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Session 2008 - 09
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General Committee Debates
Health Bill [Lords]

The Committee consisted of the following Members:

Chairmen: John Bercow, † Mr. Edward O'Hara
Creagh, Mary (Wakefield) (Lab)
Cunningham, Mr. Jim (Coventry, South) (Lab)
Gidley, Sandra (Romsey) (LD)
Hall, Patrick (Bedford) (Lab)
Horam, Mr. John (Orpington) (Con)
Merron, Gillian (Minister of State, Department of Health)
Naysmith, Dr. Doug (Bristol, North-West) (Lab/Co-op)
O'Brien, Mr. Mike (Minister of State, Department of Health)
O'Brien, Mr. Stephen (Eddisbury) (Con)
Penning, Mike (Hemel Hempstead) (Con)
Pugh, Dr. John (Southport) (LD)
Slaughter, Mr. Andy (Ealing, Acton and Shepherd's Bush) (Lab)
Turner, Mr. Andrew (Isle of Wight) (Con)
Turner, Dr. Desmond (Brighton, Kemptown) (Lab)
Waltho, Lynda (Stourbridge) (Lab)
Wilson, Mr. Rob (Reading, East) (Con)
Chris Stanton, Committee Clerk
† attended the Committee

Public Bill Committee

Thursday 18 June 2009


[Mr. Edward O'Hara in the Chair]

Health Bill [Lords]

Written evidence to be reported to the House
H 09 British Retail Consortium
9.30 am
The Chairman: Welcome back, members of the Committee, fit and ready for purpose.

