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3.36 pm
Mr. Adrian Bailey (West Bromwich, West) (Lab/Co-op): In the few moments available to me I shall single out one or two of the points that I wish to make. I had a sense of déjà vu when I read the motion, because the substantive issues have been debated fairly comprehensively before. I took part in a debate on performance indicators and targets in October last year and, of course, the South Durham health care trust has been the subject of several questions in the Chamber, which have been adequately dealt with on each occasion. I can only deduce that the official Opposition's tactic is to reiterate a specific line of attack in the hope that constant denigration of, and carping about, performance indicators, targets and star ratings will somehow mask the huge improvements in the output of the NHS that are a result of Labour's investment in it.
Conservative Members do not want to talk about the real issues that affect people's everyday lives, such as the length of time that they wait before they see their general practitioner or go into hospital for an operation, the number of people on waiting lists or the time that they have to spend in accident and emergency departments. Conservative Members do not want to discuss those points because they know that all the evidence from the indicators shows that the investment that Labour puts into the NHS is paying dividends and that the public appreciate that. They know that the NHS is the most popular service in the country—a service that not only improves the quality of life of millions of people but increases the length of their lives.
A publicly funded service that is free at the point of delivery encapsulates Labour's values through and through. Conservative Members realise that if people appreciate that the principles that underpin the NHS pay dividends, they will support Labour at the next general election. They will therefore do everything in their political power to denigrate the service and hide the reality of the situation. In short, the motion is a politically motivated attack that is not rooted in the reality of people's everyday experience of the NHS, but designed to mask that reality in the interests of short-term political dividends for the Conservative party.
3.39 pm
Mr. Andrew Lansley (South Cambridgeshire) (Con): In some respects, this has been an enlightening debate, but not in others. Conservative Members have shed
considerable light on performance indicators, the way in which performance should be measured, the excessive nature of performance indicators and Government requirements for information, and the distortion of clinical priorities in the NHS and the severe consequences of the transfer of performance measurement to a system of centrally determined targets. My hon. Friends made excellent contributions, which reflected their experience in senior positions, both in government and in the private sector, and thus had a strong bearing on the way in which performance management should be conducted in large organisations. Their contributions also reflected their personal experience and the experience of real people.The hon. Member for Sutton and Cheam (Mr. Burstow) took up some of the forceful points made by my hon. Friend the Member for South Suffolk (Mr. Yeo) in his opening speech, but also raised the issue of Basildon and Thurrock. Can the Minister explain why, if the failure of the star ratings for Basildon and Thurrock was connected to patient surveys and patients' experience, the exclusion of catering, information technology and management criteria led to an increase in those ratings? The hon. Member for Sutton and Cheam referred to the excessive requests for information from the Government. The NHS Confederation produced a report just last month based on the experience of Manchester hospitals in which it said that there had been
- "a considerable increase in often unco-ordinated ad hoc requests . . . The quality of data provided at very short notice will be poor . . . Demands from the centre have often been poorly defined and do not always ask the right question . . . Information is requested without checking whether it already exists, leading to duplication."
- "there is a lack of feedback on how information is used."
That brings me to a point made by my right hon. Friend the Member for Charnwood (Mr. Dorrell). If a system of performance management, information gathering and data collection is to be devised within a large organisation, it should meet the trust's priorities. If we are serious about the devolution of management in the NHS—and Conservative Members are—priorities should be determined locally, so the system of performance of management should be devised locally and not centrally imposed. My hon. Friend the Member for Tiverton and Honiton (Mrs. Browning) spoke about the experience of real people in the NHS, which, as the hon. Member for Dartford (Dr. Stoate) rightly said, we should take to heart and acknowledge. I am sorry that my hon. Friend's speech was followed by that of the hon. Member for Birmingham, Hall Green (Mr. McCabe), which did not reflect the experience of real people in the NHS. I do not think that the hon. Member for Milton Keynes, South-West (Dr. Starkey) is aware of what is happening in the NHS. She said that everyone in her hospital in Milton Keynes agreed that there was a problem but she went on to say that they needed the star-rating system to tell what it was. There are two
three-star hospitals in my constituency—Addenbrooke's, which has been a three-star hospital from the outset, and Papworth, which has been one since 2002. We are a fast-growing area, and have experienced pressures on capacity, but those hospitals have retained their three-star rating. The reasons for that were touched on by the hon. Member for Dartford who, as my right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) said, made a speech in keeping with Conservative philosophy.It is a matter of culture. It is about delivering in the NHS, which is not happening. Star ratings are not needed in order to deliver. We in South Cambridgeshire knew that Addenbrooke's hospital and Papworth hospital were excellent hospitals before the star rating system. I trust that the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), visited those hospitals yesterday and discovered that for himself.
If we are to have transparency and accountability in the NHS, as I hope we will, the priorities that are determined locally must be reflected in performance management and in indicators that are accessible to the public. As my hon. Friend the Member for Tunbridge Wells (Mr. Norman) rightly said at the outset of his speech, if we are to implement a system of choice for patients, that requires transparency in performance. Indeed, that is our philosophy. We have got used to Labour Back Benchers and the Government misrepresenting the policies of the Conservative party. Most of the speeches made from the Government Benches suggested that Conservative oppose performance indicators.
We are not opposed to performance indicators. We are opposed to excessive requests for information and excessive reliance on performance indicators. We are opposed to the imposition of performance indicators from the centre, rather than indicators derived from local priorities. We are particularly opposed to a system of targets and star ratings leading to a system of rewards and penalties for those who work in the NHS, which is determined from the centre and which, in the case set out in the motion, could be open to manipulation, as my hon. Friend the Member for South Suffolk said, by those at the centre, particularly Ministers.
That is not a criticism of civil servants; it never was. The Secretary of State rightly defended civil servants. We are defending civil servants by seeking to expose the ministerial interference in the system. Many in the NHS are sceptical of the credibility of the star rating system. That system will be further undermined by the fact that they can now see an instance where it appeared open to ministerial interference.
That brings us back to the case at the heart of the debate. My hon. Friend the Member for South Suffolk asked some questions of the Secretary of State, but he did not get many answers. The Secretary of State did not explain why the Prime Minister has neglected to reply to my hon. Friend's letter. It is all very well replying to my hon. Friend the Member for Woodspring (Dr. Fox), but that and the letter from the permanent secretary have served only to raise more questions than they answer.
The Secretary of State relied on a series of changes over the years, but that does not explain why, if the system is changing and has changed last year and this
year in the absence of ministerial involvement, ministerial involvement was so necessary in July 2002 to introduce the star rating system. The truth, I suspect, is that Ministers have been taken out of the star rating system in subsequent years, not least because of the interference in July 2002.Let me ask a question to which the Minister can reply in his winding-up speech. If it was necessary to drop two criteria—access to catering facilities and information management and technology—because the data were poor, were they dropped before 12 July 2002 or after? When the head of the performance development unit wrote to the Secretary of State, he made it clear that the process of consultation had already taken place. He stated:
- "Unfortunately, even if time allowed it, further revisions to the methodology to promote these trusts"—
- "would inevitably lead to other individual results we had not expected, as well as making the scoring system more complicated."
- "Alterations to the methodology have been made".
- "the changes to individual trusts that were requested."
- "This makes the scoring methodology more difficult to explain and less transparent."
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