Older People's Commissioners
Ian Lucas, supported by David Taylor, Mr. John Horam, Mr. Paul Tyler, Mr. Parmjit Dhanda, Mr. Roger Williams, Ms Joan Walley, Mr. Nigel Evans, Albert Owen and Gareth Thomas, presented a Bill to establish Older People's Commissioners for England and Wales; to make provision for the Commissioners' duties in respect of the protection of the rights and interests of older people; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 23 April, and to be printed. [Bill 34].
7 Jan 2004 : Column 261
7 Jan 2004 : Column 263
[1st Allotted Day]
NHS Performance Indicators
I inform the House that I have selected the amendment in the name of the Prime Minister.
Mr. Tim Yeo (South Suffolk)
(Con): I beg to move,
That this House calls for an inquiry into the circumstances surrounding the decision in July 2002 to upgrade the star rating of the South Durham Health Care Trust from two stars to three following the involvement of the private office of the then Secretary of State for Health and with the knowledge of 10 Downing Street; further calls for greater transparency in the calculation and publication of performance indicators throughout the NHS; and is concerned that excessive reliance on such indicators inhibits the independence of professionals and managers and leads to distortions in the allocation of resources.
I draw the attention of the House to my entry in the Register of Members' Interests.
I am delighted that on its third day back at work the House has the chance to debate the circumstances surrounding the award in July 2002 of three stars to the South Durham Health Care NHS trust. We are indebted to the Health Service Journal for exposing those circumstances in a report published on 18 December, the day the House rose for the Christmas recess. The Health Service Journal revealed facts that raise serious questions about the integrity of the way in which the star rating system was operated in 2002, about the extent of ministerial interference in the award of stars to individual trusts and about the involvement of Downing street in that process.
Let us examine the sequence of events. On 12 July 2002 the head of the performance development unit at the Department of Health, Mr. Giles Wilmore, sent a paper to the then Secretary of State, the right hon. Member for Darlington (Mr. Milburn), to whom I wrote last night to warn him that I would be mentioning him by name in today's debate. That paper explained that the methodology for calculating the 2002 star ratings had been agreed with the Commission for Health Improvement and that the inspectorate's assessment had been incorporated into the results, for which the Department was fully and solely responsible. The paper also explained that the results had been checked with the four directorates of health and social care.
The list of star ratings was attached to the paper, showing an increase in the number of hospitals receiving three stars compared with the 2001 awards. Mr. Wilmore explained that despite the overall increase in performance
"there are still a few high-profile trusts which we might have expected to be three stars which are not."
His next comment, according to the report in the Health Service Journal
, is significant and I shall quote it in full:
"Unfortunately, even if time allowed it, further revisions to the methodology to promote these trusts would inevitably lead to other individual results we have not expected, as well as making the scoring system more complicated."
In the view of Mr. Wilmore, tinkering with the basis for calculating star ratings at such a late stage would be undesirable.
7 Jan 2004 : Column 264
The then Secretary of State disagreed. Three days later, on 15 July, his private office, in the shape of Sammy Sinclair, warned Mr. Wilmore in an e-mail that the Secretary of State wanted to reconsider the issue. The Secretary of State was apparently very unhappy about the rating given to the Northumbria health care trust and asked whether it could be
"urgently revisited with the Commission for Health Improvement."
The same e-mail from the Secretary of State's office went on:
"The Secretary of State would also identify South Durham as a high-profile trust given that it serves the Prime Minister's constituency. Why has it fallen from three stars last year to two stars?"
The e-mail no doubt anticipated the questions that the Prime Minister was likely to put and it had the desired effect. The very next day, on 16 July, a new paper arrived from Mr. Wilmore, confirming that the star ratings had been recalculated. That paper stated:
"Alterations to the methodology have been made resulting in the changes to individual trusts that were requested."
There can be no doubt about what was going on. That senior official received a request from the Secretary of State to make changes to the rating of the NHS trust that serves the Prime Minister's constituency. As it happened, it also served part of the Secretary of State's constituency. Imagine the relief in his office that day as his staff scanned the latest document to find that no fewer than seven more NHS trusts had now received the coveted three stars, and those seven included the all-important South Durham health care trust.
