Clause 2 - Payments relating to past performance
Health and Social Care Bill
11:45 am
Mr Philip Hammond (Runnymede and Weybridge, Conservative)
The clause relates essentially to the same ground that we have been covering: the financial powers that the Secretary of State will have as part of his armoury at the soft end of the spectrum, culminating in the clause 16 intervention powers. There is quite a lot to say about how the clause works, and I shall attempt to restrict my remarks to the narrow issue of the amendment. I hope that the Committee will have an opportunity for broader debate under clause stand part.
Amendments Nos. 65 and 66 would render more objective the process by which the Secretary of State would proceed, and inject an element of natural justice into the proceedings.
The wording of proposed subsection (3C)(b) is extraordinary. It allows the Secretary of State to give a further sum to health authorities if they perform well
against any criteria notified to them.
They do not have to perform in a defined way against such criteria; they do not have to achieve targets; they have merely to perform well. If they want to know whether or not they are performing well, they may be hampered by the words in parenthesis at the end of paragraph (b):
whether or not the method of measuring their performance against those criteria was also notified to them.
The Secretary of State will be handing out money to those who have performed well against a criterion without telling them how he intends to measure the quality of their performance. That would be the start of a rather dangerous and slippery slope.
The amendments seek to tighten that up a little. We shall consider later amendments Nos. 67 and 68, which would further limit the Secretary of State's wide powers of discretion and ensure that NHS bodies understood explicitly the targets that they were required to meet and how they would be assessed on their performance against those targets. They would also have the opportunity to appeal if they believed that they had been wrongly or unjustly assessed, which would ensure that the process was a little more transparent, objective and accountable than under the Bill.
There are two big flaws in the provision. It gives huge power to the Secretary of State to micromanage the NHS at every level, either directly or by the implicit threat of taking over functions or withholding money; and that will lead to the distortion of clinical priorities, because trusts and health authorities will be assessed not on the overall quality of their service, but on whether they meet Government targets. For the past three years we have accused the Government of distorting clinical priorities by forcing NHS trusts and health authorities to focus on doing the Government's bidding. In particular, the waiting lists initiative forces health authorities and trusts to devote resources to dealing with those suffering from minor complaints, who are merely numbers on the waiting list, rather than addressing those in greater clinical need.
The Government consistently deny that they have used financial means to put pressure on NHS management. The clause makes it explicit that NHS managers will in future be clearly told of the Government's political priorities and of the targets that they must meet, and that they will be financially penalised if those targets are not met by not being allocated money from the performance fund.
The consultant urologist at my local hospital wrote a letter to the chief executive, a copy of which was obligingly sent to me. The consultant referred to a specific case and, for obvious reasons, I shall not mention the patient's name. He wrote:
You were fully aware of three other patients of mine who were admitted for major cancer surgery (after a three months wait) only to be cancelled three times each, within thirty minutes of being called to the theatre.
He continues,
these are but three examples of a long-standing problem. One year ago I was put under pressure by the management to treat non-urgent long waiting patients instead of patients with cancer
such as Mr. X.
Anyone who is interested in the NHS—including the Minister—and who talks to doctors and nurses, will know that whatever Whitehall intended, the practical effect of the way in which the system has operated over the past three years has been that hospital managements, not for their aggrandisement nor their financial enhancement, but for the good of their trusts, and needing to access the funds that were available to them conditional upon their meeting waiting lists reduction targets, have manipulated waiting lists. They have moved people off waiting lists when they should remain on them. Derriford hospital cardiology department springs to mind. Clinicians have been forced to prioritise minor waiting list cases ahead of those with clinical priority. The Government Whip may wish to intervene on the matter of Derriford hospital, but I doubt it.
Clause 2 institutionalises that system in primary legislation, and that is a potentially dangerous trend. These amendments—and later ones—seek to introduce a safeguard. They would not undo completely the Government's efforts because that is not within the scope of our ambitions, but would introduce safeguards by requiring the Secretary of State to make the criteria by which he would judge a trust's performance clear, objective and public. People in the country, informed opinion, clinicians and the medical representative organisations would then be able to comment on whether the criteria that the Government seek to impose and would use in allocating money or intervening to take control of the management of trusts, are the right criteria to ensure the delivery of proper health care. For that reason, I commend amendments Nos. 65 and 66 to the Committee.