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3.49 pm
The Minister of State, Department of Health (Mr. John Hutton): This has turned out to be something of a surprising debate. It rapidly recovered from the low point that it reached after the contribution of the hon. Member for South Suffolk (Mr. Yeo) and turned into a high-powered, almost policy wonk-style seminar about the virtues and merits of performance assessment, performance indicators and the use of targets. I do not think that that was quite the intention behind the Opposition motion, but the debate was interesting none the less and I should like to return to some of the contributions that have been made.
The other reason why the debate was surprising is that, when I was preparing for it, with some trepidation, I thought that the Opposition would set loose on the Government some of their Back-Bench parliamentary Rottweilers. Instead, to be fair to them, we heard some high-powered contributions from the Opposition Benches, as we did from the Labour Benches. We heard
from two former Secretaries of State, a former Minister and a leading member of the former Tory shadow Cabinet. The right hon. Member for Charnwood (Mr. Dorrell) usually speaks a great deal of sense about the national health service, and he did so again today. Many Labour Members would want to agree with much of what he said, but his problem is that no one on the Conservative Front Bench looked too chuffed with what he had to say.The Tory motion has two components. There is a sort of puerile bit of old crap at the beginning, if I can use that as a parliamentary expression, or a puerile reference to my right hon. Friend the Member for Darlington (Mr. Milburn). It also has a second section dealing with the use of performance indicators. Not a single Conservative Back Bencher referred to the first part of the motion. I know perfectly well why: they recognised that there was not a shred of substance in any of the allegations that the hon. Member for South Suffolk brought before the House today.
I congratulate my hon. Friends the Members for Mitcham and Morden (Siobhain McDonagh) and for Birmingham, Hall Green (Mr. McCabe), who spoke well and certainly rattled Opposition Members, and my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey), who also spoke well. My hon. Friend the Member for Leigh (Andy Burnham) made some important points about the funding formula. He will know that my right hon. Friend the Secretary of State is aware of the issues and is considering them very seriously. My hon. Friends the Members for Dartford (Dr. Stoate) and for West Bromwich, West (Mr. Bailey) hit the nail entirely on the head in their analysis of what lay behind the motion.
I want to congratulate the hon. Member for Tiverton and Honiton (Mrs. Browning) on her remarks as well. She was right to express her concern about the treatment of one of her relatives, and if she is prepared to write to me about the matter, I shall be very happy to look into it. I interpreted her remarks, perhaps wrongly, as largely an appeal for additional resources for the national health service. With the best will in the world, I do not think that she is in the best position to advance that sort of argument to the House.
Mrs. Browning: Just for the record, I was not asking for more money, but talking about the way in which resources have to be allocated to meet targets instead of trauma cases.
Mr. Hutton: The hon. Lady's comments certainly came across as an appeal for extra resources. I am grateful for her clarification.
The hon. Member for Tunbridge Wells (Mr. Norman) spoke very well and made a number of very important points. He will know that I agree with much of what he has to say about management in the national health service. I look forward to further contributions from him.
Perhaps I should not say this to the hon. Member for Wyre Forest (Dr. Taylor), who flummoxed us all by saying that he was going to vote both for and against the motion, but I do not think that he can do that. If he votes for the amendment, he will be seeking to delete the words of the motion and inserting words proposed by
my right hon. Friends. He is welcome to do that, but it will be rather difficult for him to vote against it 10 minutes later.The right hon. Member for Hitchin and Harpenden (Mr. Lilley) made a very important contribution about hospital-acquired infections. We certainly want to deal with that issue. Of course, it is the responsibility of the chief medical officer, and he is taking forward work in that regard.
The hon. Member for Sutton and Cheam (Mr. Burstow) made several observations about the performance assessment framework, as did the hon. Member for South Cambridgeshire (Mr. Lansley), who said—this was a surprise to us, given everything that the hon. Member for Woodspring (Dr. Fox) has said in the past—that the Conservatives are not opposed to a national set of performance indicators. He provided the helpful clarification that although he was not against those indicators, he did not want anyone to rely on them too much. That is not a terribly sensible position for him and his party to adopt—perhaps we can look forward to further clarification of exactly what he means by it.
