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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 used—non-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. Howard Stoate (Dartford) (Lab) rose—
Dr. Reid: I shall give way now, then I shall make a huge amount of progress before I give way again.
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.
Dr. Reid: Again, my hon. Friend tempts me to make invidious comparisons. I listen with great respect, not
because of personalities, but because some Opposition Members, such as the right hon. Member for Charnwood (Mr. Dorrell), have held high office in the Department of Health.
Dr. Reid: Will my hon. Friend allow me to make progress?
I was saying that the process was an iterative one—a 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 2001–02, 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 publication—the second element that worries the hon. Member for South Suffolk—precisely 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 organisations—estimated at the time to be close to half of those who made representations during the ratification process—expressed concern with data quality on two proposed indicators being used for the first time in 2002. Those
indicators were access to catering facilities, and information management and technology. If one were caricaturing the situation, as the Opposition sometimes do, one would define the criteria as 24-hour canteen facilities and 24-hour web-browsing facilities. During the consultation, a significant number of queries were raised about whether those were serious criteria.
Mr. Andrew Lansley (South Cambridgeshire) (Con) rose—
Dr. Reid: Will the hon. Gentleman allow me to finish this narrative? It is extremely important.
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 consulted—the 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.
Dr. Reid: Let me make some headway; I shall come back to the issue.
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—
Mr. Lansley: Will the Secretary of State give way?
Dr. Reid: No; this is a crucial point, and I make it in response to a demand that was made constantly from
the Opposition Front Bench. After 12 July and before publication on 24 July, not one or two trusts, but 23 of them, received a higher rating—I might add that they included the trust serving the constituencies of Maidstone and The Weald and Tunbridge Wells—while 10 trusts received a lower rating, including those serving the constituencies of Dewsbury and South Shields. People who try to identify a political pattern in what happened and thereby attribute it to a conspiracy are doing a disservice to the hard work of the officials and the trusts themselves.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:
- "Ministers were, quite properly, involved in the process of developing the ratings system—which was one of the key commitments of the NHS Plan—and in preparing the announcement of the results for which they were Departmentally responsible. As part of ensuring that changes to the ratings of individual Trusts could be justified by reference to robust evidence, officials rightly highlighted individual cases to Ministers and they, legitimately, raised questions about other cases, including South Durham. One category of cases highlighted in this way—which included at one stage South Durham—were 3 Star Trusts at risk of losing a star. Naturally Ministers wanted to be reassured that any change in the ratings was a result of a genuine change in performance."
- "The ratings of some of the Trusts under discussion at this stage of the process did change as a result of the changes to the methodology which I have described. In other cases they did not."
- "I am satisfied that no changes were made to the methodology in order to manipulate the rating of any individual Trust. I am also satisfied that political considerations played no part in any of these decisions."
- "I am also satisfied that political considerations played no part in any of these decisions."
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
ensure a robust system of performance ratings for the third year of publication and for July 2003 was passed to the independent Commission for Health Improvement in 2002. The new Commission for Healthcare Audit and Inspection will take over responsibility for the ratings process from April 2004 and will publish the 2003–04 ratings as part of its annual report to Parliament this summer. It is independent of government and will continue to ensure the integrity of the ratings.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.
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