliance but they do much more important things as well . . . they motivate people to . . . do better."
Incidentally, the Opposition Front Benchers did believe in targets. They told us before the last election that we should have a target not of waiting lists, but of waiting times. That is the policy on which they fought the last election. Of course, they have now changed. The hon. Member for Woodspring tells us that they do not believe in targets any more—they believe instead in setting measurements for quality in the system. The truth is that anyone with objectives that are to be pursued, focused and prioritised would find it reasonable to set targets.
Of course, sometimes we do not meet the targets.
Mr. Laws: Will the Secretary of State give way?
Dr. Reid: I am sorry, but I must finish as I have only eight minutes. By this year, we wanted nine out of 10 of those who wished to see a GP to have an appointment within two days, on the way to achieving a 100 per cent. figure next year. It is a matter of regret that we failed: we achieved a figure of only 88 per cent., but that is 35 per cent. more was than was ever achieved under the Conservatives.
The hon. Member for Woodspring—who will admit, given that he is the Conservative spokesman on these matters, that he is slightly biased—asked us to consult, so let me tell the House about the comments of Professor Sir George Alberti, who, like the hon. Gentleman, has considerable experience in the health service. He said:
- "The target is a bloody good thing because it has finally brought the spotlight onto a piece of the system that was unacceptable."
- "The A and E community is happier partly because they see the resources coming and partly because of the focus on them."
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