Clause 43 - Information and advice
Health and Social Care (Community Health and Standards) Bill
10:45 am
Dr Evan Harris (Oxford West and Abingdon, Liberal Democrat)
Of the two clocks in the Room, one reads 10.46 am and the other reads 10.47 am. Who knows which one is right? The Chairman regards the time on the annunciator as being right. Generally speaking, except perhaps in the ordered world of the hon. Gentleman, watches often show slightly different times.
The Secretary of State is like a man with three watches. He has Dr. Foster, which the Department of Health co-operates with by providing data; he has the Commission for Health Improvement reports; and he has star-rating systems. They often say different things. The most appropriate rating system at the moment is a CHI report, because it is not forced to measure performance on star ratings, and it is able to look at the overall picture of a trust.
The next most appropriate and most effective measure of performance is Dr. Foster, which looks at some characteristics of the patient base that a unit, team, or even a commission eventually, is dealing with. It also looks at proper clinical outcomes, such as the number of deaths within 30 days of surgery, which is a meaningful clinical outcome. Dr. Foster fails because the Government have not yet sold it all the confidential patient data, and therefore it cannot yet grasp the level of health of the patients on an individual basis. Consequently, that can distort the outcomes.
The better units, which treat the more difficult cases, will have worse outcomes. Nevertheless, they are better, and it is because they are better that they have worse outcomes. Dr. Foster cannot yet grasp that. The
star-rating system does not even come near to considering whether a unit is taking more difficult patients because it is a better unit.
In this group of clauses, the Government propose to force CHAI, whose predecessor is the best measure of hospital performance, to adopt the star-rating system. That is why the amendment is so important. Multi-star trusts have had stars knocked off on several occasions following a CHI report. That shows that the Government accept that, compared with in-depth CHI reports, the star-rating system is a joke when it comes to measuring quality and proper clinical outcomes.
The combination of the imposition of the star-rating system on CHAI and the failure to put the onus on CHAI to look at quality, rather than just provision as the Government define it, is what is so worrying about the Bill and why this group of amendments is important and worthy of support.