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2.37 pm

Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): Before I begin, perhaps you, Mr. Deputy Speaker, could pass on to Mr. Speaker how helpful Back Benchers find the new arrangement with the digital countdown.

Turning to the matter in hand, I was disappointed by the major part of the opening speech by the hon. Member for South Suffolk (Mr. Yeo), who indulged in—to inordinate length—a rather ludicrous conspiracy theory. I am pleased to say that it was effectively refuted by my right hon. Friend the Secretary of State and I do not intend to waste any more time on that matter.

More interesting was the way in which the Opposition Front-Bench spokesman and the hon. Member for North-West Norfolk (Mr. Bellingham), who is no longer in his place, let the cat out of the bag regarding their attitude to performance indicators in general. I exempt from that criticism the right hon. Member for Charnwood (Mr. Dorrell), who made an extremely thoughtful contribution, though I take exception to his mathematical distortion in respect of the differences between the Kettering and Leicestershire trusts. However, I shall take that up with him outside the Chamber, as the matter is rather more complicated than warrants debate here.

However, Conservative Front Bench Members and the hon. Member for North-West Norfolk demonstrated that the Conservatives are not just against, as it says in the Opposition motion, "excessive" reliance on performance indicators, but against all such indicators. That is an extraordinary line for the Conservative party to adopt. The NHS is a public service financed by public money. It is perfectly reasonable for it to be run in line with outcomes that the public require. That is what the performance indicators and, indeed, the NHS framework are designed to do. They are designed to set clear standards and outcomes. The frameworks are partly set by the various royal colleges, but also take into account the views of the public and of sufferers from diseases about how treatment should be shaped. The performance indicators are also clear and are designed to draw attention to the NHS services that the public feel are important. For example, people should not have to wait excessively for in-patient or out-patient services, accident and emergency services and others. It is perfectly reasonable that those performance indicators should be set by the Government, in consultation with the public. I cannot understand why the Conservatives object to that. Do they think that the Government should simply give the NHS and other public services money to spend as they wish, without interference? It is

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extraordinary that the Conservatives appear to suggest that the public should pay their taxes and buy a pig in a poke when it comes to public services.

Mr. Simon Burns (West Chelmsford) (Con): Rubbish.

Dr. Starkey: Of course it is true that doctors must exercise their clinical judgment about specific treatments for patients. However, when the Conservatives were in charge of the NHS and doctors were allowed to set NHS priorities, a very low priority was often given to operations such as hip replacements—exactly the sort of elective orthopaedic operations to which the hon. Member for Tiverton and Honiton (Mrs. Browning) objected. The suspicion was that those operations were given a low priority because they are not very interesting to do. They are dead straightforward; one needs to be reasonably competent, but for surgeons it is much more interesting to concentrate on the big, challenging operations.

However, every hon. Member knows that hip replacements are incredibly important to constituents. The problems that such operations resolve are not life threatening, although old people who have to wait for treatment are much more prone to die from other conditions. Delays in hip replacement operations can have an extremely detrimental effect on people's quality of life. That is one reason why it is very important to have performance indicators that reduce the waiting time for such operations.

I return now to the point made by the hon. Member for Tiverton and Honiton. Did she raise the matter with the Member of Parliament representing the constituency in which the hospital is sited? The issues that she raised have a much wider importance than their effect on her relative, and I repeat that the question is one of resources and their proper management. The hospital in my area faces similar problems, and it has brought in French surgeons to work in operating theatres at weekends to clear some of the backlog. Our own surgeons were working so many hours that they could not be asked to do any more. I do not understand why the hospital to which the hon. Lady referred did not do the same, instead of blaming performance indicators.

Mrs. Browning: I want to clarify the record. I am more concerned about the waiting lists for trauma surgery than the waiting lists for elective hip surgery. My point was that if there are 30 people suffering from traumatic injuries, one of them might have a fractured neck of femur. That person might be required to wait five days for an operation, on a regimen of nil by mouth. It is wrong to put elective surgery ahead of that operation in order to meet a target. Finally, I assure the hon. Lady that I have raised the matter with the relevant Member of Parliament.

Dr. Starkey: I think that the question is one of resources. The hospital concerned should have managed its resources better. It is not a matter of targets distorting provision, as it is also important to meet elective surgery targets.

