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Hugh Bayley: Does the hon. Gentleman realise that, like the NHS, every private hospital chain sets targets for cleanliness, timeliness of treatment and patient privacy? Why are the targets that are clearly necessary to maintain standards in the private sector not necessary to maintain standards in the NHS?
Tim Loughton: Independent hospitals have a different definition of targets. The standards must be met, and it does not require 62 different targets for those independent hospitals and other treatment centres to produce high quality health care. It does not require dozens, scores and hundreds of managers to investigate targets and whether they have been achieved. Why can independent hospitals do it when the NHS has to have ever increasing targets and people to administer them? That is the genuine difference.
Dr. John Reid: Will the hon. Gentleman give way?
Tim Loughton: If the Secretary of State will give me a minute to make some progress, I shall readily give way.
The position is not helped by the ridiculous spectacle of hospital trusts drafting in extra staff for the accident and emergency tests at the end of March. Let us dispel the myth that the Secretary of State has promulgated. At the end of March, the Commission for Health Improvement inspections for the star ratings were done in one week, whatever may have happened since.
Dr. Reid: Particular ratings were put out, but since March we have also maintained the statistics on the achievements in accident and emergency. They have consistently run between 87 per cent. and more than 90 per cent. for months.
On administration in the private sector, does the hon. Gentleman realise that 25 per cent. of the United States' expenditure, which is 15 per cent. of gross domestic product—that is twice what we spend, but it does not cover 43.5 million people—goes on administration. In the NHS, less than half that percentage is spent on administration.
Tim Loughton: That is why we do not hold up any experiences in the United States' system as examples that we want to follow. The Secretary of State has been in the United States investigating those systems. We have based many of our policy points on the experience in continental Europe, where things have been done differently. I am surprised that the right hon. Gentleman is so afraid of the experiences of our partners in Europe.
Most wasteful is the diversion of time and resources from dealing with patients to paperwork, inspection reports and bureaucracy. For example, at the end of September last year, there were 158,000 whole-time
equivalent NHS infrastructure support staff in England. That is an increase of 12 per cent. since the Government came to power. There are 31,000 whole-time equivalent NHS managers—an increase of 44 per cent. since 1997. It is not surprising that the extra manpower is required when it has been revealed that NHS hospitals are answerable to no fewer than 36 separate regulators out of the Government's total of 108.The Better Regulation Task Force found that the number of regulators has mushroomed, with nine more promised, yet no one in Government takes responsibility for whether they operate effectively or should exist. David Arculus, chairman of the taskforce, said:
- "If you are running an organisation like a hospital, these people impinge on almost everything you are doing, and 36 different regulators make it very difficult when you are trying to deliver a service."
- "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".
The new Secretary of State promised a new broom and a new approach when he succeeded the arch-centralist, the right hon. Member for Darlington (Mr. Milburn). On 7 September, in The Observer, he stated:
- "Targets and objectives are a necessary spur. But they're not an end in themselves—the end is the best possible medical care."
The Government should have only one target in health—to improve the health of the whole nation and the quality of the clinical and social outcomes for all patients when they come into contact with all aspects of health care. They should be prioritised purely on medical considerations. Implicit in that is doing away with a raft of targets and the target mentality, which makes the goal the achievement of targets, not the health of the patient and trust in health professionals to deliver it. We must stop treating patients as statistics, whose importance and access to appropriate health care is determined purely by whether their early treatment would be a help or a hindrance to achieving the target, regardless of the clinical effect on the patient. That is the real dividing line between a Government stuck in a Stalinist time warp and—from the Conservatives—bright, imaginative and fresh ideas relevant to health care for all in the 21st century.
This Government stand for more targets, more all-pervading bureaucracy, more demoralisation of staff and more money for maintaining the health of a system,
rather than that of the patients it exists for, micro-managed by a transient Secretary of State in Richmond house. Under the Conservatives, the health service would put patients first, give all patients real choice and power to access the whole of that system, put the quality of care ahead of the number of boxes ticked, and trust the professionals to deliver without the dead hand of the Secretary of State hovering menacingly over their every move. That is the real dividing line which we will enthusiastically set out to the British people ahead of the next election; it is one that I relish.9.45 pm
The Minister of State, Department of Health (Mr. John Hutton): I have to say to the hon. Member for East Worthing and Shoreham (Tim Loughton) that it is not terribly sensible to refer to transient leaders, given the turmoil in his party. I want briefly to return to that theme, as he would anticipate.
This has been a useful debate, because, as the hon. Gentleman said in his closing remarks, it has helped to highlight the differences between both sides of the House in relation to the NHS. The hon. Member for Woodspring (Dr. Fox) made another of his characteristic speeches. By that I mean that he spoke for half an hour, but could not bring himself to mention any of his party's policies in relation to the NHS. Having read them, I perfectly understand why.
The hon. Gentleman shared with us the illuminating insight that the Tory Administration's targets for the NHS were always aspirational. That is certainly true, because the Tories never managed to meet any of them. He also confirmed, very helpfully, although I am not sure that the hon. Member for East Worthing and Shoreham took exactly the same line, that under a Conservative Administration—if ever there were to be one in the near future—no national targets would be set for the NHS. That will be of serious concern for taxpayers and for patients.
The basic thrust of the speech made by the hon. Member for Woodspring was to deny that any progress has been made in the NHS, which is the view of the hon. Members for East Worthing and Shoreham and for Bridgwater (Mr. Liddell-Grainger). In the process, NHS managers were accused of systematic dishonesty. Those are serious allegations. If that is the hon. Gentleman's view, I am sure that at some point he will want to come to the House and to Ministers with their substance. We look forward to receiving those allegations—
Mr. Hutton: I will give way in a moment, because I want to come to the hon. Gentleman's speech.
We warmly welcome the hon. Member for Sutton and Cheam (Mr. Burstow) to his new responsibilities, and I am sure that he would want me to pass on to the hon. Member for Oxford, West and Abingdon (Dr. Harris), for whom I have a great deal of respect, my very best wishes and the best wishes of all Members of the House to him and to his partner.
I am grateful to the hon. Member for Sutton and Cheam for his support for the work of the NHS and its staff—that is very welcome—but he is quite wrong to
characterise targets as not being related to improved outcomes for patients. I am sure that, with hindsight, he will want to go away, perhaps consider some targets that we have set this year and reflect on whether he was right to make that allegation. In fact, that also goes for the two Conservative Front Benchers who contributed.I shall give the hon. Gentleman four examples in which we can say clearly that those targets are about improving health outcomes, which is the point and purpose of the work that we are doing: first, reducing the rate of smoking in the population—there is a clear evidence base for that, and it will improve the healthy lives of millions of people in Britain—and, secondly, increasing the proportion of patients who receive thrombolysis within 60 minutes of asking for professional help. Three years ago, only 38 per cent. of patients received thrombolysis within 30 minutes; now that figure has been doubled to 76 per cent. That will help to save lives.
It is quite wrong to say that that target is unrelated to health outcomes. Neither is that the case with the targets to reduce the rate of untreated psychoses in the population and to require all the hospitals to have a dedicated stroke service by 2004. All those targets are about improving health outcomes for the people of this country and the evidence base for that, which the hon. Gentleman wanted, is very sound and fully set out in all the national service frameworks to which they relate.
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