Health and Education

Part of Debate on the Address – in the House of Commons at 1:16 pm on 11 December 2008.

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Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health 1:16, 11 December 2008

No, I gave way to the hon. Gentleman earlier, and I want to finish my speech, because time does not permit me to go on too long.

Two years ago, my right hon. Friend Mr. Cameron and I said that the Government and the NHS should focus on outcomes, not targets. This summer, Lord Darzi's report endorsed the emphasis on outcomes, but it did not actually get rid of the targets. On Monday, the Secretary of State published the new operating framework and it is still littered with targets. We know what dominates the thinking of NHS managers—the so-called must-do targets, not the outcomes that in reality matter most for patients.

The Conservatives will focus on what we need to achieve the outcomes for the people whom we are here to serve, not on how people in services go about achieving them. Of course, performance management has to follow evidence of effectiveness and benchmarked performance, but objective measures such as standardised mortality rates should be mixed with more subjective ones, such as patient experience and self-reported outcomes. All those things should also be benchmarked against the best in the world.

When evidence was published by the Healthcare Commission of the scale of adverse events and harm resulting to patients, it was entirely typical of the Government that their response was, "Well that's all right, it's about the same level as elsewhere in the world." Ministers seem to be prepared to use international benchmarking only when it justifies the level of error in the NHS. They do not use international benchmarking for infections and admit that our MRSA rates are much higher than best practice or that our rates of clostridium difficile can be four times the average for other hospital systems. They do not use international benchmarks to admit that our cancer survival rate is a quarter worse than the best in Europe, that our stroke mortality is a third worse than Germany's or that deaths from lung disease in the UK are two thirds worse than the European average. The NHS should be focused on those issues. That is what is most important, not whether every PCT sets up a Darzi centre.

The Government talk about world-class commissioning. We need world-class services, but we will not get them with a one-size, top-down bureaucratic approach. We will get them through innovation, professionalism, responsiveness to patients and the rigorous application of evidence-based care. Treat the staff of the NHS like drones, and they will behave like drones; trust them like professionals, and they will respond.

The Government have de-professionalised the NHS, which is why they have seen declining productivity year on year. That is why, despite their targets, performance has fallen short. Patient choice has diminished—fewer patients say that they have experienced access to choice—and practice-based commissioning has stalled. Patient experience measures have deteriorated, and the foundation trust programme has not met its 2008 targets. Health inequalities have widened— [ Interruption. ] The Minister of State says that I do not like targets. What is the point of targets if they do not deliver? What was the point of saying that every hospital should be a foundation trust by 2008, when only about half of them are?

The Minister of State may like to recall that back in 2006, Tony Blair described his four drivers for health reform—patient choice, foundation hospitals, independent sector treatment centres and practice-based commissioning. All four have stalled or disappeared from the reform process. The Blairite reforms have gone. What do we have in their place—world-class commissioning? It does not feel world-class yet.

We will not have world-class NHS services unless the Government recognise what is really needed—to trust NHS professionals, to make the service more accountable to patients, with less to top-down bureaucracy, to reinvigorate our public health service and to focus at every level on patient outcomes. We are committed to reforms that would make a real difference to patients and NHS staff. For the Government it is all Darzi or drift; it is about money spent and money wasted; it is all inputs and not enough outputs.

The Queen's Speech is all short-term gimmicks and does not include the long-term reform that our great public services so badly need. The Government have run out of steam—they are out of ideas and out of time. I agree with my right hon. Friend the Member for Witney: bring on the election. I commend the amendment to the House.