Standing Committee E
Tuesday 10 June 2003
[Mr. Win Griffiths in the Chair]
The Chairman: I remind hon. Members that all proceedings relating to part 2 of the Bill other than those relating to Welsh clauses must be concluded by 5 pm. That is just a thought for the Committee to grapple with.
Amendment proposed [this day]: No. 31, in
Question again proposed, That the amendment be made.
The Chairman: I remind the Committee that with this we are discussing the following:
Amendment No. 360, in
clause 51, page 18, line 6, leave out 'and approved'.
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): The Commission for Healthcare Audit and Inspection will develop and propose the criteria for performance ratings. It will use its professional judgment to devise and develop a better performance rating system with constantly improving criteria. The Government accept that we are only two years into an important journey and we want CHAI to continue that development process. My right hon. Friend the Secretary of State's only interest in this area is to be assured that that process reflects priorities that he has rightly set for the health service in the interests of all patient concerns. That must be right.
I did not think that the settlement was controversial until I heard some of the comments made today. The health service, which was founded by a Labour Government, has been accountable to Parliament through the Secretary of State in this place for more than 50 years. I am surprised, therefore, to hear arguments to take away the Secretary of State's attempt to have some nexus or relationship with those criteria as they are developed.
Chris Grayling (Epsom and Ewell): But does not the Under-Secretary realise that it is precisely because so many health care professionals say that they are held back by undue interference from the centre that Opposition Members seek to reduce the influence of the centre?
Mr. Lammy: No. Health care professionals say that they want to see investment going into the NHS and they are worried about proposals to cut that investment. As a result of my responsibility for
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emergency services, for example, I know that they are pleased to see a Government prioritise emergency care and not regard it as the Cinderella service that it was considered before. Health care professionals want innovation and the spread of best practice, and that is being achieved through the Modernisation Agency and other things. They accept the need to drive up performance and to have a tough new inspectorate.
We are the Government who seek to take that forward, so I do not accept what the hon. Gentleman has to say. Independent inspection equals CHAI using its judgment in assessing NHS performance, but it must be right that the Government, on behalf of patients and the public as a whole, ensure that the criteria reflect priorities that we have rightly set.
The hon. Gentleman suggests that we are not concerned with health outcomes. I remind him—he should know this—that last year's performance ratings covered health outcomes. I do not know whether he had a look at those ratings. He will understand that mortality is clearly a health outcome, a very important one. Emergency readmissions are a health outcome, as is returning home from treatment. There are eight indicators in all to measure outcomes of clinical treatments. Again, the hon. Gentleman seems confused about performance indicators and whether they confuse health outcomes. For those reasons, and the reasons that I gave previously, it is right and proper that the elected Government are able to determine NHS priorities. CHAI should provide an independent assessment of how well NHS organisations have met those priorities.
Dr. Andrew Murrison (Westbury): I am grateful for the Under-Secretary's catalogue of health outcomes, and they are laudable, but he should accept that those that he cited concern not only the national health service. Some would argue that the NHS is only part of those health outcomes. In particular, mortality is multi-faceted and emergency re-admission also concerns social services. He must be clear about what he means by health outcomes in relation to the NHS.
Mr. Lammy: I shall not go into semantics and a wider discussion of the clinical aspects of health outcomes. Clearly, mortality is a health outcome. How the hon. Gentleman seeks to determine and define that is a matter for him. The important point is that there is a range of performance indicators and I was seeking to establish—I hope that I did so—that as well as patient-focused outcomes and a capacity focus to some of the indicators, there are also clinical outcomes.
Chris Grayling: The Under-Secretary referred to mortality in relation to health outcomes. Let me tell him a short story about a recent hospital visit, when I was told that an audited activity of general surgeons was the number of amputations they carried out. I should prefer the national health service to achieve a zero figure for the number of amputations carried out, but the saving of a leg, unlike its amputation, would not show up in the figures.
