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Cardiac Services
9. Mr. Hugo Swire (East Devon) (Con): How many performance indicators relating to cardiac treatment (a) are in place for NHS trusts for 2003–04 and (b) were in place in 2001–02. [148792]
The Secretary of State for Health (Dr. John Reid): There are five targets for cardiac treatment arising from the NHS plan. The total number of performance indicators across the whole of cardiac services, covering primary care, ambulance services, diagnosis, surgery and rehabilitation, is 37. None has been added since March 2000.
Mr. Swire : I am grateful to the Secretary of State for that response, but as the Royal Statistical Society said, many of the clinical indicators for cardiac treatment are unreliable. Even with constant quality of clinical care, there are widely different outcomes. Despite his claims to the contrary, is it not the case that too many
performance indicators are still being imposed on trusts? Given that between a third and two thirds of heart attacks occur outside hospital, often within the first few minutes of the onset of symptoms, should not the Government concentrate their efforts instead on training and encouraging paramedics in the administration of thrombolytics before patients get to hospital?
Dr. Reid: As I pointed out to the hon. Gentleman, the performance indicators cover ambulance services, paramedical primary care, diagnosis, surgery and rehabilitation. I am glad that he agrees with us on that point. On the question of whether we need to take more action to try to give relief to people who feel a heart attack coming on, I agree with him, and am glad that he supports the Government's introduction of rapid access chest pain clinics. I believe that he would also support all our five targets, some of which I outlined earlier: reducing deaths from heart disease, faster access to heart surgery, faster access to clot-busting drugs, improved services for patients with heart failure, and better primary care. We appear to be almost entirely in accord, which is heartening—along with the 25 per cent. reduction in deaths from heart disease. What a pity that the hon. Gentleman wants to cut by 20 per cent. all the investment that has contributed to that.
Dr. Brian Iddon (Bolton, South-East) (Lab): Just over two years ago, a committee was set up in Bolton with the aim of raising £1.3 million to bolt on a new coronary care unit to the existing facilities. Will my right hon. Friend join me in congratulating the committee on its success, as the building was opened a few weeks before Christmas? Will he also thank all the members of the public who have freely given their time and money to make that achievement possible?
Dr. Reid: Yes, I have no hesitation in joining my hon. Friend in thanking those people, and I hope that he will join me in thanking the 1.3 million staff of the national health service who are doing such a marginal—[Hon. Members: "Oh!"]—such a marvellous job. I have no hesitation in saying that they are doing a marvellous job. Unlike Opposition Members, I am the last to belittle their efforts, which have brought such improvements. They are doing a marvellous job in Bolton and throughout the country.
Mr. Andrew Lansley (South Cambridgeshire) (Con): The Secretary of State will be aware that one of the principal recommendations in the Kennedy report on the tragic child deaths at Bristol royal infirmary was that we should ensure that there was adequate throughput for surgical teams engaged in paediatric cardiac surgery. In November 2002, the review group said that it would seek a minimum of 300 such operations for a surgical team of at least three consultant surgeons. Given that the Secretary of State had the opinion of an expert review group, why has he preferred his own view and rejected that recommendation?
Dr. Reid: Because it would require us to close some of the most successful cardiac centres in the country, and I am not going to do that.
Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): Does the Secretary of State not agree that performance indicators have a role to play in pushing up the quality of cardiac care? In that context, the clinical decision unit at my hospital in Milton Keynes is now affording a route for GP referrals on cardiac disease, so that people can be referred there and thence to the wards, rather than going through accident and emergency? Would he like to confer with the hon. Member for South Cambridgeshire (Mr. Lansley), who visited that unit yesterday and is reported in the local press as commending it and its staff, as well as the efficient use of resources provided by the Government to improve health care for my constituents?
