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Mr. Burstow: I have listened carefully to the Under-Secretary. The hon. Gentleman's point about independence was certainly well made, and I take it on board. In the context of earlier debates, it is an important issue. As the hon. Member for Epsom and Ewell said rightly, the amendments seek further clarification of the Government's intentions. Certainly, we are not in the business of asking CHAI to duplicate its activities or the activities of others.
Having listened to the Under-Secretary and to his reassurances, I beg to ask leave to withdraw the amendments.
Mr. Burns: I am a little confused about this group of amendments. Is it right that the hon. Member for Sutton and Cheam seeks to withdraw amendments Nos. 417 and 418? I should have liked to hear an explanation of amendment No. 479, which is selected in that group.
There is no reference, explanation or discussion of how amendment No. 479 seeks to improve the Bill.
The Chairman: I am not sure whether the hon. Gentleman was making a speech, an intervention or a point of order.
Mr. Burns: I think I was doing all three.
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The Chairman: I allowed the hon. Gentleman to speak after the hon. Member for Sutton and Cheam had asked leave to withdraw the amendment. Technically, therefore, the amendment cannot be withdrawn and we must vote against it.
Amendment negatived.
Amendment made: No. 173, in
Clause 50, as amended, ordered to stand part of the Bill.
Clause 51
Annual reviews
Amendment made: No. 287, in
Chris Grayling: I beg to move amendment No. 527, in
clause 51, page 18, leave out line 3.
The Chairman: With this it will be convenient to discuss amendment No. 399, in
clause 51, page 18, line 3, leave out 'must' and insert 'may'.
Chris Grayling: Clause 51 makes the most difference today to how our hospitals are managed as CHAI must award performance rating to each NHS body.
We dealt briefly last week with the application of performance ratings to NHS foundation trusts. However, the pursuit of star ratings has become a driving part of the life of most trusts' chief executives. Their success or failure to meet the criteria can change perceptions of the performance of their trusts in a way that can often be grotesquely unfair.
Last week, I referred to the work of Dr. Foster, whose research organisation looked into the performance of NHS star ratings—the performance rating targets referred to in subsection (1). That research stated loud and clear that the ratings do not reflect the quality of clinical treatments of a particular hospital. We judge a hospital on whether it make us better, delivers high-quality treatment and puts on the road to recovery patients whose lives are in danger. Those issues are not reflected in the star-rating system, which is, instead, geared too much towards process. The obsession with the star-rating system is the seed from which the target culture has grown.
That is the root of the evil, and the amendment seeks to apply some hefty weedkiller to that root. The star-rating system is simply not working. We want the Government to return to the drawing board and come up with something better.
As is evident from amendment No. 31, we want the Government to give CHAI the job of coming up with something better. [Interruption.] We do not want the Bill to create a system of political control. The Minister of State may cough and splutter, but when we debate amendment No. 31, we will see that the Bill retains loud and clear the phrase:
''approved by the Secretary of State.''
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Ultimately, it will be a system controlled by the political masters of the NHS and not by those who, in our view, have the expertise to judge whether a hospital trust is performing.
10 am
The figures, statistics and information base on which the star-rating system is founded are fundamentally flawed. I want to go through a few examples to show why Ministers must rethink the whole set-up. I shall start with a few excerpts from the Audit Commission report that was published last week. Interestingly, a clear pattern emerges upon consideration of the performance figures for different NHS trusts over the past couple of years. That pattern is not uncommon in many large organisations where people have targets to meet.
It is custom and practise in many commercial organisations for the sales department to book as many sales as possible in the last couple of months of the financial year to try to meet its annual target. It does not reflect the actual state of the business; it represents a last-minute attempt to impress the managerial masters. That is happening in the NHS, as NHS managers struggle, for obvious reasons, during the later days before an assessment is to be made to ensure that their hospitals are as close as possible to reaching their targets.
