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Dr. Reid: With all due respect to the right hon. Gentleman, we do not have a difference of principle, but the level of sophistication, complexity and intricacy of what we are doing now is light years away from anything that was done previously. That is not to detract from the fact that he and his colleagues at the time pursued that route for a while. I am not suggesting that they did not, but as someone who has borne the responsibility in government, he would be the first to accept that when one implements such initiatives in education or health, there is an ongoing discussion and debate.
Time after time, at Question Time and in debates, the Front-Bench spokesman prior to the hon. Member for South Suffolk got up and criticised me robustly and in some ways, perhaps, legitimately for some of the criteria that are usednon-clinical, non-medical criteria. I shall return to that point, because it is not only from one side of the House that we receive practical challenges to evaluate the criteria.
Mr. Dorrell: I am grateful to the Secretary of State for giving way again, and for his recognition that some groundwork was done in the 1990s. Perhaps he will reflect on the gap between the work that we did and the work that he and his immediate predecessor are seeking to do to enhance accountability in the NHS. There was an interruption between 1997 and 2001, and the Secretary of State might care to reflect that we would have made further progress if the incremental approach, which he is rightly espousing, had been allowed to develop through that gap in the process.
Dr. Reid: The right hon. Gentleman tempts me down a road down which I do not want to go. It is fair to say that as human beings in a complex world, the incumbent of my position during the relevant period would not agree with everything that I do, and I do not necessarily agree, on reflection, with everything that was done during that period. We will let the matter rest there.
Dr. Stoate: Can my right hon. Friend clarify a couple of points for me? First, the Opposition are presumably suggesting that the trust should not have had its third star and deserved only two, which is a kick in the teeth for the enormous amount of hard work and energy put in by many people who work for it. Secondly, those on the Opposition Front Bench seem to want to scrap the entire ratings system and performance indicators, yet the right hon. Member for Charnwood (Mr. Dorrell) claims credit for it. Perhaps my right hon. Friend could unravel the Tories' thinking on this important issue.
I was saying that the process was an iterative onea process of development and refinement, and discussions were going on inside the Department of Health and externally, with trusts, among others. The system was still under development when the next set of ratings, covering performance in 200102, were published in July 2002. If we want to define the changes that were taking place, we should note that a broader set of indicators was used, more account was taken of the CHI reviews of clinical governance arrangements, and the ratings were extended to cover specialist trusts and ambulance trusts for the first time, and to include indicative ratings for mental health trusts. A great deal of change was taking place.
Again, put simply, the process of verifying data and refining the indicators to be used ran right up to the point of publicationthe second element that worries the hon. Member for South Suffolkprecisely as it did the year before, which was the first year of star ratings. As anyone who has been involved in Government would know, when publishing large amounts of data it is quite normal for that to happen, particularly when the policy is in its early stages, when such large amounts of data are involved, and in this case, in 2002, when the release had been brought forward two months from September to July, putting greater pressure on the scrutiny and verification of the data and the final publication.
We were sensitive to the need to be able to justify publicly and to the organisations concerned changes in the ratings, especially when they arose from additional indicators that we were using for the first time. I have nothing but praise, in retrospect, for the amount of work that was done by our officials and civil servants. I hope that it was not meant in that way, but there is an innuendo in the remarks of the hon. Member for South Suffolk. The officials in the Department, who are people of great integrity and commitment, would not involve themselves in something that they perceived to be a political stitch-up. That has been clear to me in the many Departments in which I have worked. Let us reject that implication out of hand.
The Department was concerned to be able to justify publicly the nature of the criteria and the verifiable accuracy of the data. For that reason, and to ensure that the published information was as accurate as possible, NHS trusts were given the opportunity to comment on and to ratify the indicator constructions to confirm that they were correct prior to publication. In addition to the trusts, others were represented.
A significant number of NHS organisationsestimated at the time to be close to half of those who made representations during the ratification processexpressed concern with data quality on two proposed indicators being used for the first time in 2002. Those
It was clear that those indicators were not of a high enough quality and that the issue could not be resolved in time for publication of the ratings. I am advised by those who were involved as officials at the time that even if the timetable from the previous year had applied, there would not have been time to improve those particular indicators. They could not, therefore, be included in a refined and improved form in the final set of indicators. They could, of course, be removed.
Mr. Lansley: I am grateful to the Secretary of State for giving way. He has described the discussions with trusts, and presumably the Commission for Health Improvement, that led to the submission to the then Secretary of State on 12 July. The point, however, is what happened that led to the change in the ratings between the 12 July submission and publication on 24 July.
Dr. Reid: A little trust from the hon. Gentleman would be welcome. I am taking him through a narrative. I started in one year and I am moving chronologically. Consultations and discussions did not stop on 12 July, but continued. My point is that, even before the Secretary of State and Ministers were asked about the issue, a huge number of trusts that had been consultedthe estimate at the time was up to 50 per cent.indicated dissatisfaction or problems with two particular criteria. As it happens, they were the criteria that were removed, which might be taken to show that they were not removed purely on the say so and diktat of the Secretary of State or purely in respect of one trust. Indeed, the Secretary of State mentioned nine trusts, and I shall go on to tell hon. Members where the movements occurred. All these suggestions take the conspiracy approach of the front page of the Daily Mirror to produce.
The change to which I have referred and which others made during the final weeks inevitably had an impact on the ratings. Some trusts benefited, while others lost out. Another part of the information that was not mentioned earlier is that, after 12 July and before publication on 24 July, not one trust, but 23 of them[Interruption.] I urge the hon. Member for South Cambridgeshire (Mr. Lansley) to listen. After 12 July
The Opposition are today asking for another inquiry into the matter. As I pointed out, one of the two chairmen of the Conservative party requested an investigation from the Cabinet Secretary. The Cabinet Secretary also took it upon himself, I think legitimately and with due diligence, to ask the permanent secretary in my Department to conduct an investigation. He wrote this morning to the chairman of the Conservative party. I am surprised that the hon. Member for South Suffolk has not been informed by his party chairman. [Interruption.] Apparently, he has now received that information. To be helpful, I shall read out just two paragraphs of the letter, which I shall place in the Library. I quote the permanent secretary:
There is nothing unusual about changes to provisional star ratings status occurring prior to publication. We could look at many trusts and see changes in the weeks beforehand. Given the importance of the data, we recognise that we have to ensure that we continue to progress the independence of the system. I can tell the House that responsibility for continuing to
In short, within three years, the Government have developed the data on which to base the performance and published them, and we have now made sure that responsibility for the publication of the data and criteria will be completely independent of government. In contrast, we know from the motion what the Opposition believe in. The motion calls for greater transparency in the calculation and publication of performance indicators throughout the NHS and goes on to express concern that these indicators might be used by people to indicate performance. If we check that position against the Opposition's actions, we see that it is difficult to find a bigger piece of hypocrisy, even in the Conservative party. Its actions in every conceivable area belie what it is demanding in parts of the motion.