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Dr. Fox: The Secretary of State's question reminds me of what happened to some of my constituents when the Bath Royal United Hospital NHS trust told them that only two patients were waiting more than 18 months anywhere in the country. We were inundated with calls all afternoon from people wanting to know who the other person was. As far as the patients were concerned, many had been waiting for that time, and I intend to deal with the accuracy of the figures.
The Secretary of State does not understand that activity is being driven by the numbers, not by the clinical importance of the conditions affecting patients. It is not acceptable to get numbers down if it means that the sickest patients might wait longer than those with less important conditions. What is absent from the Government's approach is the idea that the most appropriate people to make decisions for patients are the clinicians who look after them. We all want lower maximum waiting times across the board. That is a universal aim. We want to ensure, however, that that does not result in a clinical distortion by which some of the sickest patients have to wait longer.
Mr. David Hinchliffe (Wakefield): Will the hon. Gentleman give way?
Dr. Fox: Of course I shall give way to the hon. Gentleman in a moment.
One set of Government figures reveals the flaw in the Secretary of State's case. Their targets for seeing cancer consultants are, on the surface, laudable and sensible, but they are about gaining access to a consultant in the first place; they say nothing about when a patient will receive treatment. So let us consider what has happened in cancer treatment.
According to Department of Health figures produced in September, waiting times for cancer treatment increased in most cases between 1999 and 2002. [Interruption.] The Secretary of State says, "No, they have not", so let us look at them. Between 1999 and 2002, the average waiting time for treatment for cancer of the oesophagus was up 14.3 per cent.; for cancer of the stomach, it was up 20 per cent.; and for brain cancer, it was up 66.7 per cent. The Government have met their targets for how quickly a patient can see a consultant, but they have increased the length of time before patients receive treatment. What is the point of that?
Mrs. Joan Humble (Blackpool, North and Fleetwood): The hon. Gentleman does not mention breast cancer treatment or the initial referral. Constituents of mine have had almost immediate access to both the initial consultation and treatment. Those women would have died but for that development. They welcome the targets because they are the direct beneficiaries of them.
Dr. Fox: But if the consequence of all patients who are suspected by their GP of having breast cancer being seen within a maximum waiting time—which, again, on the surface, seems fine—is that the consultants who should
be treating those with proven breast cancer are having their activity redirected, there is no clinical gain. It is a question of what is sensible and what is appropriately judged by clinicians.With the best will in the world, politicians cannot create a system that is both specific and sensitive enough to deal with individual patients. It is nonsensical if the patients get a maximum waiting time to see a consultant but the waiting time for treatment is lengthened, because that is what will make the difference to the clinical outcome for the patient.
Dr. John Reid: With great respect to the hon. Gentleman, who has practised medicine, I say to him that the whole point is that, unless patients are seen early by a consultant, those clinical judgments cannot be made. When we took power, people waited weeks and, in some cases, months to see a consultant, even when the doctor had identified a suspected cancer. Now 98.5 per cent. of all people diagnosed with a suspected cancer see a consultant within two weeks.
That early appointment is important precisely so that the consultant can then decide, according to their clinical assessment, in what order treatment should occur. But patients have to be seen first, and under the last Conservative Government, even when people had been diagnosed, they waited weeks and months; now they are seen within two weeks. That is the point.
Dr. Fox: The Secretary of State is right: that is the point. The point is that it is not how quickly patients are seen that matters for their clinical outcome; it is how quickly they are treated. According to the Government's own figures, the waiting time from being seen to being treated is going up. It is being elongated by the fact that consultants have targets for seeing new patients, not follow-up patients, and there is no Government target for the length of time before treatment.
I recently attended a meeting with CancerBACUP at which a cancer consultant said that his hospital was making very good progress with cancer doctor numbers. He said, "We now have extra consultants, which is a good thing, except for how we did it. We delayed the retirement date for our outgoing consultant from 31 March to 1 April, brought forward the recruitment date of our new consultant from 1 April to 31 March and gave one of our retired consultants one session a week. As we were measured on 31 March, we had three consultants. Of course, we really have only one, but on paper we have three." It is that sort of statistical manipulation that is so damaging to morale, integrity and trust in the system.
Mr. Hinchliffe: The hon. Gentleman may have had some contact—in a professional capacity, I hasten to add—with the genito-urinary medicine clinic in Bristol, which I, as a member of the Health Committee, visited a little while ago. We were told that it was turning away 500 people a week because it simply did not have the capacity to treat people with serious infections and sexually transmitted diseases. The Committee, with the support of its Tory members, put forward the view that in such circumstances patients should have access to treatment and care within 48 hours; they should not be turned away to go and infect other people. To their
credit, the Government acceded to that request. Were they wrong to do so when we have such a crisis in sexual health?
Dr. Fox: That is a very good question because it goes back to what we mean by a target, as I said at the outset. It is fine for the Government to say, "This is what we regard as best practice and it is aspirational", but using targets as a means of forcing activity on the system—an activity designed on a one-size-fits-all basis—does not really work in the real NHS. That is the problem that we are identifying in this debate.
The targets and the way in which they are interpreted also have an effect on the trust and integrity in the system. In June 2003, in a damning condemnation of the culture of targets, the Audit Commission said:
- "Local managers must want to improve patient care via meeting targets—not manipulate things to theoretically meet targets without real gain. For example, practices such as offering appointments at short notice and restarting waiting times if patients cannot attend comply with DH guidelines, and allow some trusts to achieve targets, but would not be considered fair by patients. Similarly, cancelling high numbers of operations the afternoon before the due date means that the commitment to rearrange within 28 days does not apply, and the Plan target can be met—but again, this is not acting in a way that patients would think fair. Such trusts have lost sight of the real priorities, which are about improving the NHS for patients, not just meeting Government targets."
Looking at the accuracy of the figures that Ministers are so fond of quoting, the Audit Commission said:
- "A number of trusts were found to be operating in ways that seemed weighted away from the interests of patients. These include the practice of offering appointments to patients at short notice and then, when they are unable to attend, recording this as a 'patient cancellation' and resetting the 'clock' measuring their waiting time to zero."
- "You're about to breach the target, you then tell the Department to phone up 50 per cent. of the people on that waiting list and offer them, surprisingly, admission within the following two weeks, to which of course large numbers say 'Two weeks? I can't do that.' At which point they're told, 'I'm terribly sorry, you have to go back to the beginning of the waiting list" and hence the target is met."
When the all-party Public Administration Committee reported on the Government's measurements, it said:
- "The danger with a measurement culture is that excessive attention is given to what can be easily measured, at the expense of what is difficult or impossible to measure quantitatively even though this may be fundamental to the service provided (for example, patient care . . . ) There is the further danger that the demands of measurement may be so consuming of time and effort that they detract from the pursuit of a service's underlying purpose. The measurement culture is also in danger of threatening standards."
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