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3.20 pm
Dr. Howard Stoate (Dartford) (Lab): I shall be reasonably brief, as others wish to speak.
I am very pleased that we are having this debate, because Members on both sides of the House are finding it useful. I am also pleased that the Secretary of State was able to explain how the star ratings are evolving, and how the indicators are changing year on year. It was reassuring to hear about the transparency of the system, and to learn that patients' involvement and experience were at the forefront, so that the patients could see that they were playing a part in the performance of hospitals.
The facts are stark. The Government are putting record amounts of money into the health service: no one could deny that. It is important, however, to ensure that the investment is not wasted but is used to make genuine improvements in patient care. There is the rub: it is impossible to know how well investment is doing unless there is a coherent way of measuring outcomes.
I do not want to dwell on this for too long, because many Members on both sides of the House have rehearsed the same arguments, but we obviously need a robust and coherent system of measurement to ensure
that we are using money wisely—that it is targeted where it is needed most, and that we see genuine improvements in outcomes.The hon. Member for Tiverton and Honiton (Mrs. Browning) told a harrowing story of a patient who had suffered trauma. That is clearly unacceptable. Anyone experiencing such trauma will have a significant chance of experiencing long-term ill health and possibly early death if it is not treated quickly. I would certainly consider it unacceptable if people waited for five days for a similar operation at my local hospital. Without transparency, though, we do not know what is going on in our hospitals.
My local trust, the Dartford and Gravesham NHS trust, opened one of the first new hospitals under the private finance initiative following this Government's election. The fantastic new building won various design awards. Size was always going to be a problem—the hospital was never going to be large enough for an expanding population in a part of north-west Kent that is experiencing huge growth—and it soon became clear that the Government's expectations were not being met. I received complaint after complaint. Operations were being cancelled, and people were waiting on trolleys in accident and emergency for unacceptable periods.
Many factors were blamed for the problems in the early days. Some people said that there was too much management; others claimed that it was the wrong sort of management, or that the number of beds was wrong. The hospital received a zero star rating. Then, however, there was a change of culture: we appointed a new manager, Sue Jennings, who brought in a new management team. Something very radical then happened. There were no additional beds, and there was no reduction in the number of managers, but within a year of Sue Jennings's arrival the hospital had one star and the following year it had three.
The effect on morale has been dramatic. When I walk into the hospital I see that everyone is smiling. Patients are smiling, staff are smiling, and the porters welcome those who enter with a spring in their step. That change in the culture is itself driving improvements and innovations, and genuinely improving patients' experience. It is almost impossible to describe the enormous improvements that have been made. I am not saying that everything is perfect, but that change in the culture has taken place—not because of huge expansion or a radical change in the number of managers, but simply because beds are being managed more effectively by more efficient managers.
The only way in which we can objectively tell that such things are happening is through performance indicators such as the star rating system. The proof of the pudding is in the eating. The number of complaints I receive has fallen to almost zero, and the number of letters I receive from constituents saying, "I had a really good experience in the hospital," has increased dramatically. That is not accidental; it is due to the enormous amount of work put in by all the trust's staff. The whole situation has been radically improved by the fact that performance indicators enable staff and others to see how much the trust has improved, and how the culture of the hospital has changed.
I would counsel strongly against the assumption that a sudden increase in the number of beds, or a sudden change in the number of managers, can make a massive
difference. It cannot; we are talking about a change in culture, and the ability to demonstrate how much a hospital has improved.Let me give a classic example. When the hospital first opened and was clearly not doing particularly well, people would come to my surgery and say, "The Government are failing: the hospital is no good." I would say, "Look at the extra money that is going in." They would respond, "The extra money is making no difference. I am still having to wait for 12 hours on a trolley, or to wait for three months for an out-patient appointment. My operation has been cancelled. Your money is not doing any good." It was very difficult to persuade people that Government investment was making a difference. Now I can say, "Look at the performance indicators. Look at how the hospital has come on in the last couple of years"—and they now say, "Yes, I see that the money is beginning to make a difference. It is beginning to produce the improvements we have been demanding for the last few years."
Debates like this are important because they give us an opportunity to air differences of opinion and to share our experiences. It is also important that our constituents can see what is going on in their hospitals, and ensure that what we hope to achieve is being achieved.
The message is clear: the Government must go on investing in the health service as it is now. We shall not see an end to five-day waits for trauma surgery unless hospitals receive more investment, but it is clear that if hospitals do not use money effectively and have no effective measures to compare their performance with performances elsewhere in the region and the country as a whole, and with national standards, we shall not see the best results. There is no point in every hospital's reinventing the wheel. What is most important is for hospitals to take best practice from parts of the country where the system is clearly working, and use it to model their own performance. They will not necessarily perform in exactly the same way, because different local circumstances will require different approaches. But the only way in which to ensure that best practice is adopted throughout the country is to provide robust performance indicators that can be reproduced, so that we can genuinely compare like with like on a national basis.
I am very pleased that my hospital has improved so much, and I am sure that other Members can recount similar stories. As long as the Government's money is invested and as long as it is spent wisely, everyone—particularly patients and NHS staff—will reap the rewards.
