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Mr. Ian Liddell-Grainger (Bridgwater): As a member of the Public Administration Committee, I should point
out that we went on to say that we had found numerous cases where figures were being blatantly fiddled and people were lying to cover up the culture that my hon. Friend has just mentioned. Does he agree that that is happening?
Dr. Fox: The interesting point, following further investigation of the details, was what the culture meant to patients in those situations. In May 2002, the Bath Royal United Hospital trust found that more than 2,000 out-patients waiting more than 13 weeks for a consultant appointment had disappeared from official lists—at that time the trust reported just 22 such outpatients. A lot of patients who were genuinely waiting were not, on paper, waiting at all.
In autumn 2002, after a strategic health authority investigation, the Good Hope Hospital trust in Birmingham found that 30 inpatients had waited over 15 months for treatment and six outpatients had waited longer than 26 weeks for treatment, but those figures had not been correctly recorded. In March 2003, the strategic health authority for South Manchester University Hospitals trust found that long waiters—those who had been waiting longer than 18 months—were simply excluded from returns, and other patients were being inappropriately redesignated from the acute waiting list to the planned admissions list.
We all know from our constituency mailbags that those are not unusual cases. Ministers will say that they are isolated examples and that the managers in question must be sorted out because they have no place in the NHS. Those managers are merely carrying out the tasks that they know are required of them by central Government in the target culture. It is no use Ministers saying, "It has nothing to do with us," because managers know that if they fail to meet their targets or they breach the Government guidelines, they will get a phone call from someone in the Department of Health telling them how they ought to be running their hospital and which patients ought to be seen. That is simply not acceptable.
Earlier this year, we had the great accident and emergency farce. The figures published by the Department showed that the proportion of patients in England who spent less than four hours in A and E had risen to 82.4 per cent. Those were wonderful figures—we would all love to think that patients did not wait in accident and emergency—and they were released on 20 June. However, the BBC programme "Panorama" and the British Medical Association showed that they were nonsense and did not accord with what was happening in the real world. According to the BMA, two thirds of accident and emergency departments in England established special arrangements during the monitoring period, which they knew about in advance. Preliminary results from a questionnaire sent to accident and emergency staff found that the temporary use of medical and nursing staff was the most common tactic, followed by staff working double or extended shifts. Fourteen per cent. of respondents were aware of routine surgery being cancelled so that extra beds were available that week. The majority believed that efforts to meet the Government's targets distorted clinical priorities in accident and emergency.
It is nonsensical to operate a service by saying, "We know you're going to be measured this week. If you can meet the targets that week, whatever you have to do to
do so is fine. The Government will be able to tick a box and say that we've met the targets." In fact, that distorted activities in other areas and other patients suffered. Nobody believed that the exercise was genuine or sustainable and, of course, the following week, things went back to what they were before. It is an Alice in Wonderland way to run a health service, and results in a culture of distortion and deceit.Other services damaged by that culture are the non-acute services and the services for which the Government do not have a centrally driven target. The Prime Minister keeps telling us that public services are about "schools and hospitals", which betrays a great deal of ignorance of what happens in the health service, as most of our health care is provided not in hospitals but in the community. The obsession with acute hospital targets means that, far too often, too little attention is given to other services. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) will talk about the effect of targets on primary care in his winding-up speech, but while Ministers have developed obsessive-compulsive disorders about hips, knees and cataracts, mental health services have continued to deteriorate. The so-called sexual health strategy is a disaster. I am sorry that the hon. Member for Wakefield (Mr. Hinchliffe) has left the Chamber, because it would have been interesting to learn from him just how bad things have got for the GUM clinic in Bristol. The Government's immunisation strategy is in tatters, and infectious diseases such as tuberculosis have reached record levels. While diabetes becomes ever more prevalent, screening and care constantly lag behind that trend.
We also need to consider the effect of targets on staff morale, recruitment and retention. If there is one thing that shows the Government's lack of understanding of the complex way in which the health service works it is their absurd star rating system, which is designed to demoralise people, tells us nothing of any value about hospitals, and ought to be scrapped. When the star ratings, in their crude way, are applied to hospitals, they often create a misleading picture. Hospitals are treated as single units, not a complex interaction of services. Just because a hospital has a poor gynaecology service does not mean it will have a poor cardiology service. Just because it has an excellent ear, nose and throat service does not mean that it will have an excellent orthopaedic service. The star rating system does not tell patients anything of any value, but it can, in many cases, have a demoralising effect on staff in those hospitals. The chairman of the BMA, Jim Johnson, said:
- "Nobody should use star ratings to judge how well a hospital is doing. They measure little more than hospitals' ability to meet political targets and take inadequate account of clinical care or factors such as social deprivation. It is grossly unfair on staff working in low-rated trusts that public confidence in them is being undermined".
David Taylor (North-West Leicestershire): Would the hon. Gentleman care to tell the House about the links between levels of hospital-acquired infections and the outsourcing arrangements in place at many of those hospitals, a good number of them dating back to the period when his party was in office?
Dr. Fox: That is one of the most absurd arguments that I have ever heard. If a trust has contracted-out cleaning, but the hospitals are filthy, why pay the contractors? It should get someone else in to do the job. One of the biggest problems with hospital-acquired infections is simply cultural. Transmission of infection between patients has nothing to do with expenditure but a great deal to do with washing one's hands. For a doctor or nurse to wash their hands after seeing one patient and before seeing the next does not require a Government grant. It is part of the culture of the system—it is not helped by any Government target and is good practice for professionals who deal with patients. It does not require Government intervention, but it does require a bit of thought about patient care.
One area where morale has been particularly hard hit is general practice. Medeconomics, the specialist health magazine, reported in September this year:
- "There are now fewer GPs per patient than five years ago. In 1997 there were 54.3 GPs for every 100,000 people, compared to 54.1 in 2001."
- "We are not surprised by this increased vacancy rate . . . in England. Indeed it matches the findings of our own GP vacancy rate survey . . . The upward trend is a matter of great concern."
Targets are not about patients but about politics. The NHS is being run to suit the spin of the Government machine, not the clinical needs of patients. Political expediency is given priority over the need for care. New Labour has corroded the integrity of the NHS. It has put
statistics before patients, demoralising NHS staff—the staff I trained and worked with, who are becoming increasingly difficult to recruit. This is no longer about the health of the public but about the political health of the Government. And they told us that things could only get better.
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