The Secretary of State had prevailed. He had found a wayno matter at what cost in terms of lost integrityto manipulate the ratings. There is no indication that the changes had the approval of the Commission for Health Improvement or even that it was consulted. Mr. Wilmore's latest note contained a warning, however. It said that changing the results in the way described
"makes the scoring methodology more difficult to explain and less transparent."
Mr. Adrian Bailey (West Bromwich, West)
(Lab/Co-op): There is nothing new in the hon. Gentleman's allegation. It has been made a number of times and repudiated to the satisfaction of pretty much everyone except the Conservatives. As he is concerned about the integrity of the process and the abuse of ministerial position, I draw his attention to a real case of ministerial abuse, as outlined by his Front-Bench colleague, the hon. Member for West Chelmsford (Mr. Burns), in the Standing Committee on the Health and Social Care Bill on 18 January 2001
Order. Interventions are usually short. The hon. Gentleman is making a speech.
That was a pretty disgraceful performance by the hon. Member for West Bromwich, West (Mr. Bailey). I hope that other interventions will address the subject matter of the debate.
Given that the formula for calculating star ratings in 2002 had just five elements and that for one of those fiveclinical focusSouth Durham's performance for emergency readmissions for adults and children was
7 Jan 2004 : Column 265
"significantly below average", Mr. Wilmore's warning about having to make the methodology less transparent looks like a euphemism. We are dealing with some very murky waters indeed.
Mr. Ronnie Campbell (Blyth Valley)
(Lab): Will the hon. Gentleman give way?
No, given the last intervention I shall not give way; the hon. Gentleman will have to wait a little longer.
No wonder there seems to be some reluctance on the part of the Government to open up the whole episode to the public scrutiny that it needs. Before considering the effects of that ratings recalculation on the South Durham and other NHS trusts and the patients whom they serve, we need to examine the role of No. 10 Downing street.
The Health Service Journal broke its story on Thursday 18 December. Not surprisingly, given the reference in the Department of Health's e-mail to the Prime Minister, Downing street was immediately asked for comment. The next morning, on 19 December, the Prime Minister's spokesman was quoted in the Daily Mail, emphasising that, subsequent to the award of the 2002 ratings, responsibility for awarding stars had been removed from the Department of Health. The spokesman attempted to distance Downing street and the Prime Minister from the then Secretary of State's actions, saying:
"As I understand it, Mr. Milburn queried the star ratings for a number of hospitals, not just this one. In some cases, ratings changed; in other cases, they didn't."
What the Downing street spokesman did not say on 19 December and what emerged only a couple of days later was that No. 10 had indeed been consulted by the Department of Health at the very time when the then Secretary of State embarked on his manipulation of the ratings. The e-mail from the Secretary of State's office to Mr. Wilmore, which requested reconsideration of the decision to downgrade the rating of the Prime Minister's local NHS trust, was copied to the Prime Minister's health policy adviser at No. 10, Mr. Simon Stevens.
The extent of the Prime Minister's direct personal involvement remains unclear at present; although I wrote to him about the whole matter before Christmas, I have still received no reply. I trust that when the Secretary of State speaks in the debate, he will explain whether the Prime Minister expressed a view about the matter at the time. I trust that the Secretary of State will also tell us whether Mr. Stevens sent any reply from Downing street to the Department of Health in response to the e-mail that Sammy Sinclair, in the Secretary of State's office, had so helpfully copied to No. 10.
Let us turn to the consequences of the sudden re-rating of South Durham, because decisions about star ratings are not simply academic. The result of the last-minute upgrade following the then Secretary of State's intervention was to make South Durham eligible for a capital funding grant of £1 million. Very nice, too. But there is no such thing as a free lunch. That £1 million has to come from a finite pot of moneyin this case, the £85 million available for three-star trusts. Less fortunate
7 Jan 2004 : Column 266
than South Durham was, for example, the George Eliot hospital in the west midlands, one of the six hospitals that had been awarded three stars in the list originally sent to the then Secretary of State on 12 July, but which were mysteriously downgraded to only two stars by the time the ratings were published later that month. Other losers included the City hospital in Birmingham, the Royal Bournemouth and Christchurch hospitals, the Winchester and Eastleigh healthcare trust, and so on.