| Previous Section | Index | Home Page |
9.16 pm
Mr. Adrian Bailey (West Bromwich, West): We need to be clear that the Opposition motion is not just about targets. By proposing the abolition of targets, they are making it clear that they oppose the planning of public resources, performance management and public accountability. Above all, they oppose policies that they thought appropriate when they were in government.
I was interested in what the hon. Member for Woodspring (Dr. Fox) said about the inadvisability of centrally driven targets. Those of us with long memories may remember the statement by the then Secretary of State for Health, the right hon. Member for South-West Surrey (Virginia Bottomley), when she introduced the White Paper on targets, which included targets on coronary heart disease, stroke, cancer, mental illness and AIDS. She said:
- "In each of these key areas we have set challenging but achievable targets . . . In other areas, more development and research will be needed before national targets can be set. What we
- are proposing are not short-term measures. The strategy will grow and develop . . . The White Paper identifies other possible target areas for the future. This underlines the fact that it represents a beginning, not an end."
- "The NHS management executive will require health authorities to build the target-setting approach into all levels of local activity. The strategy will be central to the work of the NHS."—[Official Report, 8 July 1992; Vol. 211, c. 335–37.]
The policies on targets adopted by this Government are consistent with that approach, with one significant difference: under the Tories, the NHS was starved of fund, but under Labour targets are backed up by consistent, sustained and record investment. One reason the Tories do not want to hear about targets is that they know that the target-setting culture and the performance indicators that underpin it demonstrate just how far we are going and just how much progress has been made with the extra investment from this Government.
The current NHS targets are not figures plucked out of the air; they arose from research and consultation with interested bodies. They relate to the milestones and objectives of the NHS plan, which, in turn, was determined following the widest public and patient consultation exercise ever conducted in the service.
I consulted my trust, Sandwell and West Birmingham Hospitals trust, to find out its experience of targets. Its response was that targets are very useful in a number of areas. The first is planning. Trusts now have clarity about public and Government expectations, and that allows them to examine their services, to plan clearly and to deploy their expanding resources accordingly. It enables them to prioritise and to invest in those areas of the service designed to meet those priorities.
Targets help with staff morale. Demonstrating improved performance against targets and communicating that to staff and local communities provides a boost to staff morale and is good for both recruitment and retention. Dedicated NHS staff who do a good job like to know that their efforts are formally and publicly recognised. I acknowledge that there is a danger in that, in those hospitals not reaching targets, there is a potential for lowering staff morale. However, my experience of NHS staff is that their commitment to the public is such that they would always welcome ways to improve management and planning so that they may serve the public more effectively. Without NHS targets and performance indicators, there is no way in which staff can know what they can achieve.
Targets help the local community. Trust performance indicators are keenly reviewed by groups and individuals who can then argue their case from a more informed position than before. They also provide a clear, shared framework for discussion between the primary care trust and the hospital trust about the deployment of their increased funding. PCTs are better able to account to local people and GPs the basis for their decisions and priorities.
Targets also help in expanding NHS capacity. Where trusts are in negotiation with building contractors and commercial banks for private finance deals, the
management of risk is an essential part of those negotiations. Where the private sector can see that a trust is high performing, and therefore a lower financial risk, it enhances the prospect of private sector funding. Without financial targets, that source of financial reassurance would be lost.Targets have also helped performance. By setting standards high and targeting efforts to pull the worst performers up to the highest standards, the NHS has already raised standards throughout the country. We have already discussed a clear example of that: the 90 per cent. of people who visit accident and emergency departments and are treated and discharged within four hours of arrival. The geographical variations in that service have virtually been eliminated.
The motion has nothing to do with red tape, bureaucracy or the perversion of clinical priorities in the NHS. The profound change in the Conservatives' policy since they were in government has everything to do with their desire to undermine and privatise the NHS. It is part of a wider strategy to reduce public funding and increase private practice. It signals the end of any Tory aspiration to improve the nation's health care through the NHS. By removing targets, the Tories are removing incentives for improvements and ending the possibility of an informed dialogue between local communities and local health care providers. By removing targets, they are reducing funding for the NHS and hiding the consequences. The so-called patient passport would deprive the NHS of an estimated £1 billion. Tax relief on private medical insurance would cost another £1 billion, which would pay for 16 hospitals, or 80,000 nurses, or 25,000 consultants, or 30,000 GPs. A funding deficit on that scale would devastate the NHS's ability to meet future public expectations.
By removing targets and performance indicators, the Tories hope to disguise the full extent of the failure of their policies to deliver the service that the public want. Their policy is designed to assist a minority of the better off who can afford private treatment while short-changing the great majority who depend on a publicly funded NHS free at the point of delivery. This debate is not just about targets but about the future of the NHS. Removing targets is an essential prerequisite for the privatisation process supported by the main Opposition party. There is a clear choice between the Government's vision of a well funded, better focused NHS, sensitive to the needs of a well informed local community and the Tory sabotage of an underfunded NHS haemorrhaging money to the private sector, unable to meet local need and with no means for the public to measure that deterioration. I am confident that the public and the great majority of people who work in such a dedicated way in the NHS will back the Government.
9.26 pm
Dr. Richard Taylor (Wyre Forest): In the three minutes available to me I shall make just one crucial point. I want to pick up a phrase in the Government amendment about the House welcoming
- "the positive effect of the right targets"
The targets that we should be aiming at should include patient satisfaction because, as has been mentioned by the hon. Member for Sutton and Cheam (Mr. Burstow), we cannot yet measure patient outcomes reliably. I was interested to read in today's papers that Aston university in Birmingham is to undertake a comprehensive poll of NHS staff for the Commission for Health Improvement and the Commission for Healthcare Audit and Inspection. I hope that staff opinion will be taken into account more in performance ratings in future. I appeal to the Minister to push for staff surveys and patient surveys to be taken into account. Why does nobody take into account the full inspections of hospitals that are undertaken by all the royal colleges for accreditation? They examine the performance of a hospital in detail and could add tremendously to the value of measures such as star ratings.
