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Health Care Targets
Madam Deputy Speaker (Sylvia Heal):
We now come to the motion on the effect of Government targets on the provision of heath care. I must inform the House that Mr. Speaker has selected the amendment in the name of the Prime Minister.
Dr. Liam Fox (Woodspring):
I beg to move,
That this House notes that the Government's obsession with target-setting now pervades almost every aspect of healthcare; believes that the volume of centrally set targets and the way in which these have been imposed is having a detrimental effect on clinical outcomes, since the welfare of the patient becomes a secondary consideration to the achievement of the target; further believes that the imposition of these targets is seriously demoralising the professional staff within the NHS, diverting them from spending time with patients to additional paperwork and bureaucracy; is appalled that pressure on managers to achieve targets has led to distortions in reporting on performance, so that the public has no confidence in claims that are made about achievements in the NHS; and calls on the Government to do away with their reliance on the target-setting culture, to re-invest the money saved on bureaucracy into front line medical care and to trust doctors, nurses and other professional staff to get on with their jobs with minimal interference, in the interests of all of their patients.
I must say at the outset how bizarre it is that the Secretary of State for Health has not attempted to stay to hear a debate on such an important health issue. I understand that he recently visited the United States to learn about the benefits of its health system. It seems that he is rather more interested in that than in what happens in this House or the national health service.
The debate revolves around the question of what targets actually are. Most of us would regard targets as quality benchmarks and something against which we could monitor progress. Most of us would say that targets relate to the application of best practice and that they are aspirational. Yet, under the new Labour Government, targets have become something quite different. They have become direct commands in the health care system. They are ministerial diktats meaning that strategic health authorities and primary care trusts are simply the delivery arm of Whitehall acting on ministerial instructions.
Under the full lexicon of new Labour, we hear of "earned autonomy", which is a wonderful oxymoron, meaning "You can do what you like as long as it's what we tell you to do." We are told that PCTs control 70 per cent. of the budget, but they merely handle 70 per cent. of the budget. That is rather like saying that bank clerks control millions of pounds because they handle millions of pounds, although they have no discretion in what to do with the money. Part of the myth perpetrated by the Government is that they are decentralising the service.
The problems with targets fall into several distinct categories: their effect on patients and clinical priorities; their effect on integrity and trust in the system; their effect on non-acute services; and their effect on recruitment and morale. Let me begin by talking about the effect on patients and clinical priorities, because all hon. Members will be aware of stories that have been
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circulating widely about distortions in the system. In September, the BBC broke a story about what was happening in Leeds. It said:
"Managers at Leeds Teaching Hospitals NHS Trust say they will only accept referrals from GPs if they are sure patients can be seen within 17 weeks . . . The trust has now written to GPs in Leeds to tell them it will not accept new patients if it means it will breach the outpatient waiting time targets set by the government. In a letter to GPs, the trust warned that patients"
will have to go elsewhere. It said:
"We will accept a referral only when we have the capacity to see the patient within the maximum waiting timewhich is currently 17 weeks for outpatients by 31 March 2004. We may be unable to accept a referral from your practice."
The trust had the nerve to say:
"This is not all about waiting times . . . This is about managing the number of people coming into the trust and improving planning."
So patients are referred to where it is convenient for the system to see them. In other words, the system is not there to service the patients; the patients are there to service the system. That has been the great cultural corrosion under new Labour.
Rather more recently, on 13 October this year, the United Lincolnshire Hospitals NHS trust said about the suspension of specialist pain services in Lincolnshire:
"The Local Primary Care Trusts and the United Lincolnshire Hospitals NHS Trust has reached an impasse in negotiations regarding funding of the county-wide specialist pain services. The service has been suspended because capacity of the service is insufficient to meet a growing demand. Faced with an unwillingness on the part of the Primary Care Trusts to invest, and a likelihood of breaching monitored waiting times for new outpatients, a decision was made to suspend the service."
In other words, if a trust cannot make the targets, it can give the service up entirely and not breach Government guidelines. What sort of ethical basis is that for running a system?
The consultants at the centre of the problem said that the decision
"was taken without consultation with clinical personnel and, apart from continued access for patients with cancer pain, is not based on clinical need but rather financial and political criteria."
In their letter, the consultants also said:
"There have been a number of instances where pain clinics in the UK have stopped accepting new patients as a means of managing waiting lists, with the recent nationwide survey revealing four clinics spread across the country currently not seeing new patients"
not because the patients did not need to be seen, but because it was politically inconvenient for the managers to have to report to Ministers that they could not meet their targets. So the statistics came first and the patients came second.
Hugh Bayley (City of York):
In my health authority area in North Yorkshire, the number of out-patients waiting longer than 13 weeks has fallen over the past five years from more than 5,000 to 1,000, a fivefold reduction. The figures for the area represented by the hon. Member for Woodspring (Dr. Fox) will be similar. Does he think that we should get rid of the out-patient waiting time target? If not, precisely which targets does he suggest the NHS should abandon?
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I do not believe that the service should be forced to work to centrally driven targets determined by Whitehall. It should be up to clinicians to determine which patients are treated, and the priority of that treatment, in their locality. There will need to be a different balance of services in different parts of the country. To attempt to run the service in a one-size-fits-all target-driven culture designed in Whitehall will be catastrophic, as it is in many of the areas I mentioned.
Several hon. Members
I shall give way in a moment.
Let us consider what happened in Oxford, for example, where we saw the obscenity of patients sitting in ambulances, queuing by the accident and emergency departments so that they did not breach the four-hour waiting time for accident and emergency. The Government's Commission for Health Improvement ambulance trust review said:
"One of the reasons for long delays in A&E departments accepting patients from waiting ambulances may be their own need to achieve a target that no patient should wait more than four hours from arrival in A&E to admission . . . This illustrates how targets set for one service may work against good cooperation between services."
It is not possible to micro-manage a system as complex as the NHS from behind a Minister's desk in Whitehall. It is not possible to design a set of targets and criteria that will allow professional people to exercise their judgment appropriately.
Mr. Mark Hendrick (Preston):
How can a Government determine whether the taxpayer is getting value for money from their health care if the Government do not set the targets? Does he not accept that hospitals throughout the country do not have inexhaustible capacity? If a hospital cannot meet the need in the locality, it is feasible that that patient may have to be treated elsewhere.
The hon. Gentleman raises two important points and he betrays what is at the heart of the new Labour problem. First, he says that the Government have to set targets to get value for money, but there is no concept of what is appropriate for the patients. The most important thing is not the system but what matters to the patient. Secondly, he mentions patients going elsewhere. It is Conservative policy that patients should move anywhere they want to inside the NHS. Naturally, any policy is constrained by capacity, but patients should be able to exercise that choice themselves. Instead, they are moved around for the convenience of the administrators. That has nothing to do with what patients want or what is good for them. In that scenario, the system comes first and the patients come a very poor second.
The Secretary of State for Health (Dr. John Reid):
I thank the hon. Gentleman for clarifying his remarks. Will he confirm that for the 1,500 people who were waiting more than 26 weeks in his constituency for a consultant's appointment and who have now been completely taken off any listno one in his constituency is waiting more than 26 weeksas a result of our objectives in driving forward those targets, he would
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abandon all the targets and objectives and we would return to the situation that prevailed before the Labour Government?