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3.3 pm
Andy Burnham (Leigh) (Lab): Comment has been made on an ex-Secretary of State for Health. I begin by commenting on an ex-shadow Secretary of State for Health. The hon. Member for Woodspring (Dr. Fox) may be gone, but it will be some time before Labour Members forget his disarming honesty about Tory health tactics. Fox by name, but certainly not by nature. There was nothing cunning or shrewd about his crude campaign to disparage the efforts of NHS staff and undermine the principle of a publicly funded collective health system.
As the Daily Mirror revealed, the hon. Gentleman's tenure was dedicated to creating a four-point plan with the clear aim of fuelling public cynicism about the NHS. He fed the belief that the NHS is a financial black hole and that the people who work in it are incapable of improving it and of spending the public's money properly. Accordingly, the architect of that nasty plan has been rewarded with the chairmanship of the nasty party. What is revealing about the debate is that we now know for sure that the so-called new team on the Conservative Front Bench is sticking with that unsavoury doctrine. Part of it means undermining confidence in any mechanism that shows whether the NHS is improving. That is the essential context for the debate on the star rating system.
At other times, the attack takes a different tack, but the fundamental point is the same. Conservatives complain of the productivity gap—that double-figure percentage increases in funding lead to single-figure increases in productivity. It is an argument that shamelessly skates over the fact that the outgoing Conservative Administration left the NHS bereft of the human and physical capital it needed, something to which my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) alluded. Given the time it takes to train clinical staff and build high-tech health facilities, there will inevitably be a lag before productivity levels rise again.
What even the Conservatives cannot talk down are the black-and-white facts in the NHS chief executive's report published only in December. It shows solid progress and improvement that is a tribute to all concerned—Ministers, managers, nurses and doctors. It is hardly surprising if the public are unaware of the report's contents because it was largely dismissed by the
media, presumably because the message was not what they wanted to hear. It reported substantial and sustained reductions in waiting times and waiting lists, a major increase in productivity and, interestingly, that the public now rely heavily on services dismissed as a gimmick by both main Opposition parties. In 2002–03, NHS Direct handled 6,319,000 calls and there were 1,373,000 visits to NHS walk-in centres. Now the Conservatives criticise the NHS star rating system in the same way. That is part of the Fox plan and it should be dismissed.Patients in our borough are served by the Wrightington, Wigan and Leigh NHS trust. Initially, it was awarded a two-star rating, but after a couple of years of steady improvement and management focus on the weaknesses identified by the performance indicators, last year it received a three-star rating. The achievement of three stars has boosted morale and staff were rightly rewarded with an extra day off. Morale has clearly improved—[Interruption.] The right hon. Member for Charnwood (Mr. Dorrell) laughs. He was a Minister in that Conservative Government. What a difference it must be for members of staff to work in a health service that is on the up and receiving investment. They can feel improvements in the air, unlike when they worked in the health service in 1996, when it was under his stewardship and cuts and decline were the order of the day. It must be a very different place to work. My thanks go to the staff of the Wrightington, Wigan and Leigh NHS trust, and in particular to Sheena Cumiskey, the chief executive, and Brian Strett, the chair.
The trust is moving forward, with an application for foundation status having achieved three stars. That application is supported by the staff at our trust. Perhaps some of my hon. Friends have not given enough thought to that. It gives Leigh, the other town in the borough, a chance to shape the future of our own hospital, Leigh infirmary. I will call on local people to seize that opportunity to give our hospital a new future, given the powers that foundation status will, I hope, give us.
It is not just our trust that has had a positive experience of the star rating system. There is substantial evidence that it has lifted performance across the NHS. Let us consider the evidence given to the Health Committee's inquiry on foundation trusts—of which the hon. Member for West Chelmsford (Mr. Burns) is a member. Mr. David Jackson, chief executive of the Bradford Hospitals NHS trust, said:
- "I can tell you that when we became a three-star trust—and I was very cynical about the whole process—the atmosphere in the hospital changed and people felt they had been recognised for the hard work and motivation and commitment and it had a very tangible beneficial effect."
- "We missed three stars very marginally last year; our inpatient data was very, very good but our forms in two areas were slightly off the leading pace . . . We were disappointed that we did not get three stars . . . Having failed last year marginally, we want to achieve that three-star status."
The improvement that the chief executive report catalogues is a huge tribute to the work of my right hon. Friend the Member for Darlington (Mr. Milburn). His
real achievement for patients and people in this country stands in stark contrast to the pettiness of the Opposition motion. That said, I want the Government to make more progress on one thing. Now that the NHS is back on its feet, I want our focus to switch to a sustained attack on entrenched ill health in some of our most deprived communities and to the health inequalities that still blight Britain. We have only scratched the surface. We need to tackle those huge structural and cultural problems. Ironically, that is a call for more political influence on the allocation of NHS resources.Last year Members, including me, lobbied hard for a change in the resource allocation formula that had previously been driven predominantly by factors such as old age. We succeeded. The Secretary of State listened and produced a formula that gives far more weight to deprivation and ill health as the guiding principles of resource allocation. However, in practice, we have yet to see the major shift in resources that the change in the formula accepts is necessary.