I finish by pointing out that targets are to be aimed at. When he missed a target, even Robin Hood was not penalised or shot directly. I do not believe that targets should be enforced to such an extent that trusts are penalised for not hitting them.
9.30 pm
Tim Loughton (East Worthing and Shoreham): We have had a good debate with some interesting contributions. It is a shame that we could not hear more from the last speaker, the hon. Member for Wyre Forest (Dr. Taylor), with his professional experience. He is right. The debate should be about the right targets, which the Government are trying to weasel out of. A target is to be aimed at. It should not drive the entire service and rationale of the NHS, as it does, with all the intimidating tactics that are used.
We had some interesting contributions from Labour Members. The hon. Member for Telford (David Wright), who has momentarily disappeared, says that targets help to drive up performance and standards. It is not the targets that do that; it is the professionals and resources in the health service that drive up the performance and standards. That is the fundamental misconception of Labour Members, which is why the debate is so essential.
My hon. Friend the Member for Bridgwater (Mr. Liddell-Grainger), when not erroneously suggesting that we should put down elderly people, is a distinguished member of the Administration Committee, and gave us the benefit of the experience of people in business, who know what targets are all about. He gave the example of Lord Browne, the chief executive of BP Amoco plc, saying that any good business would have between five and 10 targets, but
under the new formula announced by the Secretary of State earlier this evening, there is one target in the NHS for every £1 billion of expenditure. If that principle were applied to business, BP would have many hundreds of targets, making it completely unmanageable. It would be absurd.The hon. Member for West Bromwich, West (Mr. Bailey), I fear, reflected the topsy-turvy world in which Labour lives, saying that staff to whom he had spoken in his constituency verily embrace the target culture and welcome it, and that it has helped with staff morale. He ought to get out more and speak to real people who will give him real answers, not the answers that he wants to hear to the warped questions that he might be asking.
We make no apology for returning once again to the subject of the Government's obsession with targets and performance tables, and, most crucially, the bureaucratic baggage that attaches itself to such a system, which is so deeply ingrained in the Government's mindset, but nowhere more extensively and damagingly than in respect of health care. The Government have a target for everything, but know the ultimate value to the health of a patient of nothing. They pursue a policy that has as its primary objective the health of the national health system, rather than the health of the patients whom it exists to serve.
As the Audit Commission stated in its June report,
- "too many targets and indicators risk obscuring where the real priorities lie."
There is one good target that has been achieved, according to a report in Hospital Doctor. The radiology department at the Ealing hospital trust has successfully reduced the wait time for a barium enema from 19 weeks to four weeks. The reduction has been achieved by local people using their ingenuity and local expertise in that hospital, rather than relying on some centrally driven bureaucratic target that the Secretary of State has told hospitals to achieve.
There are so many targets and so much measuring to be done, but the Secretary of State would be well advised to listen to an old farming adage: the pig does not get any fatter the more you weigh it. That is what all the targets are about. Individually, they all sound perfectly reasonable objectives, and none of us would not want to reach a state of improvement in health care generally, characterised by such worthy aspirations. Taken in their entirety, however, the cumulative effect of placing so much importance on these targets, completely suppressing the professional skill and judgment of doctors and nurses, is often to distort clinical outcomes; to create problems down the line for patients who do not fit neatly into the target priorities; to place intolerable pressure on intimidated managers to claim that targets have been met, irrespective of whether that is borne out by the evidence; and completely to demoralise the health professionals who came into the NHS to treat patients and to make them better. The outgoing chairman of the British Medical Association, Ian Bogle, describes it as
- "the suffocation of professional responsibility by target-setting and production line values that leaves little room for the professional judgement of individual doctors or the needs of individual patients . . . The auditing of every bowel movement on every ward in every NHS hospital would be a fitting memorial to Alan Milburn"—
- "now that he has decided to spend more time with his family".
- "The waiting time targets for new outpatient appointments at the Bristol Eye Hospital have been achieved at the expense of cancellation and delay of follow-up appointments. At present we cancel over 1,000 appointments per month. Some patients have waited 20 months longer than the planned date for their appointment."
An estimated 2 million patients are effectively being banned from making GP appointments under the advance access scheme because it would hinder GP surgeries in meeting the Government's 48-hour waiting time targets. That particularly affects elderly and disabled people who have to make special transport arrangements
On mental health, Dr. Matt Muijen, director of the Sainsbury Centre for Mental Health, has expressed concern that the targets for mental health services mean that many patients are being neglected at the expense of high-profile areas. He states:
- "The trend I am beginning to see is that fewer people get better care. People who are high risk are getting good care but there is a big group of people who just need ongoing care. What about the people who fall through the cracks? . . . We certainly know an awful lot of places where they have to close down hospital beds to fund crisis teams."
There has been a big increase in the number of operations cancelled less than 24 hours before they are due to happen. That is a result of targets that give wrong priorities to clinical problems. Last year, 70,000 such operations were cancelled. There has been an increase of 4,627 in emergency readmissions to hospital after hospital treatment, often because people are discharged too early owing to pressure on management to meet targets elsewhere in the hospital. As my hon. Friend the Member for Woodspring (Dr. Fox) said, there is serious doubt about the accuracy of the data that are produced supposedly to attain those targets—the star rating of hospitals. James Johnson, the new chairman of the BMA, says:
- "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."
| Next Section
| Index | Home Page |