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Mr. Stephen McCabe (Birmingham, Hall Green) (Lab): I am following the hon. Gentleman's argument with interest. What does he want to have done but not measured? Can he give some examples?

Mr. Burstow: I am about to deal with the review of data collection, about which the Secretary of State told the Health Committee. [Interruption.] I shall answer the hon. Gentleman's point in my own way and in due course, if he does not mind.

The Secretary of State told the Health Committee that the Department was reviewing its data collection with a view to rationalising what it collects. The NHS confederation has expressed concern for some time about the burden of reporting requirements on the NHS. In December, after a year of consultation and discussions, the Confederation published its report, "Smarter Reporting". The report found that more than half the information requests from the Department were perceived not to be useful for managing NHS trusts, either because it asked for duplicate information or because the data were of questionable value.

The survey also found that a quarter of returns that the Department required were wholly or partly duplications. Much could therefore be stripped out of data collection without materially affecting the value of the data that the Department is currently gathering. Simply cutting back the duplication would make a difference. Rationalising data collection helps to improve the quality of the data that are being collected.

In the conclusion to its report, the NHS Confederation warns that the exercise that the Department is currently undertaking entails a risk of losing the value of data collection in the existing system. I hope that the Secretary of State can assure us through the Minister who responds that an extensive dialogue is going on with the NHS Confederation and others to ensure that we get the best data collection and fill the gaps when that will add something to our understanding of service development, policy development and performance in the NHS.

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Liberal Democrat Members will support the Opposition motion because we believe that there is a need to bring into the public domain information, which is not there, about what happened in 2002. We are critical of the way in which the star rating and performance management system has been rolled out in the past few years. It is clear from the events that surrounded the 2002 star rating that the process and reporting have damaged the credibility of the star ratings system. Indeed, they have dealt it a fatal blow. How can the public have confidence in the current star ratings system? What messages have been sent to NHS staff, especially those in trusts that lost their third star because of the recalculations? They were told one minute that they were an excellent trust, then suddenly that they were considered middle rating. What message does that convey?

We will support the motion. The NHS is improving, but we need a reliable system that enables us to know that it is improving. That currently does not exist. Until it does, we cannot support the star ratings system.

Mr. Deputy Speaker (Sir Michael Lord): Before I call the next speaker, I inform the House that Mr. Speaker has placed a 10-minute limit on Back Benchers' speeches. That will apply from now.

1.59 pm

Siobhain McDonagh (Mitcham and Morden) (Lab): Whenever the star rating system is put under pressure or attacked, I feel the need to make a contribution in its defence on behalf of my constituents. It is the first system to allow people in my constituency to be heard on the subject of the performance of their local hospital. All my constituents, half of whom use St. Helier hospital, knew before 2000 that it was not up to scratch, that it was too dirty, and that the services provided were not good enough. Contributions from me, as the local Member of Parliament, and from the community health council, and missives presumably from the Department of Health all had no effect. The then chief executive carried on and refused to listen to the problems that existed. The only thing that broke that logjam was the star rating report that roundly, fairly and justly gave St. Helier hospital no stars.

That marked the beginning of the improvements in my local hospital. It also meant that there was perhaps a distortion in the allocation of funds, because funds came to that hospital for the first time for the improvement of its Nightingale wards and its standards of cleanliness. For the first time, the hospital examined how elderly people in the geriatric wards were cared for, and whether they were being provided with food but not fed. Elderly people were actually starving in the wards. The fact that the star rating system can achieve those improvements, and that it allows the public to know that the Government know what they know, is essential.

The system has led to enormous improvements in the services that people in my constituency receive today. I am not saying that St. Helier hospital is a perfect institution, but it is improving, and everyone there knows that it will be reviewed on an annual basis. That improvement must continue.

Mr. Burstow: I entirely agree with the hon. Lady that there have been significant improvements at St. Helier

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since the Commission for Healthcare Audit and Inspection report. The improvements followed that report, however, not the star ratings.

Siobhain McDonagh: I disagree with the hon. Gentleman. People know that the hospital had a zero star rating. The rating was immediately understandable and one that people generally accepted. The then chief executive decided to resign and was replaced with another chief executive who achieved incredible improvements and has now been promoted. I wish every luck to the new chief executive in carrying on in the same way.

St. Helier is far from perfect and it needs to continue to improve. I am glad that the star rating system is there to help it to continue that improvement. I should like to finish by quoting from a letter about St. Helier that I received today from a constituent:


This is about people's health improvement, and the star ratings have led to Mrs. McNaughton having a much better experience at St. Helier than she would have done prior to 2000.

2.3 pm

Mrs. Angela Browning (Tiverton and Honiton) (Con): I should like to pick up on the theme pursued by the hon. Member for Mitcham and Morden (Siobhain McDonagh). My very recent experience of what star ratings have done, and of the state of our NHS hospitals, has been quite appalling. I believe that the focus on nationally set targets skews the way in which decisions are made about resource allocation in hospitals in order to meet targets and to get the extra finance so as to go up the star ratings system.

I want to make it clear that I am speaking about a one-star hospital not in my constituency but in the home counties, to which an elderly lady relative of mine was recently admitted. She was very frail and had a fractured neck of femur—a common problem incurred when elderly people fall. She was admitted to casualty and I was anxious that she should not have to wait on a trolley for a long time. I was pleasantly surprised, therefore, when she was admitted to a ward within a few hours. I was told that she would be operated on the next day. Anyone with any medical knowledge will know that it is important to operate on a fractured neck of femur within a maximum of 48 hours, whatever the person's state of health or age. As is the normal custom, my relative was designated nil by mouth, but she went on being nil by mouth for five days, until eventually I threatened to go to the press unless she was operated on.

I shall not go into any more detail about the individuals concerned in this case because I am pursuing a formal complaint with the hospital concerned. The

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reason why I am raising it here is to point out that, in order to meet the elective surgery targets set by the Department of Health, that hospital has a long waiting list of former cases on an ongoing basis. That is where the skewing of targets and resources causes extreme detriment to patients. Hospital surgeons tell us that it is not uncommon for them to have 30 trauma cases waiting, but that their hospital management will not open up a second theatre over a weekend to deal not just with the existing backlog of trauma cases but with the increasing number of accident and emergency cases coming in. As someone who has worked in an operating theatre, I fully understand the dilemma of the doctors and nurses in our health service who, when faced with a road traffic accident admittance, for example, have to deal with some of those cases before they can deal with the fractured necks of femur or the trauma cases sitting on their wards.

The one-star hospital in question here had met the Government's target of not having people sitting round in casualty for more than three hours. It had admitted the patient to a bed, but had not had the resources to deal with the number of trauma cases that such a catchment area naturally has. My investigations have shown that this is not a one-off. In fact, I intend to pursue the matter to find out just what the state of trauma surgery in our hospitals is, whether they have one star or three.

Having been through that experience, when I hear Ministers talking about data, systems and civil servants, it all seems very remote from the day-to-day experiences of people up and down the country who are faced with a health service that, frankly, is not delivering. This is not just about what we used in the old days to call cold surgery—elective cases, as they are now called—painful though it is for people waiting to have a hip replaced. Of course we want those people to be treated as quickly as possible. When targets are introduced, they start to skew the service for others, for whom life and health are going to be critical. There is something seriously wrong with the target system that now exists, particularly in relation to surgical cases in hospitals.


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