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Dr. Reid: There is a simple way, as the hon. Gentleman knows, to get information that is classified as confidential and privy to Ministers and their advisers. It is called an election, and such information is available to the elected Government, as the hon. Gentleman well knows because, as a former adviser to a Conservative Defence Secretary, he was privy for a number of years to information given in confidence to Ministers and on which assessments were based. Much of that information would have been of interest to hon. Members, but he was not expected to reveal it, and I am not prepared to reveal information that is confidential to Ministers and their advisers. That is how it will stay.
Mrs. Angela Browning (Tiverton and Honiton) (Con) rose—
Dr. Reid: There will be plenty of opportunity for Members to intervene later.
Mr. Blunt: On a point of order, Mr. Speaker. The Secretary of State does not appear to understand the consequences of the Freedom of Information Act 2000, which allow me—
Mr. Speaker: Order. The hon. Gentleman is trying to draw me into the debate. This is not a matter for the Chair, but a matter for debate.
Mr. Yeo: Our debate is developing rather significantly. The Secretary of State accused me, I think, of relying on fragmentary evidence, but the solution to the problem is in his own hands if he publishes the documents. In relation to that request, he referred to parts of an e-mail, which did not appear in Health Service Journal, and mentioned Great Ormond Street hospital, which was not referred to anywhere in Health Service Journal. However, now that he has referred to that e-mail, is it not correct that he should place a copy of the full text in the Library?
Dr. Reid: If we are talking about the fragmentary nature of evidence, there was a glaring omission in the hon. Gentleman's own speech. I find it astounding that he failed to refer to the reply that the Conservative party chairman received from no less a person than the Cabinet Secretary—[Interruption.] If I could deal with the matter in hand. The hon. Member for South Suffolk may not share my opinions, but it would be helpful if he showed courtesy to the House.
The Cabinet Secretary, Sir Andrew Turnbull, sent a letter dated 23 December to the hon. Member for Woodspring (Dr. Fox), in response to a letter from the chairman of the Conservative party. Naturally, I shall place Sir Andrew's letter in the Library. It is astounding
that the letter, which was the first reply to the first demand for a Downing street investigation from the Conservative party chairman, has apparently not been shown to the hon. Member for South Suffolk, who spoke at considerable length about Downing street without revealing to the House the Cabinet Secretary's reply. I shall therefore remind him of what it says. He is looking puzzled—I do not know whether his party chairman has informed him of the letter. I know that there has been a holiday, but presumably they spoke on the phone to wish one another happy new year, and the matter might have been raised. In the letter, the Cabinet Secretary says:
- "I have looked into the involvement of No. 10. As they have already made clear, the adviser covering health matters, Simon Stevens,"—
- "is routinely copied policy papers from the Department, and he was one of 65 people on the copy list for emails on the criteria for awarding star ratings. He did not intervene in this correspondence regarding South Durham nor any other NHS Trust. Nor did he raise the issue with the Prime Minister."
None of these attacks has happened by accident. The attacks are part of the Conservatives' unsuccessful attempts to undermine the efficacy and reputation of the national health service, and have nothing to do with discovering the truth.
Mr. Yeo: On a point of order, Mr. Speaker. I asked the Secretary of State in my intervention a few minutes ago whether he would place in the Library a copy of the e-mail to which he referred and which is partially quoted in the Health Service Journal. Is it not a convention of the House, Mr. Speaker, that when a document is referred to and sections are quoted by a Minister that have not previously been quoted, it must be made available to hon. Members by it being placed in the Library?
Mr. Speaker: There is a distinction, as an e-mail is not a document, so the matter is at the discretion of the Secretary of State. However, there is no requirement for e-mails to be placed in the Library. [Hon. Members: "That is new."] Order. E-mails are relatively new, which is why I have to make a ruling that previous Speakers did not have to make.
Dr. Reid: Thank you, Mr. Speaker. Having grabbed two jobs, I thought that the hon. Member for South Suffolk was beginning to encroach on yours.
Let me make it clear that we are committed to providing patients, the public and, indeed, the House with credible, comprehensive and easily understandable information on how their local NHS organisations are performing. That is the primary purpose of star ratings. Our starting point—the premise that has been questioned in today's debate—is the Government's belief that the public need more information about how health services are working, both because their health is important to them and because public money pays for
those services. It is precisely because we have asked the public to increase the money that they pay for the health service that we have increased public accountability and transparency through mechanisms such as the performance ratings.That is why, in July 2000, for the first time ever, the Government introduced the concept of national health service performance ratings and the annual publication of information on all parts of the service. The rating awarded was to be based on an organisation's performance against a number of key targets such as waiting times and a wider set of "balanced scorecard" performance indicators. The hon. Member for South Suffolk said that he is troubled by three things. First, he is troubled that a Minister should respond, intervene or make queries about these issues. Secondly, he is troubled that a Minister should do so late in the process and shortly before publication. Thirdly, as I understand it, he is troubled that gradings were changed late in the ratings process. That is the essence of his concerns if we cleave away the conspiracy element.
I shall try to address those issues, and take the House through the development of the ratings process, which was pioneering, complex and difficult. Hon. Members should remember that it was not just about grading hospitals or trusts but about establishing and developing a grading system for the first time, which was as difficult as it was important.
The first set of ratings was published in September 2001, covering the performance of acute trusts in 2000–01. They were produced and published by my Department. We did not pretend then, nor do we yet claim, that those criteria were or are perfect in every way. Indeed, given the novelty of that pioneering approach to transparency, it could not be perfect at the first, second or even third attempt. We said so explicitly at the time.
We made three things clear at the very beginning: first, that the assessments were not perfect, but were based on the best available data and that we would aim to improve those data sources; secondly, that the data criteria—not the data, but the criteria for assessing performance—would also be refined and improved over the years ahead; and thirdly, that we would be working not only with trusts and the independent Commission for Health Improvement, but most obviously towards this end, within the Department of Health itself in the initial stages. In short, this was the establishment, development and refinement of an iterative process—one that was changing by the day and by the month, and which is still changing by the year.
That is the primary context that must be understood if we are to take a mature look at how things happened and what happened, rather than throwing it all aside and assuming that there is a great conspiracy behind everything that changes in Government and outside of Government.
Mr. Stephen Dorrell (Charnwood) (Con): The Secretary of State is placing great emphasis on the fact that the star ratings published in 2001 were the first time, in his view, that NHS trusts had been asked to account in public for their performance against pre-announced key performance indicators. Can he confirm that it was, in fact, my predecessor as Secretary of State for Health,
my right hon. Friend the Member for South-West Surrey (Virginia Bottomley) who introduced in the mid-1990s a system of publication of results by NHS trusts against key performance indicators, and that they were refined during my time as Secretary of State? It simply is not true to suggest that the star ratings published in 2001 were published out of the blue, with no previous experience in the health service or the Department of Health for the exercise on which they were embarking.
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