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Dr. Stoate: I entirely share the hon. Lady's concern. It is completely unacceptable that an elderly lady with a fractured hip should wait five days for an operation, and I would welcome further information on how that was allowed to happen, and on what could be done to prevent it from happening again. This raises the important point, however, that unless we measure what is going on in our hospitals, we have no way of improving them. Does the hon. Lady not agree that the only way to ensure that the health service is as good for her constituents as I hope it is for mine is to ensure that the investment goes in to improve it year on year and that we introduce changes and improvements to ensure that the money is well spent and invested, and used directly to improve patient care. We must have information before we can measure those outcomes.

Mrs. Browning: I am not saying that performance indicators and information are unnecessary. They are important management tools in any function, and particularly so in the NHS. I am not complaining about that. I am saying that, when targets are set by Ministers in Whitehall, it restricts the flexibility that hospital

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clinicians and managers have at local level, in terms of what a hospital's priority should be on any given day or week. Therefore, in hospitals such as the one I have mentioned, which has a one-star rating—I hope that Members on both sides of the House, having heard my experience, will say, "No wonder it has a one-star rating"—where the real difficulty was that surgeons were asking to open up second theatres to deal with trauma and were being denied them by the management, the management clearly had to prioritise its resources and money to make sure that it met targets in elective surgery and other priorities that are not being decided at a local level. Meeting many of those targets is locked in to the star system, and we have heard arguments today about the funding that hospitals receive.

Of course, nobody expects poor performance to be rewarded, but what choice is available to a patient who lives in one of those areas? It would be nice if all hospitals—in accordance with the experience of the hon. Member for Mitcham and Morden (Siobhain McDonagh)—were seeing an improvement. I have not seen an improvement, however, in a situation in which managers are told what their priorities should be by people who have no clinical responsibility. When we are dealing with real cases face to face rather than talking about statistics as we do in this place, and when real people whom we know and love are affected, that brings home much more clearly how wrong the current system is in terms of control from the centre that overrides what doctors believe should be the priority in a particular hospital. The hon. Member for Birmingham, Hall Green (Mr. McCabe) shakes his head, but when there are people who will die, and doctors know that they will die, doctors ask for second theatres to be opened. My experience when I worked in a theatre under the previous Labour Government was that such theatres were opened up. At weekends, there was always a standby team for a second theatre to be opened up. Things have not got better; they have got worse.

Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): Obviously, it is difficult for us to discuss the case that the hon. Lady raises, as we are not privy to all the details. Does she accept, however, that it is not self-evident that targets were the problem, but that the hospital concerned either did not have adequate resources or was not managing its resources properly? Had the hospital made available resources for the case she mentioned, I presume that it would have had to take them away from another one. Targets relate to real clinical need, so that would have meant other people waiting for operations. The case that she raises does not therefore attack targets but points to the need for additional resources.

Mrs. Browning: In terms of prioritising resources for surgical cases in a general hospital, trauma cases would be high up, at the top of the list—they would have to come higher than elective surgery because they are life-and-death cases. In relation to the individual case that I described, it was not a one-off case: the hospital had a long trauma list that appeared to be ongoing, and apart from the case of which I have personal experience, 29 other people were in similar situations. In terms of resources and a surgical budget, priority must be given

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to the trauma surgical budget over the elective budget. If one is subject to elective budget targets, and to achieving stars by meeting elective targets, or to having financial penalties in the next financial year, as some hospitals have experienced, that is wrong. It is wrong not from a management or systems point of view but from the point of view of the people who live in that area and who are dependent on that one hospital, to which they go if they have an accident.

If people have elective surgery, even under this Government, certain flexibilities exist whereby they can try to choose which hospital they go to and who operates on them. If they have an accident and are taken to hospital in an ambulance, they do not have a choice. What I am saying is that if people are taken in an ambulance to an accident and emergency department and they need surgery following that admission so that they are stuck with that one hospital, that area of surgery should be given high priority and should not be subject to problems that relate either to how the budget is spent in other areas or to the need to meet elective surgical targets.

I wanted to raise this issue because I am worried about the number of deaths in this country as a result of fractured neck of femur, particularly among the elderly. I am concerned that elderly people who are admitted on that basis are shunted down the list purely on grounds of age. That is an area of health care that needs investigation, not just because of my personal experience but because I am concerned that this is a widespread problem throughout the country and needs to be addressed as a matter of urgency.

2.15 pm

Mr. Stephen McCabe (Birmingham, Hall Green) (Lab): The truth is that there are two parts to today's debate. The first part—the only one to which the hon. Member for South Suffolk (Mr. Yeo) referred—is the Tory agenda. It has none of the "I believe" and the "Be positive" in it. It says, "Get on the negative and hit it hard." The Tory party's strategy is to undermine the health service at every turn and at every opportunity, and it must persuade the public that the health service is failing. That is the only point at which any Tory policy begins to emerge.

Coupled with that, we are starting to see a new trend in Tory performance. Yesterday, the shadow Secretary of State for Transport used the pilots' trade union as the bulwark for her argument. Today, the Tory health and education spokesman used the doctors' trade union spokesman—a gentleman whom I believe is a consultant at a one-star hospital, so, clearly, he has no vested interest—as the bulwark for his argument.

The other part of the Tory agenda is clear. The Tory party is haunted by the sleaze that bedevilled the last Tory Government, so it has decided that the easiest way to defuse that is to apply to all politics and all politicians the taint that they cannot be trusted. Today, we heard a twin strategy to undermine and attack the health service at every opportunity, and to attack the people who work in it and who are doing their best to drive up standards and performance and to give the best care to those most in need—to attack, condemn and denigrate at every turn.

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Simultaneously, the Tories are attempting to persuade the public that the way to deal with sleaze is not to make the Tories account for what they did and for why so many of them ended up in the courts and jails but to say that all politicians are liars, that all politicians try to distort, and that all politicians try to manipulate solely for personal gain.

Mr. Lilley: In his contemptible remarks, is the hon. Gentleman trying to assert that only Conservatives and all Conservatives are dishonourable?

Mr. McCabe: I am happy to give the right hon. Gentleman a list of former Conservative Cabinet Ministers and serious politicians who ended up in court and in jail. I am happy to assert that if that is what he wants. My point is that the Conservatives have a twin strategy: first, to undermine and denigrate the health service—

Mr. Lilley: Will the hon. Gentleman answer my question? He has asserted by implication that all Conservatives, but only Conservatives, are dishonourable. Will he now withdraw that foul imputation?

Mr. McCabe: I think that the right hon. Gentleman has a hearing problem. I did not assert that at all. I asserted that the Conservative party has a problem with sleaze dating back to the previous Conservative Government, and its political strategy to try to deal with that is to try to smear everyone else. I repeat that. I am not surprised that he does not like to hear it, but it is unfortunately the case, and he will hear a lot more of it if the Conservatives persist in their current performance.

Mr. Mark Francois (Rayleigh) (Con): Does the hon. Gentleman accept that the basic text for much of today's debate has been the article that appeared in the Health Service Journal, and which was produced by its own, well-respected journalists? Is he trying to tell the House that that publication is an organ of the Conservative party, because I am not aware that it is?

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