Clause 8

Quality accounts
Mike Penning (Hemel Hempstead) (Con): I beg to move amendment 87, in clause 8, page 5, line 6, after ‘containing’, insert ‘(but not limited to)’.
The Chairman: With this it will be convenient to discuss the following: amendment 156, in clause 8, page 5, line 27, after ‘containing’, insert ‘(but not limited to)’.
Amendment 169, in clause 8, page 5, line 28, at end insert—
‘(3A) When required, bodies listed in subsection (2) must provide information for injury data collection on the causes of injuries for patients admitted.’.
Mike Penning: Thank you, Mr. O’Hara. It is a pleasure to discuss this part of the Bill. I am pleased that the amendments have been grouped together. We are minded, like a lot of stakeholders, to support quality accounts. The amendments are probing amendments to find out from the Government exactly what the quality accounts will look like. Sadly, a lot of the detail is likely to be covered in secondary legislation.
Stakeholders, such as the NHS Confederation, the King’s Fund, Help the Aged and others are concerned about the lack of detail. In fact, the King’s Fund believes that the publication will be relatively passive in its form and will not give the public the accountability of quality that we are looking for. Looking back to the Maidstone debacle and the shameful events that took place in Mid Staffordshire NHS Foundation Trust, the quality of the accounts that the public can see is important, as I am sure the Minister agrees. Amendments 87 and 156 would develop exactly who will be responsible for publishing quality accounts. The phrase “not limited to” is self-explanatory about where we are coming from.
I support Liberal Democrat amendment 169. It is important that data that could be used in other areas of public analysis are available. In recent years, we have not seen data on injuries within hospitals. For example, it is difficult for us, when tabling parliamentary questions, to find out from trusts the exact type of injuries dealt with by A and E departments. It is imperative that such information is available. I have tabled the amendment to urge the Minister to develop exactly who quality accounts will be limited to.
Sandra Gidley (Romsey) (LD): We, too, welcome the general idea of quality accounts but, to be useful, we must ensure that the information has a purpose and is not just another data collection exercise with no meaningful use. The accounts will have more credibility if the public can see that the information is put to good use. I welcome the Conservative amendments. They would widen the scope of quality accounts and make them more flexible in the future.
I want to discuss amendment 169. Before being approached by the Royal Society for the Prevention of Accidents, I had not realised that the United Kingdom used to be a world leader in injury surveillance. It had much useful data on how many people were hurt in accidents, what they were doing at the time and what products might have been involved. The data were used to analyse trends. Obviously if one is analysing trends, one should then take steps to ensure that there are no such accidents in the future.
Until 2002 the Department of Trade and Industry collected that data, but when the Department was reformed as the Department for Business, Enterprise and Regulatory Reform—there has obviously been another reorganisation since then—the data were no longer collected. The amendment is a probing amendment to see whether there is any facility to use the quality accounts, which might be collecting some of that data anyway, to reinstate injury data collection, so that once again the UK can be at the forefront of data collection, analysis and the prevention of accidents.
The Minister of State, Department of Health (Mr. Mike O'Brien): Essentially, what we have here is the collection of information and its publication for a particular purpose. That purpose is not only to inform people but to ensure a focus on quality. That arises out of the review by my noble Friend Lord Darzi into high quality care for all. He determined that quality relates to three “domains”—patient safety, effectiveness of care, and patient experience. I wish to set out what we mean by that and say something more generally about the quality accounts, so that hopefully people have a clear picture of our purpose and of why we are focusing on quality, and understand therefore why we cannot accept the amendments. I appreciate and am grateful for the indication from the official Opposition both that they support the concept of quality accounts and that the amendments are probing ones, designed to elicit more information about the nature of quality accounts.
We want to develop quality accounts to see whether the focus in the “High Quality Care for All” review is being used by organisations in the health service. That means that they are, for example, protecting patient safety by eradicating health care-acquired infections and avoidable accidents. It is about the effectiveness of care, from the clinical procedure that the patient receives to their quality of life after treatment, and it is about the patient’s entire experience of the NHS, ensuring that they are treated with compassion, dignity and respect in a clean, safe and well-managed environment.
Mike Penning: The key here is public confidence in the data that are being published. While I am a localist politician, I am concerned about public confidence, because if there are problems in a trust—we all know that that happens; the Mid Staffordshire trust was a great example—in the main, as the Minister has just indicated, it is up to the trust to decide who publishes what information about what.
Mr. O'Brien: One key thing we need to do is ensure that data that are published are not just left out there, unverified. It will be the responsibility of the Care Quality Commission to ensure that the data are looked at and conform to the data that it has about that hospital. If there are problems with the data in a report, correction within 21 days can be required. The hon. Gentleman is right. If we are to focus on quality, we need to assure the public—as far as we can ever rely on the expression of an opinion by an organisation—that it is as reliable as it reasonably can be. We are concerned that it should not focus just on the things that we have focused on in the past such as particular targets— 18 weeks and others. This is looking at something different—the quality, not the quantity, of the care that is provided. We also want to ensure that a quality account, which will be locally determined, puts quality care at the forefront. By high quality care, we mean care that is beyond the minimum set by the regulator.
This is not just about saying a particular target has been hit. In order to manage the NHS and get a return on the money going into it, we have sought to set basic standards with which everyone has to comply. We are now, with quality accounts, looking at something quite different. This is not about hitting minimum standards, although that will still be relevant, because if people are not doing so it will come out in other reports such as those by the CQC. We are now asking hospitals and other NHS institutions to look at what they do well. That involves two things: identifying who is performing at a very high quality level in particular areas and then comparing the best in different areas. It is not about minimums: it is about the best and how to keep the pressure on to push the best to be better; it is about making the reasonably good, good; and it is about making the good even better and excellent. It is also about testing those who are excellent to see whether they can push themselves further. They will have to say not only what they are good at but also what further improvements over time they want to see. We know that the medical teams that forge ahead and provide quality and excellence in the NHS are those that measure their performance, and the best are often well above minimum standards. They measure how well they are doing for their own purposes, but until now nobody has taken particular notice, because people think, “They are above the minimum. We need not worry.” But how do we make everyone perform to the highest level that they can? Quality accounts are part of that process.
Mr. Andrew Turner (Isle of Wight) (Con): I welcome the purpose of getting the maximum possible, but I am concerned about the minimum. I am concerned, for example, about elderly people who are in hospitals, who have nowhere to go, who cannot go home because they cannot look after themselves and who are not sent to less significant units. This happens right across the country, not just in my constituency. In most parts of the country there is something wrong every so often—not frequently, not all the time, but regularly. That fact is neglected, and I would like to hear more about how the minimum is achieved, before we get to the maximum.
9.45 am
Mr. O'Brien: I understand the hon. Gentleman’s point and he is right that the minimum is important. As the hon. Member for Hemel Hempstead has indicated, we saw the outcome of events at Mid Staffordshire NHS Foundation Trust, where various tests on the trust did not pick up the poor quality of treatment. Therefore, we need to ensure that we examine the minimum standards as well. An organisation that looks at minimum standards of care blew the whistle on what was happening at Mid Staffordshire. We have checks in place through the Care Quality Commission and, if the organisation in question is a foundation trust, through Monitor, to some extent. Such bodies need to ensure that the quality of basic standards is examined. The NHS Choices database is available to the public, who can look in detail at how hospitals and other NHS institutions are performing and at the quality of different teams to ensure that they are doing what they are obliged to do. Checks are there, and the minimum standards will be dealt by the CQC with its new enforcement powers, which start in April 2010 for acute trusts. A core CQC registration will form part of the quality accounts, so there are ways of doing it.
My point is that, as important as it is to ensure that minimum standards are hit and maintained, it is also important to go beyond that and recognise that the NHS is not about minimum standards. We—millions of us throughout the country—do not pay taxes for the NHS to get the minimum possible standards in a hospital; we expect those standards. We want hospitals that push to get the best and the highest quality, and where excellence is important. Across the NHS, there are people, medical teams and practitioners who are dedicated to excellence and who, until now, have not been measured and congratulated. Doing that will show that the NHS cares about excellence. The NHS talks a lot about excellence but does not measure it, which is what quality accounts are about.
The local part of those quality accounts enables local involvement networks to let the hospital or other institution know what they want the quality accounts to measure, providing it is about quality. That is what we want to focus on, and it is the agenda that we are pursuing. Providers will have the freedom and the responsibility to decide what goes into the local part of quality accounts. However, we need to stipulate that quality accounts are about quality, which is why clause 8 refers specifically to
“information relevant to the quality of...NHS services”.
For that reason, amendments 87 and 156 are not the way that we want to go.
Similarly, I understand the concerns raised by the hon. Member for Romsey, who is not in her place. I agree entirely that there needs to be a robust collection of data on the type of injuries that cause people to be admitted to hospital in the first place. However, such information is not within the scope of the quality account, because that information is, in effect, about quantity, and it measures something else. The information in the quality account must be relevant to the quality of a particular provider’s care. Data on the causes of admission, such as personal injuries, are available through other means. Information on accident and emergency attendance, for example, is collected as part of the hospital episodes statistics database, and it is already available on the information centre’s website.
Statistics show that there is a remarkable appetite for information about health issues. Figures for the NHS Choices website show that around 5 million people visit that site each month, with total visits occasionally reaching around 7 million a month. Given the number of people in this country, those figures are extraordinary, and I think that, when quality accounts are made available, we will see the public’s appetite to see the quality of provision available in their local hospital.
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