I find the general attack made on performance indicators by some Conservative Front-Bench Members extraordinary, especially given that they belong to the

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Conservative party. They would not expect businesses to operate without performance indicators, so I do not understand why they think that public services should do so. Moreover, those indicators are set in ways that the public clearly support.

Do the Opposition object to specific targets? My hon. Friend the Member for Birmingham, Hall Green (Mr. McCabe), who has just left the Chamber, talked about some of the specific targets. It would be helpful if Opposition Members would say which targets they object to. Do they object to targets on waiting times, or on cancer death rates? Which targets would they get rid of, or do they want to get rid of them all?

I turn now to my constituency, which has had a rather interesting experience with the star rating system. This year, the hospital and the PCT that serve my constituency, and the constituency of my hon. Friend the Member for Milton Keynes, North-East (Brian White), were zero rated. That zero rating was quite properly applied, as the hospital and the PCT failed to meet their budgets and to meet their waiting times and accident and emergency targets.

They failed to meet those targets because of under capacity in the Milton Keynes general hospital, which is a direct inheritance of the years when the previous Conservative Government were in charge of the NHS. Milton Keynes is a growth area: its population has grown by between 2 per cent. and 3 per cent. a year since goodness knows when. However, in the 10 years preceding the election of the present Government, not one extra bed was provided at Milton Keynes general hospital. Clearly, the hospital suffered from under capacity in that time, and it has not caught up yet. This Government have been very generous in the funding that they have made available and the problem is not as bad as it used to be, but the hospital still suffers from under capacity. That is why it and the PCT were zero rated.

That zero rating highlighted even more clearly a problem that I and my hon. Friend the Member for Milton Keynes, North-East had highlighted already in our frequent representations to Ministers. The Modernisation Agency has studied the general hospital and the PCT and has crawled all over everything that is being done. It has come to the view that there is very little more that the management could do to improve matters. It has confirmed that the problem is the result of under capacity and not poor management. As a result, the case that I and my hon. Friend have been making has been strengthened. We have presented it again to my right hon. Friend the Secretary of State, who was kind enough to meet us just before Christmas. We are both confident that my right hon. Friend will devote even more resources to the problem.

The experience in Milton Keynes is therefore that the star rating system helps to make clear where a hospital or PCT is encountering problems. It is then possible for the PCT and the Department of Health to look into why those problems have arisen, and to address them.

Mr. Lansley: The hon. Lady says that the hospital in her constituency has a zero star rating. Does she accept that people consider that to be an expression by the Government of the quality of practice in the hospital? The hospital may have very good clinical practice, and

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she has said that the zero star rating is the result of under capacity. However, the star rating does not indicate whether the hospital is meeting its targets in terms of capacity; it is interpreted by people as a much wider expression of patient satisfaction. Patient satisfaction may be high if there is good clinical practice.

Dr. Starkey: In Milton Keynes, hospital managers and workers, and members of the public, are well aware of what the problem is. I and my hon. Friend the Member for Milton Keynes, North-East have been in dialogue with the hospital management. We have made it very clear that we understand that the problems that have been encountered are not the result of poor performance by anybody working in the health service in Milton Keynes, but that they are the result of under capacity. We have also made that clear to the Government.

Although everybody was very disappointed that the rating slipped from one star back to a zero star rating, we all knew that the problem was one of under capacity—and that my right hon. Friend the Secretary of State was aware of that too. People were confident that the problem would be tackled, because it was evident that only by dealing with under capacity would the hospital's performance be improved.

I should add that matters have already improved in Milton Keynes. Since the star ratings were handed out, our clinical precision unit has opened. It has greatly relieved pressure on the A and E unit, and a story in my local press this week suggests that performance is now worth something like two stars rather than zero.

Finally, I believe that the Government's commitment to a properly funded NHS is self-evident. However, greater public funding must always be coupled with clear direction through the use of performance indicators and the national service framework. In that way, the money that comes from people's taxes can be spent on improving outputs. That must also be coupled with a continued drive to modernise the way in which health services are delivered across the piece.

I am surprised that the Conservatives appear not to go along with the approach of increased funding, modernisation and a sensible system of performance indicators. I agree with my colleagues that the Conservative Front-Bench spokesmen seek simply to denigrate the NHS to soften people up in order to return to the two-tier system that the previous Government were trying to introduce.

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