3.27 pm
Mr. Peter Lilley (Hitchin and Harpenden) (Con): It is a great privilege to follow the very constructive contribution from the hon. Member for Dartford (Dr. Stoate), which had more in common with the contributions from my hon. Friends the Members for Tiverton and Honiton (Mrs. Browning) and for Tunbridge Wells (Mr. Norman) and my right hon. Friend the Member for Charnwood (Mr. Dorrell) than with that made from his own Front Bench.
The key question underlying the debate on the health service today is why, despite the superb dedication of NHS staff, the huge increase in taxpayers' money going into the health service has not resulted in a commensurate increase and improvement in clinical services. In a nutshell, the reason is that those resources are allocated by a system that is highly centralised and micro-managed from the centre and where the management is driven by the desire for media manipulation and good headlines in the press tomorrow. Perhaps I can give some concrete examples of how that obsession with media manipulation and micro-management at the centre results in, at best, waste and, at worst, the undermining of clinical standards and, invariably, staff morale.
The Government announced a waiting list initiative. They got a good headline. They announced a waiting list budget for each hospital—another good headline. They announced that each hospital should have a waiting list manager—a third good headline. What does that mean in practice? Well, in hospital A—I am not at liberty to reveal which hospital that is, but it is not in my constituency—the waiting list manager used his waiting list budget to meet his waiting list target by employing locum surgeons on Sundays, at much extra expense, but from his extra budget, to operate on people on the waiting list. That seems a good idea—expensive, but on first sight, it would reduce the waiting lists. Unfortunately, sterilisation teams are not employed on those Sundays, so all the equipment needs sterilising by the end of Sunday. Come Monday, no operation can be performed until late in the day, when all the equipment has been sterilised, but that is part of a different budget, so it does not matter. So a huge amount of money has been wasted for no extra improvement or no reduction in the waiting list. That is waste, but the result can be much worse than waste.
In the same hospital, one of the senior consultants had made major advances in reducing infection—I shall refer to that problem again in a minute—by having a dedicated ward where people went after open-wound surgery. No one with an infection was allowed on the ward. But the waiting list manager, up against his waiting list target, had some people on the list who would go over the target by just a few extra days, so the senior consultant found that they were plonked on his ward. Some of them had bowel infections—one even has MRSA—so he said that he was not prepared to operate with those infections in the feeder ward for his operating theatre. He was told that he had to, because he had to meet his targets. He said, "Well, I will if you insist." He told his patients that they could be operated on if they would first sign a disclaimer, which they would be wise to do only if they were feeling suicidal, so no operations were carried out that day. More waste, and possibly a risk to people's lives as a result of a target-driven culture in the health service. So that is what the Government's policies mean in concrete terms, and those are not isolated examples.
Patients are not interested in targets; they want to know that, when they go for treatment in hospital, they will come out healthier than when they came in. Sadly, we have a system where nearly one in 10 patients who go into hospital acquire an infection that they did not have before they went in. According to the National Audit Office, between 5,000 and 20,000 people die of superbug
infections that they get in hospitals. The European Union says that the situation is worse in our hospitals than in any other country in Europe and getting worse faster in this country than elsewhere in Europe.When that first became a matter for public concern, the Government's response was to set up a system of traffic light indicators for hospital cleanliness: red for not so clean, amber for okay and green for fine. Unfortunately, they then discovered that, of the 20 hospitals with the highest level of MRSA superbug infection in the country, they had rated 15 green, five amber and none red. So they have naturally kept quiet about that expensive, time-consuming, costly and bureaucratic initiative for some while.
I managed to raise the issue with the Prime Minister recently, asking him why we were fighting and losing that biological war in our hospitals. He said that I should not discuss negative aspects of NHS hospitals, but all hon. Members have to raise those matters and should continue to do so until our record is not the worst but the best in Europe. I will do so particularly because I had a hospital with one of the highest levels of MRSA infection serving my constituents. I am glad to say—I pay tribute to it—that it has halved that level during the past year, which shows that it can be done and that improvements can be made.
A few days after I raised the issue with the Prime Minister, the Secretary of State—I regret that he is not here—announced with great fanfare a new initiative to deal with superbugs. There were headlines in all the newspapers. I asked whether he would make a statement about that new initiative and those new policies in Parliament. He wrote back to me, saying:
- "For the record, the press notice last Friday did not announce any new policy."
- "Mr. Reid gave his backing to wide-ranging proposals . . . which seek to revolutionise the way potential infections are handled in hospitals"
- "new rules . . . a new system . . . a new drive . . . new plans".
In following this situation, I have done more than 20 radio and media interviews with consultants and people from the Academy for Infection Management. They have proposals to deal better with the problem, so why are the Government not giving them serious consideration? I have received many e-mails from consultants and doctors throughout the country pointing out what is happening and saying that solving the problem does not require large expenditure. The solution requires, above all, a transfer of responsibility back from management and bureaucracy to local clinical people. If that were successfully adhered to, it would save massive amounts, but it is not allowed because of the target-driven culture.
- "We have managed to keep MRSA out of our rehabilitation unit by a combination of pre-screening, rigorous hygiene and vigorous treatment . . . However, we have been put under pressure to relax our criteria because they delay transfers".
- "to move people out of casualty departments within a set time",
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