The Under-Secretary should not be distracted by figures that show activity. What matters, as I keep
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saying, is whether the NHS makes people better. At the moment, only a small proportion of the measurements have any clinical dimension and that is wrong. We need a system of assessment of our health care system that asks the basic question; is it making people better? We are too tied up with the process and not focused enough on outcomes.
Mr. Lammy: Is the hon. Gentleman really suggesting to the 1.2 million people who work in the NHS every day that they are not making people better?
Chris Grayling: What is most extraordinary and demonstrates the challenge that we face in this country is that in a nation with some of the world's finest and most dedicated health care professionals, our system still fails to deliver the quality of health care that is available in other European countries. We should be ashamed of that.
I conclude by referring the Under-Secretary to two comments about the Government's approach that justify our amendment. First, Dr. Gill Morgan of the NHS Confederation said last year:
''The current level of micro-management of the national health service by government is worse than ever before. The Department of Health gets involved in far too much detail, which individual organisations have the capacity to sort out themselves.''
The BMA said:
''Artificial targets imposed on an overstretched service cannot be met without resorting to ingenious massaging of the figures. It does not fool, nor does it help, patients.''
We believe that the time has come for the Secretary of State to take a step back and to trust organisations such as CHAI to do the right job for patients in this country. A clause that includes the phrase
''approved by the Secretary of State''
in relation to the way in which we measure the effectiveness of our health care system is unnecessary and should be struck out of the Bill.
This is a matter that we have pursued throughout our debates on the Bill and we shall seek to return to it at some stage. However, for the moment, I beg to ask leave to withdrawn the amendment.
Amendment, by leave, withdrawn
Amendment made: No. 289, in
clause 51, page 18, line 16, leave out subsection (6).—[Mr. Hutton.]
Question proposed, That the clause, as amended, stand part of the Bill.
Mr. Jon Owen Jones (Cardiff, Central): I am sorry to take up more of the Committee's time, but I did not speak earlier and I want to make some general points about the arguments made against the clause and in support of various amendments.
The Opposition parties have argued against assessing performance, although they say that they oppose assessment of various aspects of performance. In effect, however, they argued against the accountability that the health service should have to the taxpayers, its paymasters, and the spokespersons on behalf of the paymasters; the Government.
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Chris Grayling: I must make it absolutely clear that we did not argue against performance assessment, but against an artificial and flawed rating system that distorts relationships between hospital institutions and is unjust to those that do good clinical work. That should not happen.
Mr. Jones: I am aware that the hon. Gentleman has made that point on various occasions. However, he has also argued generally against performance review. Both Opposition parties have in effect argued that prestigious professional organisations should not be accountable to the taxpayer or to the Government on behalf of the taxpayer. They should be allowed to carry on in their own way, trusting that they have the best interests of the taxpayer at heart without any direct accountability to the taxpayer. Producer groups will promote that argument in any circumstance.
It surprises me that the Conservative party chooses to be the champion of producer interests by saying that the producers are right and should be allowed to get on with the job, given the money; or, under a Conservative Government, given some of the money but with 20 per cent. taken off. In effect, it is saying, ''Let them get on with their work and don't worry your pretty little head about it.'' That system might have some merit if we had another form of accountability. If the health service was in such a good state that it had excess capacity in almost all areas so that its consumers had a great deal of choice about where they went for treatment, accountability could be given directly to them.
Unfortunately, that is not the world in which we live. We live in a world in which the health service has suffered decades of under-investment and has insufficient capacity to offer any realistic choice, except to people who can afford it. That sort of accountability does not exist, so we must have another sort of accountability; a set of indicators of performance that the Government of the day sets out on behalf of the taxpayer, to whom they are accountable. It is not a perfect system. I can agree with arguments against individual types of performance indicators on the grounds that they are distorted, but all too often the Conservatives and the Liberal Democrats argued against the principle of subjecting those esteemed professionals to any form of direct accountability to the taxpayer.