The hon. Member for Sutton and Cheam raised several issues that I shall try to deal with. He expressed his concerns about the 2003 star ratings and whether there had been any inappropriate ministerial interference. I quote to him what Deirdre Hine, the chairman of the Commission for Health Improvement, said on 16 July:
- "The targets and many of the indicators were set by the Department of Health but we have compiled the ratings this year. I would reiterate that there has been no pressure from ministers and these have been produced absolutely independently."
The hon. Gentleman asked whether the final methodology that underpinned the eventual selection of performance indicators in July 2002 would be published. It was published on the same day as the performance indicators themselves—that is, nearly 18 months ago.
The debate has, predictably, generated a lot of heat, but very little light has emerged from any Conservative Front Benchers. I should therefore like to start by concentrating on the facts, not the hyperbole. Let us be clear about those facts. My right hon. Friend the Member for Darlington raised questions about the publications of the NHS performance ratings for 2002, and he was absolutely right to do so—any Secretary of State would have done precisely the same thing. At that time, the Department was responsible for the preparation and publications of those ratings, and my right hon. Friend was, rightly, accountable to this House for the work that was being done. Moreover, it was the first time that comparisons with a previous set of ratings were going to be possible, so it was entirely appropriate that he should be satisfied that the final assessments were fair and accurate, as some trusts stood to lose stars.
Most importantly, my right hon. Friend, in raising the questions that he did, was voicing the very same concerns about the 2002 ratings that had been expressed by NHS trusts. A significant number of NHS organisations—estimated at the time to be close to be
half all those who had made representations during the ratification process—expressed concern about the inclusion of data from two performance indicators. The data on both were unreliable because there was confusion about what was being measured. That was the view of officials, who also advised that including the information from those two indicators in the final ratings could not be justified. The exclusion of the data from those two indicators was the sole reason why the South Durham NHS trust retained its three-star rating.The two performance indicators dealt with access by doctors to the internet and access by patients to 24-hour catering facilities. Neither of those indicators, on any reasonable measurement, can be said to be so important that it should have been included in the final ratings, as neither was central to shedding light on NHS trust performance. That is why they were not used in 2002 and why neither was used in subsequent performance assessment exercises.
The hon. Member for Woodspring has repeatedly complained about the inclusion of such non-clinical data in NHS performance ratings. Far from criticising the actions of my right hon. Friend the Member for Darlington, as the hon. Member for South Suffolk chose to, he and his colleagues should welcome the fact that these two performance indicators were dropped from the 2002 ratings. Perhaps that welcome is being saved for another occasion, but I somehow doubt it.
My right hon. Friend also raised questions about the rating of eight other NHS acute trusts. In half those cases, no change at all was made to their eventual rating. That demolishes the central thrust of the Opposition attack that officials were somehow under orders to improve the star ratings of those trusts about which my right hon. Friend had expressed concerns. That is patently not the case. Equally untrue is the allegation that changes to the star ratings of individual trusts were made for political reasons. That argument has been comprehensively rebutted by the permanent secretary to the Department of Health—Sir Nigel Crisp made it clear today that he is satisfied that no such improper influences were brought to bear. In not accepting those assurances—indeed, in not even referring to them—Conservative Members are not only impugning the integrity of Ministers, but calling into the question the integrity of civil servants. I find that utterly contemptible.
The motion also calls for greater transparency in the use of performance indicators in the NHS. That is complete and utter hypocrisy. The Government have gone further than any previous Administration in providing the public with information about NHS performance. We want the public to know what is happening in the NHS and what use is being made of the initial investment. The policy that the Conservative party advocates would return us to the old days when there were no clear national targets for the NHS, and that would be unacceptable.
It is clear from the way in which the Conservative party has raised the matter that it has only one motive: to deny that any progress is being made in the NHS. That is its sole purpose. In the process of constructing that argument, it wants to help pave the way for its plans to expand the use of private medical insurance. That
deeply reactionary and cynical policy would widen health inequalities, deprive the NHS of £2 billion of vital investment and set back its long-term expansion.There is no substance to any of the allegations of wrongdoing that Opposition Members have made today. No evidence of impropriety has been disclosed; no misuse of power or authority has been established; no credible or convincing case has been made out that would lend any measure of support to any part of the interpretation of events that the Opposition presented. On that basis, I ask my hon. Friends to reject the puerile and fatuous motion.
Question put, That the original words stand part of the Question:—
The House divided: Ayes 204, Noes 338.
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