Health and Social Care Bill

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The Chairman: With this it will be convenient to discuss amendment No. 68, in page 3, line 5, at end insert—

    `(3CC) The Secretary of State shall publish annually a report detailing, in respect of each Health Authority to which he has made payments under subsection (3C) above—

    (a) the objectives notified to that Health Authority under (3C)(a) above; and

    (b) the criteria notified to that Health Authority under paragraph (3C)(b) above; and

    (c) the methods of measuring their performance which he has used in assessing them for payment of further sums in accordance with subsection (3C) above; and

    (d) his assessment of their performance against the objectives notified in accordance with paragraph (3C)(a) above and the criteria notified in accordance with paragraph (3C)(b) above; and

    (e) the further sums paid to them in accordance with subsection (3C) above.'.

Mr. Hammond: Amendments Nos. 67 and 68 continue the theme of ensuring that the Secretary of State's actions in relation to clause 2 and 3 are as transparent as possible. Amendment No. 67 provides that the Secretary of State should, within 28 days of notifying objectives and criteria to health authorities, publish them and the methods that will be used to assess their performance against those criteria. I see nothing terribly radical about that, and I hope that the Minister will take the amendment in the spirit in which we present it. A series of amendments would be needed to make similar arrangements under clause 3, but the amendment sets out the principle, which is that the arrangements made between the Secretary of State and an NHS body should be open to public scrutiny when they are made.

Amendment No. 68 provides that the Secretary of State should publish an annual report setting out the objectives of the criteria notified to health authorities, together with the methods of measurement that he has notified to them, his assessment of their performance against those objectives and details of the further sums that have been paid to them.

It will probably be apparent to the Committee why we seek to go down that route. It is an over-used phrase, but we want to ensure a level playing field. We want all trusts to be treated equally and fairly and, whenever criteria and objectives are notified, we believe that other trusts should have the opportunity to ensure that they are similarly treated. We believe also that performance against those criteria or objectives should be spelled out after the event; that the financial rewards accruing to those who have performed well should be publicly known; and, we hope, that it bears a discernible relationship to the performance that has been achieved.

We are anxious that the objectives should be publicly scrutinised because the Government's record on setting objectives for the national health service has distorted proper clinical priorities. I have already given one example from my constituency. Another example, included in the consultation documents as one of the possible criteria for success, is of the two-week maximum waiting time from urgent referral by a general practitioner to the patient being seen by a hospital specialist for a patient with suspected cancer.

That is ideal for a service with no resource limits, because the time between referral by a GP and being seen by a specialist is a time of great stress for the patient. Unfortunately, the number of surgeons able to carry out cancer operations is limited. By setting an arbitrary two-week limit, the Government have massively skewed the use of the available human resources from treating cancer to getting patients with urgent referrals through the front door. The president of the Royal College of Surgeons said:

    clinics are being snowed under with inappropriate referrals for breast cancer.

She pointed out that 90 per cent. of women with suspected breast cancer were found to be clear of the disease.

Dr. Joan Austoker, of the Cancer Research Campaign, said:

    The two-week rule has completely backfired. It has led to a waste of resources, and a waste of specialists' time.

That means that it is not just a waste of money but a waste of the time of people who could be treating patients, operating on patients and saving lives.

I know from talking to the consultant neurologist in my own hospital that that is happening all over the place. In order to meet this two-week target, people are required to spend a greater proportion of their time telling patients the bad news that because a particular consultant now has to spend twice as much time in out-patient clinics, it will be twice as long before a patient already diagnosed as needing surgery can be operated on. That is a misallocation of resources. In setting criteria for access to this money, we are afraid that the Government will inadvertently—I am not suggesting that it is deliberate—create a misallocation of resources within the NHS that will ultimately be to the detriment of patients.

One of the suggested criteria in the consultation draft is the financial performance of the NHS trusts. The bare-faced cheek of it! A Government who pilloried the previous administration for setting financial targets and measuring financial achievement of NHS trusts and health authorities now propose the meeting of budgetary criteria as a condition for accessing money needed to deliver health services.

A memo issued by a health authority somewhere in England on 9 January says:

    Recent developments in the unfolding financial position of the Health Authority, including an assumption that we will not receive the last three quarters of the Performance Fund, has led to our looking very critically at areas which are contributing to further financial risk within the Authority. An area of considerable concern is individual patient placement, where we have seen a significant rise in the number of placements made...We will, over the coming months, introduce tighter management processes and will be looking towards working with the Trusts and the management of individual placements.

    In the meantime, however, there is an immediate need to ``stem the flow'' of individual placements and to this end the Health Authority is not prepared to authorise further placements until there is a reduction in the current number of patients placed.

That is going on in the health service in order to try to comply with Government-set targets, in this case to deal with an overspend of £2.5 million. Clause 2 will enshrine a body of Government targets, including quite possibly financial targets, that health authorities will have to meet to access the funds that they need to deliver services to the people living in their areas.

Dr. Brand: I do not want to disabuse the hon. Member, but as a doctor I had to make decisions like that and I have seen letters like that in the 70s, 80s and 90s; it were ever thus. The real point is whether health authorities and trusts have the power to say publicly that their allocations are not adequate. It is an inescapable fact that it happens.

Mr. Hammond: I thank the hon. Gentleman for making that point. I am mindful that there is only a minute and a half to lunchtime.

The purpose of the amendments is to ensure that these arrangements are placed in the public domain for all to see. That will mean there is a degree of transparency which we hope will inevitably lead to a degree of objectivity and avoidance of the worst distortions that have been created when trusts or health authorities seek to comply with essentially artificial criteria set by Government which become the basis of decisions that are very important to them, such as the allocation of funding.

I commend the amendments to the Committee. I consider that the Government have nothing to fear from them if they intend to proceed as the Minister outlined. In the interests of ensuring greater scrutiny, greater accountability, transparency and an element of objectivity in these arrangements, they will greatly improve the Bill.

It being One o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at half-past Four o'clock.

The following Members attended the Committee:
Maxton, Mr. John (Chairman)
Bailey, Mr.
Bradshaw, Mr.
Brand, Dr.
Burns, Mr.
Burstow, Mr.
Dawson, Mr.
Denham, Mr.
Fitzsimons, Lorna
Foster, Mr. Michael Jabez
Hammond, Mr.
Jamieson, Mr.
Mountford, Kali
Naysmith, Dr.
Stewart, Mr. Ian
Swayne, Mr.

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