Recently, I tabled a parliamentary question to the Department of Health to ask how far each primary care trust was from its target funding in the third year of the current spending review. The results are revealing. In some of the most affluent parts of the country, PCTs will be significantly over the target. Westminster will be £76 million over target. The figure will be £41 million in Wandsworth; £27 million in East Elmbridge and Mid Surrey; £18 million in Guildford and £19 million in Cambridge. However, in some of the most deprived parts of the country, with the most entrenched problems of ill health, the picture is reversed and PCTs are hugely under target. That is because although the formula now recognises the health needs of those communities, they do not yet have the resources. Central Liverpool is £26 million under target. The figure is £25 million for the Heart of Birmingham PCT; £24 million for Barking and Dagenham; £25 million for Easington; and in Ashton, Leigh and Wigan—my PCT—it is £12 million.
I understand the rationale for the Department of Health's pace of change policy and the destabilising effects that could result from a rapid reallocation of NHS resources, but at a time of rising NHS funding the pace of change is far too slow. It is time to target new funding on the areas of the country where health is worst and that the Department itself accepts need significantly more resources.
That focus should guide the Department's work in the medium term and it should be the bold agenda that guides a third-term Labour Government.
3.11 pm
Dr. Richard Taylor (Wyre Forest) (Ind): I begin by agreeing with the right hon. Member for Charnwood (Mr. Dorrell) and other speakers: I do not want the abolition of star ratings because they have an important part to play. However, I want to discuss their accuracy and appropriateness and some of their unwanted effects, and especially to press for more notice to be taken of the views of patients when NHS ratings are being drawn up. I hope that the presence of the Commission for Patient and Public Involvement in Health will help to ensure
that the new Commission for Healthcare Audit and Inspection actually takes much more account of the views of patients.The assessment of quality in the NHS is a great interest of mine. Indeed, I held an extremely intimate Adjournment debate on the subject in Westminster Hall with a Health Minister on 10 June. I shall not go over the points that I made as they are recorded in Hansard, but I want to draw the House's attention to the balanced scorecard approach, to which the Secretary of State for Health has already referred, as that seems to be the most opaque method of assessing scores in a process that is supposed to be transparent and open to everybody.
I argued that the people of whom it is most important to take account when establishing star ratings were being neglected. They are, of course, the recipients of health care—the patients—and its providers, the nurses and doctors. I shall not repeat what I said at that debate, but my views on the accuracy of the star ratings were borne out by the Audit Commission's report, "Achieving the NHS Plan", which concluded that the number of stars related only weakly to performance and management adequacy. The commission gave the stark illustration of a trust awarded two stars, yet from the detailed knowledge of the commission's local auditors it described that trust as "failing".
I want to discuss the appropriateness of the current performance indicators and some of the possible unwanted effects of the system. As other hon. Members have pointed out, the indicators are incredibly important; the ratings carry rewards and foundation trust status. As an aside, it is no wonder that staff who are about to receive foundation status welcome it—it brings rewards. However, that high importance can bring risks. The Royal College of Nursing, in its submission to the Public Administration Committee's inquiry into targets, pointed out that there is a risk of influencing staff behaviour away from the best interests of patient care. A further risk is that to meet the target for seeing out-patients some trusts see more new patients at the cost of making essential follow-ups.
Trusts may look for ways around the targets. Examples from accident and emergency departments have received much publicity: trolleys are converted to beds, waiting areas in other departments are used for patients, and there are queues of ambulances outside. Such cases have been well rehearsed in the past.
The wait for out-patients begins only when the general practitioner's referral letter is logged in. That logging in may be delayed or, even worse, the letters may be lost. I have just received a letter from a constituent whose first delay occurred because the appointment letter was lost. A subsequent letter, in which he expected to be given a date for his appointment, stated:
- "Now you are on the outpatient waiting list to see Dr. X . . . the current waiting time is approximately 18 weeks . . . We will contact you about 4 weeks before the anticipated appointment time."
Another risk is the cancellation of admissions for elective surgery for non-clinical reasons. What are the rules about that? Cancellation on the day of the operation is obviously counted, but can the trust avoid the stigma of cancellation by not recording it if it occurs earlier than that?
An example of the inappropriateness of one existing target was published last August in the Journal of the Royal Society of Medicine. Urologists at Medway Maritime hospital considered the effects of the two-week rule for seeing patients with suspected urological cancers. They found that although it achieved more rapid times for seeing patients it had no effect at all on the interval between referral and receiving definitive treatment. There were delays for scans, X-rays, and operating theatre time. I understand that the Government have spotted that problem and that by the end of 2005 the target for all cancer treatment will be two months from urgent referral to actual treatment. Sadly, that is a long way away for patients today and I wish it could be sooner, although obviously it is an improvement.
My quandary today is which way to vote. There are valid points in the Opposition motion, but there are also valid points in the Government amendment. I shall almost certainly take the step that only I am allowed to take and vote for both the amendment and the motion. I cannot see that there is anything mutually exclusive in either. I hope that when the Minister responds to the debate he will not attack the Conservative Opposition politically, as has occurred so often in the past during questions and debates—even Mr. Speaker has referred to the matter—by hiding behind their refusal to vote for more money for the NHS, rather than actually answering the questions.
As I have said, I am not arguing for the abandonment of star ratings—I am merely arguing for greater reliability, greater local relevance, a greater impact of staff and patients' views and, above all, a greater emphasis on outcomes.
Professor Alan Maynard, director of the health policy group at York university, wrote recently in the British Journal of Health Care Management
- "Whether spending more or doing more improves population health is sometimes asserted, but never measured systematically and demonstrated. Ignorance is bliss, no doubt, for decision-makers in Whitehall."
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