Clause 51 - Annual reviews
Health and Social Care (Community Health and Standards) Bill
9:45 am
Mr Chris Grayling (Epsom and Ewell, Conservative)
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.''
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.
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.
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.