I pick out an intriguing excerpt from the Audit Commission report about waiting times for outpatient appointments. On page 11in the performance section of the report entitled ''Achieving the NHS plan'' report, it states:
''Half-way through the first year of the Plan (2001/02), auditors rated nearly two-thirds of trusts as being at high risk of missing the first milestone, which was to reduce the maximum wait to 6 months (26 weeks). Yet, after the end of that year, the DH [Department of Health] was able to report that in fact almost all acute trusts had met the target.''
That was said to be the result of ''determined and imaginative effort''. However, the small print states:
''Although undoubted progress has been made, the exact situation cannot be stated with certainty because of recently revealed inaccuracies in some trusts' waiting list information. The Audit Commission, with the Agreement of the DH [Department of Health] and CHI, has reviewed data quality within acute trusts. We found that nearly all trusts had some data-system weaknesses that increased the risk of errors. For example, a typical error was an incorrect date used for the start of waiting times—too many mistakes here could render statistics about whether waiting times are being achieved unreliable.''
I had a direct experience of how waiting time statistics—the core part of the performance ratings mentioned on page 18, line 13 of the report—were being helpfully adjusted. A constituent came to see me because she was baffled by the experience of her waiting time. She received a questionnaire from the hospital where she was due to receive treatment. To ensure that the dates for her treatment did not clash with another appointment, the questionnaire asked when she would be on holiday. That is an enlightened approach to patient care: a wise and sensible thing to do. The woman was pleased and returned the questionnaire detailing the weeks when she would not be available. That was tremendous.
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However, that well-intentioned process had a sting in the tail. The woman received a further letter from the trust saying that since she was unable to attend for treatment during those four weeks, her waiting time had been extended. Her treatment had to be carried out within 12 months, but that period was extended by an additional four weeks. A 12-month waiting time for her operation became a 13-month waiting time, which relieved the pressure in the system. However, that in no way represents a truthful or accurate reflection of genuine waiting times in that hospital. It was a manoeuvre by the hospital to give it a little more leeway to say that it had met its targets.
Mr. Stephen McCabe (Birmingham, Hall Green): The hon. Gentleman puts a sinister interpretation on the matter. Does he seriously suggest that if someone is unavailable for treatment that should not be taken into account? What kind of honesty and integrity would be in any figures that he produced if facts were not taken into account? If someone is not available, they are not available. Is that not a straightforward fact?
Chris Grayling: The hon. Gentleman is a little naïve in his understanding of the interpretation of such a situation. It is quite clearly a device used by hospitals to allow an extra month in waiting times. To ask someone when they are on holiday and to add two weeks to the maximum waiting time that is permitted under current rules to give themselves a little more leeway hardly seems to be—
Mr. Adrian Bailey (West Bromwich, West): The hon. Gentleman just said that two weeks were added; earlier he said a month. Will he clarify whether it was a month or two weeks?
Chris Grayling: I apologise to the hon. Gentleman. The example that I gave was four weeks. That person was told originally that she would be treated by August 2003. After the questionnaire was dispatched she was told that, because of her non-availability for part of that time, she would be suspended from the waiting list and her treatment would be guaranteed by the end of September 2003.
Mr. Burns: Does my hon. Friend know whether the questionnaire that was sent to his constituent warned that if she was away it might jeopardise the maximum time that she would have to wait for treatment? Does he agree that if such a warning were not in the questionnaire, it would have been fair to include it so that the constituent could have made other arrangements for her holiday to ensure that that did not happen?
The Chairman: Order. Before the hon. Gentleman answers that question, I should like him to bear in mind that we are moving to his example from the amendment that we were debating.
Chris Grayling: I shall wrap up that section of the discussion briefly by saying that I read the questionnaire, and it gave no indication whatever that it was anything other than a helpful contribution to the patient rather than an attempt to manipulate the waiting list, which it clearly was.
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I made the point about chasing statistics in the latter part of an assessment period—whether it is a financial year or a period that the Government have selected to measure a particular target—and the fact that the NHS scrambles to meet such targets. It was interesting to listen yesterday to the figures given by my own SHA, which provided substantial evidence of that and certainly called into question the validity of figures in a specific period; not their accuracy, rather the justification that drops in waiting times represent drops in long-term trends. They are, therefore, a true reflection of hospital performance that can be used to assess performance rating.
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