Dr. Reid: Yes, I am glad to do so. A peculiarity of Opposition Front Benchers is that they join in praise for the achievements of the Government and the staff whenever they make local visits, but condemn those achievements whenever they speak at the Dispatch Box. I certainly join my hon. Friend in congratulating everyone involved in that unit. The proof of the pudding is in the eating. There has been a reduction of approximately 24 per cent. in mortality for the under-75s from heart-related disease in five years. Surely, as there has been a reduction of almost 25 per cent. in the scandalously high figure that pertained before, even Opposition Front Benchers can find it in themselves to congratulate, if not the Government, at least the staff who have contributed to that reduction.
NHS Trust Reports
11. Mrs. Marion Roe (Broxbourne) (Con): How many information reports by NHS trusts were made to his Department in 2003. [148794]
The Minister of State, Department of Health (Mr. John Hutton): In 2002–03 the NHS was asked to make 123 regular information reports to the Department of Health, typically on a quarterly or a monthly basis. This compares with 134 such reports in 1996–97.
Mrs. Roe: Is the Minister aware of the major concerns of the NHS Confederation outlined in its publication of December 2003, "Smarter Reporting", which states that the current system of reporting is time-consuming and poorly co-ordinated and is often viewed by those compiling the data as unnecessary? What action has the Minister taken to cut out all unnecessary requests and to carry out an audit of what information is needed and why?
Mr. Hutton: The hon. Lady is right to raise that issue. She is probably aware of the NHS Confederation's view recently expressed that the NHS is making progress in reducing the weight of unnecessary bureaucracy and administration. As my answer made clear, we have reduced the number of regular information reports that we expect the NHS to deliver to the Department and we will continue to bear down on that, but we need to strike a balance, as I am sure the hon. Lady would accept, and make sure that we have the right information which allows patients and the public to know what is going on
in the NHS, allows the NHS to do a better job in improving services and, fundamentally, allows hon. Members to hold Ministers properly to account. We need to strike the right balance, and we are determined to continue to make further progress. I finish with this: in the last year of the previous Administration, 228 circulars were issued by the Department to the NHS, one famously dealing with how we should cook turkeys in NHS kitchens. Last year there were 12 such circulars, none of them dealing with how we cook turkeys.
Dr. Andrew Murrison (Westbury) (Con): The Minister's reply severely underestimates the number of ad hoc reports that trusts are required to furnish on an almost daily basis, as I found out when I visited my local acute hospital on Friday. The right hon. Gentleman will be familiar with the phrase that he gives hon. Members all the time in response to parliamentary questions—that the information requested is not available centrally and could only be provided at disproportionate cost. That is fair enough, but does he agree that a similar system should apply in respect of his Department? The NHS Confederation's excellent report "Smarter Reporting" proposed the idea of a yellow card. The Minister should consider that carefully, so that unnecessary data are not constantly requested from NHS trusts by the centre.
Mr. Hutton: We look seriously at everything the NHS Confederation does, and I hope that the hon. Gentleman and the Conservative Front-Bench team will do so as well. Perhaps he would like to be reminded of what Gill Morgan, the chief executive of the NHS Confederation, said in response to the attack on the NHS by the Leader of the Opposition last week, when he misquoted the NHS Confederation's view. On the subject of targets, interference and bureaucracy, Gill Morgan said last week:
- "We believe the tide has turned. The last two years have seen significant improvements, including a genuine reduction in the number of targets and a cull of the guidance and central directives sent from the Department to the service."
Mr. Archie Norman (Tunbridge Wells) (Con): May I remind the Minister that we are not opposed to clarity of reporting? What people in the health service find demoralising are the continuous changes in reporting requirements and targets. For instance, of the 148 performance indicators last year, 51 were the same, 54 were changed and 43 were altogether new. When does the right hon. Gentleman think there will be stability in the reporting requirements for the health service?
Mr. Hutton: I believe we are making progress in the right direction. I know that, to be fair to him, the hon. Gentleman is an expert on all these issues, but I am surprised that he does not have the good grace to acknowledge that. The policies and priorities framework that we issued last year for a three-year period sets out clearly the direction of travel for the NHS. The more stability we can create in the system, the better. That is what we are doing, and it has never been done before.
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